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Update June 2018


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Health & Wellbeing
 

June 16, 2018 - June 22, 2018

Many breast cancer patients can skip chemo, big study finds

In this Thursday, May 24, 2018 photo, Adine Usher, 78, meets with breast cancer study leader Dr. Joseph Sparano at the Montefiore and Albert Einstein College of Medicine in the Bronx borough of New York. Usher was one of about 10,000 participants in the study which shows women at low or intermediate risk for breast cancer recurrence may safely skip chemotherapy without hurting their chances of survival. (AP Photo/Kathy Young)

Marilynn Marchione

Chicago (AP) - Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient's risk.

The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the United States and many more elsewhere the ordeal and expense of these drugs.

"The impact is tremendous," said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. Most women in this situation don't need treatment beyond surgery and hormone therapy, he said.

The study was funded by the National Cancer Institute, some foundations and proceeds from the U.S. breast cancer postage stamp. Results were discussed Sunday at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test.

Moving away from chemo

Cancer care has been evolving away from chemotherapy - older drugs with harsh side effects - in favor of gene-targeting therapies, hormone blockers and immune system treatments. When chemo is used now, it's sometimes for shorter periods or lower doses than it once was.

For example, another study at the conference found that Merck's immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects.

The breast cancer study focused on cases where chemo's value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.

The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo to help kill any stray cancer cells. Doctors know that most don't need it, but evidence is thin on who can forgo it.

The study gave 10,273 patients a test called Oncotype DX, which uses a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy, to estimate the risk that a cancer will recur.

 What the study found

About 17 percent of women had high-risk scores and were advised to have chemo. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.

The new results are on the 67 percent of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo.

After nine years, 94 percent of both groups were still alive, and about 84 percent were alive without signs of cancer, so adding chemo made no difference.

Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test.

Will people trust the results?

All women like those in the study should get gene testing to guide their care, said Dr. Richard Schilsky, chief medical officer of the oncology society. Oncotype DX costs around $4,000, which Medicare and many insurers cover. Similar tests including one called MammaPrint also are widely used.

Testing solved a big problem of figuring out who needs chemo, said Dr. Harold Burstein of the Dana-Farber Cancer Institute in Boston. Many women think "if I don't get chemotherapy I'm going to die, and if I get chemo I'm going to be cured," but the results show there's a sliding scale of benefit and sometimes none, he said.

Dr. Lisa Carey, a breast specialist at the University of North Carolina's Lineberger Comprehensive Cancer Center, said she would be very comfortable advising patients to skip chemo if they were like those in the study who did not benefit from it.

Dr. Jennifer Litton at MD Anderson Cancer Center in Houston, agreed, but said: "Risk to one person is not the same thing as risk to another. There are some people who say, 'I don't care what you say, I'm never going to do chemo,'" and won't even have the gene test, she said. Others want chemo for even the smallest chance of benefit.

Adine Usher, 78, who lives in Hartsdale, New York, joined the study 10 years ago at Montefiore and was randomly assigned to the group given chemo.

"I was a little relieved. I sort of viewed chemo as extra insurance," she said. The treatments "weren't pleasant," she concedes. Her hair fell out, she developed an infection and was hospitalized for a low white blood count, "but it was over fairly quickly and I'm really glad I had it."

If doctors had recommended she skip chemo based on the gene test, "I would have accepted that," she said. "I'm a firm believer in medical research."


June 9, 2018 - June 15, 2018

Shorter drug treatment OK for many breast cancer patients

According to a study released in May, many women with a common and aggressive form of breast cancer that is treated with Herceptin can get by with six months of the drug instead of the usual 12, greatly reducing the risk of heart damage it can cause. (F. Hoffmann-La Roche via AP)

Marilynn Marchione

(AP) - Many women with a common and aggressive form of breast cancer that is treated with Herceptin can get by with six months of the drug instead of the usual 12, greatly reducing the risk of heart damage it sometimes can cause, a study suggests.

It’s good news, but it comes nearly two decades after the drug first went on the market and many patients have suffered that side effect.

