Breast Cancer Drug Herceptin Linked to Risk of Heart Problems: Study

 

MONDAY June 9, 2014, 2014 -- As many as one in 10 women taking the breast cancer drug trastuzumab (Herceptin) will experience some type of heart problem, according to new research.

The good news from this study is that these problems typically reverse once treatment is finished.

"The overall message here is one of tremendous reassurance," said study researcher Dr. Brian Leyland-Jones, vice president of molecular and experimental medicine at Avera Cancer Institute in Sioux Falls, S.D.

The study was published June 9 in the Journal of Clinical Oncology online. Roche, the maker of Herceptin, provided research funding. Some of the study's co-authors work for Roche or are advisers or consultants.

Herceptin is used in breast cancers that test positive for HER 2 (human epidermal growth factor receptor 2), which promotes the growth of cancer cells. Herceptin kills the cells, and is known to boost survival, both in those with breast cancer that has spread and to those with HER2-positive early breast cancer. It's given after primary treatments for breast cancer, such as surgery, chemotherapy and radiation.

However, heart problems have been linked with the drug's use, including congestive heart failure and a decrease in how well the heart can pump blood out of its main pumping chamber, the left ventricle.

Leyland-Jones and other researchers from the United States, Belgium and other countries followed more than 5,000 women with early stage breast cancer for an average of eight years. They were evaluating how often cardiac problems occurred and, when they did, whether they disappeared after the women had taken the drug for the recommended time period.

The researchers followed three groups, each with about 1,700 women. One group did not get trastuzumab. The second group took it for one year and the third for two years. The current standard of care is one year, according to Leyland-Jones.

Nearly 10 percent of women in the two-year group, and about 5 percent of those in the one-year group, had to discontinue the drug due to adverse cardiac problems, such as congestive heart failure, a decrease in the heart's blood-pumping ability or other issues.

Three cardiac deaths occurred in the two-year group, none occurred in the one-year treatment group, and two deaths occurred in the no-drug group, according to the study.

Congestive heart failure occurred in less than 1 percent of both drug groups. "What this confirms is a very low incidence of cardiac events, even when you give two years of the drug, which is no longer practiced," Leyland-Jones said.

Blood pumping problems occurred in about 7 percent of the two-year group and 4 percent of the one-year group.

The study authors don't know for sure why the drug is associated with heart issues, but they noted that HER2 is linked with the regulation of cell growth and survival in the heart. Using the drug may take away those heart protective effects.

After stopping the drug, the blood pumping problems resolved in more than 87 percent of the two-year group and more than 81 percent of the one-year group.

The new findings reaffirm previous research with shorter follow-up times, said Dr. Joanne Mortimer, director of Women's Cancer Programs and co-director of the Breast Cancer Program at City of Hope Cancer Center in Duarte, Calif. She reviewed the findings but was not involved in the study.

The new study reaffirms that the heart problems linked with the drug don't increase with time, she said, "and that's what is important."

"There's no question this is a really important drug," Mortimer said, as previous studies have shown trastuzumab to improve survival from this more aggressive form of breast cancer.

Doctors know that women with a history of high blood pressure and those over 65 are at higher risk of heart problems while on the drug, she said.

Women should have a cardiac assessment before starting trastuzumab, Leyland-Jones said, and should have cardiac monitoring while they are taking it so that any cardiac problems related to the drug can be found and treated early.

More Information

To learn more about breast cancer treatments, visit American Cancer Society.

Levodopa May Beat Newer Meds for Long-Term Parkinson's Care: Study

 

WEDNESDAY June 11, 2014, 2014 -- When it comes to which drug works best for patients with newly diagnosed Parkinson's disease, older may still be better, a new study finds.

Research published June 10 in The Lancet finds that the dopamine drug levodopa still outperforms newer medications for the long-term care of people newly diagnosed with Parkinson's.

"This study lays to rest lingering questions among both people with Parkinson's disease and their doctors about which drug is most beneficial when first beginning treatment for the disease," said James Beck, vice president of scientific affairs at the Parkinson's Disease Foundation (PDF).

