6 Things You Need to Know About Pancreatic Cancer

Supreme Court Justice Ruth Bader Ginsburg is being treated for pancreatic cancer, but doctors reportedly caught the small tumor early, which may improve her odds of surviving the usually deadly disease. Pancreatic cancer is relatively rare, but in the past few years, it has gotten more attention because it has afflicted actor Patrick Swayze and Apple CEO Steven Jobs. Here are some facts you need to know:

1. Pancreatic cancer is not a particularly common form of cancer.
Despite the high-profile cases, fewer than 38,000 people were diagnosed with the disease last year, compared with more than 215,000 cases of lung cancer and almost 185,000 of breast cancer, according to the National Cancer Institute.

2. It is, however, extremely deadly.
For all stages of the disease combined, about 20 percent of patients will be alive a year after being diagnosed, and fewer than 4 percent of patients will be alive after five years, according to the American Cancer Society. But as with most cancers, early detection improves survival; those diagnosed with the earliest form of the disease have a five-year survival rate (excluding deaths from other causes) of more than 35 percent.

3. Early detection is tough because symptoms are so vague.
There may be no symptoms at all in the earliest stages, says the NCI. But the following symptoms may indicate a problem: pain in the upper abdomen or back, loss of appetite and/or weight loss, nausea and vomiting, jaundice, and weakness; those symptoms can also indicate a host of common medical problems, so don't panic. (Ginsburg, a colon cancer survivor, underwent CT scanning during an annual checkup, which turned up the pancreatic tumor.) The difficulty of early detection is one reason the disease in its most common form is so deadly, says Gauri Varadhachary, a medical oncologist specializing in pancreatic cancer at the M.D. Anderson Cancer Center in Houston. Other factors: It tends to metastasize elsewhere in the body very early on, and it's resistant to chemotherapy and radiation.

4. Like other cancers, it's not one disease.
There are different forms of pancreatic cancer. Jobs, for example, had what's called a neuroendocrine, or islet cell, tumor. These are very rare but also slower-growing, with a better prognosis. The most common kind is called an adenocarcinoma. We don't yet know what type Ginsburg has.

5. Some people are more at risk than others.
According to the NCI, there are seven known risk factors for pancreatic cancer: being older (as with most cancers, age puts people at risk), smoking or past smoking, having diabetes, being male, being African-American, having a family history of the cancer, and having chronic pancreatitis. Obesity and diet may also be risk factors, as might exposure to certain chemicals. But many cases arise in people with none of those factors, says Varadhachary. While there's no current screening test, trials are underway to see if endoscopy and ultrasound might make a difference in high-risk people.

6. Certain hereditary genetic mutations put people at risk.
Those with a mutation in the BRCA1 and BRCA2 genes, known for their role in breast and ovarian cancer (including breast cancer in men), are also at higher risk of pancreatic cancer. Researchers are also looking at other genes that may influence pancreatic cancer, as well as other, nonhereditary mutations.

source: usnews.com

Health Advocates React To Hospice Medicaid Cuts

S.C. Lawmakers Cut Medicaid Hospice Benefits From Budget

GREENVILLE, S.C. -- The hospice mission is to serve all, regardless of ability to pay -- but that may become a bigger challenge to fulfill for hospice groups statewide.

In efforts to save money, South Carolina state lawmakers decided to cut Medicaid hospice benefits -- a move that will force dying patients to fend for themselves.

Home care is just one of the many daily services hospice provides. But after February 28, Flora Ann Brown and others who are terminally ill will no longer have hospice benefits through Medicaid.

"What will happen to them if Medicaid is taken out?" said Brown's guardian, Elaine Burdette. "Will some lose their lives, have shorter lives, because they are not getting the care they need?"

The Department of Health and Human Services was forced to cut $137 million last year. By cutting Medicaid hospice benefits, it's expected to save nearly $16 million.

"These are people if we were not involved with them they would probably end up in emergency rooms or ICUs, because they wouldn't have the care needed in their home," said Pam Melbourne, president of the Hospice of the Upstate.

Melbourne said Medicaid pays an average of $130 a day per patient for hospice care. If those same patients went to the hospital for care, Medicaid would pay $1,300 a day.

"You're not eliminating the cost, just transferring it somewhere else," Melbourne said.

"It's hard knowing there are people out there who need our service, want our service, but have to make a decision whether or not to take our services," said registered nurse Christie Dove, of the Hospice of the Upstate.

