Multivitamins Not Found to Reduce Risk of Cancer or Cardiovascular Disease

Many postmenopausal women take multivitamins in the belief that they help prevent cardiovascular disease or cancer, but a large study has found that they do neither.

Previous studies have had mixed results, some suggesting that multivitamin supplements are associated with a reduced risk for some cancers, others finding little or no effect.

For the new findings, published in the February issue of The Archives of Internal Medicine, researchers analyzed data from 68,132 women who were enrolled in a clinical trial and 93,676 in an observational study. They followed the women for an average of about eight years to track the health effects of multivitamins.

After controlling for age, physical activity, family history of cancer and many other factors, the researchers found that the supplements had no effect on the risk for breast cancer, colorectal cancer, endometrial cancer, lung cancer, ovarian cancer, heart attack, stroke, blood clots or mortality.

The scientists acknowledge that women who take vitamins also engage in other healthy behaviors, and that there may be unknown variables affecting their results.

“Consumers spend money on dietary supplements with the thought that they are going to improve their health, but there’s no evidence for this,” said Marian L. Neuhouser, the lead author and a nutritional epidemiologist with the Fred Hutchinson Cancer Research Center in Seattle. “Buying more fruits and vegetables might be a better choice.”

source: nytimes.com

Pregnancy May Delay Treatment Of Breast Cancer

By Karla Gale
NEW YORK (Reuters Health) - When breast cancer develops during pregnancy, its diagnosis and treatment of are often delayed. As a result, the woman's long-term survival may be jeopardized, doctors at the University of Texas M. D. Anderson Cancer Center report.

"Pregnancy-associated breast cancer is the most frequent cancer associated with pregnancy," Dr. George H. Perkins told Reuters Health, but it is low on the list of possible diagnoses that most doctors consider.

Furthermore, pregnancy can mask symptoms of breast cancer, making it more difficult to recognize, he noted.

The team identified all the cases of breast cancer associated with pregnancy that were treated at their institution between 1973 and 2006; 51 developed during pregnancy while 53 occurred within a year after pregnancy.

Women with pregnancy-associated breast cancer had more advanced tumors than similar young women who were not pregnant, indicating delayed diagnosis. Nevertheless, outcomes were similar in the two groups, the researchers report in the medical journal Cancer.

That's probably because most women were given a course of chemotherapy before undergoing surgery, Perkins said.

Among the 51 women who developed breast cancer during pregnancy, 25 received no treatment until after delivery. There was a trend toward worse 10-year survival rates with deferred treatment compared with treatment during pregnancy.

In addition to timely treatment, the research team also urges thorough diagnostic evaluation of breast symptoms that occur during pregnancy, using ultrasound or, with proper shielding of the fetus, mammography.

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

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

Soaring Cancer Drug Costs May Cripple Medicare

By Catherine Arnst
A new report says laws crimp Medicare's ability to control costs on cancer, leading to a 267% increase in drug spending over seven years

Medicare spending on cancer drugs has skyrocketed in recent years, and Congress has severely limited the program's ability to do anything about it, says a report in the Feb. 7 issue of The New England Journal of Medicine.

Although it is not the case with other drugs, Medicare must reimburse doctors or patients for virtually all cancer drug uses, even those not yet approved by the Food & Drug Administration. And it is not permitted to favor the lowest-cost treatment. As a result, says author Dr. Peter Bach of Memorial Sloan-Kettering Cancer Center in New York, "the prices of cancer drugs appear to be rising faster than the health benefits associated with them."

Bach notes that Medicare spending on drugs administered in a doctor's office, the vast majority of which are cancer treatments, rose from $3 billion in 1997 to $11 billion in 2004, a 267% increase. Overall Medicare spending rose by only 47% over the same period. Spending on cancer drugs is likely to rise even faster in coming years since a November decision by the agency that greatly expands patient access to cancer drugs as required by law.

Cost Gains Aren't Necessarily Treatment Gains

Medicare now allows reimbursement for an extremely broad range of "off-label" cancer treatments (meaning the drugs are used in ways that have not yet been approved by the FDA). Off-label uses are incredibly common in cancer therapy because oncologists often try a broad range of drugs against a tumor until they find one that works.