In the largest-ever trial of Parkinson's disease treatment, levodopa offered patients better mobility and a higher quality of life than the two main alternatives -- drugs called dopamine agonists and monoamine oxidase type B (MAO-B) inhibitors.

The study included more than 1,600 newly diagnosed Parkinson's disease patients who were randomly selected to take either levodopa or one of the other two treatments. They were followed for up to seven years.

"Although the differences in favor of levodopa are small, when you consider the short- and long-term benefits, side effects, quality of life for patients, and costs, the old drug levodopa is still the best initial treatment strategy for most patients," study leader Richard Gray of the University of Oxford in the United Kingdom, said in a journal news release.

Levodopa remains the most widely used treatment for Parkinson's, but prolonged use of the drug can lead to involuntary muscle spasms and movement problems. There is less risk of developing these complications with the two newer types of drugs, but the newer meds are also more likely to cause side effects such as nausea, hallucinations, swelling and sleep problems, the researchers said.

The new study is an improvement on prior efforts, Gray said. "Previous studies included too few patients, had short follow-up, and focused on the clinicians' assessments of motor symptoms rather than asking patients how the drugs affected their overall quality of life," he explained. "So, for many years there has been uncertainty about the risks and benefits of starting treatment with these different classes of Parkinson's disease drugs."

The study findings are likely to "change clinical practice worldwide, with the majority of patients from now on starting therapy with levodopa," study clinical coordinator Carl Clarke, from the University of Birmingham in the United Kingdom, said in the news release.

The PDF's Beck agreed.

"For years, the community has asked whether it is best to begin treatment with levodopa, which remains the gold-standard therapy for movement symptoms, or with alternatives such as dopamine agonists and MAO-B inhibitors," Beck said. "It turns out that levodopa may slightly edge the other drugs as an initial therapy."

However, that doesn't mean that the other medications won't be the best choice for certain patients, Beck added.

"All three [options] offer very similar effects in the near and long term," he said. "Thus, these results should allow people with Parkinson's and their doctors to choose therapies that make sense for them -- clinically as well as financially."

More information

The U.S. National Library of Medicine has more about Parkinson's disease.

Drug Shows Promise Against Arthritis Common in People with Psoriasis

 

WEDNESDAY June 11, 2014, 2014 -- A new drug called Brodalumab appears to be effective in treating patients suffering from psoriatic arthritis, a study says.

Patients who responded to brodalumab had a significant improvement in their skin and reduction in the swelling of the fingers and toes, a condition called dactylitis that is common in psoriatic arthritis, according to the study's lead researcher, Dr. Philip Mease, a rheumatologist at Swedish Medical Center in Seattle.

"We have a medication with a different mechanism of action than currently available drugs, increasing our chances to control this disease, which can be disabling and significantly affects patients' function and quality of life," said Mease.

"We know that many patients will lose response to some medications or develop adverse effects, so there is a need for medicines that work differently," he said. "We have a chance to bring patients back closer toward their normal state of being."

The study was funded by Amgen, the maker of brodalumab. Results of the study were published June 12 in the New England Journal of Medicine. The study's findings were also scheduled to be presented on Thursday at the European Congress of Rheumatology's annual meeting in Paris.

Psoriatic arthritis is a type of arthritic inflammation that affects as many as 30 percent of people who have psoriasis, according to background information in the study.

Psoriasis causes scaly red and white patches on the skin, according to the American College of Rheumatology (ACR). In psoriatic arthritis, the immune system attacks the joints as well, causing inflammation. Persistent inflammation from psoriatic arthritis can lead to joint damage, according to the ACR.

Like psoriasis, psoriatic arthritis symptoms come and go, vary from person to person, and even change locations over time.

Psoriatic arthritis may affect one joint or several. For example, it may affect one or both knees. Affected fingers and toes can become swollen. Fingernails and toenails also may be affected.

