Saturday, Dec. 30, 2017 - Jan. 5, 2018
Are 3-D mammograms really better?
US puts scans to the test
Nov. 21, 2017, Dr. Tova Koenigsberg at The Montefiore Einstein Center
for Cancer Care in New York shows an example of a traditional mammogram
scan. U.S. health officials are beginning a huge study to compare
traditional mammograms with 3-D versions, to see if the newer choice
might really improve screening for breast cancer. (Montefiore Health
System via AP)
- A better mammogram? Increasingly women are
asked if they want a 3-D mammogram instead of the regular X-ray - and
now U.S. health officials are starting a huge study to tell if the
newer, sometimes pricier choice really improves screening for breast
It’s the latest
dilemma in a field that already vexes women with conflicting guidelines
on when to get checked: Starting at age 40, 45 or 50? Annually or every
Mammograms can save lives if they catch aggressive breast cancers early.
But they also can harm through frequent false alarms and by spotting
tumors that grow so slowly they never would have posed a threat - over
diagnosis that means some women undergo unneeded treatment.
That trade-off is a
key question as doctors begin recruiting 165,000 women nationally to
compare potentially more beneficial 3-D mammograms - known
scientifically as “tomosynthesis” - with standard two-dimensional
The 3-D mammograms
have been marketed as being able to find more cancers.
“But the idea isn’t
so much finding more cancers as finding the cancers that are going to be
life-threatening,” said Dr. Worta McCaskill-Stevens of the National
Cancer Institute, which is funding the new research to tell whether the
3-D scans truly pinpoint the tumors that matter most.
It’s one of the
largest randomized trials of mammography in decades, and scientists
designed the research to do more than answer that key 3-D question. They
hope the findings also, eventually, will help clear some of the
confusion surrounding best screening practices.
“The most important
thing about this study is that it’s moving us to individualized
screening as opposed to what we have now, which is one-size-fits-all
screening,” predicted study chair Dr. Etta Pisano, a radiologist at
Boston’s Beth Israel Deaconess Medical Center.
“We are going to
have a much better understanding of how to screen women so that we do
the least amount of harm.”
Who needs a
That depends on
whom you ask. Guidelines vary for women at average risk of breast
cancer. (Those at increased risk, because of family history or genetics,
already get different advice.)
College of Radiology recommends annual mammograms starting at age 40.
The American Cancer
Society urges annual checks starting at 45 and switching to every other
year at 55, though it says women 40 to 44 still can opt for a mammogram.
And the U.S.
Preventive Services Task Force, a government advisory group, recommends
starting at age 50, with mammograms every other year. It, too, says
40-somethings can choose earlier screening.
What about 3-D mammograms?
take X-rays from two sides of the breast. With tomosynthesis, additional
X-rays are taken at different angles - not truly three-dimensional but a
computer compiles them into a 3-D-like image. First approved by the Food
and Drug Administration in 2011, they’re not yet the standard of care in
part because of questions that the new study aims to answer.
Some studies have
found tomosynthesis detects more cancer with fewer false alarms; they’re
often advertised as particularly useful for younger women’s dense
How to decide?
mammograms come with pros and cons, and weigh them, said Dr. Otis
Brawley, the American Cancer Society’s chief medical officer.
Breast cancer is
far less common at age 40 than at age 50 and beyond. After menopause,
tumors tend to grow more slowly and women’s breast tissue becomes less
dense and easier for mammograms to provide a clearer image.
Consider: For every
1,000 women screened every other year until their 70s, starting at 40
instead of 50 would prevent one additional death - but create 576 more
false alarms and 58 extra unneeded biopsies, the task force estimated.
Also, two extra women would be treated for tumors that never would have
become life-threatening - that over diagnosis problem.
As for what type to
choose, some insurers, including Medicare, cover the 3-D version, and a
small number of states mandate coverage. Other insurers may require
women to pay $50 to $100 more out of pocket. Whoever ultimately pays,
extra time to analyze the scans adds to the cost.
