Integrative Medicine: Can We Truly Integrate Care?

Is it possible to develop a model of health that incorporates Complementary Alternative Medicine (CAM) therapies with conventional treatment? Join Beverly Burns, an Integrative Medicine Specialist at UCSF's Osher Center for Integrative Medicine, for a frank and stimulating discussion of integrative medicine. Series: "Women's Health Today" [6/2006] [Health and Medicine] [Professional Medical Education] [Show ID: 11113]

Complementary Medicine: Traditional Chinese

Nearly half the US populations turns to complementary, alternative and integrative practices to maintain or improve their health. Beverly Burns of UCSF's Osher Center for Integrative Medicine explores traditional Chinese medicine including acupuncture, meridians and chi. Series: "UCSF Mini Medical School for the Public"

Telemedicine a Cost-Effective Alternative to ER Visits

(HealthDay News) -- Telemedicine is a cost-effective way to replace more than a quarter of all visits to the pediatric emergency department, according to a community-wide study conducted in New York.

Ailments, such as ear infections or sore throats, that virtually always prove manageable by telemedicine made up almost 28 percent of all pediatric ER visits in Rochester, N.Y., during one year, according to investigators from the University of Rochester Medical Center.

Their findings were presented recently at the 2008 Pediatric Academic Societies annual meeting, in Honolulu.

"We learned that more than one in four local patients are using the pediatric emergency department for non-emergencies," lead investigator Dr. Kenneth McConnochie, a professor of pediatrics at the University of Rochester's Golisano Children's Hospital at Strong, said in a prepared statement. "This mismatch of needs and resources is inefficient, costly and impersonal for everyone involved."

McConnochie and his colleagues, who direct a Rochester-based telemedicine program that provides interactive, Internet-based pediatric health-care service to the area, analyzed data for all pediatric visits to the largest emergency department in the city. Based on their experience, they determined at least 12,000 visits were ones they routinely treat with success via telemedicine.

The other visits were either problems that sometimes are treatable through telemedicine, such as asthma attacks; or ones beyond the scope of the technology, such as a serious wound or injury.

"This would've not only freed up emergency resources to people who needed them more, it would have afforded smaller co-pays for parents and more timely, personalized care," McConnochie said.

In related research presented at the meeting, McConnochie suggested that telemedicine could also help insurers and the community by providing better quality care at a lower price -- saving insurers more than $14 per child per year in that local community.

The conclusion was reached by studying two groups of children that were almost identical, but one had access to their doctor's office, the emergency department and telemedicine technology for care, while the second had only the first two options.

"We found that the first group of families, which had access to telemedicine for their children, did in fact access care for illness overall nearly 23 percent more often than the second group," McConnochie said.

But since children with telemedicine access had 24 percent fewer ER visits, which cost about seven times the cost of a doctor office or telemedicine visit, the telemedicine group ultimately still cost insurers less per child over a year.

More information
The Nemours Foundation has more about children's health.

Doctor-Patient Talks Affect Use of Breast Reconstruction Surgery

(HealthDay News) -- A lack of patient-doctor discussion may contribute to socioeconomic, age and race-related disparities in the use of breast reconstruction after mastectomy, says a study by researchers at Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston.

The study also found that breast reconstruction was more likely to occur after a surgeon discussed options with a patient, which suggests the need to increase and improve these conversations, the researchers said.

They analyzed data on 626 patients who underwent mastectomy for breast cancer. Of those patients, 253 (40.4 percent) received breast reconstruction, and 249 (39.8 percent) had a documented discussion about the option with a doctor.

About 70 percent of those who had a discussion about breast reconstruction had the procedure. But the researchers found that increasing age and lower levels of education were associated with lower rates of a documented discussion. Hispanic patients, those born outside of the United States, and those whose primary language wasn't English were less likely to undergo reconstruction after discussing it with a doctor.

The study was published in the April issue of the Journal of the American College of Surgeons.

The decision to have breast reconstruction is a complex one that's influenced by access to care, patient preference and a doctor's interaction with the patient, the researchers noted.

"Patient preferences should be respected, but an informative discussion of reconstruction is required to help patients understand and weigh the risks and benefits of this procedure," Dr. Caprice C. Greenberg, Instructor of Surgery in the Center for Surgery and Public Health at Brigham and the Center for Outcomes and Policy Research at Dana Farber, said in a prepared statement. "We learned that physicians need to improve communications with all women undergoing a mastectomy, regardless of age, race or socioeconomic status."

She and her colleagues said doctors should systematically address the issue of breast reconstruction with all patients undergoing mastectomy. Doctor-patient discussions could include interpreters and educational materials to ensure an informative discussion regardless of a patient's primary language, ethnicity or education level.

More information

Calcium Scans Help Predict Coronary Risk

(HealthDay News) -- Scanning the heart arteries for calcium deposits can help predict future cardiac problems, a new study shows, but experts aren't sure that adding such scans to routine checkups would be worth the cost.

