Zosia Chustecka

April 5, 2012 — Five common cancer procedures and tests have been identified that are not supported by evidence and should no longer be used, according to the American Society of Clinical Oncology (ASCO).

Oncologists should stop the unnecessary use of chemotherapy in patients with advanced cancers who are unlikely to benefit, and should limit their use of colony-stimulating factor (CSF) drugs in patients undergoing chemotherapy.

They should also curb their use of advanced costly imaging technologies for staging of early breast and prostate cancers, and for detecting breast cancer recurrences.

These recommendations, compiled after an extensive review of the literature and with input from more than 200 ASCO members, were published online April 3 in the Journal of Clinical Oncology.

The move is part of the Choose Wisely campaign, organized by the American Board of Internal Medicine, in which many different medical specialties identified tests and procedures that could be skipped. In total, 45 procedures and tests were deemed unsupportable by evidence.

This campaign started when Howard Brody, MD, PhD, professor of family medicine at the University of Texas in Galveston, challenged each medical specialty to take a critical look at its field and identify 5 practices that are commonly performed despite a lack of evidence (N Engl J Med. 2010;362:283-285).

"At ASCO, we took that challenge to heart," lead author Lowell Schnipper, MD, from the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, and chair of the ASCO Cost of Care Task Force, said in a statement

"By tackling the overuse of treatments and tests for some of the most common cancers, we hope to achieve substantial improvements in the quality of cancer care in the United States," he added.

Avoiding treatments that have little or no benefit means that "we also do our part to address the unsustainable cost increases that threaten our nation’s healthcare," said Michael Link, MD, president of ASCO.

Stop Chemotherapy

Perhaps the most controversial of the new proposals is the recommendation to stop using or to withhold chemotherapy in patients with advanced solid tumors who are unlikely to benefit, and to focus instead on symptom relief and palliative care.

This whole area has stirred fierce debate in recent years, and attempts in the United States to introduce legislation for end-of-life discussions were stalled after accusations that this was a form of "soft euthanasia" and that these were "death panels" to persuade people not to use medical resources.

In their paper, Dr. Schnipper and colleagues emphasize that stopping chemotherapy is recommended only for a specific subgroup of patients with advanced solid tumors — those with low performance states (3 or 4) who are not eligible for a clinical trial, and in whom there was no benefit from previous evidence-based interventions and no strong evidence supporting the clinical value of further anticancer treatment.

"If a patient’s cancer has grown during 3 different regimens, the likelihood of treatment success is so poor and toxicity so high that further anticancer treatment is not recommended," the authors write.

They cite results from the largest series of patients with nonsmall-cell lung cancer (NSCLC) from the M.D. Anderson Cancer Center in Houston, Texas, which showed that only 2% had a documented response to third-line chemotherapy, and 0% had a response to fourth-line chemotherapy (Lung Cancer. 2003;39:55-61).

However, despite the evidence for lack of effect, administering nth-line chemotherapy is common, the authors note. They cite several studies showing that many NSCLC patients receive 4 lines of chemotherapy, and that many patients with solid tumors are still being given chemotherapy within days of death. "This practice is not being driven by profit, but by a desire to help patients," the authors note, and "by the inability of patients, families, and their oncologists to make end-of-life transitions."

Oncologists admit that they find this difficult, as previously reported by Medscape Medical News. Stopping chemotherapy can feel like failure and "giving up," and sometimes patients or their relatives can demand more — in one instance, because the "chemotherapy cheers her up."

"Stopping anticancer treatment should always be accompanied by appropriate palliative and supportive care and referral to a hospice," the authors state.

"Best practice would be continuation of palliative care started concurrently at the time of diagnosis for ‘any patient with metastatic cancer and/or high symptom burden," they add. This reiterates the recent provisional clinical opinion issued by ASCO.

Limit Use of G-CSF Products

Another recommendation related to chemotherapy is to cut down on the use of granulocyte CSF (G-CSF) products for the primary prevention of the chemo-induced adverse effect of febrile neutropenia.

Two G-CSFs are available in the United States: filgrastim (Neupogen) and sargramostim (Leukine).

ASCO guidelines state that G-CSFs are recommended in patients who have "a high risk" (more than 20%) of developing febrile neutropenia as a complication of chemotherapy.

In practice, however, there is a "clear overuse of these agents." Use is inconsistent; the products are used both appropriately and inappropriately, the authors write. They note that these products are "costly" and should be used only in patients who are at high risk of developing febrile neutropenia, as specified in the guidelines.

Stay Away From High-Tech Imaging

The remainder of the new recommendations steer oncologists away from using advanced imaging technology in specific groups of cancer patients.