There is a resolution calling on the state to stop the Medicaid cuts. The measure passed unanimously in the House, and is now in a senate committee.

Copyright 2009 by WYFF4.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed

Fertility Drugs and Ovarian Cancer Not Linked, Study Says

One of the largest studies to explore whether fertility drugs increase a woman’s risk of ovarian cancer found “no convincing association” with the cancer, though researchers said they would continue to follow tens of thousands of Danish women to see if their risk increased with age.

The generally reassuring results were consistent with several other recent studies, which have tempered an initial panic set off in the 1990s when reports suggested that the widely used fertility drugs might lead to a surge in a cancer that is relatively uncommon but often fatal.

The new study, published online Thursday in the British Medical Journal, did not rule out a cancer link altogether. It suggested that the risk of one form of ovarian cancer may be elevated after use of the popular drug clomiphene (brand name Clomid), though researchers said the finding could have been a statistical aberration.

“The message to give clinicians and patients is that over all these data provide further evidence that fertility drugs do not increase the risk of ovarian cancer to any great extent,” said Allan Jensen, an assistant professor of cancer epidemiology at the Danish Cancer Society and the first author of the paper. The senior author was Susanne Krüger Kjaer.

Dr. Jensen added, “You should always balance a possible small increase in ovarian cancer risk with the physical and psychological benefits of pregnancy made possible only by use of these drugs.”

As part of the study, the researchers followed 54,362 women who had been referred to Denmark’s fertility clinics between 1963 and 1998. They gathered information about the women from Denmark’s birth, cancer and hospital discharge registries, seeking more detailed information on medications from individual medical records of a subgroup of 1,241 of the women.

Among the 54,362 infertile patients followed for an average of 15 years, there were 156 cases of ovarian cancer. The average age of the women by the end of the study was 47.

Medical records were used to analyze the relative incidence of ovarian cancer in women who had taken either gonadotropins, clomifene citrate, human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone, compared with ovarian cancer rates of women who had not taken each of the individual drugs (but may have been treated with one of the other medications).

After adjusting for risk factors, the researchers concluded there was no increase in ovarian cancer risk associated with the drugs, nor was there an increased risk for women who underwent 10 or more cycles of treatment or for women who never became pregnant despite treatment.

The only statistically significant increase was seen in an analysis looking at different types of ovarian cancer tumors; in that analysis, women who had taken clomiphene citrate had a 67 percent increase in serous ovarian cancer tumors.

A separate analysis comparing women who had used a fertility drug with women who had not used any of the drugs also found no significant differences, Dr. Jensen said, but those figures were not included in the paper. There was also no difference in risk for women who had used a combination of fertility drugs.

The research in this area is complicated by the fact that infertile women appear to be at higher risk for ovarian cancer to begin with, which is why this study compared infertile women with one another rather than with other women in the population. In addition, because ovarian cancer is quite rare, large populations must be studied to obtain meaningful results.

The scientists cautioned that the women in the study would have to be followed for many more years to see if their risk increased over time. The mean age for diagnosis of ovarian cancer in women is 63.

“This is the largest study to look at ovarian cancer and they’re right, it’s a major strength of the study,” said Louise Brinton, the chief of the National Cancer Institute’s hormonal and reproductive epidemiology branch, adding that she was surprised the authors played down the finding of an association between Clomid and serous ovarian cancer, which may be more influenced by hormonal factors than some other tumors. Clomid is one of the older drugs in use.

Dr. Roberta Ness, dean of the University of Texas School of Public Health and the author of an earlier analysis that found no association between the drugs and cancer, said that finding might have been an aberration. “When you’re doing multiple analyses and splitting this way, that way and the other, the likelihood this is just a spurious finding is greater than the likelihood it’s real.”

source: nytimes.com

Why Soy Is NOT a Health Food

Review of the health problems with soy and why it is not the health food you were led to believe it is.

Coffee Drinkers Show Lower Dementia Risk

By Amy Norton
NEW YORK (Reuters Health) - In more good news for coffee lovers, a new study suggests that middle-aged adults who regularly drink a cup of java may have a lower risk of developing dementia later in life.

Whether coffee itself deserves the credit is not yet clear, but researchers say the findings at least suggest that coffee drinkers can enjoy that morning cup "in good conscience."

The study found that among 1,400 Finnish adults followed for 20 years, those who drank three to five cups of coffee per day in middle-age were two-thirds less likely than non-drinkers to develop dementia, including Alzheimer's disease.

