I have breast cancer at 33

My Story

It was October 12, 2011. I remember the date exactly because it was my Papa's 88th birthday, and I was halfway across the country at The Grand Canyon. I've been wanting to go ever since I watched The Brady Bunch take in the scenery during reruns of the show after kindergarten. Twenty-eight-ish years later, we were there, taking pictures and meeting elk and having a once-in-a-lifetime trip.

Our first night there, though, I started feeling shooting pain that led directly to a large lump in my left breast. Sure, it was a lump in my breast, but I was only about 10% worried. I mean, have you heard of someone who found a lump in their breast because a shooting pain directed them to it, and it turned out to be cancerous?! That's certainly not what happened to Brenda Walsh in the original 90210, nor anyone else that I've ever heard of since. I also had a thorough exam by a doctor back in August, and nothing was found then at all. All signs pointed to It's Nothing/How Annoying.

However, the pain was sporadic but didn't stop. When I came back home and had a coincidental appointment with my ob/gyn a few days later, I asked her to cop a feel. She did, and while she agreed that it was Probably Nothing, she wrote me a prescription to get an ultrasound at the Woman's Diagnostic Center connected to the hospital. Long story short, that ultrasound came back abnormal, which lead me to get my first mammogram (ouch!), a bilateral ultrasound, and three biopsies (one for the lump itself, another for a different worrisome spot, and a third for my lymph nodes) the day before Thanksgiving. The day after Thanksgiving, I was told that the lump itself was malignant.

I had cancer.

I knew little to nothing about cancer, other than the hard fact that every single member of both sides of my family has died from some sort of cancer. I joked to my husband that we never have to worry about heart disease or diabetes, as "cancer is the only way we go." But not at 33! All of those dead relatives got diagnosed in their 70s and 80s. Where the heck did this come from, and why did it happen to me?

Now, 17 days after my diagnosis, I don't have those answers (and might never have them), but I feel like I know a lot more.

What I Wish I Did Before I Got This Diagnosis

Change My Diet: I feel like the easiest thing regarding prevention is changing your diet. Now, I've asked to switch to a salad instead of fries 80% of the time and haven't had McDonald's since I was 10, but I still have my share of wine, beer, "fake" food and treats. I'm still digging deep into nutritional research (with dizzying results!), but all the diets can be simplified by this: ramp up the amount of (fresh, organic) fruits and veggies big-time along with a steady 30 minutes of exercise each day, and tone down the amount of processed foods, meat, sugar, and booze. I plan on making green smoothies (which I teased a good friend incessantly about mere week ago, citing them "disgusting" and her "weird") in the morning, cutting out as much white sugar as possible (do you see how much sugar is in, say, your hot cocoa mix? Buy the unsweetened stuff instead and add peppermint oil for a natural sugar), and cutting down on my meat consumption. Sure, I can go drastic with a raw vegan sober diet - which I know would be better for me - but I need to not cry every day into a bowl of sadness, too.

Take the BRCA Gene Test (aka The BRAC Test): As a young, Jewish Ashkenazi woman recently diagnosed with breast cancer, I was told I'd be approved by insurance "no problem" (otherwise the test itself is close to $4,000). Now, I don't know if I would have been approved so easily without the cancer diagnosis, but it would have been worth investigating. Put simply, this test takes your DNA from a blood sample and informs you as to whether or not you carry the cancer gene. According to The National Cancer Institute, 12% of women have a risk of developing breast cancer in their lives, while 60% of women with a BRCA mutation are at risk. I was told that, with my current cancer diagnosis, if I tested positive for the gene, then I'd have a 65% chance of the cancer returning to either breast (not just my left, where I have it now) as well as my ovaries. Thankfully, my tests all came back negative, but I'm thinking that preventative mastectomies in those that are pre-cancerous but have the BRCA mutation is super duper smart.

Perform monthly breast self-exams: I admit, I don't remember the last time I did one. Instead, I'd rely on my yearly appointment with my ob/gyn to give me the once-over. But so much can happen in a year, and to think about not finding this lump as early as I did...(shiver). Mark it down as a monthly reminder on your phone, and take 30 seconds (OK, it might take longer if you're not an A cup like me) to thoroughly examine everything. Getting felt up by your partner doesn't count.

What I Did When Diagnosed That Was Just Right

I listened to my body: While all signs pointed to It's Nothing, I didn't ignore the shooting pain and the lump it led me to find. I had two doctors appointments before my first ultrasound, and while they agreed that it was Probably Nothing, it didn't stop me from getting it checked out further. Please, please, please don't ignore anything painful or weird-looking or that "just showed up." It's better to take a needless trip to the doctor than let something go that could be super serious (The Big C or otherwise).

I stayed away from Google: The Internet is a scary place, and I can't even imagine what I would have found if I Googled all my possible diagnoses and treatments before I had any information other than "You have Stage 2 Breast Cancer" (which has since been upgraded to Stage 1). I took each piece of information as it came (I still don't have it all, and won't for at least another week or two), asked my doctors all the questions that came along with it, and went with more/different questions to My Fairy Boob Mother, who's a 7-year breast cancer survivor (at 35!) and, essentially, a walking cancer dictionary. I knew she would be nothing but helpful and comforting, even in the face of bad news. The Internet, however, is sometimes nothing but fear-inducing, which was the opposite of what I needed.

I announced my breast cancer via pink ukulele: My family and friends-we-consider-family were told via phone, email, or in person (depending on what we could handle at the time), but as someone with a large-ish Internet presence, I couldn't imagine how I'd tell The World at Large. Even just using the phrase "lump in my breast" or "breast cancer", I knew I'd be bringing the room down big time. By writing, performing, and posting "I Got Boob Cancer (a ditty)", I think I lowered the shock value a bit, and have been told there's been lots of laughter through some tears. Mission accomplished.

As funny as it sounds, I know I've been given The Best of The Worst (my lymph nodes are clear, I'm Stage 1 instead of Stage 2, my BRAC Test is negative), and it makes me extremely grateful. The full-on hippy-dippy in me knows it's not coincidental, from the shooting pain that lead me directly to the lump itself (and early, evidently) to all the well wishes that have been beamed to me from around the world (thanks, boob cancer ditty!). And if my diagnosis at 33 helps you, well, that's even better.

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HPV Test Spots Cervical Cancer Earlier Than Pap Smear: Study

THURSDAY, Dec. 15 (HealthDay News) - To catch cervical cancer or the lesions that can lead to it, a human papillomavirus (HPV) test is the best option for women over 30, Dutch researchers report.

Using it in conjunction with the more traditional Pap smear resulted in earlier detection of precancerous lesions and prevented more cervical cancers from developing, said study author Dr. Chris Meijer, a professor of pathology at VU University Medical Centre in Amsterdam.

The study is published online Dec. 15 in The Lancet Oncology.

Nearly all cervical cancers are caused by HPV, a virus spread through sexual intercourse. Some HPV strains are more strongly linked with the cancer than others.

The superiority of HPV testing over traditional Paps at finding precancerous cervical lesions is established, Meijer noted. However, his team wanted to see if HPV testing also offered better protection and detection long-term -- in two screenings done over a five-year period.

They found it did.

While five years may sound like a long lag time between screenings, it is not, he said. "The Netherlands already has a screening interval of five years, starting from 30 years of age until 60 years," he said. The program is inexpensive and effective, he added.

In the study, Meijer's team evaluated nearly 45,000 women, aged 29 to 56. Women in one group got a traditional Pap smear and an HPV DNA test. The women in the other group got just the Pap test.

Five years later, all women got both tests.

The researchers looked to see whether HPV tests resulted in fewer high-grade cervical lesions and cervical cancer in the second screening, due to earlier detection and treatment.

In the first screen, the HPV tests found more of the early changes that can precede cervical cancer than the Pap smear alone did.

Five years later, far fewer women in the HPV group had more advanced lesions or cervical cancer than did the Pap-only women.

Four women in the HPV/Pap group were diagnosed with cervical cancer, while 14 in the Pap-only group were.

When they looked at cervical cancer or advanced lesions, 88 in the HPV arm of the study were diagnosed with one or the other compared to 122 in the Pap-alone arm.

The improved protection against advanced lesions, the researchers said, is due to the earlier detection of the precursor lesions. When they were treated, it helped prevent them from progressing.

In an accompanying commentary, scientists from the U.S. National Cancer Institute wrote that the Dutch trial does show the five-year screening interval is safe. But they added that it is unclear if the same results would hold true in a different population with different testing guidelines.

The HPV test can be done using the same specimen collected for the Pap test, Meijer said.

Costs of the tests differ. Meijer said Pap smears are about $38 in the Netherlands, while an HPV test costs about $64. However, the Dutch Minister of Health recently recommended lowering the cost of an HPV test to below that of the traditional Pap.

The new study is "further defining how we can incorporate HPV testing into our screening program," said Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon at Lenox Hill Hospital, in New York City.

She noted that she doesn't think the HPV screen will replace the Pap test completely. "It may turn out to be a first-line screen. Stay tuned for more," she said. "Certainly ask your physician if you've had HPV."

In October, three U.S. cancer groups proposed new guidelines for cervical cancer testing, extending intervals between screenings and making other changes. These guidelines, issued by the American Cancer Society and others, call for combination HPV/Pap smear testing for women aged 30 and older.

After three normal Paps, women over 30 can have the test ever two to three years, according to the American Cancer Society.

