Quick to light up despite the potential risks? Take note: there may be a way to rapidly predict your chances of developing lung cancer and provide yet more incentive to kick the habit. Researchers have discovered that smokers who excrete high levels of two tobacco metabolites (chemicals produced when the body breaks down tobacco) in their urine are up to 8.5 times more likely than those who excrete low levels to develop lung cancer.

Similar posts: endometrial cancer

Risk Factors and Causes of Breast Cancer
Research is ongoing to identify the exact causes of breast cancer. Researchers have, however, identified several breast cancer risk factors. A risk factor is something that increases the chance that a person will develop a disease. It is not a guarantee and does not predict a future diagnosis. Risk factors for breast cancer include:
Age: As we grow older, our risk of developing breast cancer increases. It is estimated that 80% of women diagnosed with breast cancer are 50 or older. This doesn't mean that younger women aren't at risk. Young women are diagnosed with breast cancer, just much less frequently.
Family and Personal History of Breast Cancer. Having a mother, sister, or daughter with breast cancer doubles your risk of the disease. While family history can play a role in breast cancer development, women shouldn't subscribe to the popular belief that women without a family history of breast cancer aren't at risk. The American Cancer Society estimates that 70 to 80% of women with breast cancer do not have a family history that includes breast cancer.
Women who have previously been diagnosed and treated for breast cancer are at a greater risk of developing breast cancer again.
Race. Of all women, Caucasian women are diagnosed more frequently than women of other races. Though Caucasian women are the most at risk, it is African American women who die of the disease the most. Asian, Native American, and Hispanic women have less of a risk.
Alcohol Consumption. Women who drink alcohol increase their breast cancer risk and the risk is heightened with the amount of alcohol consumed. Women who drink 2-5 drinks a day increase their risk by 1 1/2 when compared to women who do not drink alcohol. One drink a day only slightly elevates a woman's risk.
Alcohol and Your Breast Cancer Risk: Lifestyle Factors You Can Change
Family Planning Choices. Women who choose not to have children or have them after age 30 somewhat increase their risk of breast cancer.
How Pregnancy Decreases Risk of Breast Cancer
Genetics Genetics may play a role in up to 10% of women diagnosed with breast cancer. Hereditary breast cancer occurs when a mutated gene has been passed down from a parent. The most common genetic mutation is that of the
CA gene pair, referred to as "
CA1" and "
CA2". These genes are responsible for regulating cell growth and repairing damaged DNA, but do not properly function if mutated. Those who are found through genetic testing to be carriers of mutated
CA genes are at an increased risk of developing breast cancer. Other gene types have been associated to breast cancer, but not as prevalently as the
CA genes.
Should You Have the Breast Cancer Gene Test?
Breast Cancer Genetic Testing: What to Do with the Results
Young Women, Family History, and Breast Cancer
There are several other breast cancer risk factors, such as use of hormone replacement therapy, obesity, and oral contraceptive use.
Symptoms of Breast Cancer
A worrisome breast lump is usually what provokes a woman to see a doctor, but there are several other symptoms that can be caused by breast cancer. Breast cancer symptoms can include:
o a breast that feels warm to the touch
o nipple that becomes inverted that was not inverted before
o skin on or around breast is dimpled or has an appearance similar to an orange peel
o skin on breast that is red or blotchy
o sudden increase in breast size that is not related to menstrual cycle
o nipple discharge (clear or bloody)
o nipple pain or scaly nipples
o persistent breast pain or tenderness that is unrelated to menstrual cycle
o swelling of the lymph nodes of the armpit
o a breast lump, swelling, or mass
These are symptoms of breast cancer that can be seen or touched, but there are instances in early breast cancer where there are no symptoms that can be detected by physical examination. Imaging tests like mammograms and MRI can detect breast abnormalities that cannot be seen by the eye or by the touch.
o What You Need to Know About Breast Cancer Symptoms
o Signs and Symptoms of Inflammatory Breast Cancer
o Harmful and Harmless Breast Lumps - Know the Difference
Diagnosis of Breast Cancer
Regular breast cancer screening can reveal breast abnormalities that require additional testing. Some women detect breast abnormalities through breast-self exams at home or through a clinical breast exam by their doctor. Most breast abnormalities are found through mammography. Only 10% of symptoms are initially found through physical exam. The remaining 90% are detected through a mammogram, proving just how vital it is to have a regular mammogram. The American Cancer Society recommends that women begin having an annual mammogram beginning at age 40. Women who are at higher risk of developing breast cancer may be recommended to begin screening earlier.
o Having a Mammogram
o Video: What to Expect During a Mammogram
o Understanding Your Mammogram Report
If you are experiencing breast cancer symptoms or a screening mammogram reveals an abnormality, then further testing is done to determine if breast cancer is present and what stage the disease is in. Further testing methods used to diagnose breast cancer include:
o diagnostic mammogram
o breast MRI
o breast ultrasound
o ductogram
o ductal lavage
When imaging tests reveal an abnormality, a breast biopsy may then be done. A biopsy involves the doctor removing a small amount of breast tissue that is then studied under a microscope.
Treatment of Breast Cancer
Surgery. Most women with breast cancer will have surgery to remove cancerous tissue and for diagnostic purposes. Types of surgery used to treat breast cancer include:
lumpectomy
quadrantectomy
mastectomy
Chemotherapy. The organs in our body are made up of cells. Cells divide and multiply as the body needs them. When these cells continue multiplying when the body doesn't need them, the result is a mass or growth, also called a tumor. Chemotherapy drugs work by eliminating these rapidly multiplying renegade cells. There are other healthy cells in the body that multiply just as quickly, like hair follicle cells. Unfortunately, many chemotherapy drugs may not be able to discern the two, attacking healthy cells and causing side effects like hair loss
In breast cancer, chemotherapy is used to treat the cancer and also to prevent it from returning once it has been treated. Women who have been diagnosed with stages II through IV breast cancer are most commonly given chemotherapy, however some women diagnosed with stage I breast cancer may benefit from chemotherapy treatment.
Chemotherapy Side Effects
Hair Loss and Chemotherapy: Can It Be Prevented?
Combating Fatigue During Chemotherapy
Radiation Therapy. Radiation therapy uses certain types high energy beams of radiation to shrink tumors or eliminate cancer cells. Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. Although radiation therapy can damage nearby healthy cells, cancer cells are highly sensitive to radiation and typically die when treated. Healthy cells that are damaged during radiation are resilient and are often able to fully recover.

