Newsletter Issue #3: Full Releases...
Annual Report to the Nation Finds Declines in Cancer Incidence and Death Rates; Special Feature Reveals Wide Variations in Lung Cancer Trends across States
For Immediate Release: November 25, 2008
A new report from the nation’s leading cancer organizations shows that, for the first time since the report was first issued in 1998, both incidence and death rates for all cancers combined are decreasing for both men and women, driven largely by declines in some of the most common types of cancer. The report notes that, although the decreases in overall cancer incidence and death rates are encouraging, large state and regional differences in lung cancer trends among women underscore the need to strengthen many state tobacco control programs. The findings come from the “Annual Report to the Nation on the Status of Cancer, 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use and Tobacco Control”, online Nov. 25, 2008, and appearing in the Dec. 2, 2008, Journal of the National Cancer Institute.
Although cancer death rates have been dropping since the publication of the first Annual Report to the Nation 10 years ago, the latest edition marks the first time the report has documented a simultaneous decline in cancer incidence, the rate at which new cancers are diagnosed, for both men and women. Based on the long-term incidence trend, rates for all cancers combined decreased 0.8 percent per year from 1999 through 2005 for both sexes combined; rates decreased 1.8 percent per year from 2001 through 2005 for men and 0.6 percent per year from 1998 through 2005 for women. The decline in both incidence and death rates for all cancers combined is due in large part to declines in the three most common cancers among men (lung, colon/rectum, and prostate) and the two most common cancers among women (breast and colon/rectum), combined with a leveling off of lung cancer death rates among women.
“The drop in incidence seen in this year’s Annual Report is something we’ve been waiting to see for a long time,” said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society (ACS). “However, we have to be somewhat cautious about how we interpret it, because changes in incidence can be caused not only by reductions in risk factors for cancer, but also by changes in screening practices. Regardless, the continuing drop in mortality is evidence once again of real progress made against cancer, reflecting real gains in prevention, early detection, and treatment.”
The new report shows that, from 1996 through 2005, death rates for all cancers combined decreased for all racial and ethnic populations and for both men and women, except for American Indian/Alaska Native men and women, for whom rates were stable. The drop in death rates has been steeper for men, who have higher rates, than for women. Death rates declined for 10 of the top 15 causes of cancer death among both men and women. However, death rates for certain individual cancers are increasing, including esophageal cancer for men, pancreatic cancer for women, and liver cancer for both men and women. Overall cancer death rates were highest for African-Americans and lowest for Asian American/Pacific Islanders.
Among men, incidence rates dropped for cancers of the lung, colon/rectum, oral cavity, and stomach. Prostate cancer incidence rates decreased by 4.4 percent per year from 2001 through 2005 after increasing by 2.1 percent per year from 1995 to 2001. In contrast, incidence rates increased for cancers of the liver, kidney, and esophagus, as well as for melanoma (2003-2005), non-Hodgkin lymphoma, and myeloma. Incidence rates were stable for cancers of the bladder, pancreas, and brain/nervous system, and for leukemia.
For women, incidence rates dropped for cancers of the breast, colon/rectum, uterus, ovary, cervix, and oral cavity but increased for cancers of the lung, thyroid, pancreas, brain/nervous system, bladder, and kidney, as well as for leukemia, non-Hodgkin lymphoma, and melanoma.
“While we have made progress in reducing the burden of cancer in this country, we must accelerate our efforts, including making a special effort to reach underserved cancer patients in the communities where they live,” said National Cancer Institute (NCI) Director John Niederhuber, M.D. “This report gives us a better understanding of where we may need to redouble our efforts and try to find new ways of preventing or reducing the occurrence of kidney, liver, and other cancers that continue to show increases in both mortality and/or incidence.”
The Special Feature section of the Report highlights wide variations in tobacco smoking patterns across the United States, which, coupled with differences in smoking behaviors in younger versus older populations, helps explains the delay in an expected decrease in lung cancer deaths among women and a slowing of the decrease in lung cancer deaths among men.
The report finds substantial differences in lung cancer death rate trends by state and geographic region. For example, lung cancer death rates dropped an average of 2.8 percent per year among men in California from 1996 through 2005, more than twice the drop seen in many states in the Midwest and the South. The geographic variation is even more extreme among women, for whom lung cancer death rates increased from 1996 through 2005 in 13 states and decreased only in three. The report also notes that, in five states (Pennsylvania, Illinois, Minnesota, Nebraska, and Idaho), lung cancer incidence among women showed an increasing trend, whereas the mortality trend was level.
