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Update December 2017


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Health & Wellbeing
 

Saturday, Dec. 30, 2017 - Jan. 5, 2018

Are 3-D mammograms really better? US puts scans to the test

In this Nov. 21, 2017, Dr. Tova Koenigsberg at The Montefiore Einstein Center for Cancer Care in New York shows an example of a traditional mammogram scan. U.S. health officials are beginning a huge study to compare traditional mammograms with 3-D versions, to see if the newer choice might really improve screening for breast cancer. (Montefiore Health System via AP)

Lauran Neergaard

Washington (AP) - A better mammogram? Increasingly women are asked if they want a 3-D mammogram instead of the regular X-ray - and now U.S. health officials are starting a huge study to tell if the newer, sometimes pricier choice really improves screening for breast cancer.

It’s the latest dilemma in a field that already vexes women with conflicting guidelines on when to get checked: Starting at age 40, 45 or 50? Annually or every other year?

The issue: Mammograms can save lives if they catch aggressive breast cancers early. But they also can harm through frequent false alarms and by spotting tumors that grow so slowly they never would have posed a threat - over diagnosis that means some women undergo unneeded treatment.

That trade-off is a key question as doctors begin recruiting 165,000 women nationally to compare potentially more beneficial 3-D mammograms - known scientifically as “tomosynthesis” - with standard two-dimensional digital mammography.

The 3-D mammograms have been marketed as being able to find more cancers.

“But the idea isn’t so much finding more cancers as finding the cancers that are going to be life-threatening,” said Dr. Worta McCaskill-Stevens of the National Cancer Institute, which is funding the new research to tell whether the 3-D scans truly pinpoint the tumors that matter most.

It’s one of the largest randomized trials of mammography in decades, and scientists designed the research to do more than answer that key 3-D question. They hope the findings also, eventually, will help clear some of the confusion surrounding best screening practices.

“The most important thing about this study is that it’s moving us to individualized screening as opposed to what we have now, which is one-size-fits-all screening,” predicted study chair Dr. Etta Pisano, a radiologist at Boston’s Beth Israel Deaconess Medical Center.

“We are going to have a much better understanding of how to screen women so that we do the least amount of harm.”

Who needs a
mammogram?

That depends on whom you ask. Guidelines vary for women at average risk of breast cancer. (Those at increased risk, because of family history or genetics, already get different advice.)

The American College of Radiology recommends annual mammograms starting at age 40.

The American Cancer Society urges annual checks starting at 45 and switching to every other year at 55, though it says women 40 to 44 still can opt for a mammogram.

And the U.S. Preventive Services Task Force, a government advisory group, recommends starting at age 50, with mammograms every other year. It, too, says 40-somethings can choose earlier screening.

What about 3-D mammograms?

Standard mammograms take X-rays from two sides of the breast. With tomosynthesis, additional X-rays are taken at different angles - not truly three-dimensional but a computer compiles them into a 3-D-like image. First approved by the Food and Drug Administration in 2011, they’re not yet the standard of care in part because of questions that the new study aims to answer.

Some studies have found tomosynthesis detects more cancer with fewer false alarms; they’re often advertised as particularly useful for younger women’s dense breasts.

How to decide?

Understand that mammograms come with pros and cons, and weigh them, said Dr. Otis Brawley, the American Cancer Society’s chief medical officer.

Breast cancer is far less common at age 40 than at age 50 and beyond. After menopause, tumors tend to grow more slowly and women’s breast tissue becomes less dense and easier for mammograms to provide a clearer image.

Consider: For every 1,000 women screened every other year until their 70s, starting at 40 instead of 50 would prevent one additional death - but create 576 more false alarms and 58 extra unneeded biopsies, the task force estimated. Also, two extra women would be treated for tumors that never would have become life-threatening - that over diagnosis problem.

As for what type to choose, some insurers, including Medicare, cover the 3-D version, and a small number of states mandate coverage. Other insurers may require women to pay $50 to $100 more out of pocket. Whoever ultimately pays, extra time to analyze the scans adds to the cost.

The new study

About 100 mammography clinics across the U.S., and a few in Canada, will enroll healthy women ages 45 to 74 who already are planning to get a routine mammogram. They’ll be randomly assigned to get either the regular or 3-D version for five years. Most will be screened annually but post-menopausal women who don’t have certain cancer risk factors will be screened every other year.