There are two primary types of radiation therapy: external beam radiation therapy and internal beam radiation, also called brachytherapy. In breast cancer, external beam radiation is much more common than internal beam radiation.
How Radiation is Used to Treat Breast Cancer
Side Effects of Radiation Therapy
How to Manage Skin Side Effects Caused by Radiation Therapy
Targeted Therapy. This type of therapy is less harmful to healthy cells than chemotherapy and targets properties of cancer cells that allow for rapid uncontrolled cell growth. This type of therapy is given in tablet form or in a chemotherapy infusion. Targeted therapy often accompanies chemotherapy in the breast cancer treatment plan. Drugs used for targeted therapy include:
Herceptin
Tykerb
Avastin
Hormonal Therapy. In many cases of breast cancer, the cancer growth is fueled by the hormone estrogen that is produced by the ovaries. Hormonal therapy, also referred as anti-estrogen therapy, deprives estrogen of its ability to stimulate growth in breast cancer cells. Hormonal therapy is given to treat breast cancer and prevent recurrence.
The ovaries are the primary site of estrogen production, so hormonal treatment can include an oopherectomy, the surgical removal of the ovaries. Halting the ovary's production of estrogen through drugs may also be an option. Removal of the the ovaries and therapy to block estrogen production are recommended for pre-menopausal women with estrogen-receptor positive breast cancer or for women who have advanced breast cancer.
Aromatase inhibitors are another form of hormonal therapy used in post-menopausal women who have had estrogen-receptor positive breast cancer. It is given as a follow-up therapy to prevent recurrence.
Women's bodies produce an enzyme called aromatase that allows androgens to convert to a type of estrogen. Aromatase inhibitors suppress the this enzyme, lowering the levels of estrogen in the body. Types of aromatase inhibitor drugs include:
Arimidex
Aromasin
Femara
Selective estrogen receptor modulators (SERM) are another form of hormonal treatment used in women with estrogen receptor positive breast cancer. SERMs work by preventing natural estrogen from sending signals to the estrogen receptor. In simplified terms, SERMs rush to the estrogen receptor and take the place where natural estrogen would like to occupy. Some like to compare it to musical chairs or two jigsaw puzzle pieces. There are three SERMs that are currently prescribed:
Evista
Fareston
Tamoxifen
Breast Cancer Prevention
Unfortunately, there are no true methods of preventing breast cancer, but by avoiding breast cancer risk factors, you can decrease your risk of developing it. Because simply being a woman is a risk for developing breast cancer, women must be proactive in taking care of their breasts by:
doing self breast exams at home, beginning in their 20s
having yearly clinical breast exam by a nurse or doctor in their 20s and 30s
having a annual mammogram, beginning at age 40 (women at a higher risk may begin having mammograms earlier at the recommendation of their doctor)
Women who are classified as being at very high risk for breast cancer may choose more drastic, yet appropriate, means of reducing their risk. Prophylactic oophorectomy (removal of the ovaries) and/or prophylactic mastectomy may be a prevention method for women in this risk category. Although these methods can certainly reduce a woman's risk of developing breast cancer, it is by no means a guarantee.

