Precancerous Breast Lesions Cause Unnecessary Worry

Many women diagnosed with a precancerous breast lesion known as ductal carcinoma in situ (DCIS) are highly anxious about their prognosis, even though they face a low risk of a recurrence or of developing invasive breast cancer, a new study finds.

"Many of these women are living as if they're waiting for the other shoe to drop," said lead researcher Dr. Ann Partridge, an oncologist at the Dana-Farber Cancer Institute and Brigham & Women's Hospital, in Boston.

Her team published the findings Feb. 12 in the online edition of theJournal of the National Cancer Institute.

The study noted that 28 percent of the participants "believed that they had a moderate or greater chance of DCIS spreading to other places in their bodies, despite the fact that metastatic breast cancer actually occurs following a diagnosis of DCIS less than 1 percent of the time."

DCIS involves abnormal cells in the lining of the breast duct that have not spread outside the duct, according to the National Cancer Institute. In 2006, DCIS accounted for more than 20 percent of all diagnoses linked to breast cancer in the United States -- about 62,000 cases, the study reported.

The increasing percentage of DCIS diagnoses over the last 20 years or more has been attributed to improved detection from the increasing use of screening mammography, experts say.

But all too often, women are unnecessarily frightened by a DCIS diagnosis, said the authors of the study, which involved almost 500 women newly diagnosed with DCIS.

"In the complex treatment decision-making process, it is often possible to lose sight of the fact that DCIS poses limited risks to a woman's overall mortality," the study authors noted.

Nevertheless, approximately 38 percent of those surveyed thought they had at least a moderate risk of getting an invasive cancer over the next five years, and 53 percent reported intrusive or avoidant thoughts about DCIS. That number declined to 31 percent 18 months after diagnosis, the researchers said.

Among the 487 study participants who were newly diagnosed with DCIS, 34 percent had undergone a mastectomy, 50 percent had radiation therapy, and 43 percent reported taking tamoxifen to reduce their chances of breast cancer. The type of treatment or combination varied by surgeon, hospital volume and geographic region, the study explained.

"Although decision-making about treatment is complex, there is little doubt that women will be limited in their ability to participate in informed decision-making if they harbor gross misperceptions about the health risks they face," the study authors said. Researchers found a "strong relationship between distress and inaccurate risk perceptions," they added.

One of the difficulties of such measures of anxiety about DCIS is that the study did not determine what these patients had learned from their physicians or from other sources -- such as the Internet -- about DCIS, and how accurate that information was, said Michael Stefanek, vice president of behavioral research for the American Cancer Society.


Source :http://www.washingtonpost.com

Healthy Lifestyle Is the Secret to Longer Life, Researchers Say

Not smoking, regular exercise, maintaining normal weight, and avoiding diabetes and high blood pressure seem to be the secrets of living to age 90, researchers say.

According to the U.S. Census Bureau, about 5 million Americans are aged 85 and older, a number that will quadruple by 2050. As the population grows older, doctors should encourage older Americans to exercise and lead healthy lifestyles to cut health-care costs.

“Given the rising cost of health care, anything we can do to try and reduce disease and disability in the older years and reduce the cost of medical care is important,” Laurel Yates, a doctor of internal medicine at Harvard’s Brigham and Women’s Hospital in Boston said in her study published Monday in the Archives of Internal Medicine.

The researchers followed 2.357 men who were part of the Physicians’ Health Study. The men were evaluated when they started the study at about age 72 and were surveyed at least once a year for the next two decades. Overall, 970 men survived to age 90 or beyond.

The research found that a healthy 70-year-old, who had never smoked, had normal blood pressure and weight and exercised up to four times a week had a 54 percent chance of living until 90.

Exercising and not smoking “can have great payoff not only in terms of adding years to your life, but making those years be of good function and less disease.”

Sedentary lifestyle reduced the chances of living to age 90 by 44 percent, high blood pressure by 36 percent, obesity by 26 percent and smoking by 22 percent.

Having three of these risk factors significantly reduced the chances of surviving to age 90 to 14 percent and having five risk factors dropped the chance to just 4 percent.

The researchers also found that genes determine about 25 percent of the variation in lifespan. Therefore, 75 percent can be determined by lifestyle.

“Smoking, diabetes, obesity and hypertension each are predicted to reduce life expectancy by one to five years, while higher physical activity may add up to five years,” the study said.

Being in a good shape could add as much as 10 years to a man’s lifespan, the study found.

Yates’ study was completed by a second study belonging to Dellara F. Terry, MD, MPH, of the Boston University School of Medicine and Boston Medical Center and colleagues, who studied 523 women and 216 men aged 97 or older.