The findings, reported in the Journal of Alzheimer's Disease, add to a string of studies finding that coffee drinkers have lower risks of several diseases, including Parkinson's disease, certain cancers and diabetes.

No one is recommending that people start drinking coffee to ward off any disease, however. Researchers do not know if it's components of coffee itself -- like caffeine or certain antioxidants -- or something else about coffee drinkers that explains the recent study observations.

The current study was an epidemiological one, explained lead researcher Marjo H. Eskelinen, which means it can point to an association between coffee and dementia risk, but does not prove cause-and-effect.

Still, "the results open a possibility that dietary interventions could modify the risk of dementia," Eskelinen, a doctoral candidate at the University of Kuopio in Finland, told Reuters Health.

There are a few potential reasons why coffee could help stave off dementia, researchers point out. One reason is related to the fact that coffee drinkers may have a lower risk of type 2 diabetes, and diabetes, in turn, is linked to a higher risk of dementia.

Coffee also contains plant chemicals, such as chlorogenic acid, that act as antioxidants and may help protect body cells from damage over time. For its part, caffeine may have a protective effect on brain cells because it blocks receptors for a chemical called adenosine, which has depressant effects in the central nervous system.

More research is needed to determine whether coffee is truly protective, but for now, Eskelinen said, "those people who have been drinking coffee can still do so in good conscience."

SOURCE: Journal of Alzheimer's Disease, January 2009.

Heart Test Can Pack Radioactive Wallop

Having a CT scan of the heart to check for heart disease? You may want to ask how your hospital plans to conduct the test. A new study suggests that people who get the common heart test can get a dramatic range of radiation exposures.

In the study of 1,965 patients undergoing the CT scans (also known as cardiac CT angiography), the median exposure was roughly equivalent to 600 chest X-rays, or about 12 milliSievert (mSv) of radiation, according to the report in this week's issue of the Journal of the American Medical Association.

Traditional angiography -- a technique in which a catheter is snaked though a blood vessel and dye is injected near the heart -- exposes patients to roughly half the dose of CT angiography, or about 5--8 mSv, says study author Jorg Hausleiter, M.D., of the University of Munich in Germany. It's also about the same amount of radiation as other standard cardiac screenings, such as the nuclear stress test.

There was a wide range of exposures in the study depending on the medical center and the way the tests were performed. The median radiation dose ranged from 4.6 to 30 mSv. About 80 percent of the centers studied used techniques to reduce radiation, such as adjusting the CT scan to the patient's size (meaning smaller patients get less radiation) or precisely timing the radiation dose to a particular point in the heart rhythm (which shortens the duration of exposure).

Overall, the danger posed by radiation is very small, according to Hausleiter. Being exposed to 10 mSv increases an individual's cancer risk by 0.02 percent, he says. However, the greater the exposure to radiation, the greater the risk.

Nearly all of the 50 sites in the international study, which included sites in the U.S., Canada, Europe, Asia, the Middle East, and Latin America, were making at least some effort to limit excess radiation. Other medical centers may be doing even less to cut down on radiation during the test, says Andrew J. Einstein, M.D., Ph.D., of Columbia University Medical Center, who wrote an editorial accompanying the study.

"Probably the group of centers which were studied in this paper are more sophisticated and more aware of radiation-reduction methods than your typical center that is performing cardiac CT angiography," he says. According to Einstein, many other sites may not be using radiation-reduction techniques at all.

When cardiac CT angiography is being used appropriately -- meaning, for example, in people with chest pain suggesting blocked heart arteries, rather than as a screening test for people with no symptoms of heart disease -- the benefits far outweigh the risk of the radiation, according to Einstein and Hausleiter.

However, cardiac CT scans are often marketed directly to patients interested in finding out how much plaque they have in their arteries, even though there's no evidence to show that this is an appropriate way to use the test, Hausleiter says. Health.com: 28 days, 28 ways to slash your risk of heart disease

Critics of cardiac CT angiography question whether its benefits warrant its current widespread use and the amount of radiation exposure. In fact, on Monday the American Heart Association issued an advisory warning that imaging tests, including CT scans, be used cautiously to minimize exposure to radiation.

In the new study, Hausleiter and his colleagues looked at patients who underwent cardiac CT angiography at 21 university hospitals and 29 community hospitals between February and December 2007. They found some regional differences in radiation exposure; for example, the median dose was three times higher in South America and Latin America than in Canada and the United States.