“It’s very promising to see the progress we are making in our fight against cancer,” said Centers for Disease Control and Prevention (CDC) Director Julie Gerberding, M.D. “Unfortunately, tobacco use continues to plague our country, and it’s the primary reason why lung cancer continues to rob too many people of a long, productive, and healthy life. We must recommit ourselves to implementing tobacco control programs that we know work if we are truly going to impact the staggering toll of tobacco on our society.”
Variation in smoking prevalence among the states is influenced by several factors, including public awareness of the harms of tobacco use, social acceptance of tobacco use, local tobacco control activities, and tobacco industry promotional activities targeted in a geographic area. The 13 states where lung cancer death rates for women are on the rise have higher percentages of adult female smokers, low excise taxes, and local economies that are traditionally dependent on tobacco farming and production. In contrast, California, which was the first state to implement a comprehensive, statewide tobacco control program, was the only state in the country to show declines in both lung cancer incidence and deaths in women.
According to a U.S. Surgeon General’s report, cigarette smoking accounts for approximately 30 percent of all cancer deaths, with lung cancer accounting for 80 percent of the smoking-attributable cancer deaths. Other cancers caused by smoking include cancers of the oral cavity, pharynx, larynx, esophagus, stomach, bladder, pancreas, liver, kidney, and uterine cervix and myeloid leukemia.
"We can see that, in areas of the country where smoking and tobacco use are entrenched in daily life, men and women continue to pay a price with higher incidence and death rates from many types of cancer. This type of geographic variation in smoking-related cancers is due to smoking behaviors, not regional environmental factors," said Betsy A. Kohler, M.P.H., executive director of the North American Association of Central Cancer Registries (NAACCR).
“The observed decrease in the incidence and death rates from all cancers combined in men and women overall and in nearly all racial and ethnic groups is highly encouraging,” conclude the authors. “However, this must be seen as a starting point rather than a destination.” They say a dual effort, combining better application of existing knowledge with ongoing research to improve prevention, early detection, and treatment will be needed to sustain and extend this progress into the future.
The study was conducted by scientists at the ACS, CDC, NCI, which is part of the National Institutes of Health, and the NAACCR.
Jemal A, Thun MJ, Ries LAG, Howe HL,Weir HK, Center MM, Ward E, Wu X, Eheman C, Anderson R, Ajani U, Kohler B, Edwards BK. Annual Report to the Nation on the Status of Cancer, 1975-2005, Featuring Trends in Lung Cancer, Tobacco Use and Tobacco Control. Journal of the National Cancer Institute; Published online Nov. 25, 2008; Print issue Dec. 2, 2008. Vol. 100, No. 23.
To view the full report, go to: http://jnci.oxfordjournals.org/.
For a Q&A on this Report, go to http://cancer.gov/newscenter/pressreleases/ReportNation2008QandA.
For Spanish translations of this press release and Q&A, go to http://cancer.gov/espanol/noticias/ReportNation2008SpanishRelease.
ACS: http://www.cancer.org/.
CDC’s Division of Cancer Prevention and Control: http://www.cdc.gov/cancer.
NAACCR: http://www.naaccr.org/ .
Undiagnosed Sleep Problems May Lead To Long Term Health Issues
For Immediate Release: December 10, 2008
Sixteen percent of Georgia’s residents experience persistent problems staying awake during the day, according to a study by the Centers for Disease Control and Prevention (CDC) and published online today in the American Journal of Epidemiology.This research points to the importance of diagnosing and treating sleep problems before they could potentially develop into long term health issues.
However, only 10 percent of the people in the study reported having been diagnosed with a sleep disorder.
The study also found that in addition to problems staying awake:
1. 35 percent of Georgians wake up in the morning feeling unrefreshed,
2. 33 percent report that they snore,
3. 31 percent cannot sleep through the night, and
4. 25 percent complain that they have problems falling asleep.
“Excessive daytime sleepiness can be an indication of an undiagnosed sleep-related disorder,” says study author Michael Decker of CDC’s Chronic Viral Diseases Branch. “Insufficient sleep and sleep disorders are associated with chronic diseases including diabetes, high blood pressure, stroke and obesity. Sleep-related issues also can be primary symptoms of mental illness such as depression. But sleep-related issues also can be symptoms of other problems.”