Mease noted that psoriatic arthritis has a genetic component that makes it distinct from other types of arthritis.

"There are also certain genes that are present in people who develop the arthritis that are not present in people with psoriasis. So there seems to be a heavy genetic component for determining who gets psoriasis and goes on to get psoriatic arthritis," he said.

Current treatment for psoriatic arthritis depends on how much pain the patient has. Treatment usually starts with painkillers such as ibuprofen (Motrin or Advil) or naproxen (Aleve).

Mease noted that many patients are also given methotrexate (Trexall), which treats both arthritis and psoriasis. Other drugs, known as biologic therapy, that are also used to treat both conditions include adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade).

Current drugs such as methotrexate target a substance called tumor necrosis factor-alpha, which is produced in response to inflammation. But these drugs tend to be less effective over time, Mease said.

Brodalumab works differently. It acts against interleukin-17 receptor A, a substance found in higher levels in people with psoriatic arthritis, according to the study.

For the current phase 2 trial of brodalumab, Mease and colleagues randomly assigned 168 patients with psoriatic arthritis to a low (140 milligrams) or high dose (280 milligrams) of brodalumab, or a placebo.

The average age of the study participant was 52 years. Two-thirds of the study volunteers were women and 94 percent were white (which included Hispanics and Latinos). The average amount of time they'd had psoriatic arthritis was nine years, according to the study.

After 12 weeks, patients taking either dose of brodalumab had a greater response to treatment than those receiving placebo (37 percent and 39 percent versus 18 percent).

Moreover, 14 percent of those taking brodalumab had a 50 percent improvement in symptoms based on the American College of Rheumatology response criteria, compared with 4 percent who received the placebo, the researchers found.

Improvements were seen in both patients who had previous biologic therapy, as well as those who had not had biologic therapy in the past, the researchers noted.

After 24 weeks of treatment, 51 percent of patients taking the lower dose of brodalumab and 64 percent taking the higher dose responded to the drug. In addition, 44 percent of the patients who switched from placebo to brodalumab responded to treatment.

These responses were maintained through a year, the researchers said.

At week 12, serious side effects occurred in 3 percent of patients in the brodalumab groups and in 2 percent of those in the placebo group, they add. These included stomach pain and a skin infection called cellulitis. "This is consistent with what had been seen with other so-called biologic medications," Mease said.

Dr. Robert Kirsner is a professor and vice chairman of the department of dermatology and cutaneous surgery at the University of Miami Miller School of Medicine. "The results of this, albeit small study are extremely encouraging for patients who suffer from these conditions and for the physicians who treat them," Kirsner, who was not part of the study, said.

A phase 3 trial -- the last step before potential U.S. Food and Drug Administration approval -- is under way, testing brodalumab as a treatment for psoriasis. According to Mease, Amgen hopes to have the drug approved for psoriasis first, and then as a treatment for psoriatic arthritis.

Take Heartburn Medicines Before Breakfast for Best Effect

 

WEDNESDAY June 11, 2014, 2014 -- Many people with heartburn aren't taking their acid-reducing medicine at the right time, which makes the drugs less effective and wastes money, according to new research.

Only about one-third of those buying these medications -- such as Nexium, Prevacid and Prilosec -- over-the-counter used them properly compared to just under half of those who were prescribed the drugs by their primary care doctor. Those who were given a prescription by a gastroenterologist were most likely to use the drugs as they're supposed to be used, with seven out of 10 taking the drugs properly, according to the study.

These drugs are activated once in the body, said the study's senior author, Dr. M. Michael Wolfe, a gastroenterologist and chair of the department of medicine at MetroHealth System. "In order to activate the medicine, you must eat. For that reason, you take it before breakfast. If you don't take the drug correctly, you don't do as well," Wolfe said.

Despite labels advising users to take the drugs before breakfast, people aren't following those directions, he said. Those who aren't taking the medicines properly "are wasting money, they're not feeling well and they aren't getting symptom relief," Wolfe added.