More than 70 percent of the centers in the study were using electrocardiographically controlled tube current modulation (ECTCM), which is currently the best-known strategy for reducing radiation dose. It involves timing the radiation beam to the diastole, when the heart is resting between beats. This is when the heart is the quietest, so it's easiest to get a good image of the organ.

Another strategy involves using less energy (100 kV instead of the standard 120 kV), which is effective but useful only for patients who are not obese. Finally, sequential scans take a series of pictures of the heart at the same exact point in the cardiac cycle, which also reduces radiation dose. This approach, as well as ECTCM, can be used only in people with slow, steady heartbeats. Another problem, Einstein noted, is that doctors often don't know what a patient's heart rate will be until he or she is on the table being readied for the scan.

But the fact that centers were able to use at least one radiation-reduction technique in most patients "should serve as a wake-up call to cardiac CT laboratories that do not routinely use these methods," Einstein writes in his editorial.

Patients who undergo cardiac CT angiography are within their rights to ask about what strategies, if any, are being used to reduce radiation dosage, he said.

"I would not recommend anyone to have this test done without discussing it with their doctor first. It's not something patients should be initiating on their own," he adds.

Caution is warranted not only due to the radiation exposure, according to Einstein, but also because the dye that must be injected into the veins to perform the test can cause kidney damage in some people. While a person's doctor would be able to judge if he or she would be harmed by the dye and thus shouldn't have the test, he said, "there are some sites that would be willing to perform this test on anyone."

David J. Brenner, Ph.D., D.Sc., of Columbia University's Center for Radiological Research was not involved in the current study, but he coauthored a 2007 report warning that overuse of CT scans could contribute to excess cancer risks. He said that such CT scans are still controversial.

New technology can decrease the radiation dose from cardiac CT scans, but as this study shows, "It's very variable from institution to institution -- in part because there is no regulatory body making sure that there is some degree of quality control," says Brenner

source: edition.cnn.com

Study Spotlights Helicopter Dangers

WASHINGTON -- Emergency medical helicopter pilots had the most dangerous jobs in the U.S., racking up fatalities at a faster clip than loggers and other historically risky professions, according to a new study presented to federal air-crash investigators.

In addition to sobering statistics about the hazards of such medical chopper flights for patients as well as pilots, testimony at a National Transportation Safety Board hearing Tuesday illustrated the drawbacks of relying on voluntary industry efforts to improve safety.

Comparing 13 medical helicopter crashes that claimed 29 lives in 2008 with federal fatality rates for many other accident-prone professions, Dr. Ira Blumen, of the University of Chicago Hospitals, concluded that statistically the pilots "far exceed any of the high-risk occupations."

At least 180 people have been killed or seriously injured in U.S. medical helicopter crashes over past decade, with 2008 ending up as the most deadly year ever. Against this backdrop, the safety board is prodding regulators to require helicopter operators to install devices that can warn pilots of impending collisions with the ground, as well as digital flight-data recorders that are better able to record what occurred in the event of a crash.

During the first of four days of hearings this week, the safety board also began examining how powerful economic forces -- ranging from consolidation to how much the government will reimburse operators -- affect safety margins.

Almost half of the world's roughly 26,000 choppers fly in the U.S. One industry representative testified that it's time for operators to become more aggressive in pursuing safety goals and embracing federal mandates.

"We have to, in essence, change the way we do business," said Matthew Zuccaro, president of Helicopter Association International. He said helicopter operators must pay more attention to flight planning, adverse weather hazards and ways to retrofit the existing fleet with advanced safety equipment.

At the same time, the Federal Aviation Administration released updated figures about the results of its years-long campaign to promote voluntary industry compliance.

An FAA spokesman told reporters that so far roughly 40% of U.S. helicopters have been voluntary outfitted with collision-avoidance systems, and only about 11% have recorders. Testimony by a Canadian helicopter official offered a stark contrast to the U.S. experience.

Sylvain Seguin, vice president of Canadian Helicopters, the largest medical chopper organization in Canada, described extensive safety programs that have allowed Canada to avoid a single fatality in this segment since the 1970s. Mr. Seguin emphasized that Canadian medical choppers have two-pilot crews as opposed to many single-pilot flights in the U.S. Funded and regulated strictly by government, the craft are equipped with the latest safety devices. They are required to adhere to strict instrument-flight rules and safeguards in all cases.

Write to Andy Pasztor at andy.pasztor@wsj.com