However, the U.S. Preventive Services Task Force remains cautious about the use of the HPV test, standing by the Pap as the best bet for now.

The Dutch study was funded by Zorg Onderzoek Nederland (the Netherlands Organization for Health Research and Development).

More information

To learn more about cervical cancer, visit the U.S. National Institutes of Health.

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Smoking Linked to Skin Cancer in Women

THURSDAY, Dec. 15 (HealthDay News) -- If you're a woman who smokes and you are looking for another reason to quit, consider this: A new study has found a link between tobacco use and skin cancer.

The study found that women who had squamous cell skin cancer were more likely to have smoked than those who were free from the disease. And those who smoked at least 20 years were twice as likely to develop squamous cell skin cancer, a less aggressive form of skin cancer than melanoma.

Men who smoked had a modest risk for the two types of non-melanoma skin cancer -- basal cell and squamous cell cancer -- but the results weren't statistically significant, the study authors noted.

"We don't know why," said study lead author Dana Rollison, referring to the difference between women's and men's risk. Both men and women get a lot of exposure to the sun, the main risk factor for skin cancer, she noted.

But lung cancer research may offer a clue, said Rollison, an associate member in the Moffitt Cancer Center department of cancer epidemiology, in Tampa, Fla. Hormonal differences affecting the metabolization of nicotine and the body's ability to repair damage to lung DNA caused by smoking have been noted before, suggesting that the female hormone estrogen may play a role, she said.

The study, published online in the journal Cancer Causes Control, was done at the Moffitt Cancer Center and the University of South Florida, also in Tampa.

For the study, 383 patients with skin cancer were compared to 315 people without the disease. The participants were asked how much they smoked, when they picked up the habit and the total number of years they'd smoked. A total of 355 men and 343 women were included in the study. All were white, the group most at risk for skin cancer. Risks for both types of non-melanoma skin cancer were analyzed separately, compensating for the presence of other risk factors.

The researchers found that the more people smoked, the more likely they were to have skin cancer, Rollison said. Men who had basal cell skin cancer were significantly more likely to have smoked for at least 20 years than men with no cancer, the study authors noted.

While the study found an association between smoking and skin cancer risk, it did not prove a cause and effect.

Despite the elevated smoking-related risk among women, men overall are more likely to get skin cancer, Rollison noted. She said that "it is possible men's skin is more sensitive to sun exposure than women's."

But another skin cancer expert suggested that men may be less inclined to use sunscreen or other protection when outdoors.

"Although it could just be a genetic difference (between men and women), men tend to have more unprotected sun exposure in their lives," said Dr. Jeffrey Dover, associate clinical professor of dermatology at Yale University Medical School.

Dover said the study findings weren't surprising because "we know cigarette smoke contains carcinogens" and smokers are "blowing the smoke and ash around their faces all day."

The study is important, he added, because "although we have done well, we can do even better" at eliminating smoking as a cause of disease. "This adds more fuel to the idea that smoking has no place in our society."

Non-melanoma skin cancer is the most common form of cancer in the United States, where about 2 million cases are treated annually, according to the U.S. National Institutes of Health. Squamous cell cancer occurs in the epidermis, the top layer of skin, and can spread to other organs. Basal cell skin cancer occurs in the dermis, the skin layer beneath the epidermis. While it does not spread to other organs, it is far more common than squamous cell cancer, according to the government agency.

More information

To learn more about skin cancer, visit the U.S. National Cancer Institute.

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Apnea Treatment Might Reduce Signs of Heart Disease Risk

WEDNESDAY, Dec. 14 (HealthDay News) -- Along with helping people with obstructive sleep apnea get a better night's sleep, machines that help keep the airways open during sleep can also help improve the symptoms of metabolic syndrome, according to new research.

Metabolic syndrome is a group of symptoms that indicate a higher risk of heart disease. These symptoms include excess weight, especially in the abdomen, high blood pressure, abnormal cholesterol levels, higher blood sugar levels and insulin resistance. Many people with obstructive sleep apnea also have metabolic syndrome, according to the study.

After three months of continuous positive airway pressure (CPAP) treatment, study participants with obstructive sleep apnea and metabolic syndrome had improvements in their blood pressure, cholesterol, and blood sugar levels. Thirteen percent of those who received the breathing treatment had such significant reductions in their symptoms that they no longer qualified as having metabolic syndrome after three months of therapy.

"Patients with obstructive sleep apnea should be actively screened for metabolic syndrome or constituents of metabolic syndrome, and, in addition to lifestyle modification, weight reduction and dietary modification, [should be given] proper counseling for CPAP use, and a CPAP machine should be used regularly," said the study's lead author, Dr. Surendra Sharma, a professor and head of the department of internal medicine at the All India Institute of Medical Sciences in New Delhi, India.

Results of the study are published in the Dec. 15 issue of the New England Journal of Medicine. Funding for the study was provided by a grant from Pfizer. Sharma said that Pfizer does not produce CPAP machines, and they were not involved in the study's design, implementation or interpretation.

Obstructive sleep apnea occurs when the airways close during sleep, causing a lack of oxygen that startles the person awake momentarily, though they may not be aware of awakening. This can happen several times to 100 times an hour, according to the U.S. National Heart, Lung, and Blood Institute.

The current study included 86 adults between the ages of 30 and 65. All had obstructive sleep apnea, but none was being treated with CPAP. Eighty-seven percent also had metabolic syndrome.

The study volunteers were randomly assigned to receive CPAP or sham CPAP treatment for three months. CPAP treatment involves wearing a face mask during sleep that continuously delivers air into the airway so it remains open. The sham CPAP had modifications to reduce the airflow, and the mask used had tiny holes that allowed extra air to escape. The modifications were done in such a way that even the researchers couldn't tell who was receiving standard CPAP and who received the sham treatment.

After three months, the study volunteers went one month without treatment, and then switched groups for another three months of therapy with the opposite treatment.

Compared to the sham treatment, people treated with CPAP had an overall drop of 3.9 mm Hg systolic (the top number) blood pressure and 2.5 mm Hg diastolic blood pressure. Total cholesterol levels went down 13.3 milligrams per deciliter (mg/dL), and LDL cholesterol, the bad type, dropped by 9.6 mg/dL in the treatment group. Levels of triglyceride, another important and potentially harmful blood fat, went down by 18.7 mg/dL in those who received treatment, according to the study.

Blood sugar levels went down slightly, as did waist circumference, according to the study.

Eleven patients (13 percent) no longer qualified as having metabolic syndrome after receiving CPAP, compared with just 1 percent receiving sham CPAP.

Sharma said these positive effects likely come from the restoration of normal oxygen levels. When the body becomes oxygen-deprived in obstructive sleep apnea, it causes the body to become distressed, which causes the release of hormones that can cause cell damage that may lead to metabolic syndrome, according to Sharma.

"This study adds to the growing body of knowledge that obstructive sleep apnea has long-term consequences for your health, and that treatment reverses some of those consequences," said Dr. David Rapoport, an associate professor of medicine and director of the Sleep Disorders Program at NYU Langone Medical Center in New York City.

Rapoport said it wasn't clear from this study if any of the benefits seen came solely from weight loss in those on CPAP and weight gain for those on sham treatment.

"This study is thought-provoking and could be really wonderful news that using a breathing machine could have all of these beneficial effects. But, ultimately, we'd want to see clinical end points, such as the incidence of cardiovascular deaths, in order to know if an intervention is appropriate and helpful," said Dr. Tara Narula, a cardiologist at Lenox Hill Hospital in New York City.

More information

To learn more about CPAP, go to the U.S. National Heart, Lung, and Blood Institute.

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Vaccine attacks breast cancer in mice

Scientists in the United States said Monday they have developed a vaccine that attacks tumors in mice, a breakthrough they hope will help fight breast, colon, ovarian and pancreatic cancer in humans.

Although studies on mice often do not translate directly into remedies that work for human subjects, researchers are hopeful because of the strength of the vaccine and the particular approach it takes.

"This vaccine elicits a very strong immune response," said study co-senior author Geert-Jan Boons, a professor of chemistry and a researcher in the University of Georgia Cancer Center.

"It activates all three components of the immune system to reduce tumor size by an average of 80 percent."

The vaccine works by training the immune system to attack tumors that have a protein known as MUC1 on the surface of their cells, according to the study published in the Proceedings of the National Academy of Sciences.

MUC1 is found on more than 70 percent of the most aggressive and lethal types of cancer, including most kinds of breast, pancreatic, ovarian and multiple myeloma.

"This is the first time that a vaccine has been developed that trains the immune system to distinguish and kill cancer cells based on their different sugar structures on proteins such as MUC1," said study co-author Sandra Gendler, professor at the Mayo Clinic in Arizona.

The protein is also overexpressed in 90 percent of breast cancer patients with so-called "triple negative" tumors that do not respond to hormonal therapy such as Tamoxifen, aromatase inhibitors, or the drug Herceptin.

These patients urgently need a new approach to their cancers.

"In the US alone, there are 35,000 patients diagnosed every year whose tumors are triple-negative," Boons said.

"So we might have a therapy for a large group of patients for which there is currently no drug therapy aside from chemotherapy."

A vaccine against MUC1 could be used in combination with chemotherapy, or as a preventive measure in patients at high risk for certain cancers.

Boons, Gendler and colleagues are currently at work testing the vaccine on human cancer cells in the lab, and could begin phase I clinical trials to test the safety of the vaccine by late 2013.