Researchers will track every woman’s results including samples from biopsies plus genetic and other tests, as well as how any cancer patients fare. The giant database hopefully will help them tease out more information about which women benefit most from what type and frequency of screening.

“Mammography has been provocative over many decades. It’s important that women have a better understanding of how mammography is important for them based upon their age and other risk factors,” said McCaskill-Stevens.


Saturday, Dec. 23 - Dec. 29, 2017

Drugstore pain pills as effective as opioids in ER patients

This Thursday, Nov. 2, 2017 photo shows tablets of ibuprofen in New York. A study released on Tuesday, Nov. 7, 2017 found that over-the-counter pills worked as well as opioids at reducing severe pain for emergency room patients with broken bones and sprains. (AP Photo/Patrick Sison)

Lindsey Tanner

Chicago (AP) - Emergency rooms are where many patients are first introduced to powerful opioid painkillers, but what if doctors offered over-the-counter pills instead? A new study tested that approach on patients with broken bones and sprains and found pain relievers sold as Tylenol and Motrin worked as well as opioids at reducing severe pain.

The results challenge common ER practice for treating short-term, severe pain and could prompt changes that would help prevent new patients from becoming addicted.

The study has limitations: It only looked at short-term pain relief in the emergency room and researchers didn’t evaluate how patients managed their pain after leaving the hospital.

But given the scope of the U.S. opioid epidemic - more than 2 million Americans are addicted to opioid painkillers or heroin - experts say any dent in the problem could be meaningful.

Results were published Tuesday in the Journal of the American Medical Association.

Long-term opioid use often begins with a prescription painkiller for short-term pain, and use of these drugs in the ER has risen in recent years. Previous studies have shown opioids were prescribed in nearly one-third of ER visits and about 1 out of 5 ER patients are sent home with opioid prescriptions.

“Preventing new patients from becoming addicted to opioids may have a greater effect on the opioid epidemic than providing sustained treatment to patients already addicted,” Dr. Demetrios Kyriacou, an emergency medicine specialist at Northwestern University, wrote in an accompanying editorial.

The study involved 411 adults treated in two emergency rooms at Montefiore Medical Center in New York City. Their injuries included leg and arm fractures or sprains. All were given acetaminophen, the main ingredient in Tylenol, plus either ibuprofen, the main ingredient in Motrin, or one of three opioids: oxycodone, hydrocodone or codeine. They were given standard doses and were not told which drug combo they received.

Patients rated their pain levels before taking the medicine and two hours later. On average, pain scores dropped from almost 9 on a 10-point scale to about 5, with negligible differences between the groups.

Ibuprofen and acetaminophen affect different pain receptors in the body so using the two drugs together may be especially potent, said Dr. Andrew Chang, an emergency medicine professor at Albany Medical College in upstate New York, who led the study.

He noted that a pill combining ibuprofen and acetaminophen is available in other countries; his findings echo research from Canada and Australia testing that pill against opioids for pain relief.


US rate for gun deaths is up for the second straight year

In this July 7, 2014 file photo, Chicago police display some of the thousands of illegal firearms confiscated during the year. In a government report released on Friday, Nov. 3, 2017, the U.S. rate for gun deaths has increased for the second straight year, following 15 years of no real change. (AP Photo/M. Spencer Green, File)

Mike Stobbe

New York (AP) - The U.S. rate for gun deaths has increased for the second straight year, following 15 years of no real change, a government report shows.

Roughly two-thirds of gun deaths are suicides and those have been increasing for about 10 years. Until recently, that has been offset by a decline in people shot dead by others. But there’s been a recent upswing in those gun-related homicides, too, some experts said.

Overall, the firearm death rate rose to 12 deaths per 100,000 people last year, up from 11 in 2015, according to the report released Friday by the Centers for Disease Control and Prevention. Before that, the rate had hovered just above 10 - a level it had fallen to in the late 1990s.

In the early 90s, it was as high as 15 per 100,000 people.

In the past two years, sharp homicide increases in Chicago and other places that have been large enough to elevate the national statistics. According to the FBI’s raw numbers, the tally of U.S. homicides involving guns rose to nearly 11,000 last year, from about 9,600 the year before.

Overall, there were more than 38,000 gun deaths last year, according to the CDC. That’s up from about 36,000 in 2015, and around 33,500 each year between 2011 and 2014.