"It has been shown to be predictive" of potential heart trouble, said Dr. Diane Bild, deputy director of the division of prevention and population sciences at the U.S. National Heart, Lung, and Blood Institute, which funded the study. "Whether it is actually beneficial to the people who are screened has not been shown."

A calcium scan using computed tomography (CT) costs $300 to $600. These scans look for calcification -- hardening of the arteries caused by high blood fats and calcium deposits that can eventually cause blood vessel blockage. The scan is a potential competitor for much less expensive tests for coronary risk, such as blood cholesterol and blood pressure readings.

The new study involved more than 6,700 American men and women across a number of racial and ethnic groups -- white, black, Chinese, Hispanic -- who were followed for an average of 3.8 years. It found that the risk of a coronary event was nearly 10 times higher for those with the highest calcium deposit scores than for those with the lowest.

"This study was launched in 1999, a time when there was a lot of interest in whether this new test could predict coronary artery disease," Bild said. "A lot of studies have been done in predominantly white populations. This was one of our efforts to include minority groups."

The study does show that calcium scanning "modestly improves predictions over traditional risk factors," she said. "Several pieces of information are needed in order to understand whether this is clinically useful."

The findings are published in the March 27 issue of the New England Journal of Medicine.

The cost of such scans could be reduced, according to a statement from study lead author Dr. Robert Detrano, professor of radiological sciences at the University of California, Irvine, who is traveling in China. Scans have been done for just $30 in China, Detrano noted.

"It is mostly an issue of cost," said Dr. William S. Weintraub, chief of cardiology at the Christiana Health Care System, the largest health-care system in Delaware, who wrote an accompanying editorial in the journal. "It does add to our discrimination, but it costs a couple of hundred dollars and we're not sure how you use it."

Reducing the cost would make the test more usable, and "more epidemiological studies showing its value in risk prediction would be of great value," Weintraub said.

"But I'd be uncomfortable now with the idea of recommending this for everybody, or even defining a middle ground where we are unsure how we treat people so they get this first," he said.

A calcium scan also carries some risk, since it exposes a person to radiation, Bild noted. "It would be worth it if the benefit outweighed that risk," she said. "We don't clearly have both sides of that equation established."

More information
For more on coronary calcium scans, visit the U.S. Heart, Lung, and Blood Institute.

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Pain Relief for Osteoporosis Patients With Fractures

(HealthDay News) -- In osteoporosis patients with spinal fractures, vertebroplasty provides significant pain relief and helps decrease disability, according to a new study.

Vertebroplasty involves injection of medical-grade bone cement into a fractured vertebra to shore up the fracture and provide pain relief. It's used to treat painful vertebral compression fractures that don't respond to conventional medical therapy with analgesics or narcotics.

The study followed 884 patients for five years who were assessed before and after vertebroplasty. Their average pre-treatment pain score on an 11-point scale decreased from 7.9 (+/- 1.5) before treatment to an average of 1.3 (+/- 1.8) after treatment.

The patients' ability to manage everyday tasks such as washing and dressing was measured using the Oswestry Disability Questionnaire. The patients' scores went from an average of 69.3 percent (+/-13.5) a month before treatment to 18.8 percent (+/- 6.9) a month after treatment.

"These data provide good news for physicians and osteoporosis patients. Many osteoporosis patients with compression fractures are in terrible pain and have a greatly diminished ability to perform basic daily activities, such as dressing themselves," Dr. Giovanni C. Anselmetti, an interventional radiologist at the Institute for Cancer Research and Treatment in Turin, Italy, said in a prepared statement.

The study also found that vertebroplasty didn't increase the risk of fracture in nearby vertebra.

"Vertebroplasty is already known to be a safe and effective treatment for osteoporotic vertebral fractures. Osteoporosis patients remain susceptible to new fractures, which often occur in the contiguous vertebra to an existing fracture. Our large-scale study shows that vertebroplasty does not increase the risk of fracture in the level contiguous to previously treated vertebra and that these new fractures occur at the same rate as they would in osteoporosis patients who did not have vertebroplasty," Anselmetti said.

The study was to be presented Tuesday at the annual scientific meeting of the Society of International Radiology.

Osteoporosis affects about 10 million Americans and causes about 1.5 million vertebral fractures each year, according to the U.S. National Institutes of Health. Multiple vertebral fractures can cause chronic pain, disability, loss of independence, stooped posture, and compression of the lungs and stomach.

More information
The American College of Radiology/Radiological Society of North American has more about vertebroplasty.

Anxiety Helps Elderly Women Live Longer

(HealthDay News) -- Higher anxiety levels may help elderly women live longer, but may harm older men, U.S. research shows.

A team at the Cleveland Clinic and Case Western Reserve University followed 1,000 seniors in three Florida retirement communities for up to 15 years.

They found that women with higher levels of anxiety at the start of the study lived longer than others. Year-to-year changes in anxiety levels didn't appear to affect women's survival, either.