The new study
mammography clinics across the U.S., and a few in Canada, will enroll
healthy women ages 45 to 74 who already are planning to get a routine
mammogram. They’ll be randomly assigned to get either the regular or 3-D
version for five years. Most will be screened annually but
post-menopausal women who don’t have certain cancer risk factors will be
screened every other year.
track every woman’s results including samples from biopsies plus genetic
and other tests, as well as how any cancer patients fare. The giant
database hopefully will help them tease out more information about which
women benefit most from what type and frequency of screening.
been provocative over many decades. It’s important that women have a
better understanding of how mammography is important for them based upon
their age and other risk factors,” said McCaskill-Stevens.
Saturday, Dec. 23 - Dec. 29, 2017
Drugstore pain pills as effective as opioids in ER patients
This Thursday, Nov. 2, 2017 photo shows
tablets of ibuprofen in New York. A study released on Tuesday, Nov. 7,
2017 found that over-the-counter pills worked as well as opioids at
reducing severe pain for emergency room patients with broken bones and
sprains. (AP Photo/Patrick Sison)
Chicago (AP) - Emergency
rooms are where many patients are first introduced to powerful opioid
painkillers, but what if doctors offered over-the-counter pills instead?
A new study tested that approach on patients with broken bones and
sprains and found pain relievers sold as Tylenol and Motrin worked as
well as opioids at reducing severe pain.
The results challenge common ER
practice for treating short-term, severe pain and could prompt changes
that would help prevent new patients from becoming addicted.
The study has limitations: It only
looked at short-term pain relief in the emergency room and researchers
didn’t evaluate how patients managed their pain after leaving the
But given the scope of the U.S.
opioid epidemic - more than 2 million Americans are addicted to opioid
painkillers or heroin - experts say any dent in the problem could be
Results were published Tuesday in
the Journal of the American Medical Association.
Long-term opioid use often begins
with a prescription painkiller for short-term pain, and use of these
drugs in the ER has risen in recent years. Previous studies have shown
opioids were prescribed in nearly one-third of ER visits and about 1 out
of 5 ER patients are sent home with opioid prescriptions.
“Preventing new patients from
becoming addicted to opioids may have a greater effect on the opioid
epidemic than providing sustained treatment to patients already
addicted,” Dr. Demetrios Kyriacou, an emergency medicine specialist at
Northwestern University, wrote in an accompanying editorial.
The study involved 411 adults
treated in two emergency rooms at Montefiore Medical Center in New York
City. Their injuries included leg and arm fractures or sprains. All were
given acetaminophen, the main ingredient in Tylenol, plus either
ibuprofen, the main ingredient in Motrin, or one of three opioids:
oxycodone, hydrocodone or codeine. They were given standard doses and
were not told which drug combo they received.
Patients rated their pain levels
before taking the medicine and two hours later. On average, pain scores
dropped from almost 9 on a 10-point scale to about 5, with negligible
differences between the groups.
Ibuprofen and acetaminophen affect
different pain receptors in the body so using the two drugs together may
be especially potent, said Dr. Andrew Chang, an emergency medicine
professor at Albany Medical College in upstate New York, who led the
He noted that a pill combining
ibuprofen and acetaminophen is available in other countries; his
findings echo research from Canada and Australia testing that pill
against opioids for pain relief.
US rate for gun deaths is up for the second straight year
In this July 7, 2014 file photo,
Chicago police display some of the thousands of illegal firearms
confiscated during the year. In a government report released on
Friday, Nov. 3, 2017, the U.S. rate for gun deaths has increased
for the second straight year, following 15 years of no real
change. (AP Photo/M. Spencer Green, File)
New York (AP) - The
U.S. rate for gun deaths has increased for the second straight
year, following 15 years of no real change, a government report
Roughly two-thirds of gun
deaths are suicides and those have been increasing for about 10
years. Until recently, that has been offset by a decline in
people shot dead by others. But there’s been a recent upswing in
those gun-related homicides, too, some experts said.
Overall, the firearm death
rate rose to 12 deaths per 100,000 people last year, up from 11
in 2015, according to the report released Friday by the Centers
for Disease Control and Prevention. Before that, the rate had
hovered just above 10 - a level it had fallen to in the late
In the early 90s, it was as
high as 15 per 100,000 people.
In the past two years,
sharp homicide increases in Chicago and other places that have
been large enough to elevate the national statistics. According
to the FBI’s raw numbers, the tally of U.S. homicides involving
guns rose to nearly 11,000 last year, from about 9,600 the year
Overall, there were more
than 38,000 gun deaths last year, according to the CDC. That’s
up from about 36,000 in 2015, and around 33,500 each year
between 2011 and 2014.