The study was done in the United Kingdom and funded by UK government grants. Results were released Wednesday by the American Society of Clinical Oncology and will be presented at the group’s meeting next month.

Herceptin transformed care of a dreaded disease when it was approved in 1998 for women with advanced breast cancers whose growth is aided by a faulty HER2 gene, as 15 percent to 20 percent of cases are. It was later approved for treatment of those cancers in earlier stages, too, based on studies that had tested it in patients for 12 months. That guess, that the drug should be taken for a year, became the standard of care.

But the drug can hurt the heart’s ability to pump. That often eases if treatment is stopped but the damage can be permanent and lead to heart failure.

Some studies tested shorter use, but results conflicted. The new study is the largest so far, and involved more than 4,000 women with early-stage cancers who were given usual chemotherapy plus Herceptin for either six or 12 months.

After four years, about 90 percent of both groups were alive without signs of the disease. Only 4 percent on the shorter treatment dropped out due to heart problems versus 8 percent of those treated for a year.

“It’s great news” for patients, said the study leader, Dr. Helena Earl of the University of Cambridge in England. Earl has consulted for Herceptin’s maker, Roche. The company had no role in the study.

“There’s no reason to not immediately change practice. The findings are persuasive,” said Dr. Richard Schilsky, chief medical officer for the oncology society. Most of Herceptin’s cancer-fighting benefit seems to come in the early months of use, he said.

Others said that because so few women have died or relapsed after being treated with the drug, longer follow-up may be needed to make sure the findings hold up before guidelines should be changed. Doctors also want to see results published, and to study them to see if certain groups of women need longer treatment.

Herceptin is given through an IV every three weeks; a year of it costs $34,000 to $40,000 in England and about $70,000 in the U.S. In December, a copycat competitor known as a biosimilar was approved in the U.S. and already is used in some other countries.

Dr. Harold Burstein, a breast cancer expert at Dana-Farber Cancer Institute in Boston, said shorter treatment may increase access to the drug in countries where many women can’t afford it now, but that in the U.S., “my guess is that people will continue to aim for a year of treatment” because of lingering concerns that longer use is better, as a smaller, previous study suggested.

Dr. Jennifer Litton, a breast specialist at MD Anderson Cancer Center in Houston, said Herceptin was a true breakthrough, but scaling back treatment whenever possible is just as important to patients. She said the results show how important it can be to study drugs already on the market, and that drug companies alone should not be relied on to do studies like this.

“It’s really important that we continue to have public funding for trials so we can continue to ask all of these questions for our patients,” she said.

Herceptin’s developer, Genentech, now part of Roche, said in a statement that the new study must be viewed along with several smaller previous ones that found one year to be best. The goal of treatment “is to provide people with the best chance for a cure,” so women need to talk with their doctors about how best to reach that goal, the statement says.

Earlier this year, the American Heart Association issued its first statement on the heart effects of cancer drugs, saying women should consider carefully the risks and benefits of any therapies that may hurt hearts.


June 2, 2018 - June 8, 2018

UN health agency aims to wipe out trans fats worldwide

In this Aug. 8, 2007 file photo, a Milky-Way candy bar is deep-fried in oil free of trans fats at a food booth at the Indiana State Fair in Indianapolis. The head of the World Health Organization called on all nations to eliminate artificial trans fats from foods in the next five years. (AP Photo/Darron Cummings)

Mike Stobbe

New York (AP) - The World Health Organization has released a plan to help countries wipe out artery-clogging trans fats from the global food supply in the next five years.

The United Nations agency has in the past pushed to exterminate infectious diseases, but now it’s aiming to erase a hazard linked to chronic illness.

In a statement Monday, the U.N. health agency said eliminating trans fats is critical to preventing deaths worldwide. WHO estimates that eating trans fats - commonly found in baked and processed foods - leads to the deaths of more than 500,000 people from heart disease every year.

“It’s a crisis level, and it’s major front in our fight now,” WHO Director-General Tedros Adhanom Ghebreyesus said at a news conference in Geneva on Monday.

Officials think it can be done in five years because the work is well underway in many countries. Denmark did it 15 years ago, and since then the United States and more than 40 other higher-income countries have been working on getting the additives out of their food supplies.