In contrast to women, men with higher anxiety levels at the start of the study were more likely to die earlier, the researchers said.

"Our research indicates that anxiety may have a protective effect on women, possibly causing them to seek medical attention more frequently than men," Dr. Jianping Zhang, of the department of psychiatry and psychology at the Cleveland Clinic, said in a prepared statement. "In contrast, increasing anxiety over time is more detrimental to men. Additional research is needed to better understand the mechanisms and effects of anxiety in men and women."

The study is noteworthy due to the large amount of data collected over a long period of time, noted co-researcher Dr. Leo Pozuelo, who is also in the department of psychiatry and psychology at the Cleveland Clinic.

"Baseline higher anxiety could have led the female study participants to be more active and health-conscious," Pozuelo said in a prepared statement. "We are not certain of the absolute connection between anxiety and mortality, but this data set shows there may be a gender difference."

The study was to be presented Thursday at the annual meeting of the American Psychosomatic Society.

More information
The American Academy of Family Physicians has more about anxiety.

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Health Tip: When Caregiving Becomes Too Stressful

(HealthDay News) - Caring for a loved one who needs extensive help can be physically and emotionally draining. To continue providing loving care, it's important to monitor your own well-being, too.

Here are some warning signs of caregiver stress, courtesy of the American Academy of Family Physicians:

• Feeling unusually angry or resentful toward the person you care for, yourself or your family.


• Withdrawing from social activities.


• Anxiety.


• Sleeping too much or having difficulty sleeping.


• Feeling irritable.


• Being sick frequently.

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Born to Be Obese?

(HealthDay News) -- The brain circuitry that controls appetite might be wired differently in some people, and that could predispose them to obesity, California researchers suggest.

The study was conducted in rats, not humans, and yet it could ultimately lead to novel obesity treatments, said Philip Smith, director of the Office of Obesity Research at the National Institute of Diabetes and Digestive and Kidney Diseases.

"It is not just about drugs that modify short-term appetite," he said, "there may be drugs that stimulate development of the appropriate neural pathways. So, it is an exciting, but very early, time in this field."

The study was published in the February issue of Cell Metabolism.

Sebastien Bouret, an assistant professor of neuroscience at the University of Southern California, and his colleagues examined neural circuits emanating from the appetite, hunger and body-weight control center of the brain -- the so-called arcuate nucleus of the hypothalamus (ARH) -- in a series of rats bred to be either prone to, or resistant to, obesity.

The team found fewer neural connections projecting from the ARH in obesity-prone animals than in their leaner counterparts. Surprisingly, Bouret said, this deficiency developed very early in life, before the animals became obese, and appeared to extend into adulthood.

"Somehow, these animals are programmed to become obese," Bouret said. "The obesity is hard-wired into the brain."

When the researchers then looked at why the brains of obese rats differed from their normal-weight counterparts, they found that the neurons from obesity-prone animals were less responsive to leptin, a hormone that controls the development of these circuits, and which also signals the body's energy status and controls metabolic rate.

"This paper presumes to say, these animals must be leptin-resistant, and that is why the pathways are not developing," said Smith.

But that doesn't mean they are doomed to a life of severe obesity, said Dr. Barbara Kahn, chief of the Division of Endocrinology, Diabetes and Metabolism at Beth Israel Deaconess Medical Center, in Boston. How they live their lives also matters.

"It is important not to 'blame' the obese person or imply that he/she is responsible for being obese," Kahn noted. "Having said that, reasonable, healthy caloric restriction and a safe and sustainable program of physical activity can help limit weight gain and often bring about some degree of weight loss. In addition, healthy eating and regular exercise can reduce the complications of obesity such as type 2 diabetes and cardiovascular disease."

At the same time, she added, not everyone can wear a size 4.

"There is a certain aspect of genetics that sets somebody in a certain range of possible body weights, and then how that person lives his or her life will determine whether they are at the bottom or top of the range," she explained.

Human obesity has both genetic and environmental roots. The rats used in this study, like most humans, developed obesity when fed a high-energy diet. On a normal diet, they were heavier than normal rats, but not yet obese.

"This is quite an exciting paper," said Smith, "because it links more closely to human behavior than most rodent models we have seen."

The findings also suggest a possible therapeutic approach to combating human obesity. If drugs could be designed to influence the formation of neural circuits during development and targeted to at-risk pregnancies, Smith said, "there is a good likelihood we could have successful interventions that improve the health of the mother, and which have a major impact on disease risk for the infant, during pregnancy."

A related study from Boston University researchers in the same journal found that bulking up muscle mass can lead to a general metabolic improvement in obese individuals. "Interventions designed to increase skeletal muscle mass in at-risk human populations may prove to be critical weapons in the fight against obesity and obesity-related comorbidities, including diabetes, heart disease, stroke, hypertension and cancer," an accompanying editorial stated.

More information
For more on obesity, visit the National Institute of Diabetes and Digestive and Kidney Diseases.