Similar posts: endometrial cancer

Dysbiosis (also called dysbacteriosis) is the condition of having microbial imbalances on or within the body. Dysbiosis is most prominent in the digestive tract or on the skin, but can also occur on any exposed surface or mucous membrane such as the vagina, lungs, nose, sinuses, ears, nails, or eyes.
In small amounts the microbial colonies found on or in the body are benign or beneficial in most cases. These beneficial and appropriately sized microbial colonies carry out a series of helpful and necessary functions. They also protect the body from the penetration of pathogenic microbes. These beneficial microbial colonies also compete with each other keeping one another in check so no specific microbial colony dominates.
When this balance is disturbed, by such things as repeated and inappropriate antibiotic exposure, these colonies exhibit a decreased ability to check each other's growth. This can lead to an overgrowth of one or more of the disturbed colonies which then may damage some of the other smaller beneficial ones.
This type of situation often instigates a vicious cycle. As more beneficial colonies are damaged, making the imbalance more pronounced, more overgrowth issues occur since the damaged colonies are less able to check the growth of the overgrowing ones. If this goes unchecked long enough, a pervasive and chronic imbalance between colonies will set in, which ultimately minimizes the beneficial nature of these colonies as a whole.
Microbial colonies also excrete many different types of waste byproducts. Using different waste removal mechanisms, under normal circumstances the body effectively manages these byproducts with little or no trouble. Unfortunately though, over-sized and inappropriately large colonies, due to their increased numbers, excrete increased amounts of these byproducts. As the amount of microbial byproducts increases, the higher waste byproducts levels can overburden the body's waste removal mechanisms.
It is the combination of these two negative outcomes that causes many of the negative health symptoms observed when dysbiosis is present.

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The Center for Disease Control and Prevention (CDCP) and the National Institute of Justice interviewed 8,000 men and 8,000 women and determined that an estimated 876,000 rapes occur each year in the United States. The American Medical Association says over 700,000 sexual assaults occur annually, and the National Crime Victimization Survey conducted a survey of victims which put the number at 433,000. Find out what you should do after you or someone you know has been raped. If you or someone you know have been raped, share your tips for surviving and healing after rape.

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According to ABC News, a 21-year-old woman who has two wombs, has given birth to twin girls. Sarah Reinfelder of Michigan recently gave birth to daughters Kayin Joy and Valerie Marie. The odds of successfully giving birth under these conditions is one in five million. Having two uteri is a condition called Mullerian abnormality. Previously, Mrs. Reinfelder had experienced miscarriage of twins, but 10 months ago gave birth to a single baby boy. As you can imagine, both the parents and doctors were worried that this last pregnancy would also result in miscarriage. In most cases of double uteri, the uterine muscles are simply not strong enough to support a double pregnancy. Fortunately, Mrs. Reinfelder successfully delivered her twins seven weeks early. Both of the babies are breathing on their own and expected to progress normally.

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- TUESDAY, March 17 (HealthDay News) One year of medical costs paid by
a companys health insurance for a premature baby could cover the medical
costs of almost a dozen healthy, full-term babies, a new report from the
March of Dimes claims.

Medical costs for healthy, full-term babies during their first year
average $4,551, of which about $3,800 is covered by employer heath
insurance. But for preterm babies, the cost is almost $50,000, with about
$46,000 paid by employer insurance.

The report is really aimed at the business community, Jennifer L.
Howse, the March of Dimes president, said. The purpose of the report is
to underscore the very serious financial consequences of the rising
problem of premature birth in our country.

By highlighting the costs of premature birth, the March of Dimes is
hoping to get businesses to take steps to make sure employees and their
families get good prenatal care, Howse said. Being an employer who
provides employee health insurance, you are a stakeholder in prevention,
she said. Good prevention equals a healthier workforce.

Howse noted that the costs of preterm birth can be substantial and
continue well beyond the first year of life. These can include cerebral
palsy, mental retardation or neurological impairment. The more severe the
disabilities and problems experienced by the newborn, the higher the costs
will be, she said.

In the United States, preterm births cost $26 billion annually,
according to a report from the Institute of Medicine. About 543,000
preterm infants are born each year, a number that has increased more than
36 percent since the 1980s.

Premature birth is a leading cause of newborn death, and infants who do
survive face the risk of lifelong health conditions. In fact, 25 percent
of infants born prematurely will have lifetime problems resulting from
their early birth, Howse said. They will require more in the way of
health care, rehabilitation and special education, she said.