But Bach argues that the high spending on cancer drugs has brought little advantage to patients. Several studies have shown, for example, that the magnitude of the cost increase for each new drug for colon cancer exceeded the magnitude of improvement in efficacy. "It's pretty clear with many of these new drugs, their cost effectiveness is lower than previous drugs," Bach told BusinessWeek. "For each extra day or year of life they give, we're paying more than we did for the last one."

Cancer drugs, long a backwater of the pharmaceutical market, have become incredibly lucrative over the past decade as a new generation of treatments arrived with fewer side effects and better outcomes—but only for some patients. The prices of these drugs, however, are much higher than for cancer treatments in the past because there are few if any competitors for any one drug. Fifteen years ago, Bristol-Myers' (BMY) Taxol was the only commonly used cancer drug that cost more than $2,500 per month. Today, Genentech's (DNA) Avastin, Eli Lilly's (LLY) Erbitux, and Novartis' (NVS) Gleevec, all widely used, can cost $10,000 per month and up.

Medicare Could Negotiate Cancer Drug Prices

Medicare is barred by law from negotiating with drug companies on prices, but it can hold the line when it concludes that several drugs are virtually interchangeable. In that case, the agency can reimburse for the least costly alternative, no matter which drug is used, or choose a weighted average of prices for that class of drug. When it comes to cancer drugs, however, Congress requires Medicare to pay for any drug used "for a medically accepted indication," or for which the treated condition is major or life-threatening.

Bach recommends that Congress rectify the situation by establishing a center for comparative effectiveness—a concept embraced by President Obama's Administration—that would determine when a cancer drug's use is reasonable and necessary, based on clinical research. However, Bach acknowledges that patients may not be keen on this solution, as an authority other than their oncologist would end up restricting their access to some treatments. "This is going to be tough going," he says. "But that is maybe one of the trade-offs we need to make to bring prices under control."

Childhood Cancer Survivors Skip Breast Screenings

Many Women Who Survived Cancer in Childhood Forgo Breast Cancer Screenings Despite Increased Risk

Jan. 27, 2009 -- Women who underwent chest radiation therapy for a childhood cancer have a significantly higher risk for developing breast cancer at a younger age. Yet a new study in the Journal of the American Medical Association shows that many of them do not undergo the recommended screenings.

"Most young women at risk of breast cancer following chest radiation for a pediatric cancer, including women at highest risk (Hodgkin lymphoma survivors), are not being appropriately screened," Kevin C. Oeffinger, MD, of Memorial Sloan-Kettering Cancer Center in New York, and colleagues write.

About 20,000 to 25,000 women 25 and older in the U.S. have received chest radiation for a childhood cancer, according to background information in the journal report. For the past decade, experts have recommended yearly screening mammograms for women who received moderate- to high-dose chest radiation beginning either at age 25 or eight years after the treatment, whichever occurs last.

In 2008, the Children's Oncology Group (COG) updated the guidelines to include breast magnetic resonance imaging (MRI) along with yearly mammograms. The American Cancer Society recommends the same.

But some women in the new study had never even had a mammogram.

About 12% to 20% of women who receive moderate- to high-dose chest radiation for a childhood cancer will be diagnosed with breast cancer by age 45, but some develop the disease much earlier. "The risk of breast cancer begins to increase as early as 8 years after radiation and the [midpoint] age of breast cancer diagnosis ranges from 32 to 35 years," Oeffinger's team writes.

Oeffinger and colleagues based their findings on a 114-item questionnaire filled out by 625 female participants, aged 25 to 50, of the Childhood Cancer Survivors Study (CCSS). All the women had survived childhood cancer and had been treated with chest radiation.

The researchers compared the women's responses to similarly aged childhood cancer survivors who did not receive chest radiation, and siblings with no history of childhood cancer.

Among women 25 to 39 who had received chest radiation for childhood cancer:

• Most (47.3%) never had a mammogram.
• 63.5% had not received a screening mammogram within the past two years, despite guidelines that recommend annual exams.
• Less than a fourth (23.3%) had a screening or diagnostic mammogram in the previous year.
• They were three times more likely to have had a mammogram if their doctor recommended one.
  

Among women 40 to 50 who had received chest radiation for childhood cancer:

• They were more likely to have had mammograms than those aged 25 to 39.
• About two-thirds (76.5%) had a screening mammogram in the past two years (compared with 70% for women who did not receive chest radiation during childhood and 67% for siblings without history of childhood cancer).
• Slightly more than half (52%) had regular breast cancer screenings. (This finding was not significantly higher than those who never had chest radiation.)