Terriers Join Fight Against a Killer Disease in Humans

(HealthDay News) -- A feisty breed of terrier could stop scientists from barking up the wrong tree as they research a deadly lung disease in humans.

The illness, called idiopathic pulmonary fibrosis (IPF), affects 128,000 Americans, is typically fatal within three years of diagnosis, and kills more than 40,000 people in the United States annually -- a death toll equivalent to that of breast cancer.

A fatal condition that looks remarkably like IPF also strikes the diminutive West Highland White terrier ("Westie"), however. And recently, medical scientists from the human and veterinarian worlds met for the first time to share information and pool resources against a mysterious killer.

"People may be a little startled at first to learn about this idea -- 'You're kidding me, you actually think there's promise in studying this dog to help my Dad with this disease?' And the answer is -- 'Yes'," said Mark Shreve, chief operating officer of the patient advocacy group Coalition for Pulmonary Fibrosis, based in San Jose, Calif.

Because the Westie is so tightly bred, and because the illness progresses faster in dogs than humans, it is conceivable that dog-based research might yield valuable clues to the genetics or environmental factors that trigger pulmonary fibrosis in both species, experts explained.

"And if it transpires that it is the same disease, then obviously the options are limitless as to how we can look at information from dogs and use it to understand the disease in humans and vice versa," said Dr. Brendan Corcoran, director of the Hospital for Small Animals at the University of Edinburgh, Scotland, and a pioneer in researching pulmonary fibrosis in Westies.

According to Shreve, most people find it hard to believe that a disease like IPF even exists amid the wonders of modern medicine.

"We are dealing here with one of the few diseases left on the planet for which there are no proven causes and no treatments," he said.

Idiopathic pulmonary fibrosis occurs spontaneously, although certain factors -- such as smoking or exposure to airborne toxins -- do raise risks for the illness. "IPF is a progressive scarring process in the lungs that gradually robs a person of the ability to breathe," Shreve explained.

Some sort of signaling seems to go awry at the cellular level, he said, converting normal, expansive lung tissue into stiff, fibrotic scar tissue.

"Once it starts in patients with IPF, your body just never sends a signal to stop that scar tissue from being produced," Shreve said. "This scar tissue is obviously not lung tissue that is able to process oxygen."

There have so far been very few promising leads in discovering the root causes of IPF, said Dr. Jesse Roman, one of the country's leading researchers in the disease and a professor of medicine at Emory University in Atlanta.

"Studies do suggest very specific [cellular] pathways, and there's a number of molecules that everybody is tuned into," he said. "But how you block them and how they relate to what happens in humans, that's less clear."

So, scientists are turning to creative new ways of looking at IPF.

Cross-talk between scientists worldwide led to the first-ever summit on the disease that included both veterinary and human medical researchers. The meeting was held in October on the campus of Purdue University in West Lafayette, Ind., and was attended by Corcoran, Roman and others. It was sponsored by the Westie Foundation of America and the American Kennel Club (AKC) Canine Health Foundation.

Westies, which grow to just under a foot in length, are described by the AKC as "courageous and self-reliant, but friendly."

"They're a very popular pet because of their size and their nature," Corcoran said.

However, pulmonary fibrosis does pop up in the breed with regularity, first revealing itself as excessive panting and shortness of breath. The illness also tends to develop in the terriers' late middle-age (about eight or nine years), mimicking its typical onset in humans at about age 50 to 60.

Westies inevitably succumb to the lung fibrosis about a year and a half after their diagnosis, Corcoran said.

Still, "there's still the contentious issue of whether this is the same disease as occurs in humans," he said. The exact prevalence of the disease among Westies is also unclear, he added. That means the first aim of Westies-centered research will be epidemiological -- studying disease prevalence and gathering a core of dogs and their owners that researchers might follow going forward.

Getting postmortem samples of canine lung tissue will also be crucial to a better understanding of the causes of the disease, Corcoran said. But that has its own challenges, he added.

"Getting owners to volunteer their dogs for necropsy is always problematic," he said. In fact, it's often "harder in many instances to get lung pathology samples from dogs than it is from humans," Corcoran said.

"However, one of our plans is to try and build up a group of concerned owners who will volunteer to donate their dog when that day arrives. We've been having some discussions on that already with our colleagues in America," Corcoran said. "Hopefully, the more publicity that we get with this condition, the more we may get owners coming forward and volunteering their dogs for research."

Corcoran and the other experts said that a cure for IPF is definitely not around the corner -- the disease has been as tenacious in keeping its secrets as, well, a terrier.

But Westies may be just the foe in the fight against IPF requires. Corcoran pointed out that the dogs' tight breeding means genetic research could yield important clues. And their shorter lifespan -- a seventh of that of humans -- means scientists can watch the disease in "fast-forward," which might also speed research.

Westies are also free of certain confounding factors, such as smoking, that often muddle human research. "The dogs might turn out to have a very pure form of the disease that allows you to investigate the disease itself and not worry about other factors," Corcoran noted.