The latest CDC report means the nation is approaching two decades since there’s been any substantial improvement in the rate of gun deaths, said Dr. Garen Wintemute, a prominent gun violence researcher at the University of California, Davis.

The rate for the first three months of this year was about what it was for the same period last year. Hopefully, it’s a sign it will level off again, Wintemute said.

Most gun deaths tend to happen in warm weather so it’s too early to know what is happening this year, said Bob Anderson, the CDC’s chief of mortality statistics.

The CDC also reported a continued increase in the death rate from drug overdoses, which hit 20 per 100,000 last year, up from 16 the year before. Heroin and other opioids are driving the deadliest drug epidemic in U.S. history.


Saturday, Dec. 16 - Dec. 22, 2017

VA study shows parasite from Vietnam may be killing vets

FILE - This Sept. 7, 2016 file photo shows a display of preserved liver fluke parasites at the Siriraj Hospital in Bangkok, Thailand. (AP Photo/Sakchai Lalit, File)

Margie Mason and Robin McDowell

Herold, W.Va. (AP) - A half century after serving in Vietnam, hundreds of veterans have a new reason to believe they may be dying from a silent bullet - test results show some men may have been infected by a slow-killing parasite while fighting in the jungles of Southeast Asia.

The Department of Veterans Affairs this spring commissioned a small pilot study to look into the link between liver flukes ingested through raw or undercooked fish and a rare bile duct cancer. It can take decades for symptoms to appear. By then, patients are often in tremendous pain, with just a few months to live.

Of the 50 blood samples submitted, more than 20 percent came back positive or bordering positive for liver fluke antibodies, said Sung-Tae Hong, the tropical medicine specialist who carried out the tests at Seoul National University in South Korea.

“It was surprising,” he said, stressing the preliminary results could include false positives and that the research is ongoing.

Northport VA Medical Center spokesman Christopher Goodman confirmed the New York facility collected the samples and sent them to the lab. He would not comment on the findings, but said everyone who tested positive was notified.

Gerry Wiggins, who served in Vietnam from 1968 to 1969, has already lost friends to the disease. He was among those who got the call.

“I was in a state of shock,” he said. “I didn’t think it would be me.”

The 69-year-old, who lives in Port Jefferson Station, New York, didn’t have any symptoms when he agreed to take part in the study, but hoped his participation could help save lives. He immediately scheduled further tests, discovering he had two cysts on his bile duct, which had the potential to develop into the cancer, known as cholangiocarcinoma. They have since been removed and - for now - he’s doing well.

Though rarely found in Americans, the parasites infect an estimated 25 million people worldwide, mostly in Asia.

Endemic in the rivers of Vietnam, the worms can easily be wiped out with a handful of pills early on, but left untreated they can live for decades without making their hosts sick. Over time, swelling and inflammation of the bile duct can lead to cancer. Jaundice, itchy skin, weight loss and other symptoms appear only when the disease is in its final stages.

The VA study, along with a call by Senate Minority Leader Charles Schumer of New York for broader research into liver flukes and cancer-stricken veterans, began after The Associated Press raised the issue in a story last year. The reporting found that about 700 veterans with cholangiocarcinoma have been seen by the VA in the past 15 years. Less than half of them submitted claims for service-related benefits, mostly because they were not aware of a possible connection to Vietnam. The VA rejected 80 percent of the requests, but decisions often appeared to be haphazard or contradictory, depending on what desks they landed on, the AP found.

The number of claims submitted reached 60 in 2017, up from 41 last year. Nearly three out of four of those cases were also denied, even though the government posted a warning on its website this year saying veterans who ate raw or undercooked freshwater fish while in Vietnam might be at risk. It stopped short of urging them to get ultrasounds or other tests, saying there was currently no evidence the vets had higher infection rates than the general population.

“We are taking this seriously,” said Curt Cashour, a spokesman with the Department of Veterans Affairs. “But until further research, a recommendation cannot be made either way.”

Veteran Mike Baughman, 65, who was featured in the previous AP article, said his claim was granted early this year after being denied three times. He said the approval came right after his doctor wrote a letter saying his bile duct cancer was “more likely than not” caused by liver flukes from the uncooked fish he and his unit in Vietnam ate when they ran out of rations in the jungle. He now gets about $3,100 a month and says he’s relieved to know his wife will continue to receive benefits after he dies. But he remains angry that other veterans’ last days are consumed by fighting the same government they went to war for as young men.