Because the study reflects Georgians in urban and rural areas, there is a probability that the findings can be generalized to the rest of the United States, but further studies would be needed to confirm this, Decker said.
This study analyzed 2005 data from the Georgia Study of Chronic Fatigue Syndrome, in which 6,530 randomly selected adults were interviewed. According to William Reeves, chief of the Chronic Viral Diseases Branch, prevalence of daytime sleepiness and sleep-related complaints were similar among metropolitan, urban, and rural Georgians.
Diagnosis of sleep-related issues is important. People who don’t get enough sleep, or have poor quality sleep, can present a hazard on the roads and in their jobs. Their sleep-related problems may also be associated with a reduced quality of life.
“Our findings highlight the need to educate the public about the symptoms of sleep disorders and to prompt them to seek appropriate care. We must also educate health care providers to recognize symptoms of sleep disorders when they are reported, and to act upon them,” says Decker.
CDC has created the Web site www.cdc.gov/sleep to provide information about sleep and sleep disorders. To access this article, please link to http://aje.oxfordjournals.org/cgi/content/full/kwn365.
For information about the American Journal of Epidemiology, please link to aje.oxfordjournals.org/. The study citation is DOI: 10.1093/aje/kwn365.
Measles Initiative to Announce Major Achievement in Public Health
GLOBAL MEASLES DEATHS DROP WORLDWIDE
GLOBAL MEASLES DEATHS DROP WORLDWIDE
For Immediate Release: December 3, 2008
The Measles Initiative partners – led by the American Red Cross, U.S. Centers for Disease Control and Prevention, the United Nations Foundation, UNICEF and the World Health Organization – will announce the latest achievement in global health during a press teleconference on Thursday, December 4, 2008 at 10:00 a.m. EST, 4:00pm CET.
Speakers will present new data about the remarkable reduction in measles deaths globally since 2000. Partners will also discuss progress toward the United Nations goal for measles mortality reduction, how this progress has been achieved, and remaining challenges for reducing measles deaths globally.
What:
A press teleconference to announce new progress in reducing measles deaths around the world. There will be time for questions and answers with each of the speakers.
Who:
Dr. Hussein Abdel-Razzak Al Gezairy, Regional Director, Eastern Mediterranean Region, World Health OrganizationAnn M. Veneman, Executive Director, UNICEFDr. Julie L. Gerberding, Director, Centers for Disease Control and PreventionBonnie McElveen-Hunter, Chairman of the Board, American Red CrossKathy Calvin, Executive Vice President and Chief Operating Officer, United Nations Foundation.
When
Thursday, December 4, 200810:00 a.m. EST/ 4:00p.m. CET
MEDIA CALL IN INFORMATION:
U.S.: 1.866.814.1918Int’l Dial-In: +1.703.639.1362Passcode: Measles Initiative callHost: Christy FeigCompany: American Red Cross
To pre-register for the call, please contact Christy Feig at feigc@usa.redcross.org or (202) 303-5074.
The Measles Initiative is a partnership committed to reducing measles deaths globally. Launched in 2001, the Initiative— led by the American Red Cross, the U.S. Centers for Disease Control and Prevention, the United Nations Foundation, UNICEF and the World Health Organization—provides technical and financial support to governments and communities on vaccination campaigns. To learn more, visit http://www.measlesinitiative.org/.
National Birth Defects Prevention Study Shows Assisted Reproductive Technology is Associated with an Increased Risk of Certain Birth Defects
For Immediate Release: November 17, 2008
Infants conceived with Assisted Reproductive Technology (ART) are two to four times more likely to have certain types of birth defects than children conceived naturally, according to a study by the CDC. The report, “Assisted Reproductive Technology and Major Structural Birth Defects, United States,” was released in the journal Human Reproduction.
“Today, more than 1 percent of infants are conceived through ART and this number may continue to increase,” says Jennita Reefhuis, Ph.D., epidemiologist at CDC′s National Center on Birth Defects and Developmental Disabilities. “While the risk is low, it is still important for parents who are considering using ART to think about all of the potential risks and benefits of this technology.”