One instance is patients with early-stage prostate cancer and early-stage breast cancer, who have a low risk for metastasis. In these cases, advanced imaging technologies, such as positron emission technology (PET), computed tomography (CT), and radionuclide bones scans, should not be used to determine whether the cancer has spread, the authors note.

"These tests are often used in staging evaluation of low-risk cancers, despite a lack of evidence suggesting that they detect metastatic disease or survival," the authors state. "Unnecessary imaging can lead to harm through unnecessary invasive procedures, overtreatment, and misdiagnosis."

In addition to the potential harm from unnecessary exposure to ionizing radiation, as well as anxiety, there is also a huge monetary cost from such scans, the authors note.

The list price of a fluorodeoxyglucose PET with concurrent CT scan is around $2500 to $5000, depending on the scan and location. In many instances, patients are directly responsible for a portion of these costs.

The other instance where advanced imaging is discouraged is in patients who have been treated for breast cancer with curative intent who are now asymptomatic.

"The majority of patients with breast cancer diagnosed today present with early-stage, node-negative disease that is found on screening mammography," the authors write.

"As a result of earlier diagnosis and the efficacy of adjuvant therapies…most of these women have a normal life expectancy and a low risk of recurrence."

Several studies have now shown that in such patients, there is no benefit from routine imaging with PET, CT, or radionuclide bone scans, or from serial measurement of serum tumor markers, including CEA, CA 15-3, and CA 27-29, the authors state.

In addition to no benefit, there might be harm from false-positive results, leading to unnecessary invasive procedures, overtreatment, and misdiagnosis, they add.

Instead, such patients should be followed with mammography, with careful attention paid to patient history and physical examination, they suggest. Breast magnetic resonance imaging is not recommended for routine surveillance, because it has a high-false positive rate.

Lower Cost to Patients and Society

Reconsidering the use of these top 5 cancer treatments, tests, and procedures is likely to improve the value of cancer care, the authors note. This means achieving the desired clinical outcome at the lowest cost to the patient and society.

At the same time, each patient with a life-threatening disease is a challenge. In each case, the oncologist must take the unique features of each individual into consideration when making decisions on the management of their cancer, they add.

Dr. Schnipper reports serving as a consultant for ITA partners. Several of his coauthors report consultancy agreements with a number of pharmaceutical companies. Coauthor Douglas Blayney, MD, from Stanford Cancer Center in California, reports owning stock in Abbott, Amgen, Bristol-Myers Squibb, Express Scripts, Johnson & Johns, and United Healthcare.

J Clin Oncol. Published online April 3, 2012. Abstract

Medscape Medical News © 2012 WebMD, LLC

Ancient Chinese medicine is known to ease pain and treat diseases, but Israeli researchers now think it can help barren women.

Tzvi Ben Gedalyahu, Arutz Sheva, January 16, 2012

Ancient Chinese medicine is known to ease pain, treat diseases and boost fertility for women who already have babies, but Israeli researchers at Tel Aviv University now think it can help women who have never conceived.

Traditional herbal preparations and acupuncture, remedies that the Western medical community calls by the acronym TCM, can be combined with intrauterine insemination (IUI) for women hoping to be mothers, according to Dr. Shahar Lev-Ari and Keren Sela.

Their research, published in the Journal of Integrative Medicine, shows a significant increase in fertility when the therapies are administered side-by-side.

When combining IUI with TCM treatments, 65.5 percent of the test group of 29 women were able to conceive, compared with 39.4 percent of the control group, who received no herbal or acupuncture therapy. About two-thirds of the women who conceived in each group ended up delivering healthy babies.

The method is as “close to nature” as possible and can be used by women employing sperm donors, or after a partner’s sperm is centrifuged to enhance its motility in the uterus.

Dr. Lev-Ari, a cellular biologist, and Sela, a TCM practitioner specializing in women’s health, followed the progress of 29 women between the ages of 30 and 45 who were receiving IUI treatment combined with TCM therapy, and compared their results to a control group of 94 women between the ages of 28 and 46 who were undergoing IUI treatment alone.

In addition to their IUI treatments, the 29 women in the first group received weekly sessions of acupuncture and a regime of Chinese medicines, which consisted of powdered or raw Chinese herbs such as Peonia Albae and Chuanxiong, designed to meet each woman’s specific needs. All herbal preparations were approved by the Israeli Health Ministry.

The vast difference in success rates is even more surprising when the age of the average participant was taken into account, Dr. Lev-Ari and Sela note. “The average age of the women in the study group was 39.4, while that of the control group was 37.1. Normally, the older the mother, the lower the pregnancy and delivery rates,” they explain.

www.israelnationalnews.com

In Vitro Fertilization Should Have One-Embryo Limit, Health Experts Say

In vitro fertilization often leads to twins born prematurely.