The study was published in the June issue of The American Journal of Gastroenterology.

Heartburn is a painful, burning feeling just below the breastbone, experienced at least once a month by about 44 percent of U.S. adults. About 7 percent have heartburn daily. Frequent heartburn may indicate a condition called gastroesophageal reflux disease, or GERD. Food and acid from the stomach backs up, or refluxes, into the esophagus. Reflux can damage the esophagus and cause serious issues over time.

Direct costs related to GERD, including acid-reducing medicines, top $10 billion each year in the United States, according to background information in the study.

The medications looked at in this study are a class of drugs known as proton pump inhibitors. They work by reducing the amount of stomach acid produced, according to the U.S. National Library of Medicine. Unlike antacids, such as Tums or Rolaids, proton pump inhibitors don't provide immediate relief of heartburn symptoms. It takes about 7 days of continuous use for the drugs to reach their maximum acid-suppressing potential, the study noted.

Wolfe and his colleagues surveyed 610 patients who used heartburn medicine for their GERD. Of that group, 190 got a prescription heartburn medicine from a gastroenterologist and 223 received a prescription from their primary care doctor. The other 197 bought over-the-counter heartburn medicines.

Those prescribed the medicines by their gastroenterologist did best, Wolfe noted, with 71 percent taking the medicines correctly. Only 47 percent of those who got prescriptions from their primary care doctors took them correctly. And just 39 percent of those who bought them over-the-counter used them right, the investigators found.

In a previous study, only one-third of primary care doctors told patients to take the medicines before meals, but nearly all gastroenterologists did, according to the report.

In his study, Wolfe found, the severity and frequency of symptoms were better in those who were prescribed the drug by a gastroenterologist compared to a primary care doctor.

"If you have frequent heartburn, you have a disease, GERD," Wolfe said. "And you really should see a physician and not treat yourself," he explained.

Dr. John Lipham is director of the Digestive Health Center at Keck Medicine of the University of Southern California. Lipham reviewed the findings but was not involved in the study.

"It's something we have known since these medications came out, that they work best if you take them 30 minutes or so before a meal," said Lipham.

However, he pointed out that the new study puts some data behind what experts knew from experience.

Lipham said the new study is the first, to his knowledge, to show a difference in taking the medicine correctly depending on who prescribed it.

Wolfe and Lipham both find that patients often think of the proton pump inhibitors in the same way as antacids, meant to be taken when heartburn strikes.

"But these [proton pump inhibitor] medicines don't work that way," Lipham said. "They need to be stimulated by acid and need to build up in your system. You have to take them at the correct time each day and you also need to take them every day to get the maximum effectiveness of the medications."

As to why doctors aren't all telling their patients how to use these drugs, Wolfe speculated that primary care doctors may be too busy and don't have the time to read all of the drug literature.

The bottom line is "it boils down to education," said Wolfe. Physicians and consumers need to take the time to learn about the drugs.

Ideally, Wolfe said, you should take the medicine in the morning, then ''eat something that causes your stomach to make acid, such as protein, an egg, a piece of cheese, yogurt." For those who hate breakfast, he advises drinking a glass of milk or at least a cup of coffee.

More information

To learn more about heartburn, visit the U.S. National Library of Medicine.

Posted: June 2014

Mylan Launches Generic Actonel Tablets, 150 mg

 

PITTSBURGH, June 11, 2014 /PRNewswire/ -- Mylan Inc. (Nasdaq: MYL) today announced that it has launched Risedronate Sodium Tablets USP, 150 mg, the generic version of Warner Chilcott's Actonel® Tablets. Mylan received final approval from the U.S. Food and Drug Administration (FDA) for its Abbreviated New Drug Application (ANDA) for this product, which is indicated for the treatment and prevention of osteoporosis in postmenopausal women.

Risedronate Sodium Tablets USP, 150 mg, had U.S. sales of approximately $171.6 million for the 12 months ending March 31, 2014, according to IMS Health.