The study shows that among pregnancies resulting in a single birth, ART (which includes all fertility treatments in which both eggs and sperm are handled, such as in vitro fertilization) was associated with twice the risk of some types of heart defects, more than twice the risk of cleft lip with or without cleft palate and over four times the risk of certain gastrointestinal defects compared with babies conceived without fertility treatments. Despite these findings, the absolute risk of any individual birth defect remains low. In the United States, cleft lip with or without palate affects approximately 1 in every 950 births; doubling the risk among infants conceived by ART would result in approximately 1 in every 425 infants being affected by cleft lip with or without palate.
The study examined multiple births separately from single births because ART increases the chance of a multiple birth. Children born as part of a multiple birth are more likely to have a birth defect regardless of use of ART. The study showed use of ART did not significantly increase the risk of birth defects among multiple births.
However, ART might contribute to the risk of major birth defects by directly increasing the risk of defects among single births. It may also have an indirect impact because ART increases the likelihood of having twins, which is a risk factor for many types of birth defects. Researchers believe this suggests the need for further studies to determine risk for ART in pregnancies with multiple births.
The study examined data from 281 births conceived with ART and 14,095 conceived without infertility treatments. The National Birth Defects Prevention Study is a population-based study that currently incorporates data from birth defects research centers in Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, New York, North Carolina, Texas and Utah. These ten centers have been working on the largest study of birth defects causes ever undertaken in the United States. Information is gathered from more than 30,000 participants to look at key questions on potential causes of birth defects. While the causes of most birth defects are unknown, studies show that smoking, alcohol, and obesity increase a mother's risk of having a child with a birth defect.
Since 1981, ART has been used in the United States to help women become pregnant. It is defined as any procedure that involves surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. ART does not include treatments in which only sperm are handled (i.e., intrauterine—or artificial—insemination) or procedures in which a woman takes medicine only to stimulate egg production without the intention of having eggs retrieved.
The number of infants born after ART doubled in the United States from 1996 through 2004. According to data from the 2002 National Survey of Family Growth, almost 12 percent of U.S. women aged 15-44 years have reported using infertility services. In 2005, more than 134,000 ART procedures were performed and approximately 52,000 infants were born as a result of these procedures.
For more information about birth defects please call toll free 1-800-CDC-INFO (232-4636) or visit http://www.cdc.gov/ncbddd/bd/facts.htm.
New Army technology could save soldiers' lives
Story Highlights
Cutting-edge technology on display at U.S. Army Science Convention
Some of greatest minds in science gathered at four-day conference in Florida
Regenerative-medicine research could help injured soldiers regrow tissue and bone
Remotely controlled robots could help remove wounded from combat zones
ORLANDO, Florida (CNN) -- Regrowing a fingertip cut off in an accident sounds like something from a futuristic movie. But with innovative technology developed by the U.S. Army, such regrowth is possible today.
This research project and a hundred others were on display this month at the 26th Army Science Convention. Some the greatest minds in science from around the world gathered at the four-day conference to exchange ideas and showcase collaborative projects between the Army's research laboratories, universities and partner industries.
The main goal is to develop technology to make soldiers safer and more effective, said Thomas H. Killion, the Army's chief scientist.
The Army's regenerative medicine study combined properties from the intestinal lining and the urinary bladder to create a regenerative substance called Extracellular Matrix.
The cream-colored crystallized powder, called "magic dust," boosts the body's natural tendency to repair itself, said U.S. Army Biological Scientist Sgt. Glen Rossman. When the matrix is applied to a missing digit or limb, "the body thinks it's back in the womb," Rossman said.
One civilian participated in the regenerative-medicine study after cutting off the tip of his finger in a model plane's propeller. Researchers continually applied the matrix to the wound, and after four weeks, the body grew skin and tissue to replenish the damaged area.
The U.S. military branches have begun a consortium with private institutions to develop treatments for severely injured troops. With the help of grants, the Armed Forces Institute of Regenerative Medicine is studying nerve and vein transplantation, treating burns without scarring and regeneration of tissue, skin and even bone.
Through both animal studies and civilian clinical trials, the institute is developing therapies for the large number of soldiers injured by improvised explosive devices and other explosives in Afghanistan and Iraq.
"We are working on trying to regenerate limbs, to repair limbs and to keep them from being amputated," institute Project Director Col. Bob Vandre said.
Army scientists also have developed an engineered skin substitute made in a laboratory from patients' own cells. A postage stamp-sized patch of skin could grow several times larger than the original sample. The engineered skin could then be placed over a wound or burn, protecting it from infection, and eventually cover large portions of the body that have been damaged.