Babies conceived through in vitro fertilization (IVF) – informally known as test-tube babies – are significantly more likely than other newborns to suffer complications. It’s not because of genetic defects, but rather because IVF procedures frequently produce twins, triplets or higher degrees of multiples. Multiples are more likely to be born prematurely, and thus to suffer complications afterward.

A new study led by Keith Barrington, chief of neonatology at Sainte-Justine University Hospital in Montreal, has measured how extreme the causation is: While IVF accounts for only 1 percent of Canadian births, 17 percent of babies admitted to the neonatal intensive care unit (NICU) where Barrington works were IVF babies. An American doctor confirmed that the numbers are similarly disproportionate in the United States. In his paper, published in the upcoming Journal of Pediatrics, Barrington advocates legal intervention to reduce the risk.

In IVF, eggs are fertilized with sperm in a laboratory. A few days later, when the fertilized eggs have developed into multi-cellular masses, one or more of these embryos are transferred into a woman’s uterus. “In the latest U.S. report on mothers under 35 years, 10 percent had a single embryo transferred, and 90 percent had two or more,” Barrington told Life’s Little Mysteries, a sister site of LiveScience.
Women don’t necessarily go into the procedure wanting to have multiples, but when more than one embryo is transferred, they are more likely to get pregnant at all. Compared to natural pregnancies, it’s also much more likely they’ll end up expecting twins or triplets. And this is what puts these babies at risk.

“For triplets, the rate of prematurity is very close to 100 percent. For twins it is about 70 percent,” said Barrington.

Premature babies face grave health risks. “A substantial proportion and very likely the majority of infants admitted to a NICU (neonatal intensive care unit) are admitted because of complications relating to prematurity,” Marc Fritz, chief of reproductive endocrinology and infertility at the University of North Carolina School of Medicine, explained.

The health problems faced by these premature newborns place a huge burden on Canada’s national health care system. Barrington calculated that a mandatory one-embryo transfer policy would dramatically reduce neonatal intensive care with estimated annual savings of approximately $40 million.

Several European countries with nationalized health care have instituted the one-embryo policy already, and Quebec implemented the rule last year for mothers under 35. Since then, Barrington said, the number of twin pregnancies in Quebec resulting from IVF has gone from 30 percent to 3.8 percent, and there are no more triplets.

The United States does not have nationalized health care, and so IVF places no large burden on the government, or on insurance companies. “Costs are borne primarily by the patients themselves, because IVF is not covered by insurance in the large majority of states,” Fritz said.

Costs aside, though, infant lives might still be saved by a one-embryo policy, Barrington argues. He says such a requirement in the U.S. could prevent the deaths of 700 premature twins and triplets a year, out of a total of about 41,000 IVF births.

But mothers for whom the chance of pregnancy is very low will likely suffer from a one-embryo law, Fritz cautioned.

“Whereas it is true that the number of multiple births resulting from IVF is significantly lower where such policies are in place, it also is true that success rates are significantly lower in those countries than they are in the U.S, where the maximum number of embryos transferred is governed by practice guidelines rather than by law,” said Fritz.

Fritz believes medical research, rather than government policy, ought to address the problem. “Strict regulation certainly is one way to achieve the goal [of reducing the incidence of multiple births resulting from IVF], but one that would unfairly penalize many couples and preclude their being able to have children,” he said.

“Much of research in the field is aimed squarely at finding methods for optimal embryo selection, so as to be able to reduce further the average number of embryos transferred without significantly decreasing the likelihood for achieving a successful pregnancy.”

This article was provided by Life’s Little Mysteries, a sister site to LiveScience. Follow Natalie Wolchover on Twitter @nattyover

By Mary Agnes Welch, Winnipeg Free Press , March 1, 2011

New research by an Israeli scientist suggests vitamin A could act almost like an antidote to the effects of alcohol on very early embryos during the critical development of the head and central nervous system. That’s when the worst effects of FASD start.

WINNIPEG — It’s too early to call it a cure, but plain old vitamin A could curb the devastating effects of fetal alcohol spectrum disorder.

New research by an Israeli scientist suggests vitamin A could act almost like an antidote to the effects of alcohol on very early embryos during the critical development of the head and central nervous system. That’s when the worst effects of FASD start.

"Scientifically, this is a very interesting story," said Abraham Fainsod, a professor of genetics and biochemistry at the Hebrew University of Jerusalem. "If we can continue our research, we could do some good."

On Monday, Manitoba pledged $750,000 to help set up a joint FASD research consortium between the Hebrew University and the University of Manitoba. Sorting through the vitamin A issue will be among the projects earmarked for funding.

"This has the possibility of being a relatively simple solution," said Geoff Hicks, Fainsod’s counterpart at the University of Manitoba. "That’s why everyone is so excited."