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WHO sets new goal in fight against malaria

LONDON (AP) — Health officials hope to virtually eliminate malaria deaths in the next few years — despite having failed to meet an earlier goal of cutting the disease's incidence in half by 2010.

In a report released Tuesday by the World Health Organization, experts said they only managed to reduce malaria by 17 percent since 2000. Last year, there were about 216 million cases of malaria worldwide, with about 81 percent of those in Africa, mostly in children under five.

But those figures come with a big margin of error since WHO did not have enough data for more than two dozen African countries to accurately track malaria's spread.

Dr. Robert Newman, director of WHO's malaria program, said it is disappointing not to have reduced malaria by 50 percent by last year. But, he said, it was "truly significant progress" that the parasitic disease's death rates fell by more than one-third in Africa.

He described the current goal of cutting malaria deaths to "near zero" by the end of 2015 as "aspirational," but added that it wouldn't be accomplished unless every person at risk has access to a bed net and suspected cases are properly diagnosed and treated. Newman also said it would cost $6 billion a year — about three times more than the world currently spends — to be successful.

"It is unacceptable that people continue to die from malaria for lack of a $5 bed net, a 50 cent diagnostic test and a $1 anti-malarial treatment," Newman said in an email.

Some experts questioned if WHO should be setting such lofty goals, especially at a time of declining funding.

"I understand why people want these big, audacious targets, but it may undermine malaria (control) in the long term," said Richard Tren, director of the nonprofit Africa Fighting Malaria.

Health officials tried in the 1950s to eradicate malaria, but gave up about a decade later. That failure prompted donors to lose interest, allowing the disease to surge.

"It may be reckless to overreach," Tren told The Associated Press.

The financial crisis won't help matters.

The world's top funder of public health programs — the Global Fund to Fight AIDS, Tuberculosis and Malaria — recently announced it has run out of money for its next round of grants.

Dr. Tido von Schoen Angerer, an executive director at Medecins Sans Frontieres, warned the cash-flow problems at the Global Fund could mean delays in getting new bed nets and money for new treatment programs. "We really risk losing some of the hard-won (gains) in malaria control," he said.

WHO's Newman said other major donors — including the Bill & Melinda Gates Foundation, Britain and the U.S. — are not expected to trim their donations. Gates has previously called for malaria to be completely wiped out, a goal Newman says might be possible in several decades.

Malaria is a potentially fatal disease caused by parasites spread to people via mosquito bites. It is most serious in young children and pregnant women.

Newman said there are new tools being developed that could eventually help stop the disease, including longer lasting bed nets, a vaccine, and new medicines.

He also said more investment is needed to improve disease surveillance. For many African countries where malaria is circulating, officials use modeling estimates, not actual cases of sick patients.

"Unless we know where we still have malaria, we cannot successfully take the fight to the next level," he said.

___

Online:

www.who.int

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Cancer group aims to boost trust in guidelines

NEW YORK (Reuters Health) - In a field plagued by frequent controversy, the American Cancer Society has taken "a major step forward" with a new system for developing trustworthy screening recommendations.

Instead of having cancer specialists develop its guidelines, the ACS now leaves that to generalist health care professionals accompanied by a patient advocate.

The approach has previously drawn criticism for another prominent guideline-writing organization. The ACS argues, however, that it gets rid of an obvious conflict of interest, because oncologists might benefit financially from recommending new screening tests, which lead to more diagnoses and treatment.

Still, pulling the cancer experts, or subspecialists, was the toughest part of revamping the guideline process, said Dr. Tim Byers of the ACS, who led the new efforts.

"The conflict is that they know the most about it, but they also have the most self-interest in it," he told Reuters Health.

The ACS is the largest voluntary health organization in the U.S., and its guidelines are used by patients, doctors, insurance companies and policymakers alike. An article in today's Journal of the American Medical Association outlines its new system.

Most other groups that develop medical guidelines still have leading specialists at the helm. One exception is the government-backed U.S. Preventive Services Task Force, which consists of generalists such as family doctors and public health experts.

A few months ago, the panel caused an uproar among urologists when it issued a draft recommendation that healthy men not get screened for prostate cancer with the so-called PSA test.

And in 2009, it triggered a media storm after it recommended that doctors scale back routine mammograms for women in their 40s and 50s. Both recommendations are at odds with the ACS's guidelines.

While the U.S. Preventive Services Task Force does consult with subject experts before making its recommendations, it hasn't been explicit about it, which has fueled criticism of its guidelines.

BE CLEAR ABOUT THE HARMS

Subspecialists will still have an advisory role in the guideline development at the ACS, but they will no longer be able to vote and will not be writing the guidelines.

Byers said making recommendations always involves some degree of value judgment, and that the new ACS guidelines will be more transparent about that.

"We need to more explicitly describe potential harms along with benefits, and when we make recommendations to be clear about the balance between benefits and harms," he said.

While some screening tests -- say, mammography or colonoscopy -- have been shown to save lives, all have downsides.

For instance, there is the cost of looking for disease in healthy people, the anxiety and the potential for procedure complications. The tests may also sound a false alarm that can lead to unnecessary biopsies, which carry their own risks. And in some cases, early detection means doctors diagnose and treat cancers that would never have caused any harm if left alone -- a phenomenon known as overdiagnosis.

"Overdiagnosis is an inherent issue in any screening, even screening that is proven to be beneficial like mammography," said Byers.

BREAKING NEW GROUND

The ACS will also conduct systematic reviews of the medical evidence before making recommendations, to make sure as much as possible of its guidance is based on data instead of opinion.

Recent studies have shown that many guidelines rely more on expert opinions that real experiments, making them vulnerable to personal biases.

In an email to Reuters Health, Dr. Sheldon Greenfield of the University of California, Irvine, called the ACS's new system "a major step forward."

He added that a major challenge would be to make sure the public grasps the complexity of the science in the guidelines.

Greenfield recently chaired an Institute of Medicine committee that released standards for how to make clinical guidelines better and more trustworthy.

Earlier this year, he told Reuters Health that good guidelines need to be based on extensive reviews of the medical literature done by researchers with no financial conflicts of interest.

Greenfield also said the guideline panels have to represent all stakeholders, including doctors from other specialties and patients. Fulfilling all three requirements, he said, was "about as common as peace in the Middle East."

Dr. Michael LeFevre of the U.S. Preventive Services Task Force also applauded the ACS's efforts.

"This is the first time I have seen a major organization use the Institute of Medicine model," he told Reuters Health.

WILL CANCER SCREENING GUIDELINES EVER BE THE SAME?

LeFevre said he believes the new system might help align the advice from the two organizations.

"Many of the differences between Task Force recommendations and others have to do with the different processes by which those conclusions are reached," he said. "The process that was outlined certainly moves in the direction of the process that we use."

Byers was less convinced that the differences would disappear. Instead, his hope is "that we can be more explicit about what the reasons for those differences are."

The ACS is currently developing guidelines on lung cancer screening, a topic that sparked debate in the media earlier this year. According to Byers, the new system will be used "in spirit" to those guidelines, although it is too late to apply it full-out.

SOURCE: http://bit.ly/t7yGNh Journal of the American Medical Association, December 14, 2011.

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Could Statins Help Those Hospitalized With Flu?

WEDNESDAY, Dec. 14 (HealthDay News) -- Statins, the drugs that can dramatically lower cholesterol levels, may one day also prove useful in combating serious cases of the flu.

A preliminary study in the Journal of Infectious Diseases finds that patients hospitalized with influenza were less likely to die if they were taking a statin, compared with their peers who weren't taking one of the drugs. The effect held even after adjusting for heart disease.

But it's far too soon to consider adding statins to the existing anti-flu armamentarium, the authors stated.

"At this point, statins should not become the standard of care for people hospitalized with the flu," cautioned study co-author Dr. Ann Thomas, a public health physician with the Oregon Public Health Division in Portland. "We would like to see more studies, [and] I think it would be worthwhile to do these studies."

Right now, preventive vaccinations and antiviral medications are the best weapons against this wily foe, but both stop far short of perfection.

Statins have piqued the interest of virologists and others because they may have anti-inflammatory properties that might mitigate the damage from the influenza virus.

"There have been a couple of studies that have found an apparent association between statins and improved mortality in patients who've had sepsis [blood infections], who've had community-acquired pneumonia," said Dr. Bruce Hirsch, an attending physician in infectious diseases at North Shore University Hospital in Manhasset, NY.

This is the first observational study to investigate a possible relationship between statins and deaths from the flu.

The authors reviewed chart records on more than 3,000 patients hospitalized with laboratory-confirmed influenza in 10 states during the 2007-2008 flu season.

Patients on statins were 41 percent less likely to die, the study found, even after adjusting for age, the presence of heart, lung and/or kidney disease, whether or not they had had a flu shot, or whether or not they had received antiviral medications such as Tamiflu (oseltamivir).

But the study also suffers from several limitations, as the authors themselves acknowledged.

Perhaps most importantly, the authors do not know if patients taking statins were already healthier than people not taking statins.

"The big question at baseline was were the people on statins healthier than those not on statins and did that account for why they were less likely to die?" Thomas said. "That's difficult to answer."

"There's no question that these observations are striking in terms of death from influenza but they can't say why," said Dr. Len Horovitz, a pulmonary specialist with Lenox Hill Hospital in New York City. "Why did these people start statins? Were they cardiac patients? Did they think it was a good idea because their cholesterol looked lousy?"