“In the best of all worlds, if you came down with cholangiocarcinoma, just like Agent Orange, you automatically were in,” he said, referring to benefits granted to veterans exposed to the toxic defoliant sprayed in Vietnam. “You didn’t have to go fighting.”

Baughman, who is thin and weak, recently plucked out “Country Roads” on a bass during a jam session at his cabin in West Virginia. He wishes the VA would do more to raise awareness about liver flukes and to encourage Vietnam veterans to get an ultrasound that can detect inflammation.

“Personally, I got what I needed, but if you look at the bigger picture with all these other veterans, they don’t know what necessarily to do,” he said. “None of them have even heard of it before. A lot of them give me that blank stare like, ‘You’ve got what?’”


Update Saturday, Dec. 2 - Dec. 8, 2017

Study suggests women less likely to get CPR from bystanders

A study released on Sunday, Nov. 12, 2017 shows women are less likely than men to get CPR from a bystander and more likely to die, and researchers think that reluctance to touch a woman’s chest may be one reason. (AP Photo/Rogelio V. Solis)

Marilynn Marchione

Anaheim, Calif. (AP) - Women are less likely than men to get CPR from a bystander and more likely to die, a new study suggests, and researchers think reluctance to touch a woman’s chest might be one reason.

Only 39 percent of women suffering cardiac arrest in a public place were given CPR versus 45 percent of men, and men were 23 percent more likely to survive, the study found.

It involved nearly 20,000 cases around the country and is the first to examine gender differences in receiving heart help from the public versus professional responders.

“It can be kind of daunting thinking about pushing hard and fast on the center of a woman’s chest” and some people may fear they are hurting her, said Audrey Blewer, a University of Pennsylvania researcher who led the study.

Rescuers also may worry about moving a woman’s clothing to get better access, or touching breasts to do CPR, but doing it properly “shouldn’t entail that,” said another study leader, U Penn’s Dr. Benjamin Abella. “You put your hands on the sternum, which is the middle of the chest. In theory, you’re touching in between the breasts.”

The study was discussed Sunday at an American Heart Association conference in Anaheim.

Cardiac arrest occurs when the heart suddenly stops pumping, usually because of a rhythm problem. More than 350,000 Americans each year suffer one in settings other than a hospital. About 90 percent of them die, but CPR can double or triple survival odds.

“This is not a time to be squeamish because it’s a life and death situation,” Abella said.

Researchers had no information on rescuers or why they may have been less likely to help women. But no gender difference was seen in CPR rates for people who were stricken at home, where a rescuer is more likely to know the person needing help.

The findings suggest that CPR training may need to be improved. Even that may be subtly biased toward males - practice mannequins (they’re not called “woman-nequins”) are usually male torsos, Blewer said.

“All of us are going to have to take a closer look at this” gender issue, said the Mayo Clinic’s Dr. Roger White, who co-directs the paramedic program for the city of Rochester, Minnesota. He said he has long worried that large breasts may impede proper placement of defibrillator pads if women need a shock to restore normal heart rhythm.

The Heart Association and the National Institutes of Health funded the study.

Men did not have a gender advantage in a second study discussed on Sunday. It found the odds of suffering cardiac arrest during or soon after sex are very low, but higher for men than women.

Previous studies have looked at sex and heart attacks, but those are caused by a clot suddenly restricting blood flow, and people usually have time to get to a hospital and be treated, said Dr. Sumeet Chugh, a cardiologist at Cedars-Sinai Heart Institute in Los Angeles. He and other researchers wanted to know how sex affected the odds of cardiac arrest, a different problem that’s more often fatal.

They studied records on more than 4,500 cardiac arrests over 13 years in the Portland area. Only 34 were during or within an hour of having sex, and 32 of those were in men. Most already were on medicines for heart conditions, so their risk was elevated to start with.

“It’s a very awkward situation, and a very horrifying situation to be one of the two people who survives,” but more would survive if CPR rates were higher, Chugh said.

Results were published in the Journal of the American College of Cardiology.
 


DAILY UPDATEE

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HEADLINES [click on headline to view story]

Are 3-D mammograms really better? US puts scans to the test


Drugstore pain pills as effective as opioids in ER patients

US rate for gun deaths is up for the second straight year


VA study shows parasite from Vietnam may be killing vets


Study suggests women less likely to get CPR from bystanders


 



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