"Our goal is to restore the function to our wounded warriors who have given so much in battle," Vandre said.
Armed Forces Institute scientists also say they also have developed a process to rebuild missing or damaged bone. A web-like tube of calcium-phosphate ceramic, called hydroxyapatite, acts as a biodegradable scaffold that is set in place of the missing bone, giving the body a platform on which to rebuild.
Scientists say the scaffold allows the body to regrow its own natural tissue, bone and veins so it can support itself. Because of the complexity of the process, researchers so far have regrown only 3 centimeters of bone in clinical trials on rats, but they hope to reach 5 centimeters in two years. With the regrown bone, scientists could avoid placing titanium or other medical devices in the body.
Of course, to apply this technology, the Army needs a way to safely remove injured soldiers from combat zones. Enter the Battlefield Extraction Assist Robot, or BEAR, a human-shaped machine with eyes, ears and arms for lifting heavy objects.
Built by Vecna Technologies in association with the Army, BEAR is still a prototype. But its potential is promising. BEAR is outfitted with lights, two cameras and infrared abilities, and it can travel up to 10 mph. The device also can lift 250 pounds while balancing on its toes.
Vecna robotic engineer Andrew Allen says BEAR can be remotely operated, reducing the chance of injuries to soldiers' human rescuers.
"BEAR can easily be replaced; it costs money and not lives," Allen said.
Robot technology has exploded in the past six years, said Army scientist John Parmentola. Robot prototypes of all kinds were on display at the conference, and about 10,000 military robots are expected to be deployed in the field in 2009.
Robots can be outfitted to accomplish various tasks. One can detect 38 different chemical or biological explosives from a distance of 3 to 5 meters. The robot could be used to scan car doors or truck lids for explosives or chemical residue.
Another, called Packbot, is deployed in Iraq for surveillance, reconnaissance and explosives removal. Packbot has been outfitted to react to voice commands, given remotely through an earpiece. Loud background noises do not distort the commands, because the system monitors the vibrations of the operator's jawbone.
Finally, some robots come with a retractable apparatus called a Zipper Mast or Situational Awareness Mast, which can be equipped with a camera or antenna and raised to peer over walls or send radio communications.
The smallest Zipper Mast is not much bigger than a coffee pot and can extend to a height of 8 feet. Designed by the U.S. Army's Tank Automotive Research, Development and Engineering Center, the larger mast is affixed to tanks and can reach heights over 30 feet.
Scientists Able To Create Nerve Disease In Lab For Research
December 22, 2008
Washington (dbTechno) - Scientists have come out and announced that they have managed to create a potentially-fatal nerve disease in the lab in order to do research on its development.
The nerve disease is known as SMA or spinal muscular atrophy, and can be devastating for people.
The nerve disease is known as SMA or spinal muscular atrophy, and can be devastating for people.
It is a genetic disorder that can greatly impact muscle functions, killing motor neurons.
Scientists from the University of Wisconsin-Madison and University if Missouri-Columbia have managed to use skin cells from a child with the disease in order to re-create it in a lab.
By using this new human model, the hope is that they will be able to watch the disease develop, and figure out new ways to possibly treat it.
They carried out this re-creation of the disease using technology known as induced pluripotent stem cells of iPS cells.
They were able to grow the disease by turning the cells into stem cells.
These new iPS cells are going to be able to grow and will be studied closely to try and learn more on the disease.
The new research has been reported on in the journal Nature. .
Eating Strategies for Healthier Holiday Parties
Sunday, December 21, 2008; 12:00 AM
SUNDAY, Dec. 21 (HealthDay News) -- Rather than worry about gaining or losing weight during the holidays, focus on simply keeping steady on the scales by following some simple healthy eating strategies, one dietitian says.
"Trying to diet during the holidays is setting yourself up for failure and personal torture," Jennifer Ventrelle, clinical nutritionist and registered dietitian at Rush University Medical Center, said in a news release issued by the Chicago facility. "Set an achievable goal: to maintain your weight through the holiday season."
Since eating plays such a big role in the holiday fun, Ventrelle said to never go to a party hungry. Instead, eat a healthy snack -- such as yogurt or fruit, an apple and peanut butter, or a bowl of high-fiber cereal -- before the event to avoid gorging at the party.