Dr. Terry split the participants into two groups based on gender and the age they developed diseases, such as heart disease, diabetes, high blood pressure, dementia, stroke, chronic obstructive pulmonary disease, osteoporosis and Parkinson’s disease. The findings showed that almost one-third of the survivors had developed these illnesses by age 85, but were not disabled by them. The study also reports that men had better mental and physical function than the female centenarians, which the researchers say is consistent with other studies.

“One explanation for this may be that men must be in excellent health and/or functionally independent to achieve such extreme old age. Women on the other hand may be better physically and socially adept at living with chronic and often disabling health conditions,” the authors write.

The studies did not find any connection between moderate alcohol consumption and a longer life.

Source : http://www.efluxmedia.com

Doctors Outraged at Blue Cross Request

Doctors across the country seethed with indignation Tuesday over a request by insurance giant Blue Cross to California physicians to report patients' pre-existing health conditions, possibly causing them to lose insurance coverage.

"This is outrageous," says Dr. Arthur Feldman, chairman of medicine at Jefferson Medical School in Philadelphia. "The 'Blues' are sitting on billions of dollars while most cannot afford health insurance and 46 million have no insurance. This will require congressional action."

"This so simply and succinctly exposes what health care 'insurance' in the United States is: a business," says Dr. Joanna Cain, director of the Center for Women's Health at Oregon Health and Science University in Portland.

"For a business, this makes sense," she says. "For a basic service that more Americans every day are losing access to, that will impact the financial future of the nation with a less healthy population, and that makes us the laughing stock of the developed world for not covering basic medical care for our citizens, it makes no more sense than any of our health care financing schemes."

The doctors' reactions to the proposal by the state's largest for-profit health insurer echoes that of the California Medical Association, which blasted the idea Tuesday morning. Dr. Richard Frankenstein, president of the Association, told The Associated Press that the letter sent by the insurer asks doctors to "violate the sacred trust of patients to rat them out for medical information that patients would expect their doctors to handle with the utmost secrecy and confidentiality."

Cost-Cutting Effort, Company Says

Telephone messages left with the press office of WellPoint Inc., the Indianapolis-based company that operates Blue Cross of California, were not immediately returned. A spokesperson for the company told the Los Angeles Times, who broke the story Tuesday morning, that the request was made in an effort to cut costs for members.

Experiment to treat genital herpes produces no protection

A once-promising experiment to see if treating genital herpes with a common drug could dramatically reduce susceptibility to HIV infection has found no protection whatsoever -- a shocking setback for researchers hoping to find a pill that would slow the spread of the AIDS epidemic.

Results of the long-awaited study, which included gay men in San Francisco, Seattle, New York and Peru, as well as women in Africa, were released here Monday at the 15th annual Retrovirus conference, the premiere annual scientific meeting of AIDS researchers.

Nearly 20 years of various studies on herpes had shown that herpes infection nearly tripled the risk of contracting HIV. The assumption was simple -- use acyclovir, a proven anti-herpes drug, to knock down that infection, and the odds of avoiding HIV would dramatically improve -- by at least 50 percent, on par with the prevention benefit now attributed to male circumcision.

Results of the study were shielded from researchers and subjects alike until the study period was completed, but when statisticians tabulated their data, the answer was certain: Those who took acyclovir to suppress their herpes infections acquired HIV infections at exactly the same rate as those who took a placebo.

"This was a huge setback for HIV prevention," said Dr. Sharon Hillier, a researcher at the Magee-Women's Research Institute at the University of Pittsburgh.

Scientists had a lot of reasons to think that the results of this study could be as exciting as the findings in 2005 and 2006 that adult male circumcision -- the surgical removal of the foreskin -- reduced by as much as 60 percent the risk that those man would contract HIV.

"Many people thought this was going to be a slam dunk," said Dr. Connie Celum, the University of Washington professor who led the study since it was approved in 2004.

"It was definitely disappointing, but it was also very clear," she said of the result.

Now the long and difficult task is to find out why it did not work, and what might be done to come up with different outcome.

The theory that immediately jumped to the top of the list of possibilities is that suppressing herpes was not enough. Although acyclovir is a very effective treatment for herpes simplex 2, it does not eradicate it, and many of those who take it will continue to have occasional flareups of genital ulcers.

Dr. Kevin DeCock, director of the Department of HIV/AIDS at the World Health Organization, said he was disappointed but not entirely surprised by the results of the study. "What we really need," he said, "is a herpes vaccine."
Source :http://www.sfgate.com