The latest CDC report means
the nation is approaching two decades since there’s been any
substantial improvement in the rate of gun deaths, said Dr.
Garen Wintemute, a prominent gun violence researcher at the
University of California, Davis.
The rate for the first
three months of this year was about what it was for the same
period last year. Hopefully, it’s a sign it will level off
again, Wintemute said.
Most gun deaths tend to
happen in warm weather so it’s too early to know what is
happening this year, said Bob Anderson, the CDC’s chief of
The CDC also reported a
continued increase in the death rate from drug overdoses, which
hit 20 per 100,000 last year, up from 16 the year before. Heroin
and other opioids are driving the deadliest drug epidemic in
Saturday, Dec. 16 - Dec. 22, 2017
VA study shows parasite from
Vietnam may be killing vets
FILE - This Sept. 7, 2016 file photo shows a
display of preserved liver fluke parasites at the Siriraj Hospital in
Bangkok, Thailand. (AP Photo/Sakchai Lalit, File)
Margie Mason and Robin McDowell
(AP) - A half century after serving in
Vietnam, hundreds of veterans have a new reason to believe they may be
dying from a silent bullet - test results show some men may have been
infected by a slow-killing parasite while fighting in the jungles of
The Department of
Veterans Affairs this spring commissioned a small pilot study to look
into the link between liver flukes ingested through raw or undercooked
fish and a rare bile duct cancer. It can take decades for symptoms to
appear. By then, patients are often in tremendous pain, with just a few
months to live.
Of the 50 blood
samples submitted, more than 20 percent came back positive or bordering
positive for liver fluke antibodies, said Sung-Tae Hong, the tropical
medicine specialist who carried out the tests at Seoul National
University in South Korea.
surprising,” he said, stressing the preliminary results could include
false positives and that the research is ongoing.
Medical Center spokesman Christopher Goodman confirmed the New York
facility collected the samples and sent them to the lab. He would not
comment on the findings, but said everyone who tested positive was
Gerry Wiggins, who
served in Vietnam from 1968 to 1969, has already lost friends to the
disease. He was among those who got the call.
“I was in a state
of shock,” he said. “I didn’t think it would be me.”
who lives in Port Jefferson Station, New York, didn’t have any symptoms
when he agreed to take part in the study, but hoped his participation
could help save lives. He immediately scheduled further tests,
discovering he had two cysts on his bile duct, which had the potential
to develop into the cancer, known as cholangiocarcinoma. They have since
been removed and - for now - he’s doing well.
Though rarely found
in Americans, the parasites infect an estimated 25 million people
worldwide, mostly in Asia.
Endemic in the
rivers of Vietnam, the worms can easily be wiped out with a handful of
pills early on, but left untreated they can live for decades without
making their hosts sick. Over time, swelling and inflammation of the
bile duct can lead to cancer. Jaundice, itchy skin, weight loss and
other symptoms appear only when the disease is in its final stages.
The VA study, along
with a call by Senate Minority Leader Charles Schumer of New York for
broader research into liver flukes and cancer-stricken veterans, began
after The Associated Press raised the issue in a story last year. The
reporting found that about 700 veterans with cholangiocarcinoma have
been seen by the VA in the past 15 years. Less than half of them
submitted claims for service-related benefits, mostly because they were
not aware of a possible connection to Vietnam. The VA rejected 80
percent of the requests, but decisions often appeared to be haphazard or
contradictory, depending on what desks they landed on, the AP found.
The number of
claims submitted reached 60 in 2017, up from 41 last year. Nearly three
out of four of those cases were also denied, even though the government
posted a warning on its website this year saying veterans who ate raw or
undercooked freshwater fish while in Vietnam might be at risk. It
stopped short of urging them to get ultrasounds or other tests, saying
there was currently no evidence the vets had higher infection rates than
the general population.
“We are taking this
seriously,” said Curt Cashour, a spokesman with the Department of
Veterans Affairs. “But until further research, a recommendation cannot
be made either way.”
Baughman, 65, who was featured in the previous AP article, said his
claim was granted early this year after being denied three times. He
said the approval came right after his doctor wrote a letter saying his
bile duct cancer was “more likely than not” caused by liver flukes from
the uncooked fish he and his unit in Vietnam ate when they ran out of
rations in the jungle. He now gets about $3,100 a month and says he’s
relieved to know his wife will continue to receive benefits after he
dies. But he remains angry that other veterans’ last days are consumed
by fighting the same government they went to war for as young men.