Premature infants also require more time in the hospital, averaging
more than 14 days in their first year of life, compared with a little more
than two days for healthy, full-term infants. In addition, premature
infants average more than 21 outpatient visits, compared with 14 for
full-term infants, according to the report.

Combined, infant and maternity costs for a premature infant average
$64,713, compared with $15,047 for an infant born without complications,
and employer health plans pay more than 90 percent of those costs,
according to the report.

In addition, costs for complicated deliveries were also significantly
higher than for uncomplicated deliveries, whether the infant was premature
or full-term. Maternity care for a complicated delivery costs, on average,
$14,667, the report found, compared with $10,652 for an uncomplicated
delivery.

To help businesses address the problem of premature delivery, the March
of Dimes developed a Web-based pregnancy and newborn health information
program called Healthy Babies, Healthy Business. Howse described
the program as an easy way for employers to deliver accurate, up-to-date
information directly to employees to help reduce the number of premature
deliveries and, at the same time, reduce health-care costs.

The March of Dimes report was compiled by Thomson Reuters, using data
on inpatient and outpatient medical costs, prescription drugs for infants
from birth through the first year and for mothers, including the delivery,
prenatal services in the nine months before and the three months after
delivery. It was to be presented Tuesday to business leaders at a luncheon
in Washington, D.C., sponsored by the March of Dimes and the National
Chamber Foundation, a think-tank affiliated with the U.S. Chamber of
Commerce.

Dr. Maureen Hack, from the Department of Pediatrics at Rainbow Babies
and Childrens Hospital in Cleveland, said that the costs covered in the
report are only a small part of the costs associated with preterm
delivery.

This is only the tip of the iceberg, Hack said. This might be what
it is costing the employers for the first year, but these kids have
continuing health problems and, later on, they have educational
problems.

And prenatal care, Hack noted, might not be enough to prevent preterm
births. s very complex, she said. There are a lot of factors that
contribute to preterm births.

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Autologous endometrial coculture (AEC), a state-of-the art assisted reproduction technique, involves the placement of a patient’s fertilized eggs on a layer of cells, initially extracted from the woman’s own uterine lining. This procedure, which is used in conjunction with the typical IVF cycles, creates a more natural environment for the development of the embryo, thereby enhancing the success rates of pregnancy. Now, a recent study published in the journal, Fertility and Sterility has demonstrated that AEC is beneficial for patients with a history of repeated failures following conventional ART cycles.

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The American Cancer Society recently published this two part series on endometrial (cervical) cancer:

We do not yet know what causes most cases of endometrial cancer. But we do know that certain risk factors are linked to this disease. A risk factor is anything that changes a person's chance of getting a disease such as cancer. Different cancers have different risk factors. For example, being in strong sunlight without protection is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But risk factors don't tell us everything. Someone can have several risk factors and still not get a disease. Also, not having any risk factors doesn't mean that you won't get the disease.

Hormone Levels
A woman's hormone balance plays a part in most endometrial cancers. Many of the risk factors for endometrial cancer affect estrogen levels. Before menopause (change of life), the ovaries are the main source of the two main types of female hormones estrogen and progesterone. The balance between these hormones changes during a woman's menstrual cycle each month. A shift in the balance of these two hormones toward more estrogen increases a woman's risk for getting endometrial cancer.

After change of life, the ovaries stop making these hormones, but a small amount of estrogen is still made in fat tissue. Female hormones can also be taken as birth control pills to prevent pregnancy and as hormone therapy to treat symptoms of menopause.

Estrogen therapy: Using estrogen to treat symptoms of change of life is known as estrogen therapy or menopausal hormone therapy. Estrogen treatment can reduce hot flashes, improve vaginal dryness, and help prevent the weakening of the bones (osteoporosis) that can happen with menopause. But the use of estrogen alone increases a woman's risk of getting endometrial cancer. Studies show that giving progesterone-type drugs along with the estrogens helps lower this risk. But studies also show that giving this combination of the hormones increases a woman's chance of getting breast cancer and blood clots.

It is important to discuss the pros and cons of estrogen therapy with your doctor. If you choose to take it, you should use the lowest dose that is needed for the shortest period of time. You should also have follow-up exams for cancer at least every year. Let your doctor know right away if you have any vaginal bleeding or discharge that isn't normal.

Birth control pills: Using birth control pills lowers the risk of endometrial cancer. The risk is lowest in women who take the pill for a long time. And this protection continues for at least 10 years after a woman stops taking this form of birth control. But you need to look at all of the pros and cons when choosing a birth control method endometrial cancer risk is only one factor to think about. It's a good idea to talk to your doctor about the different methods of birth control to find the one that is best for you.