Given all of this, "why wouldn't you look at a Westie and research how the disease progresses?" said patient-advocate Shreve.

"We think it's a very creative approach to trying to help out humans," he said, "and our patients don't really have the patience to hang around waiting for a miracle.

More information
To learn much more about IPF, visit the Coalition for Pulmonary Fibrosis.

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Realistic Expectations Help Ward Off Holiday Depression

(HealthDay News) -- For many people, heightened expectations, financial and social stress, and memories of lost loved ones can cause tension, anxiety and sadness.

All of that can lead to seasonal blues during the holidays, says an expert at Cedars-Sinai Medical Center.

For example, people who expect difficult relationships to improve just because it's Christmas are likely to be disappointed.

"In terms of relationships, nothing magical 'just happens' during the holidays," Dr. Mark H. Rapaport, chair of the department of psychiatry and behavioral neurosciences at Cedars-Sinai, said in a prepared statement.

"If you don't get along with your in-laws during the year, you're probably not going to get along with them during the holiday season, either. Understanding that before you go to visit them can improve how you'll handle your feelings while you're there," he said.

Planning ahead can help people cope with many sources of holiday-related stress and anxiety.
"If you plan ahead and focus on what you really enjoy about the season, you can spend more time 'living in the moment,' which is the key to getting the most out of each holiday experience," Rapaport said.

He offered some tips for coping with the holidays:

• Have realistic expectations about interactions with family and friends.
• Make a list and prioritize activities that you feel are most important.
• Limit your drinking. Too much alcohol can lead to bad behavior, hangovers, and remorse which, in turn, can lead to depression.
• Share holiday responsibilities such as shopping, cooking, party planning, and activities.
• Get regular exercise. Walking for just 30 minutes three times a week can give you a big boost.
• Keep your holiday spending under control.
• Eat well, get enough rest, and make time for yourself.
• Spend time with caring and supportive people and reach out to those who may benefit from your support.
• Don't worry too much about details. Live in the moment as much as possible and look for meaningful moments throughout the season.

More information
Mental Health America has more about holiday depression and stress.

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Health Tip: What's Plantar Fasciitis?

(HealthDay News) - Plantar fasciitis is a common condition -- caused by overuse -- and characterized by often severe pain in the heel.

The American Academy of Orthopaedic Surgeons offers additional information about the condition, including its risk factors:

• Women and people who are overweight are more likely than others to develop plantar fasciitis.
• Frequent running or walking for exercise may increase your risk of developing the condition.
• People with flat feet or very high arches are at greater risk.
• Standing or walking on hard surfaces for long periods also may increase your risk.
• The injury usually doesn't hurt during exercise, but pain begins to develop afterward.
• Pain may be most severe when waking up in the morning, or after rest.
• Plantar fasciitis requires treatment to prevent it from becoming chronic.

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Cancer Patients Gain From Reporting Symptoms Online

(HealthDay News) -- Having cancer patients report to doctors on their symptoms and side effects online may improve their care, a new study finds.

Even the sickest cancer patients are willing and capable of reporting their symptoms online, says a team from Memorial Sloan-Kettering Cancer Center in New York City.

"Cancer care has become increasingly complex, causing office visits to become more compressed. This makes it challenging for the clinician to comprehensively assess each patient's symptoms in that brief window of time," study author Dr. Ethan Basch, a medical oncologist, said in a prepared statement.

"Because cancer therapies can be highly toxic, early detection of symptoms and timely treatment is vital. What is exciting to us about online self-reporting is that patients can alert clinicians to crucial symptoms in real time," Basch said.

The study included 107 lung cancer patients receiving outpatient chemotherapy who had access to a secure Internet patient reporting system developed by Basch and his colleagues. The patients were able to access the Symptom Tracking and Reporting (STAR) site using computers in waiting room kiosks and at home to report cancer symptoms and chemotherapy-related side effects.

The patients were followed for up to 16 months and 40 visits. All of the patients used the waiting room kiosks at some or all of their office visits, and an average of 78 percent logged onto the system at any given office visit. Patients were more likely to use STAR if they had prior computer experience.

The study found that 98 percent of patients found STAR easy to use, 90 percent said it was useful, and 77 percent believed it improved the quality of their discussions with clinicians.
The study appears in the Dec. 1 issue of the Journal of Clinical Oncology.

More information
The U.S. National Cancer Institute has more about coping with cancer.

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Health Tip: Female Infertility

(HealthDay News) - About 7.3 million females in the United States aged 15 to 44 had difficulty becoming pregnant or carrying a baby to term in 2002, according to the U.S. Centers for Disease Control and Prevention.




The U.S. Department of Health and Human Services lists these factors that may contribute to female infertility:

• Age.
• Stress.
• Unhealthy diet.
• Being overweight or obese, or significantly underweight.
• Strenuous exercise.
• Smoking or drinking alcohol.
• Sexually transmitted disease.
• Health conditions that affect hormone production.