Eating small, lower-calorie meals during the day can also offset the calorie load of a dinner party. When at the party, eat slowly and use a small plate. "Take a small first helping. That way, if your host expects you to take seconds, the total will be one normal-size dinner," she said.
Keeping portions small, she said, also allows you to eat your favorite foods without overloading, as sometimes, one taste can help satisfy a craving.
If you are the party host or are supposed to bring a dish, keep it healthy. Serve or bring fresh fruit and vegetables when possible, Ventrelle said. If you are the host, give away the leftovers to remove your temptation.
Don't socialize in the kitchen or next to the buffet table where you might be tempted to nibble. Move around both during, before and after the event, she said.
"A decrease in physical activity is a prime contributor to holiday weight gain," Ventrelle said. "Without exercise, you burn fewer calories, and you're also likely to eat more."
More information
The U.S. Department of Agriculture has more about healthy eating.
SOURCE: Rush University, news release, Nov. 14, 2008
Got the flu? CDC says Tamiflu may not be much help
By MIKE STOBBE
The Associated Press Friday, December 19, 2008; 5:56 PM
ATLANTA -- The medical arsenal against the flu just got weaker. Government health officials said Friday that a leading flu medicine, Tamiflu, might not work against all cases of the flu this year. The most common flu bug right now is overwhelmingly resistant to Tamiflu, they said. The alert is "an early heads-up" for doctors. If current trends continue, they may need to change how they treat patients this flu season, said Dr. Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention.
Health officials say they aren't too worried, for several reasons. First, it's early in the flu season, and it's not clear this strain will dominate through the next several months. Second, not many people take antiviral medications for the flu.
Third, the flu vaccine _ the primary weapon against flu _ seems well matched against the circulating bugs.
But doctors need to take it seriously, said William Schaffner, a Vanderbilt University infectious diseases expert.
"Each influenza seasons provides a bit of a surprise and we got our (surprise) a little early this year," he added.
The flu causes 200,000 hospitalizations and 36,000 deaths annually, according to official estimates. The elderly, young children and people with chronic illnesses are considered at greatest risk.
For the public, the best course of action is vaccination, health officials said. Only about 30 percent of U.S. adults had gotten a flu vaccination this flu season, according to an online survey conducted by the RAND Corporation in November. A flu shot is recommended for those 50 and older, children from 6 months to 18 years, pregnant women, nursing home patients and those with certain medical conditions or who care for people with those conditions.
For people who get the flu, the two most commonly used antivirals are Tamiflu, a pill also known as oseltamivir, and Relenza, an inhaled drug also called zanamivir. The drugs are most effective if taken within two days of getting sick but most people don't see a doctor that quickly.
Early tests indicate that 49 of 50 samples of the main flu virus circulating this year _ H1N1 _ were resistant to Tamiflu. The samples came mainly from Hawaii, Texas and ten other states. Widespread flu has not yet been reported in most of the country.
"It could fizzle out," or H1N1 could become the dominant strain, Gerberding said.
A spokesman for Tamiflu's manufacturer _ Roche, a Swiss company _ said it's too early to draw strong conclusions about the drug's usefulness this flu season. The basis of the CDC's alert "is a small sample in a limited number of states, and Tamiflu is showing good activity against other circulating viruses," said spokesman Terry Hurley.
For those sick with the flu, doctors cannot simply choose Relenza instead of Tamiflu. That treatment is not approved for children younger than 7 or people who have asthma or certain other breathing problems. GlaxoSmithKline PLC, which makes Relenza, said Friday it has enough to meet the demands of the current flu season.
An option for some patients, Gerberding said, may be a combination of Tamiflu and rimantadine, another antiviral medication that works against H1N1 but lost effectiveness against another kind of flu virus.
However, it's not clear how well that combination will work, Schaffner said.
"This is a 'best advice with our back against the wall' kind of thing," he said.
___
On the Net:
The CDC flu report:http://www.cdc.gov/flu/weekly/
New insight into effectiveness of colonoscopy
A study suggests the test reduces risk of death 60% to 70% instead of up to 90% and finds that it's better at detecting cancer on the left side of the colon.
By Karen Ravn December 22, 2008
Don't be overconfident of that recent colonoscopy's clean bill of health.That's the lesson of a new study suggesting that colonoscopies reduce the risk of dying from colorectal cancer not by up to 90%, as believed, but by perhaps 60% to 70%. Further, they're much better at finding problems in one side of the colon than the other.
