In recent years, women have been urged to learn the symptoms of ovarian cancer, such as bloating and abdominal pain, because the disease is difficult to detect in its early stages. Symptoms might tip off a woman and her doctor that a more specific test, such as transvaginal ultrasound, is needed.
While it's important to pay attention to symptoms, a new study has found that symptoms are absent in 80% of patients with ovarian cancer and that ultrasound alone was considerably better as a screening tool than symptoms alone. No combination of symptoms and ultrasound findings improved the detection of ovarian cancer compared with ultrasound alone.
The study, by researchers at the University of Kentucky, examined 272 women who had surgery because of an abnormal ultrasound test that indicated either a benign or cancerous tumor. The women were asked to recall any symptoms they had prior to surgery. The researchers found only six of 30 women with ovarian cancer had symptoms. The only value of using symptoms and ultrasound together was when both screening results were negative. In this case, negative findings in both could reduce unnecessary surgeries in women with benign conditions.
No one is saying that symptoms should be ignored, however. In an editorial accompanying the study, Dr. Ilana Cass of Cedars-Sinai Medical Center in Los Angeles noted that the women in the study already had advanced-stage disease. It's possible that women with early-stage disease have a different cluster of symptoms than women with advanced disease. The earlier ovarian cancer is detected, the greater the chances of long-term survival. In addition, previous studies have found that using the CA 125 blood test -- a modestly accurate screening tool for ovarian cancer -- along with evaluating symptoms enhances the detection of the disease.
Symptoms should not be ignored, said the authors of the study, which was published online Monday in the journal Cancer.
"It is important to educate patients that informative symptoms should not be ignored and that the degree to which symptoms are a resultant indicator of early stage ovarian malignancy has yet to be determined," they wrote.
Moreover, checking for symptoms is easy, quick and inexpensive. The major symptoms linked to ovarian cancer are:
Socioeconomic differences may not be the only culprit when it comes to explaining the difference in survival rates between blacks and whites with cancer.
Even when researchers adjusted for factors such as income, education, age and severity of illness, they found that African Americans were more likely to die from breast, ovarian and prostate cancer than were whites. That's the conclusion of a study to be published July 15 in the Journal of the National Cancer Institute. (The link will take you to the abstract. Unfortunately, you have to pay to read the whole report.)
“A lot of factors that have been used to explain population statistics that surround socioeconomic disparities and access to care are not present here,” says study coauthor Dr. Kathy Albain of Loyola University Health System in Maywood, Ill., in a telephone interview.
Now, the question left is why.
The fact that the disparity was found only in sex-specific cancers suggests a racial difference in hormonal environment or in genes that control the metabolism of drugs, toxins and hormones, Albain says.
But the study (which looked at cancer outcomes in nearly 20,000 adults) has certain limitations. For that reason, other researchers still question if these conclusions about genetic differences can be drawn yet. For example, differences in survival could be related to disparities in the quality of the two populations' overall health or their tendency to adhere to the cancer therapies they received.
Albain adds that although the gene patterns reducing cancer survival may be more common in blacks, not all African Americans will carry them. And some white people will. Once the important genetic patterns are identified, "We can then alter treatment regardless of the race that has the pattern.... It could be a win-win for all patients of all races.”
For men with prostate cancer, even those with the early-stage type, the urge to treat is undeniable and understandable. The same apparently holds true for their doctors. But sometimes no treatment, at least for a while, is better -- both for men with cancer and for the healthcare system as a whole.
More men -- and, again, their doctors (who are paid by procedure, not by performance) -- need to ask themselves whether less might ultimately provide more. That's the suggestion posed by a smart, making-the-big-picture-personal piece in today's New York Times.
For writer David Leonhardt, the true test of health reform can be summed up with our medical and insurance systems' approach to prostate cancer, specifically the common, slow-growing kind. It's the kind that can often be monitored with what is known as watchful waiting without the risk of side effects that comes with radiation and surgery.
But if the treatments have roughly similar benefits, they have very different prices. Watchful waiting costs just a few thousand dollars, in follow-up doctor visits and tests. Surgery to remove the prostate gland costs about $23,000. A targeted form of radiation, known as I.M.R.T., runs $50,000. Proton radiation therapy often exceeds $100,000.
And in our current fee-for-service medical system — in which doctors and hospitals are paid for how much care they provide, rather than how well they care for their patients — you can probably guess which treatments are becoming more popular: the ones that cost a lot of money.
If you doubt that similar-benefits contention and want an in-depth look at how the treatments compare, there's this report: "Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer" from the Agency for Healthcare Research and Quality.
The report, released last year, concludes:
Published evidence indicates that no one therapy can be considered preferred for localized prostate cancer due to limitations in quality of the body of comparative effectiveness evidence. All treatment options result in adverse effects (primarily urinary, bowel, and sexual) though the severity and frequency may vary between treatments and according to the provider/hospital. Even if differences in therapeutic efficacy exist, differences in AEs [adverse effects], convenience, and costs are likely to be important factors in individual patient decision making. Despite this uncertainty, patient-reported satisfaction with any individual therapy received is high.