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Prostate Cancer Treatments Often Compound Existing Health Problems

(HealthDay News) -- More than a third of prostate cancer patients may receive treatments that are inappropriate because of problems they are already having with urinary, bowel or sexual function, a new study suggests.

These mismatches might occur, because patients don't give enough information to their doctor or because their doctor favors a particular type of treatment, according to the report in the Nov. 26 online edition of Cancer.

"We found an awful lot of patients whose treatment seemed to be contraindicated by urinary, bowel or sexual problems they had before they got treated," said lead researcher Dr. James Talcott, from the Center for Outcomes Research at Massachusetts General Hospital Cancer Center in Boston. "That's pretty good evidence that information wasn't transmitted or didn't factor in with the treatment decision."

Unlike other cancers, there are several treatment options for prostate cancer. The treatment that is best for an individual patient is based on several factors, including stage at which the cancer is diagnosed, age of the patient, and existing problems with urinary, bowel or sexual function that the patient has.

Treatments include external radiation therapy; brachytherapy, in which tiny radioactive particles are implanted into the prostate gland, and the surgical removal of the prostate gland.
Although these treatments are effective, each has a different set of side effects. External radiation can lead to bowel dysfunction, brachytherapy can cause urinary problems, and surgery can damage nerves involved in sexual function.

Treating patients who already have problems in these areas with a procedure that could exacerbate their problem is usually not recommended.

For example, treatment designed to preserve normal functions, such as nerve-sparing, prostate-removal surgery, is not appropriate for patients who have already lost sexual function, Talcott said.

To find the extent of treatment mismatches, Talcott's team collected data on 438 prostate cancer patients. Patients were asked to complete questionnaires that included questions about urinary incontinence and other urinary problems, and bowel and sexual dysfunction.

The researchers found that 89 percent of the patients had some level of urinary, bowel or sexual problem before starting treatment. Among these patients, 34 percent of those with one serious symptom had a mismatched treatment, as did 37 percent who had a less serious symptom. Moreover, 40 percent of those who had several symptoms also received contraindicated therapy.

In addition, among patients with significant dysfunction in all three areas for whom no treatment would be recommended, only 5 percent chose watchful waiting. In this strategy, patients are not treated but are followed closely.

These mismatches appear to occur because doctors and patients don't communicate well. Patients are often reluctant to talk about urinary, bowel and sexual problems, Talcott said. "And, sometimes patients override their doctor's recommendation," he added.

Talcott also thinks that physicians can be wedded to a particular treatment at the exclusion of others. "Surgeons believe in surgery, and radiation oncologists believe in radiation," he said. "That may be part of the problem."

To counterbalance physician bias, patients should get another opinion, Talcott said. "Patients should always get a second consult," he said. "It's a good idea to talk with a surgeon, a radiation oncologist and possible a medical oncologist."

One expert thinks that patients need to make an informed decision about which treatment is best.

"The kind of doctor that you see often predetermines the treatment you receive," said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society. "Urologists are much more likely to have a surgical solution, and those who see a radiation oncologist are more likely to have radiation."

Patients need to be well-informed about their condition and the possible treatments and their side effects, Brooks said. "Patients need to arm themselves with as much information as possible about what their treatment options are, and what some of the contraindications of particular treatments are," he said.

Men also need to know what all the treatment options are, Brooks said. "Men need to be aware that, in some cases, depending on their overall medical condition and the stage of their cancer, that it is, at times, appropriate not to have any active treatment," he said. "Watchful waiting is a legitimate option in a significant proportion of men."

"In addition, doctors need to work with their patient to choose the best treatment option, Brooks said.

"If one takes the time to have a discussion, educate the patient and not rush them into a decision, then you may be able to allow them to get past their emotional response and make a more educated, logic-based response," Brooks said.

Brooks noted that because there are so many treatment options in prostate cancer, patients may insist on a particular treatment even though it's not the best choice for them.

"Where treatments are contraindicated in other places in medicine, doctors don't provide a treatment for a patient just because that's what they say they want," Brooks said. "You explain that that treatment is simply the wrong treatment for you, and therefore, we are not going to take that approach."

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For more on prostate cancer, visit the American Cancer Society.

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Urine Test Results Can Point to Heart Dangers

(HealthDay News) -- Even a small amount of a protein called albumin in the urine of patients with stable coronary artery disease increases their risk of cardiovascular death, say U.S. researchers.

The findings from this study of almost 3,000 patients, age 50 and older, with stable coronary artery disease (CAD) have implications for assessing and perhaps treating patients with vascular disease.

The study was published in the current issue of the journal Circulation.

Albumin is normal and necessary in blood, but its presence in urine indicates leakage in the kidney filtration system and possible damage to cells that line the kidney's blood vessels, according to background information in the study.