What research Fainsod has done on frogs, Hicks will now try to reproduce using mice, which are the model for mammals.

They’ll be looking at retinoic acid, one of the main biological forms of vitamin A and a critical element in cell development and revitalization. That’s why so many wrinkle creams tout vitamin A as a key ingredient.

Alcohol prevents the conversion of vitamin A to retinoic acid because both compete for one particular enzyme and the alcohol usually wins. While the body is processing alcohol, it’s not making any new retinoic acid, which, in embryos, interrupts the normal development of the head and brain cells.

Fainsod’s research suggests adding more vitamin A to the equation — rebalancing the amount of alcohol and retinoic acid — can reverse or curb brain defects caused by alcohol.

But Fainsod is quick to say vitamin A can never be seen as a licence to drink while pregnant. Too much vitamin A can cause birth defects that mimic the effects of alcohol. And scientists haven’t yet figured out what the correct balance might be.

But vitamin A could one day be added to food as folic acid was added to white flour to reduce birth defects like spina bifida.

Or it could be given to at-risk populations or chronic alcoholics who are unable to quit drinking but who risk having multiple children with FASD.

© Copyright (c) Winnipeg Free Press

New research by an Israeli scientist suggests vitamin A could act almost like an antidote to the effects of alcohol on very early embryos during the critical development of the head and central nervous system. That’s when the worst effects of FASD start.

Photograph by: Ian Waldie, Getty Images

Released: 2/15/2011 11:45 AM EST
Source: American Technion Society

Newswise — An international team of researchers has found that the use of bisphosphonates – drugs already taken by millions of healthy women to prevent bone-loss – for more than one year was associated with a 50 percent reduction in the risk of postmenopausal colorectal cancer. The results were published this week in the Journal of Clinical Oncology.

According to lead researcher Prof. Gad Rennert, M.D., Ph.D., of the Technion-Israel Institute of Technology Faculty of Medicine and chairman of the Department of Community Medicine and Epidemiology at the Carmel Medical Center of Clalit Health Services, these findings further support the role of bisphosphonates as a possible new drug class for cancer prevention.

"We formerly identified a new class of drugs associated with a reduced risk of breast cancer," said Rennert. "And, now, by showing a similar effect on colorectal cancer risk reduction, we can assume that this class of medications has a broad effect – not necessarily limited to a specific cancer site." Such an effect, if proven in randomized trials, could lead to the recommendation for the use of these medications by the general population for cancer prevention, he added. 

Rennert and colleagues extracted data from the Molecular Epidemiology of Colorectal Cancer (MECC) study, a population-based case-control study in northern Israel, conducted together with senior author Stephen Gruber, M.D., MPH, Ph.D. of the University of Michigan, Ann Arbor. Using pharmacy records, the team evaluated the use of bisphosphonates in 1,866 postmenopausal female participants.

The researchers found that the use of bisphosphonates prior to diagnosis was strongly associated with a significant reduced relative risk for colorectal cancer – even after making adjustments for a large variety of known risk or protective factors for colorectal cancer such as family history, dietary components, physical activity, body mass index, and the use of other medications such as aspirin, statins and hormone replacement therapy.

"Bisphosphonates share the same mevalonate metabolic pathway as do statins, which we have previously shown to be associated with risk reduction of colorectal cancer," said Dr. Gruber. "This fact adds to the credibility of the current finding by adding biological plausibility."

Colorectal cancer is among the leading cancers in western countries, with more than 150,000 new cases diagnosed every year. In the U.S. alone, colorectal cancer kills some 50,000 deaths per year, making it one of the country’s leading causes of cancer death.

"While the disease is generally caused by bad dietary habits and lack of physical activity, it can possibly be prevented by several medications, such as aspirin and cholesterol-lowering medication of the statins group," said Prof. Rennert. "And now, we can add bisphosphonates to the list of tools for potential prevention of colorectal cancer."

The Technion-Israel Institute of Technology is Israel’s leading science and technology university. Home to the country’s first winners of the Nobel Prize in science, it commands a worldwide reputation for its pioneering work in nanotechnology, computer science, biotechnology, water-resource management, materials engineering, aerospace and medicine. The majority of the founders and managers of Israel’s high-tech companies are alumni. Based in New York City, the American Technion Society (ATS) is the leading American organization supporting higher education in Israel, with offices around the country.

Press Release, January 18, 2010

Antioxidants are sold over the counter everywhere. They’re added to food, drink and face cream. But according to Prof. Nava Dekel of the Biological Regulation Department, we still don’t have a complete understanding of how they act in our bodies. New research by Dekel and her team, recently published in the Proceedings of the National Academy of Sciences USA (PNAS), has revealed a possible unexpected side effect of antioxidants: They might cause fertility problems in females.

