Improved behavior and screening responsible for cancer death decline

An article published in the Fall, 2008 issue of the Journal of Economic Perspectives concludes that improved behavior and increased screening among Americans are major contributors to the 13 percent decline in cancer mortality from 1990 to 2004 recently announced by the National Cancer Institute. In a study that is the first to evaluate the reasons for the decline, David Cutler of Harvard University examined data for breast, colorectal, lung and prostate cancer, and uncovered three factors leading to improved cancer survival. The most important of these is cancer screening, such as mammography and colonoscopy, which can detect cancer at an early, treatable stage. Second in importance is improved personal behavior, including a reduction in smoking. Dr Cutler ranks improved treatments, including surgery, chemotherapy and radiation as third in importance, and notes that their contribution comes at a high cost. "Drugs that are quite expensive have been shown to extend life by only a few months among patients with metastatic cancer, which raises questions about the relative value of such costly treatments," Dr Cutler stated. "In contrast, while screening can be expensive, increased screening has led to significantly longer life expectancy for those diagnosed early with colorectal or breast cancer."

"We typically think of the war on cancer as developing a new cure," Dr Cutler remarked. "An equally important question is figuring out how we can take what we know and make it work for more people. We should think about the war as not just developing the next weapon, but using what we have in a smarter way. A health care system working for cancer would prevent people from getting it, catch it early, and then treat people accordingly. If our healthcare system was focused in this way, there could be a huge benefit."

Garvan To Play A Role In International Cancer Genome Consortium

Minister for Health and Ageing, The Hon. Nicola Roxon MP, has announced that Australia would make a substantial contribution to the International Cancer Genome Consortium by tackling pancreatic cancer, one of the deadliest cancers and fourth most common cause of cancer death. The consortium brings together the world's leading scientists, through 11 funding organizations in 8 countries, and aims to catalogue the genetic changes of the 50 most common cancer types. The Australian team will be led by Professor Sean Grimmond from the University of Queensland's Institute for Molecular Bioscience in Brisbane and Professor Andrew Biankin from the Garvan Institute of Medical Research in Sydney. It will also involve collaborative contributions from the Walter and Eliza Hall Institute of Medical Research in Melbourne, Johns Hopkins University in Maryland, the Ontario Institute for Cancer Research and the University of California, San Francisco.

Professor Biankin, also a surgeon at Sydney's Bankstown Hospital, has treated hundreds of patients with pancreatic cancer. "It's a very aggressive cancer, killing around 90% of people within a year of diagnosis," he said. "Unlike the other common cancers, survival rates have not improved in over 30 years."

"Now that the technology and knowledge exists to process vast amounts of data quickly, it will allow us to uncover many of the triggers and genetic mechanisms underlying the disease, and therefore improve treatment."

The project is being funded through the National Health and Medical Research Council of Australia (NH&MRC), and at $27.5 million it is the largest single grant the NH&MRC has ever awarded. Further support will be provided by The Cancer Council NSW, the Queensland Government, the Garvan Institute and the University of Queensland. Applied Biosystems Inc. and Silicon Graphics, large international companies specialising in gene sequencing and array analysis and high performance computing systems respectively, are also making significant contributions.

Professor Rob Sutherland, Director of Garvan's Cancer Research Program, as well as Inaugural Director of the planned Garvan St. Vincent's Campus Cancer Centre, acknowledges the great potential for discovery. "We are thrilled to be part of an international team that is throwing its spotlight and resources on this particular cancer," he said.

"A decade ago, it took years to sequence one person's DNA, so we could only dream about identifying the detailed gene mutations that lead to the initiation and progression of different cancers. Today it's possible to sequence 500 hundred individual cases of 50 types of cancer in 5 years."

"While no-one is under the illusion that we'll cure all cancers within the next 5 years, this international collaboration will greatly accelerate progress."

"Some cancers may be cured, some will be targeted more effectively, others will be progressively demystified. Medical research is a long-term process of discovery."

Notes:

ABOUT GARVAN

The Garvan Institute of Medical Research was founded in 1963. Initially a research department of St Vincent's Hospital in Sydney, it is now one of Australia's largest medical research institutions with nearly 500 scientists, students and support staff. Garvan's main research programs are: Cancer, Diabetes & Obesity, Immunology and Inflammation, Osteoporosis and Bone Biology, and Neuroscience. The Garvan's mission is to make significant contributions to medical science that will change the directions of science and medicine and have major impacts on human health. The outcome of Garvan's discoveries is the development of better methods of diagnosis, treatment, and ultimately, prevention of disease.