"We found that virtually any degree of albuminuria, even albumin below the level we call microalbuminuria, placed a patient at significantly higher risk of cardiovascular events," lead author Dr. Scott D. Solomon, associate professor of medicine at Harvard Medical School and director of Noninvasive Cardiology at Brigham and Women's Hospital in Boston, said in a prepared statement.

He and his colleagues also found that the hypertension drug trandolapril (an ACE inhibitor) lowered albumin levels in patients' urine.

The findings of this study and previous research by the same team indicate that "we cardiologists need to pay more attention to kidney function in our patients, and we need to look at two aspects -- filtration and albuminuria," Solomon said.

"It is important for cardiologists to understand that these are not patients who will even come to dialysis or even necessarily see a nephrologist," he said. "But they do have mild kidney disease that puts them at increased risk for a cardiovascular event."

More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about protein in urine.
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Cell Insights May Predict Breast Cancer's Spread

(HealthDay News) -- U.S. researchers believe they're on the way to solving a major question about breast cancer: Which women have a type of lesion in their breast duct that will progress to invasive disease?

"It's an exciting step forward -- people have been trying to get traction on this big clinical problem for about 40 years, and this is a big crack in the door," said lead researcher Thea Tlsty, a professor of pathology at the University of California, San Francisco.

Ductal carcinoma in situ (DCIS), as this type of lesion is officially known, is diagnosed in about 47,000 American women every year, according to the U.S. National Cancer Institute. To prevent its recurrence as invasive breast cancer, DCIS generally is treated by lumpectomy alone (approximately 25 percent of cases) or lumpectomy with adjunctive treatments such as radiation, chemotherapy, and/or hormones (approximately 40 percent).

In about 25 percent of cases, complete mastectomies are performed. Less than an estimated 5 percent of women choose "watchful waiting" in lieu of a surgical intervention, Tlsty said.

But doctors are still confronted with a guessing game when it comes to predicting those patients at highest risk for recurrence, Tlsty said. "Only about 12 to 15 percent of women diagnosed with DCIS are going to have a future invasive cancer, and all the others won't. Up until now, the problem was that we couldn't distinguish the 12 to 15 percent from those who were not [at risk]," explained Tlsty.

Consequently, some women unknowingly are overtreated by having a mastectomy, and others are undertreated if they chose a course of watchful waiting rather than surgical intervention, Tlsty added.

In their pilot study, published in the November issue of Cancer Cell, the UCSF team looked at how a collection of biomarkers, including molecules called p16 and ki67, interact to predict invasive tumors, she explained.

Because this initial study was done on tissue samples from 70 women, a larger retrospective study is under way at UCSF to validate the initial results, Tlsty said.

Further research, including a large prospective trial, is also needed before the findings can be ready for clinical use, she added. If that work upholds the results of the pilot study, the biomarkers could be ready for clinical use within four to five years, Tlsty said.

Dr. Joseph Geradts, a professor of pathology at Duke University in Durham, N.C., said that finding biomarkers that predict the conversion of DCIS into invasive cancer is "the holy grail of breast cancer research." He said there have been a number of previous studies that have been published, but, so far, they've been "mostly a fruitless effort."

According to Geradts, the UCSF study "is valuable," because "the authors propose two new biomarkers that in the past have not been looked at." The UCSF team's findings "are intriguing preliminary data" that "merit confirmation and subsequent studies," he added.

Geradts said his own lab currently is researching whether changes in DNA may identify a tumor's capacity to metastasize or become invasive. Other researchers are looking at other DCIS biomarkers, he said.

"DCIS itself is a non-life threatening condition" with rare exceptions, noted Dr. Eric Winer, director of breast oncology at the Dana-Farber Cancer Institute in Boston, and women are usually treated to help prevent invasive cancer. If the findings of the initial UCSF study are confirmed, then with "careful investigation, we may get to the point where we don't have to treat all women with DCIS, and we may be able to tailor it so some women get less, and some women get more" depending upon their risk for invasive breast cancer, Winer said.

"It's a very complex and interesting study" added Dr. Richard Bleicher, a surgical oncologist at Fox Chase Cancer Center in Philadelphia. "We need to be cautiously optimistic."

Bleicher added that while the findings have "significant potential," women at this point shouldn't "pin all your hopes on it," because the p16 assay is not something they can ask their doctors for at this point in time.

More information
For more on breast cancer, visit the U.S. National Cancer Institute.
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Low-Carb Diet May Slow Prostate Tumor Growth

(HealthDay News) -- In mice, a low-carbohydrate diet slowed prostate tumor growth, possibly because fewer carbohydrates leads to a drop in insulin production, U.S. researchers say.

"This study showed that cutting carbohydrates may slow tumor growth, at least in mice. If this is ultimately confirmed in human clinical trials, it has huge implications for prostate cancer therapy through something that all of us can controls, our diets," lead researcher Dr. Stephen Freedland, a urologist at Duke University Medical Center, said in a prepared statement.