Common antioxidants include vitamins C and E. These work by eliminating molecules called reactive oxygen species that are produced naturally in the body. Stress can cause these chemically active molecules to be overproduced; in large amounts they damage cells indiscriminately. By neutralizing these potentially harmful substances, antioxidants may, theoretically, improve health and slow down the aging process.

But when Dekel and her research team including her former and present Ph.D. students Dr. Ketty Shkolnik and Ari Tadmor applied antioxidants to the ovaries of female mice, the results were surprising: ovulation levels dropped precipitously. That is, very few eggs were released from the ovarian follicles to reach the site of fertilization, compared to those in untreated ovaries.

To understand what lies behind these initial findings, the team asked whether it is possible that the process of ovulation might rely on the very ‘harmful’ substances destroyed by antioxidants – reactive oxygen species.

Further testing in mice showed that this is, indeed, the case. In one experiment, for instance, Dekel and her team treated some ovarian follicles with luteinizing hormone, the physiological trigger for ovulation, and others with hydrogen peroxide, a reactive oxygen species. The results showed hydrogen peroxide fully mimicked the effect of the ovulation-inducing hormone. This implies that reactive oxygen species that are produced in response to luteinizing hormone serve, in turn, as mediators for this physiological stimulus leading to ovulation.

Among other things, these results help fill in a picture that has begun to emerge in recent years of fertility and conception, in which it appears that these processes share a number of common mechanisms with inflammation. It makes sense, says Dekel, that substances which prevent inflammation in other parts of the body might also get in the way of normal ovulation, and so more caution should be taken when administering such substances.

Much of Dekel’s research has focused on fertility — her previous results are already helping some women become pregnant. Ironically, the new study has implications for those seeking the opposite effect. Dekel: ‘On the one hand, these findings could prove useful to women who are having trouble getting pregnant. On the other, further studies might show that certain antioxidants might be effective means of birth control that could be safer than today’s hormone-based prevention.’

Dekel and her team are now planning further studies to investigate the exact mechanics of this step in ovulation and to examine its effect on mice when administered in either food or drink. In addition, they plan to collect data on the possible link between females being administered antioxidant supplements and the difficulty to conceive. 

Prof. Nava Dekel’s research is supported by the M.D. Moross Institute for Cancer Research; the Jeanne and Joseph Nissim Foundation for Life Sciences Research; the Yeda-Sela Center for Basic Research; the Willner Family Center for Vascular Biology – Head; the Dwek Family Biomedical Research Fund; the Phyllis and Joseph Gurwin Fund for Scientific Advancement; and the J & R Foundation. Prof. Dekel is the incumbent of the Philip M. Klutznick Professorial Chair of Developmental Biology.

The Weizmann Institute of Science in Rehovot, Israel, is one of the world’s top-ranking multidisciplinary research institutions. Noted for its wide-ranging exploration of the natural and exact sciences, the Institute is home to 2,700 scientists, students, technicians and supporting staff. Institute research efforts include the search for new ways of fighting disease and hunger, examining leading questions in mathematics and computer science, probing the physics of matter and the universe, creating novel materials and developing new strategies for protecting the environment.

Weizmann Institute news releases are posted on the World Wide Web at http://wis-wander.weizmann.ac.il/, and are also available at http://www.eurekalert.org/.

October is breast cancer awareness month and Cherrill Hicks sifts through the science to find ways to reduce your risk of the disease.

By Cherrill Hicks
Published: 7:00AM BST 27 Sep 2010

1 Comment

Survival rates for the disease have gone up Photo: CORBIS

From freshly ground flaxseed to green-tea supplements, there’s a wealth of advice on preventing breast cancer. But how can we distinguish between half-baked theories and guidance based on decent scientific evidence? Doctors can’t predict who will develop breast cancer, which kills 12,000 women a year. A woman’s individual risk is largely down to factors beyond her control, such as genes, family history and, to some extent, chance. Nevertheless, there’s good research to show taking certain steps can reduce the risk.

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• HRT link to breast cancer

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• My daughter and genome research

• Household cleaners may double risk of breast cancer

• How do I tell my children I’ve got cancer?

*Stop smoking

Until recently, no definite link had been found between smoking and breast cancer. But recent research suggests nicotine may promote its development. This came from a small laboratory study but if the results are confirmed, it could have implications for nicotine replacement products.

*Limit your use of the Pill

There seems to be a small increase in risk of breast cancer with prolonged use of the contraceptive Pill, although it returns to normal 10 years after stopping. Bear in mind that breast cancer is uncommon in the age group using the Pill: surgeon Lester Barr from the Genesis Breast Cancer Prevention Appeal, advises stopping at about 30.