Currently, Mylan has 303 ANDAs pending FDA approval representing $105.3 billion in annual brand sales, according to IMS Health. Forty-one of these pending ANDAs are potential first-to-file opportunities, representing $25.4 billion in annual brand sales, for the 12 months ending Dec. 31, 2013, according to IMS Health.

Mylan is a global pharmaceutical company committed to setting new standards in health care. Working together around the world to provide 7 billion people access to high quality medicine, we innovate to satisfy unmet needs; make reliability and service excellence a habit; do what's right, not what's easy; and impact the future through passionate global leadership. We offer a growing portfolio of more than 1,300 generic pharmaceuticals and several brand medications. In addition, we offer a wide range of antiretroviral therapies, upon which approximately 40% of HIV/AIDS patients in developing countries depend. We also operate one of the largest active pharmaceutical ingredient manufacturers and currently market products in approximately 140 countries and territories. Our workforce of more than 20,000 people is dedicated to improving the customer experience and increasing pharmaceutical access to consumers around the world. But don't take our word for it. See for yourself. See inside. mylan.com

SOURCE Mylan Inc.

Posted: June 2014

Guidelines address long-term needs of prostate cancer survivors

 

The guidelines are designed to promote optimal health and quality of life for the posttreatment prostate cancer survivor by facilitating the delivery of comprehensive posttreatment care by primary care clinicians. They are based on recommendations set forth by an expert panel convened as part of the work of the National Cancer Survivorship Resource Center, a collaboration between the American Cancer Society and The George Washington University Cancer Institute, funded by a 5-year cooperative agreement from the Centers for Disease Control and Prevention (CDC).

Prostate cancer survivors represent more than four in ten male cancer survivors and one in five of all cancer survivors in the United States. While guidelines exist for treatment and surveillance for recurrent disease, availability of guidelines for long-term posttreatment care is limited. The American Cancer Society Prostate Cancer Survivorship Care guidelines were developed using a combined approach of evidence synthesis and expert consensus. They address health promotion, surveillance for recurrence and screening for second primary cancers, and the assessment and management of physical and psychosocial long-term and late effects resulting from prostate cancer and its treatment. A key challenge to the development of the guidelines was the limited availability of published evidence informing the clinical management of prostate cancer survivors after treatment.

Among the recommendations:

• Since information needs evolve as patients transition from treatment through various stages of survivorship, survivor and caregiver information needs should be assessed regularly, with information and support services provided or referred to as necessary.
• Primary care clinicians should provide regular evaluations of survivors to determine appropriate levels of participation in health promotion and lifestyle modification programs.
• Primary care clinicians should conduct routine assessments of body mass index among survivors across the prostate cancer survivorship continuum, with recommendations for limiting consumption of high-calorie foods and beverages for survivors who are overweight or obese.
• Primary care clinicians should educate survivors regarding the association between physical activity and lower overall and prostate cancer-specific mortality and improved quality of life.
• Since smoking after treatment of prostate cancer increases the risk of cancer recurrence and second cancers, primary care clinicians should assess for tobacco use and offer or refer survivors to cessation counseling and resources.
• While existing evidence is not definitive with regard to frequency of monitoring for recurrence using PSA testing, a leading clinical practice guideline, The NCCN guidelines for prostate cancer treatment recommend measuring serum PSA levels every 6 to 12 months for the first 5 years after definitive treatment, and then to recheck annually.
• Clinicians should be aware of a small increased risk of second primary cancers after radiation therapy compared with men receiving surgery. While evidence does not support increased frequency or intensity of screening, adherence to routine ACS screening guidelines for the early detection of any new cancers is recommended.
• Survivors should be assessed for physical (e.g.: urinary, sexual, bowel) and psychosocial effects of prostate cancer and its treatment; the focus of assessment should be tailored to the type of cancer treatment received and current disease state to trigger appropriate self-management and clinical management strategies for support and therapy.
• Estimates indicate that as many as 30% of patients with prostate cancer experience clinically relevant general distress, 25% have increased anxiety, and nearly 10% experience major depressive disorder. These guidelines affirm early identification, treatment, and ongoing assessment for psychological distress as important aspects of prostate cancer survivorship care.