A randomized controlled trial could provide some of these answers but only two have been registered, one of which is terminated and the other of which is no longer recruiting.

This study was sponsored by the U.S. Centers for Disease Control and Prevention's Emerging Infections Program, which usually only does observational studies, Thomas said.

More information

The U.S. Centers for Disease Control and Prevention has more on the seasonal flu.

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Poor mental health harming productivity, says OECD

LONDON (Reuters) - One in five workers suffer from a mental illness such as depression or anxiety and these conditions increasingly affect productivity in the workplace as many struggle to cope, a report by the OECD said on Monday.

The Organization for Economic Co-operation and Development found people with mental illness are often off sick from work, and between 30 and 50 percent of all new disability benefit claims in OECD nations are now due to poor mental health.

Policymakers need to find new ways to tackle the social and economic problem of mental illness, the report said, as trigger factors, such as stress at work, are likely to increase.

"Increasing job insecurity and pressure in today's workplaces could drive a rise in mental health problems in the years ahead," it said.

"The share of workers exposed to work-related stress, or job strain, has increased in the past decade all across the OECD. And in the current economic climate, more and more people are worried about their job security."

Depression alone is already a major cause of death, disability and economic burden worldwide and the World Health Organization predicts that by 2020 it will be the second leading contributor to the global burden of disease across all ages.

Two studies published in September and October found that up to 40 percent of Europeans suffer from mental and neurological illnesses each year, and the annual cost of brain disorders is almost 800 billion euros.

The OECD's report, entitled "Sick on the Job? Myths and Realities about Mental Health at Work" found that most people with a mental disorder are in work, with employment rates of between 55 percent and 70 percent -- about 10 to 15 percentage points lower than for people without a disorder.

But people with mental illness are two to three times as likely to be unemployed as people with no mental health problems. This gap represents a economic major loss, the report said.

"Most common mental disorders can get better, and the employment chances be improved, with adequate treatment," the OECD said.

But it said health systems in most countries were narrowly focused on treating people with severe disorders such as schizophrenia, who account for only a quarter of all sufferers.

"Taking more common disorders more seriously would boost the chances for people to stay in, or return to, work," the OECD said, adding that around 50 percent of people with severe mental disorders and more than 70 percent of those with moderate illness currently get no treatment at all.

The OECD urged policymakers to focus on providing good working conditions which help employees reduce and manage stress, to introduce systematic monitoring of sick leave, and to help employers reduce workplace conflict and avoid unnecessary dismissal caused by mental health problems.

(Reporting by Kate Kelland; Editing by Rosalind Russell)

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'Love Hormone' May Buffer Kids From Mom's Depression

FRIDAY, Dec. 9 (HealthDay News) -- Children born to mothers with postpartum depression are at increased risk for mental health problems, but a hormone called oxytocin may reduce the risk, according to a new study.

Oxytocin, which is produced naturally in the body and has been associated with feelings of love and trust, may help protect kids from the negative effects of maternal depression, the researchers found. A synthetic version of the hormone is available as medication.

In the study, Israeli researchers looked at 155 mother-child pairs. By the time they were 6 years old, 60 percent of children born to mothers who were consistently depressed for the first year after giving birth had mental health problems, mainly anxiety and conduct disorders.

Among the 6-year-old children whose mothers did not have postpartum depression, only 15 percent had mental health problems, the investigators noted.

The study also found that children born to mothers with extended postpartum depression were less verbal and had lower levels of playfulness and creativity, less engagement with their mothers, diminished social involvement, and less empathy for the pain and distress of others.

These children and their mothers also had disordered functioning of the oxytocin system, as shown by lower levels of oxytocin in their saliva and a variant on the oxytocin receptor gene that increases the risk of depression, according to study leader Ruth Feldman, a professor in the psychology department and the Gonda Brain Sciences Center at Bar-Ilan University, and colleagues.

Among the children born to depressed mothers, the 40 percent who did not have mental disorders by age 6 had normal functioning of the oxytocin system and normal levels of oxytocin in their saliva.

The study was slated for presentation Thursday at the annual meeting of the American College of Neuropsychopharmacology, in Hawaii.

"We found the functioning of the oxytocin system helps to safeguard some children against the effects of chronic maternal depression," Feldman said in a college news release. "This study could lead to potential treatment options for postpartum depression and methods to help children develop stronger oxytocin systems."

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The Nemours Foundation has more about postpartum depression.

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Brazil's Lula is beating cancer, doctors say

SAO PAULO (Reuters) - Doctors in charge of throat cancer treatment for former Brazilian President Luiz Inacio Lula da Silva called his response to chemotherapy "impressive" and said the tumor in his larynx had shrunk by 75 percent in size.

The popular Lula is undergoing his third and final round of chemotherapy on Monday, which will be followed by radiation therapy in the coming months, finishing in February.

Doctors on the team treating the former president at the Hospital Sirio-Libanes said they were "impressed".

"It was an extraordinary reduction (75 percent) that surprised the medical team," said oncologist Artur Katz, adding that a 30 to 40 percent shrinkage would have been a positive response to treatment.

The team of physicians said that Lula would be able to return to political life by March next year if he continued to respond well to the treatment.

He would also not likely lose any capacity in one of his defining traits as a public speaker - his burly and explosive voice - as doctor's ruled out surgery in light of the shrinkage of the tumor.

Lula's diagnosis in late October shocked Brazilians and raised debate about political life without the charismatic former union boss, who remains an influential force in Latin America's largest economy.

Analysts and politicians have even speculated Lula could run for president again in 2014 if President Dilma Rousseff didn't seek reelection.

Lula, who turned 66 a little over a month ago, plays a vital role in his left-leaning Workers' Party.

He has also been a powerful advisor and peacemaker for Rousseff this year as she deals with infighting in her ruling coalition and weathers the resignation of now seven ministers, six of them due to corruption scandals.

Before taking office in January, Rousseff was herself treated successfully for cancer at the same medical center that is treating Lula.

(Additional reporting and writing by Reese Ewing, editing by Anthony Boadle)

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Brazil's Lula is beating cancer, doctors say

SAO PAULO (Reuters) - Doctors in charge of throat cancer treatment for former Brazilian President Luiz Inacio Lula da Silva called his response to chemotherapy "impressive" and said the tumor in his larynx had shrunk by 75 percent in size.

The popular Lula is undergoing his third and final round of chemotherapy on Monday, which will be followed by radiation therapy in the coming months, finishing in February.

Doctors on the team treating the former president at the Hospital Sirio-Libanes said they were "impressed".

"It was an extraordinary reduction (75 percent) that surprised the medical team," said oncologist Artur Katz, adding that a 30 to 40 percent shrinkage would have been a positive response to treatment.

The team of physicians said that Lula would be able to return to political life by March next year if he continued to respond well to the treatment.

He would also not likely lose any capacity in one of his defining traits as a public speaker - his burly and explosive voice - as doctor's ruled out surgery in light of the shrinkage of the tumor.

Lula's diagnosis in late October shocked Brazilians and raised debate about political life without the charismatic former union boss, who remains an influential force in Latin America's largest economy.

Analysts and politicians have even speculated Lula could run for president again in 2014 if President Dilma Rousseff didn't seek reelection.

Lula, who turned 66 a little over a month ago, plays a vital role in his left-leaning Workers' Party.

He has also been a powerful advisor and peacemaker for Rousseff this year as she deals with infighting in her ruling coalition and weathers the resignation of now seven ministers, six of them due to corruption scandals.

Before taking office in January, Rousseff was herself treated successfully for cancer at the same medical center that is treating Lula.

(Additional reporting and writing by Reese Ewing, editing by Anthony Boadle)

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Memory issues after cancer may not be due to chemo

NEW YORK (Reuters Health) - Women treated for breast cancer with radiation with or without chemotherapy had more thinking and memory problems a few years after their treatment ended than women who'd never had cancer, in a new study.

Research has suggested some women experience mental haziness, dubbed "chemo brain," during and soon after chemotherapy treatment. And one recent study found evidence of changes in the activity of certain brain regions in women who'd undergone chemotherapy (see Reuters Health story of November 15, 2011).

But some researchers have questioned whether those problems are due to the specific drug treatments, or possibly to the cancer itself. In the new report, breast cancer survivors showed certain small mental deficits, regardless of whether or not they'd had chemotherapy.

"It's a very, very subtle thing. We're not talking about patients becoming delirious, demented, amnesic," said Barbara Collins, a neuropsychologist who has studied chemotherapy-related cognitive changes at Ottawa Hospital in Ontario, Canada, but wasn't involved in the new study.

"We're talking about a group of people that are saying, 'I'm pretty much still able to function, but I find it harder...it doesn't come as easily, and I can't do as many things at the same time.'"

The current study involved 129 breast cancer survivors in their fifties, on average. About half of them had been treated with radiation and chemotherapy, while the other women only had radiation.

Six months after finishing treatment, and another three years later, women took a range of thinking and memory tests. Their scores were compared against the performance of 184 women who'd never had cancer, but were a similar age and from the same areas.

On three out of five types of memory tests, women who'd had either course of treatment performed similarly to the non-cancer group. But on two, their scores were noticeably lower.

At both six months and a few years after treatment, cancer survivors scored worse on tests of "executive functioning," which included naming words beginning with a particular letter.

And on tests of processing speed, which included marking specific numbers on lists of random numbers and letters -- a measure of speed and concentration -- women who'd received radiation only or chemo and radiation had lower scores than women with no cancer history at the later time point.