*Weigh up the risks and benefits of HRT

HRT (used for menopausal symptoms) slightly increases the risk of breast cancer within one to two years of use, with the risk increasing the longer it is used. Current advice is to use the lowest dose for the shortest acceptable time and to review treatment regularly with your doctor. HRT also makes breast tissue more dense, making cancer harder to diagnose from a mammogram.

*Breastfeed

Another personal decision, but one large study of women in 30 countries has shown that the longer you breastfeed, the greater the protection against breast cancer. Breastfeeding is thought to be linked to lower oestrogen levels, or making breast cells more resistant to cancerous changes.

*Have babies early (before 35)

There’s no doubt that bearing children, and having them early in life, reduces breast cancer risk. In one study, women who had a baby before 20 were half as likely to get breast cancer as women who hadn’t been pregnant or who had a baby at 35 or older.

*Cut down on alcohol

A recent, large study showed just one glass of wine a day increases the risk by 12 per cent. The less you drink the lower the risk: a maximum 14 units a week for women (stricter than government limits) is now recommended by Cancer Research UK. A unit is a small (125ml) glass of wine, a half pint of standard beer or one small (25ml) measure of spirits.

*Take regular exercise

In one study, walking briskly for as little as a couple of hours each week reduced the risk of breast cancer by 18 per cent. Just 30 minutes of moderate activity a day, at least five days a week is the current advice.

*Keep to a healthy weight, especially if you’re older

Studies show that being overweight after the menopause increases the risk of breast cancer, probably because at this stage, the more fat you carry, the higher your levels of oestrogen.

*Eat less fat

One US study from 2006 has shown that women who ate a low-fat diet had a reduced risk of breast cancer, while a large European study found that the increased risk is linked only to saturated fats. The jury is still out on whether fried or red meat significantly increase the risk. Eating more plant oestrogens (found in soy and certain vegetables and fruit) may help.

*Be ‘breast aware’

Know how your breasts look and feel at different times and watch for changes that aren’t normal for you. If you’re between 50 and 70, you’ll be offered a mammogram (breast X-ray) every three years; women at high risk will be offered screening earlier and more often.

*Consider gene testing

This may be worthwhile if you have a strong family history of breast or ovarian cancer (if a mother or sister had either under 50, for example). Three out of every 100 breast cancers are caused by a faulty inherited gene and if you are found to carry one, you will be offered early screening for the disease. Make sure you get genetic counselling before having a test.

*And don’t worry about…

…coffee, stress, food additives, pesticides, antiperspirants, underwired bras, abortion or if a breast gets bumped or bruised. There’s no evidence that any of these increase the risk.

The Genesis Breast Cancer Prevention Appeal: www.genesisuk.org

2 September 2010 Last updated at 23:03 GMT

Link between bone drugs and oesophageal cancer

The drugs work by strengthening the bones

Long-term use of bone-strengthening drugs – used to treat fractures – may boost the risk of oesophageal cancer, Oxford University research suggests.

The study of 3,000 people found taking bisphosphonates for five years upped the risk from one in 1,000 to two in 1,000 for 60 to 79-year-olds.

The researchers said the risk was small, but reliable information on risks and benefits was needed.

But experts said for many, the case for taking the drugs "would be strong".

The findings, published in the British Medical Journal, were based on an analysis of anonymised GP records.

They contrast with previous research which found no increased risk for the bone-strengthening drugs. 

Anyone who is taking these drugs and is worried about their risk of cancer should talk to their doctor”

End Quote Dr Laura Bell Cancer Research UK

It is not known why the risk may be increased, although the drugs are known to irritate the oesophagus.

Thousands of stomach and colorectum cancers were also studied, but no increased risk was found.

Lead researcher Dr Jane Green said even if the findings were confirmed by other studies "few people" taking bisphosphonates would ever develop the cancer.

"Our findings are part of a wider picture. Bisphosphonates are being increasingly prescribed to prevent fracture and what is lacking is reliable information on the benefits and risks of their use in the long term."

About 600,000 people in the UK are currently taking the drugs – including a tenth of all women over the age of 70.

Dr Laura Bell, from Cancer Research UK, agreed the findings should be treated with caution, pointing out the risks were "still small".

"Anyone who is taking these drugs and is worried about their risk of cancer should talk to their doctor."

The National Osteoporosis Society said: "It is a case of balancing the reduced risk of fractures against the side effects of treatment.

"When you consider the fact that there are 230,000 osteoporotic fractures every year in the UK and 1,150 hip-fracture-related deaths every month, the case for treatment is strong."

A common test to diagnose gestational diabetes — a temporary condition which can harm both mother and child if left untreated — also has predictive power for Type 2 adult-onset diabetes, a new Tel Aviv University study finds.