Overall findings:

• Older women were more likely to undergo breast cancer screening in the past two years or to have received regular screening.
• The chances a woman would report having a mammogram jumped nearly twofold for every five-year increase in age.

"Findings from this study should provide the foundation for targeted interventions involving both clinicians and cancer survivors," the authors conclude.

An accompanying editorial written by doctors in the United Kingdom emphasizes the need for well-designed programs to provide ongoing education for women and their doctors about the risks of breast cancer after childhood chest radiotherapy.

Aliki J. Taylor, MD, PhD, MPH, of the University of Birmingham in Enlgand, and Roger E. Taylor, MD, MA, of Swansea University in Wales also encourage future studies to determine if exposure to radiation during mammography increases the cancer risk for these women, and to explore breast MRI as a possible alternative. They also suggest investigating whether more women in this high-risk group would undergo breast cancer screening if it were provided at no cost.

source: webmd.com

Remove Second Breast to Prevent Cancer?

By Miranda Hitti
Study Probes First Breast Cancer and Decision to Get Preventive Mastectomy in Second Breast

When a woman has a mastectomy to remove breast cancer in one breast, what should she do about the other breast?

Her first breast cancer may hold some clues, according to a new study, published in the advance online edition of Cancer.

"Not every woman who has breast cancer will get another breast cancer in the opposite breast," researcher Kelly Hunt, MD, tells WebMD.

"We tried to distill down some of those factors with our study and figure out which ones may be the most important ones," says Hunt, a professor of surgical oncology at the University of Texas M.D. Anderson Cancer Center.

But the findings don't amount to a checklist for getting a preventive mastectomy; breast cancer experts say that's still a personal decision that each patient must weigh with her doctors.
Mastectomy Study

Hunt's study included 542 women who had a mastectomy at the M.D. Anderson Cancer Center to remove a cancerous breast, and also chose to get a precautionary mastectomy in the unaffected breast, a procedure called contralateral prophylactic mastectomy.

Immediately after the contralateral prophylactic mastectomy, tests showed that the vast majority of women -- about 95% -- had no cancer in that breast, and only 1.5% had an invasive tumor in that breast.

Because women typically get preventive mastectomies to curb their future risk, Hunt's team also followed another 1,574 women who had mastectomy to remove a cancerous breast but chose not to have a preventive mastectomy in their second breast. Over the next four years or so (50 months), only 2.4% of the women developed breast cancer in their remaining breast. It's not clear how many of those cancers were invasive tumors.

Key Factors

Hunt and colleagues found three factors that were more common among women with cancer in the breast that they had removed as a precaution. Those factors are:

• Having more than one tumor in the breast that was first diagnosed.
• Having invasive lobular cancer in the breast that was first diagnosed.
• Being at high risk for breast cancer, according to the Gail model.

Hunt points out that invasive lobular breast cancer isn't common; it accounts for about 5% of all breast cancers. And she notes that the Gail model was designed to gauge future breast cancer risk for women who haven't been diagnosed with breast cancer; it wasn't intended for use for breast cancer patients.

Hunt says the Gail model may be a "useful tool" for women with breast cancer, but it will take more studies to confirm that. "We're hoping to develop a risk calculator that we can put online that would be useful to clinicians and patients," Hunt says.

"We're learning more and more that all breast cancers are not the same and they really shouldn't all be treated the same," she says. "We have general guidelines that really help to make sure women get the appropriate treatment, but each individual patient has unique factors and features ... that are important to consider."

Breast Cancer Experts Weigh In

Julie Gralow, MD, director of medical oncology at the Seattle Cancer Care Alliance and an associate professor of oncology at the University of Washington, tells WebMD that the risk factors noted in Hunt's study "make sense," but the study "doesn't convince me that we should be recommending" preventive mastectomy based on those factors.

"Nobody would recommend a prophylactic mastectomy in a group that over the next four years only had a 2.4% chance of getting it on the other side," says Gralow, referring to the comparison group in Hunt's study.

Women who have had breast cancer are at "high risk" for another breast cancer, "but 'high' is a relative term," notes Victor Vogel, MD, the American Cancer Society's national vice president for research.