Those scores differed by about one to three points on a scale where 50 is considered average.

CAUSES STILL UNCLEAR

One limitation of using tests to measure cognition is that it's not clear how exactly they apply to functioning in everyday life, Paul Jacobsen, from the Moffitt Cancer Center in Tampa, Florida, and his colleagues wrote Monday in the journal Cancer.

The researchers also didn't have information on women's thinking and memory skills before they were diagnosed with cancer or treated.

Cancer survivors who'd had radiation without chemotherapy scored similarly to those who were treated with radiation and chemo on all measures of mental ability.

That challenges the notion that chemotherapy is the driving force behind mental changes in breast cancer survivors, researchers said.

"People talk about 'chemo brain,' and there's sort of a general view that if people have cognitive problems after the cancer treatment, it must be due to the fact that they had chemotherapy," Jacobsen told Reuters Health.

"We provided the most definitive evidence to date to suspect it's not just chemotherapy that is contributing to cognitive problems after breast cancer."

What exactly might be the cause, or causes, is still up for debate.

"There is very likely something to do with having cancer that already affects your cognitive function," Collins said. "What is it? Could it be stress? Could it be anxiety? Could it be depression? That's a possibility."

It could also be that the immune system's response to cancer affects the brain, she added.

Collins said that most of the data still points to some mental effect of chemotherapy in certain patients -- but that small differences between treatment groups might have been missed in this analysis.

Still, she said, "We can't be too quick to conclude, even if we find some subtle things, that they're all due to the chemotherapy. We have to step very carefully here in terms of understanding what the real factors are."

Collins told Reuters Health that women should know foggy thinking and memory after cancer treatment tends to improve over time. "Nobody's suggesting they don't get their chemotherapy, not at all," she said.

Many women won't notice any mental fuzziness after treatment at all, Jacobsen added, but he said those that do should talk to their doctors to rule out other causes and to consider strategies to compensate for those problems.

SOURCE: http://bit.ly/gzHzeL Cancer, online December 12, 2011.

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Cancer Outpatients at Greater Risk for Blood Clots

MONDAY, Dec. 12 (HealthDay News) -- Cancer patients receiving chemotherapy most often develop blood clots after they are discharged from the hospital, according to a large new study.

Efforts to prevent this common and potentially life-threatening complication of cancer treatment should focus on outpatients -- not those still in the hospital, the researchers said.

A blood clot, also called a venous thromboembolism (VTE), is a mass of red blood cells, clotting proteins and platelets that block the flow of blood. Once cancer patients develop one clot, they're much more likely to develop others, according to a news release from the University of Rochester Medical Center.

"One in five patients develops blood clots after a cancer diagnosis and we believe that number is rising," study author Dr. Alok Khorana, an associate professor in the James P. Wilmot Cancer Center at URMC, said in the release.

After examining nearly 18,000 cancer patients over four years, the researchers found that of the 5.6 percent who developed blood clots, 78 percent were receiving treatment as outpatients.

The retrospective, observational study is slated for presentation Monday at the American Society of Hematology annual meeting in San Diego. Data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"The Surgeon General recently issued a Call to Action to reduce VTE. At this point public health efforts have focused on inpatient prophylaxis. These new data suggest that to reduce the burden of VTE in cancer patients, prevention efforts will have to shift to the outpatient arena as well," Khorana said.

Doing so would reduce health care costs, the researchers suggested.

Cancer patients need more information on blood clots, they also said.

"Ongoing public health issues that we must address are how to educate patients on the importance of blood clot prevention, and improving compliance to preventive treatment," Khorana said. "Patients should immediately report to their physicians any unusual symptoms such as swelling or redness in limbs, or shortness of breath, even if they are otherwise feeling well."

More information

The U.S. National Cancer Institute provides more information on treatment of cancer.

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655,000 malaria deaths in 2010: WHO

Malaria caused the death of an estimated 655,000 people last year, with 86 percent of victims children aged under five, World Health Organisation figures showed on Tuesday. The figure marked a five percent drop in deaths from 2009.

Africa accounted for 91 percent of deaths and 81 percent of the 216 million cases worldwide in 2010.

In its annual World Malaria Report for 2011, the WHO hailed as a "major achievement" a 26 percent fall in mortality rates since 2000 despite being well short of its 50 percent target.

The UN health agency aims to eradicate malaria deaths altogether by the end of 2015 and reduce the number of cases by 75 percent on 2000 levels.

International funding for the fight against malaria peaked at $2 billion (1.5 billion euros) this year but the WHO estimates $5 billion will be needed each year until 2015 if its targets are to be reached.

The cash has funded an big increase in the number of households with insecticide-treated mosquito nets, particularly in sub-Saharan Africa where 50 percent now have the nets compared with just three percent in 2000.

To finance the fight, the WHO suggested a tax on financial transactions or the rolling out of a tax on airline journeys which it said, if extended to other countries, could generate significant extra funds.

"Other country-specific schemes, such as tourist taxes, may offer opportunities to raise funds for control programmes in malaria endemic countries," the report said.

WHO director general Margaret Chan welcomed the "significant and durable" progress in the fight against malaria but said parasite resistance to drugs was causing concern in parts of South-east Asia.

"Parasite resistance to antimalarial medicines remains a real and ever-present danger to our continued success," said Chan.

"There is an urgent need to develop an Asia-wide framework to ensure sustained and coordinated action against this public health threat."

According to the WHO, malaria is endemic in 106 countries and is currently transmitted in 99 of them.

Of the 99, 43 recorded a fall in reported cases of more than 50 percent between 2000 and 2010.

Six countries account for 60 percent of deaths from Malaria: Nigeria, Democratic Republic of Congo, Burkino Faso, Mozambique, Ivory Coast and Mali.

Europe had an estimated 176 cases of malaria in 2010 with no reported deaths.

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Chewing Khat Raises Heart Disease, Death Risk: Study

TUESDAY, Dec. 13 (HealthDay News) -- Chewing the green leaves of the khat plant for its amphetamine-like effect appears to raise the risk for both stroke and death among heart patients, according to a large new study from the Middle East.

The finding, however, could have relevance far beyond that region, as emigration has increasingly brought khat-chewing to the shores of both Europe and North America.

Consumed by an estimated 10 to 20 million people worldwide, for centuries the naturally grown Catha edulis shrub has been widely available (and most popular) across East Africa and the southern Arabian Peninsula, where some people munch on khat in pursuit of a euphoric or aroused state of mind.

"We need to be careful about the risk of using 'herbs' and 'natural substances,' and khat is an example, although it is leaves, which appear 'harmless'," said study co-author Dr. Jassim Al Suwaidi, senior consultant cardiologist at Hamad General Hospital in Doha, Qatar.

"It has chemical constituents that are similar to harmful drugs," Suwaidi noted, "such as cocaine and amphetamine, and may cause heart attack as well as increase the risk of death and stroke from heart attack."

Suwaidi and his colleagues report their findings in the Dec. 12 issue of Circulation.

The principal active ingredients in khat are cathine and cathinone. According to the U.S. National Institute on Drug Abuse (NIDA), these chemicals are similar in structure to amphetamine and have similar (although weaker) stimulant effects.

The NIDA notes that the euphoria, elation, alertness and arousal from chewing khat typically last anywhere from 1.5 to three hours, but can endure for a full day. Blood pressure and heart rates may rise during that time, followed by the short-term onset of depression, irritability and sleep problems.

Long-term chewing of khat can lead to tooth decay and gastrointestinal problems, in addition to cardiovascular issues such as coronary artery spasm.

Because cathinone is a Schedule I narcotic under U.S. federal law, khat is illegal and as with drugs such as heroin or mescaline, cannot be used for medical or other purposes.

Although banned in Germany, France and the Netherlands, khat is currently legal in the United Kingdom.

Khat is legal and in widespread use throughout Yemen and Ethiopia, and is currently permitted for sale in Israel.

To explore how khat might boost health risks among individuals with a history of heart disease, between 2008 and 2009 the authors focused on roughly 7,400 men and women who were part of the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2) Study.

All were being treated for acute coronary syndrome in one of 65 hospitals across Saudi Arabia, Bahrain, Yemen, Qatar, United Arab Emirates and Oman.

Of these participants, about 20 percent were deemed to be regular khat chewers, almost all (96 percent) from Yemen. They more likely to be older and male (14 percent were women), but less likely to have heart health risk factors than non-Khat chewers.

While still being treated in hospital, khat heart patients had about double the death rate due to cardiovascular illness compared to non-khat heart patients (7.5 percent death rate vs. 3.8 percent).

One month out, the risk spread was even greater: a 15.5 percent death rate among khat users vs. 6.4 percent among non-users. And at one year, the death rate was nearly 19 percent among khat users, compared with just under 11 percent among non-users.

Overall, Suwaidi and associates determined that independent of other contributing factors, khat-using heart patients were more likely to experience arrhythmia, heart failure, heart attack or a stroke than non-khat-using heart patients, in addition to facing a higher risk for death, regardless of gender.

"The ease and rapidity of travel [make khat] available in distant places," Suwaidi said. "And hence it is important to be aware of these practices," he noted, adding that prior research suggests that the elevated risk attributed to khat use among heart patients is very likely to also apply to otherwise healthy patients.

Dr. Kirk Garratt, clinical director of interventional cardiovascular research at Lenox Hill Hospital in New York City, commented on the study.