Dr. Gabriel Chodick of Tel Aviv University’s Department of Epidemiology and Preventive Medicine at the Sackler Faculty of Medicine has proven that women who “fail” the glucose challenge test, a series of four blood tests conducted over a single four-hour period, have a higher chance of developing adult onset diabetes later in life. In his latest published research, Dr. Chodick found that nearly half the women who fail all four of the four-part tests, demonstrating an elevated blood sugar level, developed Type 2 diabetes within ten years.

Dr. Chodick’s study statistically proves what has been anecdotally believed by healthcare practitioners in the past. “While doctors take this into consideration, there usually isn’t close follow-up in the clinical setting,” says Dr. Chodick. He says that women in the highest risk group (those who fail all four of the tests) should be given special counseling and intervention to prevent the onset of diabetes, which can greatly diminish quality of life and lead to adverse effects including heart disease, blindness and liver cancer.

In the retrospective study, Dr. Chodick, Dr. Varda Shalev and their colleagues collected data on more than 185,000 women in Israel who took the glucose challenge test, then acquired information from the health registry as to what percentage of these women contracted diabetes later in life.

Dr. Chodick and his colleagues ascertained that women who failed all four glucose challenge blood tests had a nearly 50% chance of developing Type 2 diabetes within the ten years following the test. Those who failed three of the four tests had a 20% overall chance of developing the disease within the same period.

“This is the first-ever study to show the long-term health of those who failed the glucose challenge test,” says Dr. Chodick.

While doctors commonly advise that women with gestational diabetes exercise and supplement their diet with fiber and fruit (and, in the most extreme circumstances, take insulin injections), women who take the advice usually have the health of their child in mind, not themselves. After giving birth, they resume adverse eating and lifestyle habits.

Dr. Chodick, whose life’s work is focused on preventative medicine, hopes to change attitudes and policies through his new study. Gestational diabetes currently affects 3 to 5% of all pregnant women in the U.S., and rates are continuing to rise, Dr. Chodick says. “It’s an epidemic that can be stopped with information and action.”

Diabetic Medicine, July 2010 American Friends of Tel Aviv University (2010, July 8). Women with gestational diabetes: Common glucose test also accurately predicts adult-onset diabetes.

Popping a couple of pain pills helped Laurie J. Besden study night after night. They helped her pass the Pennsylvania bar exam. They helped her get more done in a day than many of her colleagues. Then they helped her land in jail.

Besden doesn’t seem like any drug addict you’d picture. She’s smart, motivated — and an overachiever. But she’s one of an alarming number of women who have turned to prescription pills to get ahead — or even just to keep up.

Almost 6 percent of American women, that’s 7.5 million adult women, report using prescription medicines for a boost of energy, a dose of calm or other non-medical reasons, according to the latest numbers from the National Institute on Drug Abuse (NIDA).

While street drug use has been declining in recent years, prescription drug abuse has been up since the 1990s. The trend has been most striking in women because unlike with most drugs, which are more commonly abused by men, women are just as likely to abuse prescription drugs, says Susan R.B. Weiss, chief of NIDA’s Science Policy Branch.

Blame what some are calling the superwoman syndrome. Overworked, overwhelmed and overscheduled women juggling families, friends and careers are turning to stimulants, painkillers and anti-anxiety meds to help launch them through endless to-do lists.

“Women load their lives with so much that they get in over their heads, and some turn to prescription pills to cope,” says Talia Witkowski, a psychologist in Los Angeles.

Witkowski, 30, began abusing her prescription attention deficit hyperactivity disorder drugs in high school, and has been clean for three years.

“For many women, even those whom you would never suspect, pills offer an escape,” she says. But what many women don’t realize is that they are conducting a dangerous experiment on their health and their mind.

Start of a secret addiction
After graduating from the Dickinson School of Law at Pennsylvania State University in 1999, Laurie Besden felt overwhelmed by the pressure to pass the bar. So she stole a box of Vicoprofen, which contains the narcotic painkiller hydrocodone, from her ex-boyfriend’s father’s house and popped two pills. She had heard the medication could offer a burst of energy and ability to focus.

“I had energy to study for 12 hours and then clean the house like a superwoman,” recalls the 35 year old from Plymouth Meeting, Penn. Eventually, her two-a-day habit grew to 20 a day.

After she passed the bar, she tried to quit, but couldn’t. “If I didn’t take them, I was going to be sick,” she says. “I needed the pills to get out of bed so my heart wouldn’t go into palpitations.”

Then she started a prestigious — and demanding — clerkship, and realized she was completely dependent on her secret stash of pills to get through the day.

For years, she hid this addiction from her friends and family. She no longer even tried to imagine life without her little helpers. Then her source — a doctor who prescribed these pills for any phony condition — had his medical license revoked. Besden figured out how to call in her own prescriptions, using false names and impersonating doctors.