Source: Alison Heather Research Australia

Female Hormone Replacement Therapy

For women on HRT, tenderness may be warning sign By Julie Steenhuysen Tue Oct 13, 10:28 am ET

CHICAGO (Reuters) – Women whose breasts became tender after taking hormone replacement therapy had nearly twice the risk of developing breast cancer than women whose breasts did not become tender on the drugs, U.S. researchers said on Monday.

They said breast tenderness may be a way to identify women who have a higher risk of developing breast cancer while taking hormone replacement therapy to treat menopause.

"We report that an increase in breast tenderness, easily detected by physicians or patients, identifies a population at particular risk for breast cancer," Dr. Carolyn Crandall of the University of California Los Angeles and colleagues reported in the Archives of Internal Medicine.

The team analyzed data on the more than 16,000 women who took estrogen-plus-progestin as part of the widely publicized Women's Health Initiative or WHI study, which was halted in 2002 when researchers found healthy menopausal women who took the drugs were more likely to develop breast cancer.

Most of the women in the WHI studies took Premarin or Prempro made by Wyeth.

Doctors now recommend hormone replacement therapy for women suffering severe menopause symptoms, but caution that they should use the lowest dose possible for the shortest period of time.

Crandall and colleagues culled through the data to see if breast tenderness played a role in breast cancer risk. In the study, 8,506 took estrogen plus progestin and 8,102 got placebo pills.

The women had mammograms and breast exams at the start of the trial and every year after that. They reported whether they had breast tenderness at the beginning of the trial and a year later.

Based on their analysis, the researchers found women who took hormone treatments had triple the risk of developing breast tenderness.

And those who had breast tenderness after taking the pills were at 48 percent higher risk of invasive breast cancer than other women who took hormone replacement therapy.

The team said the relationship between breast tenderness and breast cancer risk was not clear.

It may be that hormone therapy is causing breast-tissue cells to multiply more rapidly, but the team could not tell that by the study, Crandall said.

"We need to figure out what makes certain women more susceptible to developing breast tenderness during hormone therapy," Crandall said in a statement.

The team said breast tenderness while taking combination hormone therapy "may be a marker of increased breast cancer risk," and women who develop breast tenderness after taking the drugs should consult their doctors about whether they should continue on the therapy.

Wyeth said in a statement that while the findings are interesting and may warrant further study, breast tenderness is not an established risk factor for breast cancer.

They said breast tenderness can occur in up to 25 percent of women after starting combined hormone therapy and is usually transient.

"Wyeth continues to support the appropriate use of hormone therapy and recommends that it be used at the lowest dose for the appropriate duration consistent with treatment goals and risks for the individual woman," the company said.

More than 400,000 women die from breast cancer globally each year. About 75 percent of breast cancers are estrogen-receptor positive, meaning they are fed by estrogen.

Agent Orange Diseases & VIetnam era Service Members

New bill to aid vets hurt by Agent Orange - by land & sea

BY Jake Pearson DAILY NEWS WRITER

Wednesday, October 28th 2009, 4:00 AM

The U.S. military dumped nearly 20 million gallons of the deadly herbicide to remove foliage during the Vietnam War.

Bobby Condon was a young kid from Flatbush when he enlisted in the U.S. Navy to fight in the Vietnam War.Nicknamed "Brooklyn" by fellow soldiers, Condon, now 63, has developed an Agent Orange-linked cancer - but was denied coverage by the Veterans Administration because he never set foot in Vietnam.

"I would have flown to Saigon and put my feet on the ground for 30 minutes [had I known]," said Condon, a flight operator on the USS Intrepid who last year was diagnosed with chronic lymphocytic leukemia (CLL), an incurable form of cancer. "But I was denied and I didn't get nothing."

This week, Sen. Kirsten Gillibrand will introduce legislation that will require coverage for the estimated 800,000 nationwide "blue-water vets," like Condon, who have illnesses linked to Agent Orange exposure but never set foot in Vietnam.