"Colonoscopy seems to prevent two-thirds of deaths on the left side," says Dr. Nancy Baxter, a colorectal surgeon and researcher at St. Michael's Hospital in Ontario, Canada, and lead author of the study. "But there's not much effect at all on the right."She led a team of researchers who reviewed public health records in Ontario to identify more than 10,000 people, or "case patients," ages 52 to 90. All had been diagnosed with colorectal cancer between January 1996 and December 2001, and all had died of the cancer by December 2003.For each case patient, the researchers selected five controls who matched for age, sex, socioeconomic status and residence location but differed in that they were still alive at the time of the case patient's death.
The researchers then compared the percentage in each group that had received a colonoscopy between January 1992 and the date six months before the case patient was diagnosed with colorectal cancer. Essentially, they were looking at a window of at least several years in which case patients and controls might have had colonoscopies. And they tried to maximize the chances that a case patient's colonoscopy was done for simple screening purposes.
The study, published online last week in the journal Annals of Internal Medicine, confirmed that controls were more likely to have had a colonoscopy than were case patients. That is, having a colonoscopy was associated with fewer deaths. But the advantage of a colonoscopy was restricted to patients with cancer on the left side of their colon.Experts suggest several explanations for the left- versus right-side difference. For one thing, it's harder to examine the right side of the colon.In a colonoscopy, the doctor inserts a scope at the lower left of the inverted-U-shaped colon, then moves it up, across and down to the lower right.
The process is a bit like maneuvering a very narrow, floppy garden hose through a long tunnel, says Dr. Jacques Van Dam, professor of medicine and director of endoscopy at the Stanford University Medical Center.The actual exam is performed as the doctor withdraws the scope and looks for polyps. A variety of tiny tools -- loops, snares, jaws with teeth -- can be passed through the scope and used to take out any growths the doctor finds.On average, a colon is about a yard long, with several curves and sharp turns along the way. It takes a good deal of skill and practice not only to reach the end without bumping into the walls (which hurts the patient), but then to withdraw the scope slowly and not miss any polyps.
Physiology also complicates the right-side picture. "The stool is more liquid on the right side," Baxter says. "So it coats the lining and makes polyps harder to see."But the right side of the colon isn't just harder to examine. Cancer on the right side is actually different from cancer on the left side. "They're like two different diseases," says Dr. Heinz Lenz, professor of medicine and preventive medicine at the Keck School of Medicine and Norris Comprehensive Cancer Center at USC.
Polyps on the left are generally mushroom-shaped, projecting out on a stalk, while polyps on the right side are generally flatter, with no stalk. So polyps on the left are easier to see and to remove.Besides, while most colorectal cancers develop from polyps, some develop directly from the lining of the colon. This may happen more often on the right side, Baxter says.In an additional complication, the most characteristic symptom of colorectal cancer -- blood in the stool -- doesn't occur with cancer in the right side, where symptoms may just be abdominal discomfort or pain, Lenz says.
For patients with these complaints, doctors are less likely to recommend a colonoscopy.Right-side detection can probably be improved by improving colonoscopy technique and pre-colonoscopy preparation. But because of the differences between left- and right-side cancers, it may be very hard, even impossible, to get right-side detection up to left-side standards.
The Canadian study was limited to some extent by its design and its data. It was not a randomized, controlled trial, so it couldn't prove that colonoscopy causes a reduction in cancer deaths. Also, the researchers didn't have enough information to know for sure whether colonoscopies were for screening or diagnostic purposes. Because they're performed when doctors already suspect disease, diagnostic colonoscopies are more likely to be followed by death than screening ones, which are performed on apparently healthy people.
The quality of colonoscopies keeps improving, Baxter says, so current colonoscopies may well be more accurate than the ones in the study, which were mostly done in the 1990s.In any case, colonoscopy is a highly effective weapon against colorectal cancer -- the third most common cancer in the United States, and the second most deadly, after lung cancer."A 60% to 70% mortality reduction . . . should not be considered disappointing," Dr. David Ransohoff, a professor of medicine at the University of North Carolina, wrote in an editorial with the study.
By comparison, mammograms are only associated with a 25% reduction in deaths from breast cancer, and PSA testing has not been shown to reduce deaths from prostate cancer."It would be dangerous if the study led doctors to recommend fewer colonoscopies," Lenz says.mailto:says.health@latimes.com