Total number of menstrual cycles (periods): Having more periods during a woman's lifetime raises her risk of endometrial cancer. Starting periods before age 12 or going through menopause (change of life) late raises the risk. Starting periods early is less a risk factor for women with early change of life. Likewise, late change of life may not lead to a higher risk in women whose periods began later in their teens.

Pregnancy: During pregnancy, the hormonal balance shifts toward more progesterone. So having many pregnancies reduces endometrial cancer risk. Women who have not been pregnant have a higher risk.

Obesity (being very overweight): Most of a woman's estrogen is made by her ovaries, but fat tissue can change some other hormones into estrogens. Having more fat tissue can increase a woman's estrogen levels and, as a result, increase her endometrial cancer risk.

Tamoxifen: Tamoxifen is a drug that is used to treat women with breast cancer. It is also used to reduce the risk in women who are at a high risk of getting breast cancer. The drug acts like estrogen in the uterus. It can cause the uterine lining to grow and increase the risk of endometrial cancer in women who take this drug.

The risk of getting endometrial cancer in women taking tamoxifen is fairly small (about 1 in 500). It must be balanced against the value of this drug in treating breast cancer and reducing the chances of the woman getting cancer in the other breast. This is something women may want to talk about with their doctors. If you decide to take tamoxifen, you should have yearly pelvic exams. You should also be sure to tell your doctor if you have any endometrial cancer symptoms, such as discharge or bleeding that isn't normal.

Read the second part of this American Cancer Society article tomorrow.
As Pat always says, feel good and keep smiling.

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Sudden loss of consciousness due to a brief and temporary reduction of blood supply to the brain. For what to do if someone faints.
A simple faint is one that occurs in an otherwise healthy person. One cause is a sudden increase in activity of the vagus (tenth crania]) nerve, which runs from the brain to the heart and other organs and is one of the main controllers of the hearts action. The vagus overactivity causes the heartbeat to slow down to about half its normal rate, resulting in a sudden fall in blood pressure. The temporary drop in blood supply to the brain causes dizziness and a need to lie down. The person rapidly becomes pale, sweaty and nauseated, and may quickly lose consciousness.
Vagus overactivity may be triggered by the psyche in response to such things as gory, alarming or emotionally disturbing sights; nasty smells; overwhelming fear; or hearing bad news. A simple faint can also result from a fall in blood pressure when blood pools in the skin of people standing still for too long in the sun or an overcrowded, overheated place. Rising abruptly from a sitting, squatting or prone position can also cause fainting, especially in people using certain antidepressants or drugs to reduce their high blood pressure.
As soon as the blood pressure falls in a simple faint, normal controls begin to restore it. These are helped by lying (or falling!) down. The heart rate speeds up to normal, colour returns to the skin, and the episode is over within a few seconds or minutes. Simple fainting is also called vaso-vagal syncope, and is one of the types of shortlived unconsciousness that are commonly called blackouts. About half of us will have a simple faint at least once in our lives.
Sudden loss of consciousness can have more sinister causes, such as severe pain; rapid, severe blood loss; HEART ATTACK; TRANSIENT ISCHAEMIC ATTACK or STROKE. If someone who has fainted does not recover within minutes or has other worrying symptoms and signs, send for medical help. Consult your doctor if you faint frequently or have attacks of dizziness or faintness after starting a new medication.

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Evidence from epidemiological studies supports protective roles in reducing prostate cancer for dietary selenium, vitamin E, lycopene, and soy foods. High plasma levels of Vitamin D may also have a protective effect. Estrogens from fermented soybeans and other plant sources (called phytoestrogens) may also help prevent prostate cancer. The selective estrogen receptor modulator drug toremifene has shown promise in early trials. Two medications which block the conversion of testosterone to dihydrotestosterone, finasteride and dutasteride, have also shown some promise. The use of these medications for primary prevention is still in the testing phase, and they are not widely used for this purpose. The initial problem with these medications is that they may preferentially block the development of lower-grade prostate tumors, leading to a relatively greater chance of higher grade cancers, and negating any overall survival improvement. More recent research found that finasteride did not increase the percentage of higher grade cancers. A 2008 study update found that finasteride reduces the incidence of prostate cancer by 30%. In the original study it turns that that the smaller prostate caused by finasteride means that a doctor is more likely to hit upon cancer nests and more likely to find aggressive-looking cells. Most of the men in the study who had cancer aggressive or not chose to be treated and many had their prostates removed. A pathologist then carefully examined every one of those 500 prostates and compared the kinds of cancers found at surgery to those initially diagnosed at biopsy. Finasteride did not increase the risk of High-Grade prostate cancer.
Green tea may be protective (due to its polyphenol content), although the most comprehensive clinical study indicates that it has no protective effect. A 2006 study of green tea derivatives demonstrated promising prostate cancer prevention in patients at high risk for the disease. Recent research published in the Journal of the National Cancer Institute suggests that taking multivitamins more than seven times a week can increase the risks of contracting the disease. This research was unable to highlight the exact vitamins responsible for this increase (almost double), although they suggest that vitamin A, vitamin E and beta-carotene may lie at its heart. It is advised that those taking multivitamins never exceed the stated daily dose on the label. Scientists recommend a healthy, well balanced diet rich in fiber, and to reduce intake of meat. A 2007 study published in the Journal of the National Cancer Institute found that men eating cauliflower, broccoli, or one of the other cruciferous vegetables, more than once a week were 40% less likely to develop prostate cancer than men who rarely ate those vegetables. The phytochemicals indole-3-carbinol and diindolylmethane, found in cruciferous vegetables, has antiandrogenic and immune modulating properties.