Leonhardt is right. This one example highlights the seemingly large and intractable problems of rising healthcare costs (proton radiation therapy isn't cheap) and getting the most effective healthcare for our national dollars.
And, come decision-making time, if less-expensive treatments are as effective as more high-tech ones, perhaps it's time to question some of the recommendations for expensive treatment and screenings.
Pancreatic cancer is now the fourth-leading cause of death for men and women in the United States, and the nation's growing girth among all age groups could be playing a role.
A study examined 841 patients with pancreatic cancer and 754 healthy people of similar age, race and gender. It found that people ages 14 to 39 who who were overweight (a body mass index of 25 to 29.9) or people ages 20 to 49 who were obese (a BMI of 30 or greater) had an increased risk of pancreatic cancer. In the second age group, being overweight or obese was also linked to an earlier onset of pancreatic cancer by two to six years.
The risk of developing the disease appeared to level off for those who gained excess weight in their 40s. And after age 50, disease risk and weight were not related. However, being overweight at an older age was found to be associated with a lower survival rate for people with the disease.
The median survival rate for people with pancreatic cancer is less than 10 months and the five-year survival rate is less than 5%. But, the authors of the study note, both of the major risk factors for the disease -- obesity and smoking -- can be addressed with lifestyle changes.
The Food & Drug Administration is wrestling with a welter of big issues: safeguarding the nation's food supply, marshaling vaccines and drugs to combat pandemic flu, taking on new responsibilities to regulate tobacco products and dietary supplements.
But that doesn't mean the agency has forgotten about our furry friends and their medical needs. The FDA today approved for the first time a drug for the treatment of cancer in dogs. In clinical trials, the drug Palladia, or toceranib phosphate, was found to shrink cutaneous mast-cell tumors, which are responsible for one-in-five skin tumors seen on dogs, better than a placebo. Mast-cell tumors, which normally appear as lumps on the skin but often spread elsewhere, are the second most common form of the estimated 1.2 million cases of cancer reported yearly in dogs.
As anyone knows who's dug deep into their wallets to treat Fido's cancer, veterinarians have been treating dogs for a variety of forms of cancer for years. But until now, they have used chemotherapy drugs developed for humans and never rigorously tested on dogs. Palladia, which is not intended for human use, is the first to run the FDA's gantlet to prove its safety and effectiveness in canines. By the end of the trials presented to the FDA, 60% of dogs treated with the drug had had their skin tumors shrink, disappear or stop growing, according to a June 3, 2009, news release from Pfizer Animal Health, the maker of Palladia.
Speaking to veterinarians at the American College of Veterinary Internal Medicine Forum earlier this month, George Fennell, vice of president of Pfizer Animal Health's companion animal division, said that Palladia won't be available to most vets before early 2010. Until then, Fennell said that the human caregivers of canine cancer patients should discuss treatment options with their vet, who may refer the dog to a specialist for treatment with Palladia.
Exercise can be a boon for those dealing with the rigors of cancer, either during or after treatment. Workouts such as yoga and strength training can help people cope with the effects of chemotherapy and other treatments, plus alleviate pain and ease depression and anxiety. Yet many cancer patients and survivors are hesitant to do any physical activity, and some treatments have been associated with compromising cardiovascular function.
But a recent study shows that cardiovascular function may not be influenced much by cancer treatments. The study, from the Lombardi Comprehensive Cancer Center at Georgetown University Medical Center, reported on 49 women who attended a doctor-run fitness clinic for cancer survivors. Information collected on the women included demographics and physical activity levels, plus their type of cancer treatment and its duration, and how long it had been since that treatment.
The women ranged in age from 30s through 70s. Their types of cancer varied (breast, ovarian, rectal and Hodgkin's disease) as did their treatments (surgery, radiation, herceptin, chemotherapy and antiestrogen therapy).
The study participants were asked to do a modified three-minute step test, and 35 women completed it. But the type of treatment, the duration of it and time since treatment seemed to have no effect on completing the test or on heart rate recovery.
In a release, study co-author Dr. Priscilla Furth said, "That isn't to say there aren't side-effects of some treatments that may hinder physical activity, but when it comes to actual cardiovascular fitness as measured in our clinic, many of the standard treatments didn't have a role."
A noninvasive treatment for Barrett's esophagus, a condition caused by chronic acid reflux, eradicates the condition in most people, according to a study published in this week's issue of the New England Journal of Medicine.
Barrett's esophagus is diagnosed when chronic acid reflux causes changes in cells that line the esophagus. Some people with the condition will go on to develop cancer of the esophagus. One newer procedure for treating Barrett's esophagus is radiofrequency ablation, in which heat is used to destroy the abnormal cells in a noninvasive, outpatient procedure.