In 2002, she was arrested for the first of what would be five times before she was convicted in 2004 for prescription fraud and jailed for almost a year.

Pills all around
Abuse of prescription drugs has risen right along with increases in the number of prescriptions for stimulants and painkillers seen since the early ’90s, experts note. According to IMS Health, a research firm that tracks prescription use, the use of stimulants has nearly tripled over the past decade.

And as the drugs have become more commonplace, our attitude has become increasingly cavalier. After all, a kid can be given an amphetamine for ADHD, couldn’t Mom benefit from a little extra focus, too?

“Many people may not consider what they’re doing abuse because they’re using a prescribed drug,” says Weiss, of NIDA. “Many of these medications are being taken as performance-enhancers.”

What’s more, studies have found that women are more likely to be prescribed an abusable prescription drug, especially narcotics and anti-anxiety drugs. “Not surprisingly, availability increases use patterns,” Weiss says.

Women aren’t just abusing their own prescriptions; they’re also dipping into friends’ supplies. In one survey, 29 percent of  U.S. women admitted to sharing or borrowing somebody else’s prescription drugs in their lifetime. This study, published in the Journal of Women’s Health, found the rate of borrowing was highest among women ages 18 to 44.

That stat is backed by the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, which found that the main source of prescription drugs among non-medical users — a whopping 56 percent — was free drugs from friends and family.

The most commonly abused pills are opiod painkillers, stimulants and central nervous depressants, generally used to treat anxiety and sleep disorders. But these drugs are used for specific brain chemical imbalances, and if you are healthy, you risk tweaking your brain’s natural abilities to sleep, focus and calm down.

These pills can also undermine your confidence if you begin relying on a pill versus your own strengths and capabilities to get through the day, Weiss says.

Popping too many pills also can trigger an irregular heartbeat and lead to cardiac arrest — and even death. In fact, there’s been an exponential rise in the number of unintentional drug poisoning deaths, which spiked nationwide by more than 68 percent between 1999 and 2004, according to the Centers for Disease Control and Prevention. Accidental overdose often happens when users build up tolerance to the drugs and must take more and more for the same effect.

Another big worry is that these pills can interact with many other common medications. When combined with over-the-counter cold medicine, for instance, stimulants can drive up blood pressure to dangerously high levels.

But the potential for addiction is the most serious consequence, experts warn.

At age 15, Witkowski, the Los Angeles psychologist, started abusing medications including the Ritalin she’d been prescribed. Once she got into college, she began experimenting with other drugs. “I knew I was living a lie, but I couldn’t stop,” she says.  Finally she got help from a treatment program called Heal Your Hunger.

As Witkowski learned, addicts can recover, especially under the guidance of a therapist or program that specializes in addiction.

“An addiction specialist will be able to offer a solid assessment on how much control the addict has lost and what treatment plan is best,” says Dr. Ken Thompson, medical director of Caron, an alcohol and drug addiction treatment center headquartered in Wernersville, Penn. He advises women pursue gender-specific treatment.

“Women often have different motivations than men in abusing prescription drugs, and by being in a women’s-specific program, they’re able to deal with those reasons more effectively,” he says.

A true addiction is a lifelong struggle  ”This doesn’t mean they’re always going to suffer or be miserable, but they will have to pay attention to their recovery and do things to support staying clean,” Thompson says. At Caron, for instance, addicted women who are in the process of healing are encouraged to eat healthy, exercise, relax and do mind-body activities like yoga.

Dr. Harold C. Urschel III, co-founder of Enterhealth, an addiction recovery program in Dallas, says these are the same strategies he recommends all women follow, especially if they’re turning to a pill to relieve stress or anxiety, even just once. “You’re cheating yourself when you use a pill,” he says.

That’s a message Besden has come to accept, especially in jail, which she says saved her life. “I was forced to get clean, something I didn’t think would happen until I died,” she says. After jail, she sought treatment at Caron where she learned how to live without drugs. Since then she’s been rebuilding her life.

Clean now for six years, Besden’s had her license to practice law in Pennsylvania reinstated. She’s a working attorney in civil law who finds satisfaction in every day activities — like swimming, hanging out with her dog Marcus and helping other lawyers recover from addiction. 

Yet she’s also an addict in recovery, attending five support meetings weekly and touching base with her sponsor, and hopes she can inspire other women who have a secret addiction to get help. “Getting clean was the hardest thing I’ve ever done,” she says, “but getting clean and maintaining my sobriety is by far the biggest accomplishment of my life.”

Karen Asp, a freelance journalist who specializes in fitness, health and nutrition, is a contributing editor for Woman’s Day and writes regularly for Self, Prevention, Real Simple, Women’s Health, Shape and Men’s Fitness.  

URL: http://www.msnbc.msn.com/id/35526012/ns/health-behavior/