"Because of technicality in the law, hundreds of thousands of American veterans are being denied the health care benefits they need and deserve," said Gillibrand, adding there are about 13,500 such veterans in New York State.

The U.S. military dumped nearly 20 million gallons of the deadly herbicide to remove foliage during the Vietnam War. In 1991, Congress passed legislation requiring the VA to cover all sicknesses linked to Agent Orange exposure. But in 2002, the VA changed its policy to cover only those veterans who had "boots on the ground," excluding sailors and pilots such as Condon.

"I didn't even hear about Agent Orange until I came back," said Condon, who believes he got sick from working on planes that were flown through Agent Orange drop zones.

A spokesman for the VA wouldn't comment on pending legislation.

Daily Aspirin Linked to Steep Drop in Cancer Risk

MONDAY, Dec. 6 (HealthDay News) -- Long-term use of a daily low-dose aspirin dramatically cuts the risk of dying from a wide array of cancers, a new investigation reveals. Specifically, a British research team unearthed evidence that a low-dose aspirin (75 milligrams) taken daily for at least five years brings about a 10 percent to 60 percent drop in fatalities depending on the type of cancer.

The finding stems from a fresh analysis of eight studies involving more than 25,500 patients, which had originally been conducted to examine the protective potential of a low-dose aspirin regimen on cardiovascular disease.

The current observations follow prior research conducted by the same study team, which reported in October that a long-term regimen of low-dose aspirin appears to shave the risk of dying from colorectal cancer by a third.

"These findings provide the first proof in man that aspirin reduces deaths due to several common cancers," the study team noted in a news release.

But the study's lead author, Prof. Peter Rothwell from John Radcliffe Hospital and the University of Oxford, stressed that "these results do not mean that all adults should immediately start taking aspirin."

"They do demonstrate major new benefits that have not previously been factored into guideline recommendations," he added, noting that "previous guidelines have rightly cautioned that in healthy middle-aged people, the small risk of bleeding on aspirin partly offsets the benefit from prevention of strokes and heart attacks."

"But the reductions in deaths due to several common cancers will now alter this balance for many people," Rothwell suggested.

Rothwell and his colleagues published their findings Dec. 7 in the online edition of The Lancet.

The research involved in the current review had been conducted for an average period of four to eight years. The patients (some of whom had been given a low-dose aspirin regimen, while others were not) were tracked for up to 20 years after.

The authors determined that while the studies were still underway, overall cancer death risk plummeted by 21 percent among those taking low-dose aspirin. But the long-term benefits on some specific cancers began to show five years after the studies ended.

At five years out, death due to gastrointestinal cancers had sunk by 54 percent among those patients taking low-dose aspirin.

The protective impact of low-dose aspirin on stomach and colorectal cancer death was not seen until 10 years out, and for prostate cancer, the benefits first appeared 15 years down the road.

Twenty years after first beginning a low-dose aspirin program, death risk dropped by 10 percent among prostate cancer patients; 30 percent among lung cancer patients (although only those with adenocarcinomas, the type typically seen in nonsmokers); 40 percent among colorectal cancer patients; and 60 percent among esophageal cancer patients.

The potential impact of aspirin on pancreatic, stomach and brain cancer death rates was more problematic to gauge, the authors noted, due to the relative paucity of deaths from those specific diseases.

They also found that higher doses of aspirin did not appear to boost the protective benefit. And while neither gender nor smoking history appeared to affect the impact of low-dose aspirin, age definitely did: the 20-year risk of death went down more dramatically among older patients.

And while cautioning that more research is necessary to build on this "proof of principle," the authors suggested that people who embark on a long-term, low-dose aspirin regimen in their late 40s and 50s are probably the ones who stand to benefit the most.

Dr. Alan Arslan, an assistant professor in the departments of obstetrics and gynecology and environmental medicine at NYU Langone Medical Center in New York City, described the findings as "very significant."

"[This] is the largest study to show that people who take aspirin for a long period of time have a reduced risk of death from many cancers, especially gastrointestinal cancers," he noted.

"The take-home message for patients is that if someone is taking low-dose or regular aspirin, it may put them at a reduced risk of death from cancer," Arslan added. "However, if someone is not already taking aspirin they should talk with their physician before starting. Aspirin has risks of side effects, including bleeding and stroke."