"We know very well that when you have cardiovascular disease any exposure to any meaningful stimulant would be expected to increase heart risk, by changing the vascular dynamic of the blood vessels that control the blood flow through the brain and heart," he said. "We also know that these drugs can facilitate or trigger irregular heart rhythms, which can be very problematic.

"Cocaine, for example, can have a negative impact on people both with and without heart disease," Garratt added. "And those with heart disease face an especially elevated risk. So these findings are not really surprising."

More information

Visit the U.S. National Institute of Drug abuse for more on khat.

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Pharmacyclics' blood cancer drug responses rise

SAN DIEGO (Reuters) - Interim results from an early stage trial of Pharmacyclics Inc's experimental blood cancer drug show the number of leukemia patients responding to the medicine has increased over time.

At 10 months follow-up, 70 percent of patients treated with the lower dose of the drug, known as PCI-32756, had a significant improvement in their condition. That is up from the 48 percent response rate reported by trial investigators after six months of follow-up.

The trial includes 61 patients with chronic lymphocytic leukemia who have stopped responding to at least two other types of treatment.

In the high-dose group, 44 percent of patients have responded to PCI-32756 after 6.5 months of follow-up.

The findings are "phenomenal," especially for patients who had already been treated with earlier rounds of therapy, said Dr, John Byrd, professor of hematology and oncology at Ohio State University in Columbus, and a lead investigator in the trial.

The updated results are being presented at a meeting of the American Society of Hematology.

PCI-32765 is an oral drug designed to target an enzyme known as Bruton's tyrosine kinase and block the function of cancerous B-cells. The drug is being studied as a treatment for a range of B-cell malignancies.

Side effects seen in the CLL trial included diarrhea, nausea and high lymphocyte counts.

Eighty-two percent of patients remain on treatment, and 8 percent have seen their disease worsen.

Pharmacyclics said earlier this week it had licensed PCI-32765 to Johnson & Johnson for $150 million upfront and as much as $825 million in payments tied to development milestones.

The announcement sent shares of Pharmacyclics down nearly 20 percent as investors theorized that the J&J deal made it less likely Pharmacyclics would be acquired by a larger company, at least in the near term.

(Reporting by Deena Beasley; Editing by Peter Cooney)

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No extra birth defect risk after cancer treatment

NEW YORK (Reuters Health) - Radiation and chemotherapy given to young cancer patients don't seem to increase the risk that their own children will have birth defects years later, according to a new study.

Researchers said the finding was "reassuring" because some doctors have wondered if powerful drugs and radiation -- especially radiation directed near the ovaries or testicles -- might have long-term effects on egg and sperm cells' DNA.

There's already evidence the treatments can affect a growing girl's uterus, for example, in ways that can cause other pregnancy problems.

"We do know that some of the treatments the children receive can really wreak havoc with the reproductive system," said study author Lisa Signorello, from the International Epidemiology Institute in Rockville, Maryland.

"A lot of children are rendered infertile from strong treatments. We know now that depending on the types of treatment they received, they have higher rates of miscarriage (and) higher rates of low birth weight," she told Reuters Health.

"As a cancer survivor, the worries extend to the health of your children in many ways."

For the new study, the researchers followed close to 2,800 childhood cancer survivors in the United States and Canada and gave them regular surveys into adulthood that included questions about pregnancies and births.

Signorello and her colleagues recorded all instances of birth defects in the next generation, and compared the chance of having a baby with a birth defect to the dose of radiation or chemotherapy drugs cancer survivors had received.

Out of 4,700 babies born to survivors at least five years after they finished treatment, 129 -- just under 3 percent -- had at least one birth defect, including cleft lip and palate, Down syndrome and heart and blood vessel defects.

Babies born to parents who were treated with radiation around the testicles and ovaries or chemotherapy drugs had similar rates of birth defects as those born to parents who'd never received radiation or the DNA-altering drugs.

Among babies of women who'd survived childhood cancer, those rates were 3 percent after chemo and radiation compared to 3.5 percent when mothers hadn't had those treatments. They were 1.9 percent and 1.7 percent, respectively, in babies born to fathers who'd had cancer.

And higher doses of chemotherapy drugs or radiation to the areas around the testicles and ovaries -- such as for treatment of kidney cancer -- weren't linked to a greater chance of having a baby with a birth defect than low doses.

About 3 percent of U.S. babies have a birth defect, Signorello and her co-authors wrote Monday in the Journal of Clinical Oncology. Their results from childhood cancer survivors don't include birth defects that were definitively linked to family history, and the study did not have a control group of parents who'd never had cancer.

"These kinds of studies are very important in terms of counseling for children who have cancer and go through these treatments," said Anna Chiarelli, a senior scientist at Cancer Care Ontario in Toronto, who has studied pregnancy outcomes after childhood cancer treatment.

"There has always been that concern, what effect it will have, because of course the child is in a developing phase," she told Reuters Health.

Some 11,000 U.S. kids under age 14 will be diagnosed with cancer this year, representing less than 1 percent of new cancer diagnoses, according to the American Cancer Society.

Though previous studies also haven't found any extra birth defect risk after cancer treatment, Signorello said the size of the current study, and the fact that her team had access to medical records with information on cancer treatment, make the findings more conclusive.

Chiarelli, who wasn't involved in the new research, agreed. "This is a very significant study. I think it has gone further than the other ones," she said.

For childhood cancer survivors treated with chemo and radiation, she added, "If they choose to have children, they should feel reassured that for either (men or women) it seems their risk is no different from children who didn't have those types of therapies."

"I think on the heels of a number of studies that have tried to look at this, I hope (people) see this as a positive message and a reassuring one, and one that doctors can use to provide the best kind of information to their patients," Signorello concluded.

SOURCE: http://bit.ly/gPtMdm Journal of Clinical Oncology, online December 12, 2011.

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Psych Episode Near Childbirth May Presage Bipolar Disorder

FRIDAY, Dec. 9 (HealthDay News) -- New mothers who experience a psychiatric disorder within 30 days after giving birth have an increased risk of developing bipolar disorder, according to a new study.

Researchers examined data from more than 120,000 Danish women born between 1950 and 1991 who had received first-time psychiatric care either as an outpatient or an inpatient for any type of psychiatric disorder other than bipolar disorder. Of those women, 2,870 had first-time psychiatric contact within a year of giving birth to their first child.

During follow-up, more than 3,000 of the 120,000 women were diagnosed with bipolar disorder. Of those, 132 had first-time psychiatric contact within a year after giving birth.

Fifteen years later, bipolar disorder had been diagnosed in nearly 14 percent of women with initial contact within 30 days after giving birth compared with less than 5 percent of women who had initial contact one month to one year after giving birth, and 4 percent of those with initial contact one year or more after giving birth.

Twenty-two years later, bipolar disorder had been diagnosed in 19 percent of women who had initial contact within a month of giving birth, compared with 6.5 percent of those who had initial contact within a month to a year after childbirth, and 5.4 percent of those with initial contact one year or more after giving birth.

The study appears online in the journal Archives of General Psychiatry.

"Childbirth has an important influence on the onset and course of bipolar affective disorder, and studies have shown that episodes of postpartum psychosis are often best considered as presentations of bipolar affective disorder occurring at a time of dramatic psychological and physiological change," the researchers wrote. "It is also clear, however, that a high number of women with the new onset of a psychiatric disorder in the immediate postpartum period do not receive a diagnosis of bipolar disorder."

"The present study confirms the well-established link between childbirth and bipolar affective disorder and specifically adds to this field of research by demonstrating that initial psychiatric contact within the first 30 days postpartum significantly predicted conversion to bipolar affective disorder during the follow-up period," the study authors concluded. "Results indicate that the presentation of mental illness in the early postpartum period is a marker of possible underlying bipolarity."

While the study suggests an association between psychiatric episodes soon after childbirth and bipolar disorder, it does not show cause and effect.

More information

The U.S. National Institute of Mental Health has more about bipolar disorder.

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Hormone imbalances and diseases that cause memory problems

There are times in a woman's life when you can't seem to keep it together. You may lock your keys in the car, leave your purse in a restaurant, or just feel your head is in a fog. You may have times when you draw a blank in conversations. You worry and ask yourself, "Could this be signs of early Alzheimer's?" There are a number of illnesses and hormonal issues that can impair memory. Learn about the many health problems that may be contributing to your memory problems.

Is it dementia? If your memory is slowly getting worse over weeks or months, it would be wise to get a check-up. If you find more and more difficulty with simple things like cooking or dressing yourself, you need a medical evaluation performed. There are tests that can rule out metabolic problems such as thyroid conditions that impact memory. You need to get answers.

Confusion, memory lapses, and focus problems: These are symptoms associated with many illnesses other than dementia. Diseases such as asthma, COPD, or blocked carotid arteries result in less oxygen reaching the brain. Heart disease reduces blood flow which results in less available oxygen. Certain diseases such as kidney or liver failure result in toxin buildup in the bloodstream. Urinary and lung infections also impact available oxygen levels. Any health problem that affects oxygen levels or circulating red blood cells, can impair memory and thinking.

Menopause and hormone imbalance: Women often experience severe memory problems during the years leading up to and during menopause. They begin to feel they are losing it. Hormonal imbalances directly affect mental function. It is important to get help to solve these hormonal problems. It takes specialized tests to diagnose which hormones are out of balance. Estrogen is just one of several hormones that can really cause havoc in your emotions and physical state.

