June 23, 2018 - June 29, 2018
Cancer group says colon screening should start at 45, not 50
undated microscope image provided by the National Institutes of Health
shows human colon cancer cells with the cell nuclei stained red.
According to new American Cancer Society guidelines, most U.S. adults
should begin getting screened for colon cancer when they turn 45. (NCI
Center for Cancer Research/NIH via AP)
New York (AP) - New
guidelines released Wednesday recommend U.S. adults start colon cancer
screening earlier, at age 45 instead of 50.
The American Cancer Society’s
advice puts it out of sync with guidelines from an influential
government advisory group, which kept the age at 50 in an update two
Cancer society officials
acknowledge the shift to 45 could cause confusion for doctors and
patients but felt strongly that they needed to act now. The advocacy
group was influenced by its study, published last year, that found
rising rates of colon cancer and deaths in people younger than 50.
Experts aren’t sure why there has been a 50 percent increase in cases
The guidelines are for men and
women ages 45 to 75 of average risk for colon cancer; recommendations
are different for people with certain conditions, like Crohn’s disease,
or a family history of colon cancer. The group endorses six kinds of
screening exams, from inexpensive take-home stool tests performed every
year to colonoscopies done every 10.
“All of these tests are good tests,
and the choice should be offered to patients,” said the cancer society’s
Dr. Rich Wender. “The best test is the test that gets done.”
The same tests are recommended by
the U.S. Preventive Services Task Force, a panel that reviews evidence
and issues advice for a variety of screenings and treatments. It updated
its colon cancer guidelines in 2016 and its next review isn’t expected
until around 2021.
That panel’s recommendations drive
what screening is covered by insurance under the Affordable Care Act,
although 20 states have laws that link coverage to the cancer society
guidelines. It’s not uncommon for groups to have slightly different
guidelines although those for colon cancer have been about the same for
Most colon cancer occurs in adults
55 and older, and the good news is rates of cases and deaths have been
falling for decades. Colon cancer, combined with rectal cancer, is the
second leading cause of cancer death in the U.S. This year, more than
140,000 Americans are expected to be diagnosed with it, and about 50,000
will die from it.
Doctors will probably look to
specialty medical societies to sort out the different guidelines, said
Dr. Marcus Plescia, of the Association of State and Territorial Health
Officials. But it may take a little while before they offer clear
Some experts have worried about
pre-50 risks of colon cancer in some racial and ethnic groups, and at
least one specialty society for gastroenterologists has urged screening
of black adults starting at age 45.
Others argue that instead of
lowering the age for routine screening, more effort should be put into
getting more people tested. Only about two-thirds of people 50 and older
have been following screening guidelines.
“It’s hard enough to get people to
do it at all,” Plescia noted.
Dr. Andrew Wolf, the lead author of
the latest guidelines, said they considered and rejected that reasoning.
“We should be able to do both,”
said Wolf, a University of Virginia internist.
US approves 1st drug developed
to prevent chronic migraines
Food and Drug Administration approved the drug Aimovig, the first in a
new class of long-acting drugs designed to prevent chronic migraines,
clearing the monthly shot for sale. (Amgen Inc. via AP)
Linda A. Johnson
Trenton, N.J. (AP) - U.S.
regulators Thursday approved the first drug designed to prevent chronic
The Food and Drug Administration’s
action clears the monthly shot Aimovig (AIM’-oh-vig) for sale. It’s the
first in a new class of long-acting drugs for preventing migraines.
Three other shots are expected to win approval by next year, and several
pills for preventing migraines are being tested.
Current prevention treatments
include pills originally developed for epilepsy and other conditions and
the wrinkle reducer Botox, but many patients abandon them because they
don’t help much or cause serious side effects.
Amgen Inc. of Thousand Oaks,
California, and Swiss drug giant Novartis AG developed Aimovig. Injected
monthly just under the skin using a penlike device, the drug will cost
$6,900 per year without insurance.
Migraines can cause disabling
symptoms: throbbing headaches, nausea and vomiting, and sensitivity to
light and sound. About 10 million Americans get them frequently. They’re
most common in people in their 30s, mostly women, and can last for
several hours or even days.
In one study, patients given
Aimovig saw their migraine days cut from eight to four a month, on
average. Those who got dummy shots had a reduction of two. Each patient
group had similar minor side effects, mostly colds and respiratory
Some patients saw their migraines
completely eliminated, said Sean Harper, Amgen’s research director.
Aimovig and the migraine drugs in
development target a substance called CGRP whose levels spike in the
blood during a migraine, triggering symptoms.
The long-term safety of Aimovig,
also known as erenumab, hasn’t been tested, and Amgen plans to track
outcomes in women who become pregnant while taking it.
June 16, 2018 - June 22, 2018
Many breast cancer patients can skip chemo, big study finds
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
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
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
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)
(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
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.
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
June 2, 2018 - June 8, 2018
UN health agency aims to wipe out trans fats worldwide
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
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
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
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
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
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
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
“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
Health officials: Stay out of
the pool if you have diarrhea
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)
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
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.