Similar posts: endometrial cancer

AIs produced significantly lower recurrence rates than tamoxifen in both cohorts, Dr. Ingle reported. The proportional reduction was 23% in cohort 1 and 29% in cohort 2. The absolute gains were 2.9% at 5 years and 3.9% at 8 years in cohort 1, and 3.1% at 3 years and 3.5% at 6 years in cohort 2.
In cohort 1, the proportional reductions were similar in the first 2 years and the last 3 years of treatment; there were further reductions beyond 5 years, but these were not significant, Dr. Ingle noted. In cohort 2, there were significantly greater reductions during the first 3 years of treatment than there were beyond the 3 years, he added.
"These findings raise the issue of value for longer AI therapy," he commented
There was no significant difference in breast cancer mortality between the 2 therapies in cohort 1 (there was a 1.1% benefit for AIs at 5 years, and 0.5% at 8 years). There was a significant reduction in breast cancer mortality for the AIs in cohort 2 (0.7% at 3 years and 1.6% at 6 years from treatment divergence), but as Dr. Ingle and several physicians in the audience pointed out, the gains were very small.
The fact that nonbreast cancer mortality and overall mortality were not higher with the AIs in either cohort is reassuring regarding their overall safety.
Dr. Ingle said the fact that nonbreast cancer mortality and overall mortality were not higher with the AIs in either cohort is "reassuring regarding their overall safety."
He also said that any efficacy gain had to be balanced against tolerability in each individual patient.
During the discussion period, a British doctor questioned the cost-effectiveness of using AIs instead of tamoxifen in light of the very small gain in mortality that was seen. Tamoxifen is now available as a generic, so is much cheaper than the branded AIs. In the United States, it's the difference between $5 and $300, Dr. Muss pointed out to Medscape Oncology.
Concerns Over Survival Data
In an interview, Dr. Muss elaborated on some of the concerns surrounding the mortality data, which he said were "not clean."
First, there is CYP2D6, Dr. Muss said, the enzyme that metabolizes tamoxifen to its active form. Between 5% and 10% of white women are deficient in this enzyme and are poor metabolizers of tamoxifen, and there is research to suggest that the drug is not effective in this patient population, as reported by Medscape Oncology.
So, in all the clinical trials, it could be that between 5% and 10% of women taking tamoxifen were not metabolizing it and the drug was ineffective, Dr. Muss said. Conversely, some of the women who were high metabolizers and who were responding to tamoxifen might have come off the drug early because of adverse effects. Both of these effects could introduce bias into the results, he pointed out.
There is the question of patient compliance with the 2 different approaches, Dr. Muss continued. He pointed at that in another presentation at the same session, results from the Tamoxifen Exemestane Adjuvant Multinational (TEAM) study reported noncompliance in 29% of women taking tamoxifen and in 19% of women taking AIs. This trial was just being reported, so data from it were not included in the meta-analysis, but there may be a similar issue with compliance in the other trials. "When you are looking at a difference of 10% between compliance with these drugs, and a difference of only 1% in survival, that may be due to chance," he commented. An intention-to-treat analysis would not take into account the patients who dropped out, he said.
AIs May Be a Better Choice
Overall, Dr. Muss said that he feels that AIs "may be a better choice," than tamoxifen, particularly for older patients, but he would be influenced more by toxicity than by efficacy.
Tamoxifen has 2 major adverse effects blood clots and uterine cancer, Dr. Muss said. Thromboembolism is a major concern, because most women with breast cancer are older and have comorbidities, such as hypertension and vascular problems. Neither of these adverse effects are seen with AIs, although these drugs have their own problems, he commented. In particular, AIs are associated with aches and pains in the joints, which can be severe and pose major problems. "Some women say they are unable to walk," he noted, "and there is not much that can be done, [other than] maybe change to another aromatase inhibitor."
AIs also carry the risk for osteoporosis, but this can be monitored and countered with bisphosphonates, he pointed out. "Oncologists have become very good bone doctors . . . since these drugs have been around," Dr. Muss commented. Also, there is now some research suggesting that these drugs also have an effect on the breast cancer itself, he noted. (New data suggesting the bisphosphonate zoledronic acid has a direct anti-tumor effect was presented at the SABCS meeting, as recently reported by Medscape Oncology.)
AIs should be a part of the treatment for every postmenopausal woman, Dr. Muss said, as laid out in the American Society of Clinical Oncology guidelines. "But from where we sit today, it is not, to me, totally convincing that you have to start every patient on an aromatase inhibitor as initial endocrine adjuvant therapy."
"However, I would say that at some stage in the course of treatment, maybe 2 years later, and there are data for 5 years later, an aromatase inhibitor should be used as part of the patient's treatment," he said. The switching data show that there may be some survival advantage, he added.
A major question than remains, however, is how long such treatment should be continued, Dr. Muss said. "The overview analysis shows that most women who are treated with tamoxifen relapse after 5 years, so it may be that you have to continue women on endocrine therapy for many, many years to do the best you can." These studies are currently in progress, comparing 5 years of therapy with 10, and 10 years of therapy with 15, he noted.