The study, by researchers at the University of North Carolina, involved 127 people with the condition who were randomized to receive either radiofrequency ablation or a simulated "sham" version of the procedure. The study found that 77.4% of the patients who received radiofrequency ablation had complete removal of the abnormal cells compared with 2.3% in the sham group. Only 1.2% of the treated patients went on to develop esophageal cancer compared with 9.3% in the untreated group.
Most people give their fingerprints little thought, simply assuming they're at the tips of their hands where they belong. And if they're undergoing treatment for head and neck cancer, like a recent traveler to the United States, they have considerably more important things to worry about anyway.
But that fingerprint assumption can make for a travel nightmare.
A cancer patient from Singapore who was attempting to visit relatives in the United States was held up for four hours in customs because officials couldn't detect his fingerprints. His chemotherapy drug, capecitabine, had caused them to disappear.
The traveler, known as Mr. S., finally got through, but he was advised to carry a doctor's note next time. One would imagine he figured that out sometime in the first hour.
His oncologist went beyond writing a single note, issuing a heads up to pretty much everyone about the possibility of fingerprint loss. His travel warning, in the form of a letter to the editor, was published online Tuesday in Annals of Oncology.
It concludes, in referring to patients taking the drug capecitabine: "These patients should prepare adequately before traveling to avert the inconvenience that Mr S was put through."
The letter also points out that others may benefit from long-term use of the drug. And, if so, more people could encounter trouble when traveling.
Here's some background:
Capecitabine (brand name Xeloda) is a common chemotherapy drug. Sometimes, it causes a reaction called hand-foot syndrome, especially when taken long term, leaving the palms and soles tender and red and making them swell and peel. (More on capecitabine from Rxlist.)
Other drugs can cause the condition as well, says Cancer.net, including cytarabine, floxuridine, fluorouracil, idarubin and liposomal doxorubicin.
Here's what Chemocare.com advises for managing the condition. Reducing friction and heat exposure is crucial. Those conditions, on top of the drug-caused effects on the capillaries, do not improve your chances of hassle-free traveling.
-- Tami Dennis
Photo: Don't make the airport travel experience more difficult than it needs to be. Carry a note from your doctor if you lack fingerprints.
Colorectal cancer that has spread from the primary tumor site to other areas of the body, called metastatic disease, has long been considered a disease with a poor prognosis. But an analysis of survival statistics show that the outlook for patients with advanced colon cancer has greatly improved. Only 8% of patients survived five years with the disease in 1990 compared with 30% of people diagnosed with the disease after 2004.
The study, published today in the Journal of Clinical Oncology, suggests that new chemotherapy treatments and biological agents, along with improvements in surgery to remove tumors from the liver, have resulted in big gains in survival. The study is the first to examine survival rates for metastatic colorectal cancer in the last 20 years. The authors of the study say median survival is now more than 30 months, compared with eight months for patients diagnosed before 1990.
The study also compared the effects of surgery and chemotherapy on survival rates. Since 2000, more patients undergo surgery to remove parts of the liver invaded by cancer. They found that liver resection surgery led to increased survival statistics, as did the availability of several new cancer medications beginning in 2004.
". . .The degree and rapidity of the improvement is of a magnitude that is rarely seen in metastatic cancers," Dr. Scott Kopetz, an assistant professor at M.D. Anderson Cancer Center's Department of Gastrointestinal Medical Oncology and the study's lead author, said in a news release. "Many of these patients are not necessarily disease-free, but living with their cancer with a high quality of life. For some patients, our goal of making metastatic colorectal cancer a chronic condition is closer to becoming a reality."
Metastatic colorectal cancer remains incurable, the authors note. And more research is needed to find medications to use for patients who have exhausted all of the options available to them.
-- Shari Roan
Photo credit: The Colossal Colon, top view, is part of the Colossal Colon Tour put together by Cancer Research and Prevention Foundation.
With a Stage 3 breast cancer diagnosis, chemotherapy and radiation are often urgently needed. And many African American women refuse them.
In a study published in the July 1 issue of Cancer, researchers at Emory University found that of 107 women diagnosed with Stage 3 breast cancer, of whom almost 87% were African American, a fifth of patients decided against chemotherapy. More than a fourth chose not to get radiation. (Here's more information on chemotherapy and radiation from breastcancer.org.)
African American women may be more reluctant to pursue such treatment because of the time involved (they're often caretakers of others) and, of course, because of the cost. Here's a good overview of these and related issues from netwellness.org, with information provided by Case Western Reserve University, Ohio State University and the University of Cincinnati. The site points out that African American women are also generally more likely to be under-treated.
With African American women being diagnosed with advanced breast cancer at almost twice the rate of white women, we need to figure out how to overcome such treatment resistance. Researchers in the study helped launch a community outreach clinic. That's obviously just the beginning.
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