“In the best of all
worlds, if you came down with cholangiocarcinoma, just like Agent
Orange, you automatically were in,” he said, referring to benefits
granted to veterans exposed to the toxic defoliant sprayed in Vietnam.
“You didn’t have to go fighting.”
Baughman, who is
thin and weak, recently plucked out “Country Roads” on a bass during a
jam session at his cabin in West Virginia. He wishes the VA would do
more to raise awareness about liver flukes and to encourage Vietnam
veterans to get an ultrasound that can detect inflammation.
“Personally, I got
what I needed, but if you look at the bigger picture with all these
other veterans, they don’t know what necessarily to do,” he said. “None
of them have even heard of it before. A lot of them give me that blank
stare like, ‘You’ve got what?’”
Update Saturday, Dec. 2 - Dec. 8, 2017
Study suggests women less likely to get CPR from bystanders
A study released on Sunday, Nov. 12, 2017 shows
women are less likely than men to get CPR from a bystander and more likely
to die, and researchers think that reluctance to touch a woman’s chest may
be one reason. (AP Photo/Rogelio V. Solis)
Anaheim, Calif. (AP)
- Women are less likely than men to get CPR from
a bystander and more likely to die, a new study suggests, and researchers
think reluctance to touch a woman’s chest might be one reason.
Only 39 percent of
women suffering cardiac arrest in a public place were given CPR versus 45
percent of men, and men were 23 percent more likely to survive, the study
It involved nearly
20,000 cases around the country and is the first to examine gender
differences in receiving heart help from the public versus professional
“It can be kind of
daunting thinking about pushing hard and fast on the center of a woman’s
chest” and some people may fear they are hurting her, said Audrey Blewer, a
University of Pennsylvania researcher who led the study.
Rescuers also may worry
about moving a woman’s clothing to get better access, or touching breasts to
do CPR, but doing it properly “shouldn’t entail that,” said another study
leader, U Penn’s Dr. Benjamin Abella. “You put your hands on the sternum,
which is the middle of the chest. In theory, you’re touching in between the
The study was discussed
Sunday at an American Heart Association conference in Anaheim.
Cardiac arrest occurs
when the heart suddenly stops pumping, usually because of a rhythm problem.
More than 350,000 Americans each year suffer one in settings other than a
hospital. About 90 percent of them die, but CPR can double or triple
“This is not a time to
be squeamish because it’s a life and death situation,” Abella said.
Researchers had no
information on rescuers or why they may have been less likely to help women.
But no gender difference was seen in CPR rates for people who were stricken
at home, where a rescuer is more likely to know the person needing help.
The findings suggest
that CPR training may need to be improved. Even that may be subtly biased
toward males - practice mannequins (they’re not called “woman-nequins”) are
usually male torsos, Blewer said.
“All of us are going to
have to take a closer look at this” gender issue, said the Mayo Clinic’s Dr.
Roger White, who co-directs the paramedic program for the city of Rochester,
Minnesota. He said he has long worried that large breasts may impede proper
placement of defibrillator pads if women need a shock to restore normal
The Heart Association
and the National Institutes of Health funded the study.
Men did not have a
gender advantage in a second study discussed on Sunday. It found the odds of
suffering cardiac arrest during or soon after sex are very low, but higher
for men than women.
Previous studies have
looked at sex and heart attacks, but those are caused by a clot suddenly
restricting blood flow, and people usually have time to get to a hospital
and be treated, said Dr. Sumeet Chugh, a cardiologist at Cedars-Sinai Heart
Institute in Los Angeles. He and other researchers wanted to know how sex
affected the odds of cardiac arrest, a different problem that’s more often
They studied records on
more than 4,500 cardiac arrests over 13 years in the Portland area. Only 34
were during or within an hour of having sex, and 32 of those were in men.
Most already were on medicines for heart conditions, so their risk was
elevated to start with.
“It’s a very awkward
situation, and a very horrifying situation to be one of the two people who
survives,” but more would survive if CPR rates were higher, Chugh said.
Results were published
in the Journal of the American College of Cardiology.