"We are hopeful that the hard work that went into the development of these much-needed guidelines will pay off in improved care for the approximately 240,000 men diagnosed with prostate cancer every year," said Rebecca Cowens-Alvarado, MPH, principal investigator for the National Cancer Survivorship Resource Center, director of Cancer Control Mission Strategy at the American Cancer Society and co-author of the report. "The adoption of these guidelines will be a critical step forward to improve the delivery of prostate cancer survivorship care."

Malaria: Blood cells behaving badly

 

June 10, 2014

American Institute of Physics (AIP)

New insight into how malaria parasites perturb flow, turning infected cells into sticky capillary cloggers, may lead to new and better treatments. All the billions of flat, biconcave disks in our body known as red blood cells (or erythrocytes) make three basic, tumbling-treadmill-type motions when they wend their way through the body's bloodstream ferrying oxygen from our lungs to our brains and other tissues. That is, unless they are infected with malaria parasites, in which case their motions are completely different.

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New insight into how malaria parasites perturb flow, turning infected cells into sticky capillary cloggers, may lead to new and better treatments.

A team of researchers at the National University of Singapore (NUS) has discovered this striking difference by comparing the flow dynamics of healthy vs. malaria-infected red blood cells. Reported this week in the Journal of Applied Physics, from AIP Publishing, their work may provide insights into developing better-targeted drug treatments for malaria in the future.

"By gaining a better understanding of why and how erythrocytes undergo changes in geometry and physical properties, we hope to elucidate such changes as possible targets for possible effective treatment of malaria," said Nhan Phan-Thien, a professor in the Department of Mechanical Engineering at the National University of Singapore.

Malaria, a life-threatening disease caused by Plasmodium parasites, afflicts hundreds of millions of people each year and is responsible for more than half a million deaths -- mostly children living in Sub-Saharan Africa. Transmitted through the saliva of a female Anopheles mosquito, the parasites have a complicated, multi-stage life cycle part of which is spent inside the red blood cells of their human host.

Once the mosquito takes a blood meal and infects a person, malaria parasites invade red blood cells, making the cells stiffer and stickier. These cells also morph from a bi-concave shape to a more spherical form during the late "schizont stage" of malaria, which occurs 36 to 48 hours after onset of the infection. When red blood cells become stiff and deformed, they can become stuck in narrow capillaries and cause anemia, because fewer blood cells can flow to deliver oxygen to the different organs in the body, including the brain.

In the new paper, the NUS team reports how they used a particle-based method called "dissipative particle dynamics" to zero in on the three typical modes of motion of a cell or capsule in shear flow -- tank-treading, tumbling, or trembling -- and uncover the behavior of healthy and malaria-infected erythrocytes.

"Tank-treading mode is a steady state, in which a cell remains stationary while its membrane rotates around the internal fluid continuously," Phan-Thien explained. "Tumbling mode is an unsteady state in which the cell flips or tumbles periodically in its original shape as a rigid body. And the trembling mode is a transitional state between the two other modes, and is characterized by a shape variation and an angular oscillation."

The team discovered that, when experiencing the same shear rate, if a healthy erythrocyte undergoes a tumbling motion, the malaria-infected cell instead exhibits only a tumbling motion.

What advantage can malaria parasites gain by affecting the tumbling motion of erythrocytes? "Tumbling may allow the red blood cell to make better contact with the blood vessel wall and provide an opportunity to adhere to it," said Phan-Thien. The advantage to the parasite in making the red blood cell stick could be that it stalls the cells and keeps them from circulating and be cleared by the spleen or the immune system.

The researchers also found that at rates where a healthy erythrocyte undergoes a trembling motion, a malaria-infected cell can't exhibit the tank-treading motion. "And if a healthy erythrocyte undergoes a tank-treading motion, the malaria-infected one will exhibit any one of the three dynamic motions," noted Phan-Thien.