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The off-color jokes flew around the room. As the anecdotes got bawdier, the laughter intensified. Some recited from memory, others read from notebooks they brought along.
The setting for the hilarity was the Montefiore Einstein Cancer Center at Montefiore Hospital. The participants were cancer patients, some with advanced stages of the illness.
They were taking part in the hospitals monthly Strength Through Laughter therapy. It is one of several types of laughter or humor therapy being offered by medical facilities around the country for patients diagnosed with cancer or other chronic diseases.

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Lyme disease it has become epidemic on Long Island and much of the New
York Metropolitan Area, indeed across the United States. But as bad as the
illness has become, so has treatment for it health insurers have
discouraged long-term treatment for what is often a long-term illness.
Suffolk County Long Island Legislator Edward Romaine recently held a
public meeting on Lyme disease.
Eva Haughie, President, Empire State Lyme Disease ociation. She has
had Lyme disease for nearly 20 years. Her ociation is based in Manorville.
Dr. Joseph Burrascano, East Hampton, New York He is a pioneer in the
treatment of Lyme disease. And because of the push by medical insurers to
only cover short-term treatment two, three or four weeks of antibiotics
and Dr. Burrascano having developed a protocol for treating the many
people who are not cured in the short-term but have chronic Lyme disease,
he ended up being attacked. But he came through it and is regarded as a
major leader in the field.
Staci Grodin, Co-Founder and President, Turn the Corner Foundation. A
Lyme Diseases victim, her Turn the Corner Foundation has raised over $2
million and funded important Lyme disease research.
Sandy Berenbaum, Licensed Clinical Social Worker, Brewster, New York. She
has specialized with working with those with chronic Lyme disease. Her
accounts were most poignant, and her explanation of why health
insurers balk at providing compensation for long-term treatment most illuminating.
Diane Blanchard, President, Time for Lyme. A former resident of Westhampton, where she and members of her family contracted Lyme disease, she presently lives in Greenwich, Connectcut. Her organization, Time for Lyme, focuses on education and research.
Suffolk County Health Commissioner Dr. Humayan Chaudhry. confirms how Lyme disease has become .
Suffolk County Legislator Edward Romaine
New York State emblyman Fred W. Thiele, Jr., Sag Harbor, New York who
talks about the bill he has before the New York State embly requiring
health insurers to provide compensation for long-term treatment of Lyme
diseases a measure that has been bottled up in Albany.
Shelter Island Town Supervisor Alfred Kilb, Jr. Shelter Island has long
been a particular hotspot for Lyme disease and Kilb describes Shelter
Islanders he knows with chronic cases of the disease.
(c) Video Voice, Inc. 2007 all rights reserved.