Hypoglycemia: When you're suffering from low blood sugar, you may experience memory or focus problems until you eat some protein.

Thyroid Imbalances: The thyroid gland is one of the most important endocrine glands, affecting every cell and function of the body. Hypothyroidism, myxedema, and hyperthyroidism all affect your physical and mental state. Memory problems can be the result of thyroid and endocrine imbalances. Lab tests can help identify metabolic problems.

Fibrofog: Fibromyalgia is an autoimmune disease affecting thousands of women. One of its most stressful symptoms is fibrofog. Memory, learning, and retention problems are experienced to some degree by all Fibromyalgia patients. Patients feel like they are in a fog. Its severity varies from day to day and with each patient. Doctors are not sure what metabolic problems causes the disturbance.

Stress: Some women work better when stressed and others come unglued. Stress can debilitating at times. Memory problems are only one symptom. If stress is tearing you part, mentally and physically, you need help. You must find a way to deal with your stress in a more positive manner. It may be exercise, music, gardening, meditation, yoga, or sewing but find something that relaxes you. It is much healthier to use one of the activities above to deal with your stress rather than resort to prescription drugs. Counseling is the next step if nothing else works. Prescription drugs should be your last step in your efforts to deal with excessive stress.

Health checkups are important: If you have having memory problems, get a checkup. Most women avoid tests, afraid their memory problems are due to early dementia. Others may just ignore the symptoms. Tests can rule out the many health problems that may be affecting your health and memory. There is less fear when you know what is causing your problems. If it turns out to be dementia, you will receive diagnosis earlier so that you can benefit from therapies that might slow it down.

References:

http://www.cigna.com/individualandfamilies/health-and-well-being/hw/medical-topics/confusion-memory-loss-and-altered-alertness-confu.html

http://www.askdocweb.com/memoryloss.html

http://www.webmd.com/epilepsy/news/20030516/epilepsy-drug-linked-to-memory-problems

http://www.msnbc.msn.com/id/24187064/ns/health-health_care/t/incontinence-drugs-linked-memory-problems/#.TtmhHnpSg-U

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Side Effects Cause Many Older Women to Drop Breast Cancer Drugs

MONDAY, Dec. 12 (HealthDay News) -- Severe side effects may be key to why so many older breast cancer patients stop taking drugs that can help prevent a tumor's return, a new study finds.

The research also revealed a large gap between what these breast cancer patients tell their doctors about drug side effects and what they actually experience, according to the study authors from Northwestern University in Chicago.

Their study included 686 postmenopausal women with estrogen-sensitive breast cancer who were asked about their symptoms before treatment with estrogen-blocking drugs called aromatase inhibitors, which include medications such as Arimidex, Aromasin and Femara. The women were tracked at three, six, 12 and 24 months after starting treatment.

After three months, about one-third of the patients had severe joint pain, 28 to 29 percent had hot flashes, nearly one-quarter had decreased libido, 15 to 24 percent had fatigue, 16 to 17 percent had night sweats and 14 to 17 percent had anxiety, the investigators found.

Other symptoms included weight gain, breast sensitivity, mood swings, and feeling bloated, irritable and nauseous.

The number of women who experienced drug side effects rose the longer treatment continued, the investigators noted.

As a result of the side effects, 36 percent of the patients stopped treatment before an average of just over four years, the researchers said. Of this group, 10 percent had quit after two years and the remainder quit between 25 months and about four years.

Patients most likely to stop taking the drugs before the recommended five years were those who still had residual side effects from recent chemotherapy or radiation therapy when they started taking the aromatase inhibitors.

Those most likely to continue taking the drugs included women who had surgery for breast cancer but not chemotherapy or radiation therapy, and those who weren't taking many other medications, the results indicated.

The study was presented Friday at the San Antonio Breast Cancer Symposium.

"Clinicians consistently underestimate the side effects associated with treatment," lead investigator Lynne Wagner, an associate professor in medical social sciences at Northwestern University Feinberg School of Medicine and a clinical psychologist at Robert H. Lurie Comprehensive Cancer Center of Northwestern University, said in a university news release.

"[Doctors] give patients a drug they hope will help them, so they have a motivation to underrate the negative effects. Patients don't want to be complainers and don't want their doctor to discontinue treatment. So no one knew how bad it really was for patients," she explained.

Wagner said the findings are "a wake-up call to physicians that says if your patient is feeling really beaten up by treatment, the risk of her quitting early is high. We need to be better at managing the symptoms of our patients to improve their quality of life."

Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

More information

The U.S. National Cancer Institute has more about breast cancer.

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Study Questions Use of MRI Before Back-Pain Injections

MONDAY, Dec. 12 (HealthDay News) -- Patients who need steroid injections to ease lower back pain frequently undergo an MRI beforehand. But a new study finds that the expensive imaging tests have little or no clinical value for these patients.

Researchers at Johns Hopkins University School of Medicine found that the MRI does not typically improve results for patients who are candidates for the injection, and it has only a minor effect on doctors' decision-making.

"More is not necessarily better," said study researcher Dr. Steven P. Cohen, an associate professor of anesthesiology and critical care medicine at Hopkins.

The study is published online Dec. 12 in the Archives of Internal Medicine.

Lower back pain is one of the top three reasons people seek medical attention in the United States, and epidural steroid injections are the most common treatment at U.S. pain clinics. The injections deliver cortisone directly into the spinal canal to ease inflammation and pain.

Indiscriminate use of MRIs, which cost about $1,500 each, prior to injection greatly adds to soaring health costs associated with back pain, the authors say.

The American College of Physicians recommends MRIs for injection candidates only when underlying conditions, such as fractures or tumors, are suspected. The American College of Occupational and Environmental Medicine recommends the imaging only when certain persistent neurologic symptoms fail to improve, according to background information in the study.

Trying to assess the value of pre-injection MRI, Cohen evaluated 132 patients -- average age 52 -- treated at one of several pain clinics in the United States for sciatica. This is a painful condition in which the root of the sciatic nerve at the bottom of the spinal column is compressed or pinched.

Patients were assigned to two groups. Both groups got MRIs. In one group, the patients' doctors did not see the MRI results. In the other group, the doctor had the MRI results before deciding on treatment.

Overall, treatment barely differed, and three months later, both groups reported similar improvement in pain and functioning. Thirty-five percent in the group whose doctor didn't know the MRI results reported a positive outcome, compared with 41 percent of those whose doctors saw the MRI.

The reason may be because abnormal findings on the MRI and symptoms don't correlate much, Cohen said. Many middle-aged people who don't have back pain will have abnormal findings on the MRI.

While Cohen advocates against routine use of MRIs, he sees their value in certain cases. They should still be done, he said, when there are risk factors for serious problems. For example, an elderly woman who has fallen and may have a fracture of the vertebrae should have the MRI, he said.

Other research has found that doctors who have a financial interest in the imaging equipment are more likely than others to order the tests. Duke University Medical Center researchers looked at 500 lumbar spine MRI results ordered by two groups of doctors. One group had a financial interest in imaging equipment; the other did not.

They found 86 percent more negative scans -- indicating the test wasn't needed -- in the financial-interest group. They reported the findings at the 2011 Radiological Society of North America meeting.

Dr. Richard Deyo, a professor of family and internal medicine at Oregon Health and Science University in Portland and co-author of a commentary accompanying Cohen's study, said it's important to remember that "only a relatively small fraction of the people who get low back pain" will need the injection.

"It may be premature to suggest we stop doing MRIs for these patients," Deyo said. "Maybe the answer is to be more selective about who needs the injection." Better patient selection might naturally reduce the number of MRIs ordered, he said.

More information

To learn more about epidurals for back pain, visit the U.S. National Institutes of Health.

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Birth Defects Seem Rare in Kids of Childhood Cancer Survivors

MONDAY, Dec. 12 (HealthDay News) -- Children of parents who survived childhood cancer are unlikely to suffer from birth defects, finds a new study that should allay some concerns about long-term effects of treatment.

It appears that DNA damage done by chemotherapy and radiation of the reproductive organs doesn't increase the risk that children will inherit those damaged genes, researchers say.

"We found that DNA damage from radiation and chemotherapy with alkylating agents are not associated with the risk of genetic birth defects in the offspring," said lead researcher Lisa Signorello, an associate professor of medicine at Vanderbilt University in Nashville.

"This is really reassuring," she said. "This is one less thing for childhood cancer survivors to worry about." The prevalence of birth defects among the children of cancer survivors is similar to that of the general population, added Signorello, who's also a senior epidemiologist at the International Epidemiology Institute in Rockville, Md.

While life-saving in many cases, radiotherapy and chemotherapy with alkylating agents, such as busulfan, cyclophosphamide and dacarbazine, can damage DNA.

Signorello noted that childhood cancer survivors have a higher rate of infertility and a greater risk of having miscarriage, preterm birth and low birth-weight infants.

Although cancer treatment can cause DNA damage to the sperm and eggs, "it may be that these damages get filtered out," she said.

Genetic-based birth defects are rare, accounting for about 3 percent of births. Although earlier research found little or no increased risk for birth defects among the children of cancer survivors, the studies were small in size and lacked detailed data about radiation and chemotherapy, such as radiation doses to the testes and ovaries, the researchers noted.

The report was published in the Dec. 12 issue of the Journal of Clinical Oncology.