"Whether the Gail model is the appropriate way to estimate that risk is highly debatable," Vogel says. "What you'd want is a study in which patients with a first breast cancer had a Gail model score, and then in five years, you look to see whether the Gail model accurately predicted the number of second breast cancers. And I am not aware that any such study has ever been done."

Gralow and Vogel also point out that when breast cancer is diagnosed, many doctors now perform MRI scans of both breasts. Those scans help show the extent of breast cancer in the affected breast and check the other breast for cancer.

Hunt's study started before that practice became common, so not all of the patients got MRI scans before opting for preventive mastectomy. Genetic testing also wasn't a routine procedure for the patients in Hunt's study, and isn't recommended for most breast cancer patients.
No Rush to Decide

Hunt, Gralow, and Vogel encourage women to take their time in deciding whether or not to get a contralateral prophylactic mastectomy and to focus on treating the breast cancer that they already know they have.

"A lot of women will come to my office and immediately say, 'Why don't you just take both breasts off?' and I try to explain to them that depending on their risk, not everyone needs that dramatic measure," Hunt says. "I always try to get patients to give much more time and consideration to it."

"There shouldn't be this sense that we have to do this [preventive mastectomy] right now," Vogel says. "This is not urgent, it's not life-threatening immediately ... it can be done after the primary therapy, when you get a little emotional distance from it and you can make these decisions with a calm heart."

Gralow notes that preventive mastectomy hasn't been shown to improve breast cancer survival, though it does cut the odds of getting breast cancer again. That's because if a recurrence happens, chances are it would be found and treated.

No Rush to Decide continued...

Still, "it's perfectly understandable that maybe women wouldn't want to go through that a second time," Gralow says. "For some women, even a couple percent chance of getting another breast cancer is enough to say, 'I just don't want to deal with it.'"

Gralow says she would support a woman who made that choice, as long as the patient understood the risks and benefits. Her advice: "If you're not sure, you shouldn't do it, because it's permanent."

source: webmd.com

What diets and supplements fight prostate cancer?

Asked by Edward Siguel, Rockville, Maryland
What are the best diets and supplements to prevent and treat prostate cancer? What about tomatoes? Or vitamin E? Or antioxidants?
I've heard arsenic may be effective, but some side effects are frequently undesirable.


Expert Answer:
Conditions Expert
Dr Otis Brawley
Chief Medical Officer,
American Cancer Society

There is no definite non-drug prostate cancer preventative. Epidemiologic studies suggest that men who have a diet high in fruits, vegetables, and soy products and low in fat (especially animal fat) may have a lower risk. Also men with diets high in tomato products seem to have a lower rate of prostate cancer. This was especially true of tomato products cooked in olive oil such as tomato sauces. There is growing interest in Vitamin D as a possible correlate with prostate cancer prevention.

These are all epidemiologic correlations. I caution that there have been epidemiologic correlations that when the identified behavior was tested in a controlled study, the behavior did not lower risk. For example studies suggested a correlation between Vitamin E and Selenium and reduced risk of prostate cancer. These hypotheses were tested in a study in which 32,000 men were randomized to a daily selenium pill versus placebo and 32,000 men were randomized to a daily vitamin E pill versus placebo for about five to six years. The men getting selenium and vitamin did not have a lower rate of prostate cancer compared to those getting the placebo and there was concern that selenium might be increasing risk of diabetes and vitamin E might actually be correlated with an increased risk of prostate cancer. The lesson here is be careful adopting things that sound good and have not been tested scientifically.

Some have advocated supplements advertised to promote prostate health and suggested they prevent prostate cancer. It almost always says in the small print that these supplements have not been tested. One should be careful.

The drug finasteride, marketed as Proscar by Merck, has been FDA approved as a medical treatment for benign prostatic hyperplasia or BPH. BPH is a common benign growth of the prostate that makes it difficult to urinate. The drug shrinks the prostate and improves urinary flow symptoms. In a large long term randomized study of finasteride and placebo, it was found that finasteride reduced the risk of prostate cancer by more than 25%. Those who were diagnosed with prostate cancer however had a higher proportion of high grade more aggressive prostate cancers. It has sense been shown that finasteride helps screening find small prostate cancers not that it causes high grade prostate cancers.

There are lots of questions about the benefits, risks and accuracy of prostate cancer screening so studies with finasteride continue.

I know of no data on arsenic and caution that it is a very dangerous compound.