Mammography has led to fewer late-stage breast cancers

 

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In the last 30 years, since mammography was introduced, late-stage breast cancer incidence has decreased by 37 percent, a new study from the University of Michigan Comprehensive Cancer Center finds.

The analysis takes into account an observed underlying trend of increased breast cancer incidence present since the 1940s, a sort of inflation rate for breast cancer.

Researchers looked at early-stage and late-stage breast cancer diagnoses between 1977-1979, before mammography became popular, and compared it to diagnoses between 2007-2009. Based on trends observed in the pre-mammography period of the 1940s to the 1970s as well as continued trends over time, the researchers took into account a central estimated increase in breast cancer incidence of 1.3 percent per year. This is called an annual percentage change, or APC.

Think of the APC like the inflation rate: $1 from 1977 does not go as far in 2007. Just as the cost of money rises, the number of breast cancer diagnoses is increasing, independently of efforts to detect it earlier.

In the current paper, published in Cancer, the researchers looked at the late 1970s data and projected incidence of early-stage and late-stage breast cancer in 2007-2009 based on the APC. They then compared the projected rates to actual rates.

Late-stage breast cancer incidence decreased 37 percent from the projected rate, and early-stage breast cancer incidence correspondingly increased 48 percent from 1977-1979 to 2007-2009. They also conducted similar analyses with other APC values, ranging from 0.5 percent to 2 percent. All estimates showed a substantial decrease in late-stage disease.

"When you factor in this temporal trend, our analysis shows that there has been a shift from late-stage to early-stage breast cancer over the last 30 years. This is what you would expect with a successful screening program. Not only are we detecting more early-stage cancer, but we are decreasing the number of late-stage cases that tend to be more challenging to treat and more deadly," says senior study author Mark Helvie, M.D., professor of radiology and director of breast imaging at the U-M Comprehensive Cancer Center.

There are many reasons why breast cancer incidence is increasing over time, including reproductive, dietary and environmental factors. Prior estimates showed a 1 percent to 3 percent annual increase in the United States and Europe before mammography screening began. In countries in Africa, Asia and Eastern Europe with no routine screening mammography, breast cancer rates are increasing as much as 3 percent to 5 percent per year.

Importantly, the current study also found that since mammography was introduced, there has been an overall 9 percent decrease in invasive breast cancer, when factoring in a 1.3 percent annual percentage increase. This has been offset by an increase in ductal carcinoma in situ, so-called stage 0 breast cancer, which is not invasive.

"While we have seen an increase in overall breast cancer incidence over the last 30 years, the drop in late-stage diagnoses is a positive benefit of mammography and our heightened awareness of early detection. The decrease in late-stage disease, together with improved treatments, contributes to the decreased mortality from breast cancer in the United States in the last 20 years," Helvie says.

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Story Source:

The above story is based on materials provided by University of Michigan Health System. Note: Materials may be edited for content and length.

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Journal Reference:

1. Mark A. Helvie, Joanne T. Chang, R. Edward Hendrick, Mousumi Banerjee. Reduction in late-stage breast cancer incidence in the mammography era: Implications for overdiagnosis of invasive cancer. Cancer, 2014; DOI: 10.1002/cncr.28784

New biometric watches use light to non-invasively monitor glucose, dehydration, pulse

 

In a pair of papers published in The Optical Society's (OSA) open-access journal Biomedical Optics Express, groups of researchers from the Netherlands and Israel describe two new wearable devices that use changing patterns of scattered light to monitor biometrics: one tracks glucose concentration and dehydration levels, and the other monitors pulse.

The glucose sensor is the first wearable device that can measure glucose concentration directly but noninvasively, the authors say.