For the study, Signorello and colleagues collected data on more than 20,000 children who had survived cancer. The data were taken from the 1970 and 1986 Childhood Cancer Survivor Study. Fifty-seven percent of them had been treated for leukemia or lymphoma.

The researchers also looked at the health of nearly 4,700 children of these survivors.

Of the parents treated for cancer, 63 percent had radiation therapy and 44 percent of men and 50 percent of women had chemotherapy.

Among their children, 2.7 percent had at least one birth defect such as Down syndrome, achondroplasia (dwarfism), or cleft lip.

Three percent of the mothers exposed to radiation or treated with alkylating chemotherapy had a child with a genetic birth defect, compared with 3.5 percent of mothers who survived cancer, but weren't exposed to these treatments, the researchers found.

Only 1.9 percent of children of the cancer-surviving fathers had these birth defects, compared with 1.7 percent of children of fathers who did not have chemotherapy or radiation, they said.

"This is very encouraging, because there has been a worry," said Dr. Michael Katz, senior vice president for research and global programs at the March of Dimes.

Dr. Jeanette Falck Winther, a senior researcher at the Institute of Cancer Epidemiology at the Danish Cancer Society in Copenhagen and co-author of an accompanying journal editorial, said the study findings should address some of the reproductive concerns of childhood cancer survivors, geneticists and pediatric oncologists.

"Our hope is that this reassuring information will be used by the physicians in counseling childhood cancer survivors who desire and are able to have children," she said.

More information

For more information on childhood cancer, visit the American Cancer Society.

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Women and depression: Factors that contribute to depression

Depression is a major health problem in today's troubled world. Thousands of women each day struggle to get up, go to work, and take care of themselves and their children. Antidepressant drugs are prescribed by the thousands each day. What is contributing to the climbing rate of depression in this country?

There have been a number of research studies focused on trying to understand the factors responsible for the increased cases of serious depression. One group of researchers studied 92, 539 postmenopausal women from different income, cultural, and religious backgrounds. They published their findings in the Women's Health Initiative. Another research study conducted by Michel Lucas, Harvard School of Public Health, Nurse's Health Study, followed 49.821 women by questionnaires from 1993 until 2000. These women were depression-free when the research project began. These and other research studies point to several factors that increase the risk for women to develop depression.

Women lack support in modern times: in years' past, women supported each other in times of stress and trial. Now women are working so many hours, they have little time to socialize with friends. Often family members add to their stress. People live thousands of miles from loved ones. Our hectic lifestyle has led to the breakdown of social support nets that women used to have. In the old days, women got together to sew quilts or cook. They received support during these activities. It helped them to see through their current troubles. They helped each other get through bad marriages, rough economic times, and death. Most modern women have no support network.

Obesity and poor diet choices: Excessive sugar, empty foods, and junk food adds to metabolic disturbances that contribute to depression and its severity.

Lack of Exercise: Exercise lessens the risk for depression. The longer you exercise, the better it is to prevent or lessen depression. This was so even when taking into account smoking, weight, and certain illnesses.

Insufficient quality sleep: Insomnia and other sleep disturbances contribute to depression. This is a serious problem in pre-menopause and post-menopause health problems.

Sedentary lifestyle habits: Watching more than 21 hours of television per week added a 13% higher risk for depression. Women who watch one hour or less had the least depression. With all the sad economic news, deaths and natural disasters, should that surprise you?

Alcohol, illegal drugs, and prescription drug abuse: The development of depression associated with self-destructive lifestyle habits such as alcohol and prescription drugs are well established. Many drugs directly cause depression or make it worse in some cases.

Hormonal Imbalances: Women's hormones, including estrogen, progesterone, testosterone, and the thyroid, directly affect mood and emotions. When your hormones are out of balance, you may experience depression, sadness, anxiety, and lack of energy.

Endocrine Imbalances: Hypothyroidism is a major endocrine imbalance that affects every function of the body including mental stability. Thyroid hormones affect overall hormonal balance. Depression can be the direct result from low thyroid function. Other endocrine glands too may be underactive.

Fibromyalgia, Lupus, and other autoimmune diseases: Certain diseases with constant chronic pain lead to depression. These diseases affect a woman both mentally and physically. The drugs used to control that chronic pain often make it worse.

Brain Chemistry: In depression, neurotransmitters located in your brain do not communicate normally. Your brain chemistry must be balanced correctly to be mentally healthy. These neurotransmitters, when imbalanced, may cause you to be more agitated, more emotional, more angry or sad.

Genetics: This is a major risk factor in the development of depression. If you have close family members who suffer from depression, you have a greater risk factor for depression.

What does attitude have to do with it? Even with depression in your genetic background, some women never experience debilitating depression. They may be down but they keep fighting. Researchers are not sure why some women get depressed and other women do not, given the same adverse life situations. That answer may involve your attitude toward life and circumstances. It involves the principle of the glass half full versus the glass half empty. Every woman sees trouble in her life but some manage to smile through it. Some women keep a positive attitude despite it all. They know their life will get better with time. You can control how you react to life's troubles. You must choose joy over a negative outlook. This may be one of the hardest changes to make. Even in the middle of trouble, there are blessings and joys. You must learn to focus on those positive blessings. Focusing on others who are in worse circumstances may help you to realize how blessed you really are. Volunteering at a shelter for homeless women is good medicine when you are feeling bad. Helping others has shown to benefit the person helping as well as the one being helped.

Does religious association help? According to the findings from several studies, women that attend church services are happier and deal better with adverse circumstances. They are 27% less likely to suffer from depression. Church groups offer needed support during bad times and good; offers counseling services to its member for free; and have numerous individual groups for activity, fun, and support.

If you are experiencing serious depression, get some help first through counseling before using prescription drugs. There are churches who offer free counseling. There are some county and state programs that offer low-cost counseling services. Research your options first.

References:

http://www.medicalnewstoday.com/articles/237616.php

http://www.medicalnewstoday.com/articles/237541.php

http://www.nimh.nih.gov/health/publications/women-and-depression-discovering-hope/what-causes-depression-in-women.shtml

http://physioage.com/about-hormones/women/159

http://www.nhlbi.nih.gov/about/directorscorner/messages/2009-messages/womens-health-initiative-study-on-depression-ssris-and-cardiovascular-disease/index.html

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Depression, Disability Can Follow ICU Care: Study

FRIDAY, Dec. 9 (HealthDay News) -- Depression and new physical problems are common among patients released from the intensive care unit after treatment for a potentially deadly condition called acute lung injury, a new study finds.

The findings may also apply to ICU patients with other types of disease or injury who get hooked up to breathing machines, according to the researchers.

"When people are discharged from the ICU, we tend, understandably, to focus on their physical health, but our data tell us we need to focus on their mental health, too," study leader Dr. O. Joseph Bienvenu, an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, said in a Hopkins news release.

"Depression can make recovery much more difficult. Identifying depressive symptoms early -- and treating them -- could make a real difference in how patients fare physically in the long term," he added.

The researchers looked at the depression levels and physical abilities of 186 survivors of acute lung injury three, six, 12 and 24 months after they became ill. Physical abilities included whether people could perform basic tasks of daily living such as shopping, preparing food and using the telephone.

Forty percent of the patients developed depressive symptoms during the two years of follow-up, even though they had not previously experienced such symptoms.

In addition, 66 percent of the patients developed new physical impairments during the follow-up period.

The average age of the patients in the study was 49, and they should be in the prime of their lives, the researchers noted. Instead, many had become disabled and unable to return to work.

The researchers will continue to follow these patients to find out if the depression symptoms and physical impairments persist beyond the initial follow-up of two years.

The study was published Dec. 9 in the American Journal of Respiratory and Critical Care Medicine.

More information

The Society of Critical Care Medicine has more about ICU care.

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Type of Muscular Dystrophy Linked to Raised Cancer Risk

TUESDAY, Dec. 13 (HealthDay News) -- People with a certain type of muscular dystrophy have twice the risk of being diagnosed with cancer as the general population, although the actual risk is relatively low, a new study finds.

Myotonic muscular dystrophy (MMD) is characterized by progressive weakness and muscular wasting that can affect many muscles, including those of the face, neck, hands and feet. The condition can range from mild to severe.

The study, published in the Dec. 14 issue of the Journal of the American Medical Association, included 1,658 patients in Denmark and Sweden who were diagnosed with MMD between 1977 and 2008, and followed until they were diagnosed with cancer, died or emigrated.

During follow-up, about 40 percent of the patients died and about 6 percent developed cancer. The number of MMD patients who developed cancer (104) was twice as high as the 52 cases that would be expected in the same number of people in the general population, Dr. Shahinaz Gadalla of the U.S. National Cancer Institute and colleagues explained in a journal news release.

Gadalla and colleagues said their findings indicate that MMD patients are at increased risk for cancer.

"Most notably, we observed significant excesses of endometrial cancer, brain cancer, ovarian cancer and colon cancer. Our data also suggested possible excesses of eye cancer, other female genital organ cancer, thyroid cancer and pancreatic cancer," the researchers wrote.

People with MMD should make sure they are getting recommended cancer screenings, especially for colon cancer, according to the researchers.

The study authors also urged people with MMD not to be overly worried. Though the risk of certain cancers are higher compared to the general population, the chances of getting a specific cancer is still low.

"The incidence rates for a number of the excess cancers are relatively low, despite their large relative risks," the authors concluded.

More information

The Muscular Dystrophy Association has more about myotonic muscular dystrophy.

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