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In some prospective studies, treatment of gestational diabetes has resulted in a decrease in shoulder dystocia (a frequently discussed perinatal outcome), but cesarean delivery has not been shown to reduce perinatal morbidity. Patients diagnosed with gestational diabetes should monitor their blood glucose levels, exercise, and undergo nutrition counseling for the purpose of maintaining normoglycemia. The commonly accepted treatment goal is to maintain a fasting capillary blood glucose level of less than 95 to 105 mg per dL (5.3 to 5.8 mmol per L); the ambiguity (i.e., the range) is due to imperfect data. The postprandial treatment goal should be a capillary blood glucose level of less than 140 mg per dL (7.8 mmol per L) at one hour and less than 120 mg per dL (6.7 mmol per L) at two hours. Patients not meeting these goals with dietary changes alone should begin insulin therapy. In patients with well-controlled diabetes, there is no need to pursue delivery before 40 weeks of gestation. In patients who require insulin or have other comorbid conditions, it is appropriate to begin antenatal screening with nonstress tests and an amniotic fluid index at 32 weeks of gestation. (Am Fam Physician 2003;68:1767-72,1775-6. Copyright 2003 American Academy of Family Physicians.).
Screening for gestational diabetes mellitus is widely practiced despite lack of evidence that it prevents adverse perinatal outcomes. Although the disorder affects approximately 2.5 percent of pregnant women and has been the subject of extensive research, its diagnosis and management continue to be debated.
Definition and Complications
Gestational diabetes mellitus is defined as glucose intolerance that begins, or is first recognized, during pregnancy. A wide range of complications is associated with the disorder. For the mother, gestational diabetes increases the risk of preeclampsia, cesarean delivery, and future type 2 diabetes. In the fetus or neonate, the disorder is associated with higher rates of perinatal mortality, macrosomia, birth trauma, hyperbilirubinemia, and neonatal hypoglycemia. Some studies have found an association between gestational diabetes and increased perinatal mortality rates, but other studies have shown no increased risk.
Diagnosis of Gestational Diabetes
Patients do not have to fast before a 50-g, one-hour glucose challenge test.
Initial screening for gestational diabetes is accomplished by performing a 50-g, one-hour glucose challenge test at 24 to 28 weeks of gestation. Patients do not have to fast for this test. To be considered normal, serum or plasma glucose values should be less than 130 mg per dL (7.2 mmol per L) or less than 140 mg per dL (7.8 mmol per L). Using a value of 130 mg per dL or higher will increase the sensitivity of the test from 80 to 90 percent and decrease its specificity, compared with using a value of 140 mg per dL or higher. Thus, the lower screening level of 130 mg per dL identifies more patients with gestational diabetes at the cost of more false-positive results. Current recommendations from the American Diabetes Association (ADA) and the American College of Obstetricians and Gynecologists (ACOG) accept either value for defining an abnormal initial screening result. [Reference 4--Evidence level C, consensus/expert opinion; Reference 15--Evidence level C, consensus/expert opinion]
An abnormal one-hour screening test should be followed by a 100-g, three-hour venous serum or plasma glucose tolerance test. After the patient has been on an unrestricted diet for three days, venous blood samples are obtained following an overnight fast, and then one, two, and three hours after an oral 100-g glucose load. During the test period, patients should remain seated and should not smoke. Two or more abnormal values are diagnostic for gestational diabetes.
The diagnostic criteria from the National Diabetes Data Group (NDDG) have been used most often, but some centers rely on the Carpenter and Coustan criteria, which set the cutoff for normal at lower values (Table 1).Compared with the NDDG criteria, the Carpenter and Coustan criteria lead to a diagnosis of gestational diabetes in 54 percent more pregnant women, with an increased cost and no compelling evidence of improved perinatal outcomes. While the ADA supports use of the stricter criteria, the most recent ACOG practice bulletin supports the use of either criteria set.Whole blood glucose values are approximately 10 to 15 percent lower than serum or plasma values.[corrected]


TABLE 1 Criteria for Abnormal Result on 100-g, Three-Hour Oral Glucose Tolerance Tests in Pregnant Women*
Blood sample

National Diabetes Data Group / Carpenter and Coustan
Fasting
105 mg per dL (5.8 mmol per L) / 95 mg per dL (5.3 mmol per L)
1-hour
190 mg per dL (10.5 mmol per L) / 180 mg per dL (10.0 mmol per L)
2-hour
165 mg per dL (9.2 mmol per L) / 155 mg per dL (8.6 mmol per L)
3-hour
145 mg per dL (8.0 mmol per L) / 140 mg per dL (7.8 mmol per L)
Gestational diabetes mellitus is diagnosed if two or more of the values (venous serum or plasma glucose levels) are met or exceeded.


Management of Gestational Diabetes
BLOOD GLUCOSE MONITORING
In patients requiring insulin therapy, the ideal frequency of glucose monitoring has not been established. A common practice is to check the glucose level four times daily. A first morning glucose level can rule out fasting hyperglycemia, and additional one- or two-hour postprandial values can ensure adequate control.
Postprandial testing is preferable to preprandial testing. In one randomized study comparing postprandial and preprandial blood glucose monitoring in patients with gestational diabetes who required insulin therapy, those who measured their glucose levels after meals had larger drops in A1c (-3.0 versus -0.

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