The WHO is now pushing middle- and lower-income countries to pick up the fight, said Dr. Francesco Branca, director of the WHO’s Department of Nutrition for Health and Development.

Artificial trans fats are unhealthy substances that are created when hydrogen is added to vegetable oil to make it solid, like in the creation of margarine or shortening. Health experts say they can be replaced with canola oil or other products. There are also naturally occurring trans fats in some meats and dairy products.

The WHO recommends that no more than 1 percent of a person’s calories come from trans fats.

“Trans fats are a harmful compound that can be removed easily without major cost and without any impact on the quality of the foods,” Branca said.

Countries will likely have to use regulation or legislation to get food makers to make the switch, experts said.

At the WHO news conference Monday, a representative from a leading food industry trade group said companies are working to reduce trans fats in their products.

“We call on food producers in our sector to take prompt action and we stand ready to support effective measures to work toward the elimination of industrially produced trans fats and ensure a level playing field in this area,” said Rocco Rinaldi, secretary-general of the International Food and Beverage Alliance.

Dr. Tom Frieden, a former director of the U.S. Centers for Disease Control and Prevention who worked with WHO officials on the call to action, called its move unprecedented.

“The world is now setting its sights on today’s leading killers - particularly heart disease, which kills more people than any other cause in almost every country,” said Frieden, president of Resolve to Save Lives, a New-York-based project of an organization called Vital Strategies.

In the U.S., the first trans fatty food to hit the market was Crisco shortening, which went on sale in 1911. Trans fatty foods became increasingly popular beginning in the 1950s, partly because experts at the time thought they were healthier than cooking with butter or lard.

Food makers liked artificial trans fats because they prolonged product shelf life. They used them in doughnuts, cookies and deep-fried foods.

But studies gradually revealed that trans fats wreck cholesterol levels in the blood and drive up the risk of heart disease. Health advocates say trans fats are the most harmful fat in the food supply.

In the U.S., New York City in 2006 banned restaurants from serving food with trans fats. The same year the FDA required manufacturers to list trans fat content information on food labels.

Many manufacturers cut back, and studies showed trans fat levels in the blood of middle-aged U.S. adults fell by nearly 60 percent by the end of the decade.

In 2015, the FDA took steps to finish the job of eliminating trans fats, calling for manufacturers to stop selling trans fatty foods by June 18, 2018 - a deadline that arrives next month. FDA officials have not said how much progress has been made or how they will enforce their rule against food makers that don’t comply.

“The removal of trans fats from the food supply as an additive counts as one of the major public health victories of the last decade,” said Laura MacCleery, policy director for the Washington, D.C.-based advocacy group, Center for Science in the Public Interest.


Health officials: Stay out of the pool if you have diarrhea

This microscope image provided by the Centers for Disease Control and Prevention shows Cryptosporidium parvum parasitic organisms in a stool smear specimen, the cause of a patient’s cryptosporidiosis. The CDC said hotel pools and hot tubs are a major source of the diarrheal illnesses people get from swimming. The parasite can survive normal chlorine levels. (CDC via AP)

Mike Stobbe

New York (AP) - Health officials say hotel pools and hot tubs are a major source of the stomach bugs people get from swimming. And they’re reminding people with diarrhea to stay out of pools, hot tubs and water playgrounds.

U.S. public health officials report on safe swimming every year. Thursday’s version from the Centers for Disease Control and Prevention focused on outbreaks in 2000 through 2014 that were tied to swimming or bathing in treated recreational water spots.

In an average year, there were 15 such outbreaks and about 1,800 related illnesses. Overall, a third were tied to hotels.

A parasite called cryptosporidium (kript-toe-spor-ID’-ee-um) caused most of the outbreaks. It can survive normal chlorine levels, which is why people with such illnesses are urged to refrain from swimming.
 


DAILY UPDATEE

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HEADLINES [click on headline to view story]

Many breast cancer patients can skip chemo, big study finds


Shorter drug treatment OK for many breast cancer patients


UN health agency aims to wipe out trans fats worldwide

Health officials: Stay out of the pool if you have diarrhea


 



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