Previous studies linked insulin and a related substance called insulin-like growth factor (IGF) with the growth of prostate tumors in mice. Freedland and his colleagues theorized that reducing levels of these substances might slow prostate tumor growth.

They compared tumor growth in mice eating either a low-carbohydrate diet; a low-fat but high-carbohydrate diet; or a Western diet high in fat and carbohydrates.

Mice fed the low-carbohydrate diet had the smallest tumor size and longest survival, the team found.

""Low-fat mice had shorter survival and large tumors , while mice on the Western diet had the worst survival and biggest tumors. In addition, though both the low-carb and low-fat mice had lower levels of insulin, only the low-carb mice had lower levels of the form of IGF capable of stimulating tumor growth," Freedland said.

The study is published in the Nov. 13 online edition of the journal Prostate.

Freedland is currently organizing a clinical trial to examine the impact of a low-carbohydrate diet on prostate tumor growth in men.

More information
The American Cancer Society has more about prostate cancer.

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Pill Poses Little Cervical Cancer Risk

(HealthDay News) -- Women taking oral contraceptives are at a slightly increased risk for developing cervical cancer, but a decade after stopping the pill even this very small risk disappears, a new British study suggests.

However, that finding doesn't change the recommendation for women to continue getting screened for cervical cancer, experts say.

"This is good news," said lead researcher Dr. Jane Green, an epidemiologist in the Cancer Epidemiology Unit at the University of Oxford. "We have been able to estimate the lifetime risk of cervical cancer for women on the pill and find it's really quite small," she said.

"The small increase in cervical cancer we see in women who are taking oral contraceptives starts to fall once pill use stops and has really gone away by 10 years after stopping use," Green said.

"The pill has many other benefits, including reducing the risk of other cancers, such as ovarian cancer and womb cancer," Green added.

The report is published in the Nov.10 issue of The Lancet.

In the study, Green and her colleagues from the International Collaboration of Epidemiological Studies of Cervical Cancer collected data on almost 16,600 women with cervical cancer and more than 35,500 women without cervical cancer. These women had participated in a total of 24 studies.

Green's team confirmed that the risk of cervical cancer among women who use oral contraceptives does increase over time. But this increase in risk is very small -- women who take contraceptives for five years or more have only about twice the risk compared with women who never took the pill.

In absolute terms, that means that a 20-year-old woman living in a developed country who uses an oral contraceptive for 10 years increases her odds of developing cervical cancer by age 50 from 3.8 cases per 1,000 women (without Pill use) to 4.5 per 1,000 women after using oral contraception. In less developed countries, where access to cervical cancer screening is more limited, that risk rises from 7.3 to 8.3 cases per 1,000 women, the researchers estimated.

Similar risk was seen for invasive and localized cancer and in women who have the human papillomavirus (HPV), which causes about 70 percent of all cervical cancers, Green noted.
Although the risk for cervical cancer associated with the Pill is small, Green advised women to still be screened for the disease. "Screening for cervical cancer is effective," she said. "The advice is to go for regular screenings."

Eventually, Green hopes that the vaccination against the human papillomavirus will go a long way to preventing many cases of cervical cancer.

One expert agreed that the findings showed the risk for cervical cancer from oral contraceptives was very small.

"This is reassuring news for women," said Dr. Peter Sasieni, from the Wolfson Institute of Preventive Medicine at Queen Mary University of London and author of an accompanying journal comment. "There is really a minimal risk from oral contraceptives, and that risk disappears fairly soon when you stop taking them," he said.

"When making a decision about what from of contraception to use, women shouldn't worry about cervical cancer," Sasieni concluded. "It's not an issue," he said.

However, he believes that taking oral contraceptives is another good reason to get screened regularly for the disease. "By going for regular screenings, a women can reduce her risk by 80 percent," Sasieni said.

Another expert agreed that women shouldn't worry about the Pill and cervical cancer risk.
"I don't think women are basing their decision of which form of contraception to use on the risk for cervical cancer," said Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society. "People who want to use oral contraceptives should not be alarmed over the slight increase in cervical cancer risk," she said.

However, women -- whether they take oral contraceptives or not -- should be getting regular cervical cancer screening, Saslow said.

More information
For more on cervical cancer, visit the American Cancer Society.
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Abilify Approved for Adolescents With Schizophrenia

(HealthDay News) -- The U.S. Food and Drug Administration has approved the Bristol-Myers Squibb antipsychotic drug Abilify (aripiprazole) for adolescents aged 13 to 17 diagnosed with schizophrenia, the company said Tuesday.

The FDA first approved the drug to treat schizophrenia in adults in November 2002. More than 12.5 million U.S. prescriptions for the medication have since been written, the drug maker said.

Expanded approval to teens was based on a six-week, 13-nation study that "demonstrated significant improvement with Abilify compared to placebo," a company statement said.

Abilify also is approved to treat acute manic or mixed episodes in people with bipolar I disorder.

More information
The FDA has more about this drug.
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