And while other wearable devices have been made to monitor pulse, the authors claim their new design would be less sensitive to errors when the wearer is in motion, for example while walking or playing sports

Both of the watches described in the two papers make use of the so-called "speckle" effect, the grainy interference patterns that are produced on images when laser light reflects from an uneven surface or scatters from an opaque material. When the material that is scattering the light is moving -- say, in the case of blood flowing through the circulatory system -- "the speckle pattern changes with changes in the flow," explained biomedical engineer Mahsa Nemati, a graduate student in the Optics Research Group at the Delft University of Technology in the Netherlands and the lead author of the Biomedical Optics Express paper on monitoring pulse. Those light variations are a valuable source of information, she says.

The 'Holy Grail' of Diagnostics

In the first paper, bioengineer Zeev Zalevsky of Israel's Bar-Ilan University and his colleagues describe a new wearable biometric system that uses the speckle effect to directly monitor the glucose concentration in the bloodstream, as well as the wearer's relative hydration level.

"Glucose is the holy grail of the world of biomedical diagnostics, and dehydration is a very useful parameter in the field of wellness, which is one of our main commercial aims," Zalevsky said.

The watch-like device consists of a laser to generate a wavefront of light that illuminates a patch of skin on the wrist near an artery, and a camera that measures changes over time in the light that is backscattered off the skin. Unlike other chemicals present in the blood, glucose exhibits a so-called Faraday effect. This means that in the presence of an external magnetic field (generated by a magnet attached to the device) the glucose molecule alters the polarization of the wavefront and thus influences the resulting speckle patterns. Analyzing these changing patterns provides a direct measurement of the glucose concentration. Because one of the main signs of mild to moderate dehydration is muscle weakness, which will alter the strength of the signals, the same device can also be used to indicate the relative dehydration level of the user as it changes over time.

Zalevsky and his colleagues are now working to reduce the margin of error in the device's readings. "Around 96 percent of our in vivo measurements were within a range of 15 percent deviation from the readout of a medical reference glucometer device," Zalevsky noted. "The main factor for errors now is the stability of our device on the wrist of the user. We are currently investing efforts in deriving proper calibration and motion cancellation procedures that will allow us to reduce this sensitivity."

Zalevsky says this is the first step toward non-invasive, continuous in vivo measurement of glucose that is based on sensing an effect that is directly related to glucose concentration. The team expects a commercial version of the device to reach the market within two to three years.

Pulse Tracker

In the second Biomedical Optics Express paper, Nemati and her colleagues at Delft and at Phillips Research developed a method that could be used to monitor pulse non-invasively with a sensor that isn't thrown off by the wearer's movement.

Using simulated heart beats generated in milk and measurements performed on the finger of a volunteer, they found that speckle changes can be used to accurately measure flow pulsations -- that is, the heart rate -- even when the light source used to create the speckle pattern is also moving, as would be the case with a wearable biometric sensor. The researchers found that just a couple of pixels from the image were sufficient to extract the pulse rate.

"This paper shows for the first time that a speckle pattern generated from a flowing liquid can give us the pulsation properties of the flow in spite of motion-induced artifacts," Nemati said. "Sophisticated optics is not necessary to implement this, so the costs for devices can be kept low. Another advantage is that the devices can be non-contact or far from the sample," she added.

The team is currently working with companies to integrate their motion-friendly pulse-monitoring technique into existing sensors, for potential use clinically as well as in sports, Nemati said.

Smokers, passive smokers more likely to suffer hearing loss, study shows

 

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Giving up or reducing smoking and avoiding passive exposure to tobacco smoke may reduce your risk of hearing loss, new research shows.

Smokers and passive smokers more likely to suffer hearing loss, study shows

Current smokers have a 15.1% higher odds of hearing loss than non-smokers The University of Manchester study, funded by Action on Hearing Loss, Medical Research Council and the National Institute for Health Research, found.

Passive smoking also increased the likelihood of hearing loss by 28%.

But ex-smokers had a slightly reduced risk of going deaf -- which may be because once they quit they adopt a more healthy life style overall.

The study is published in the Journal of the Association for Research in Otolaryngology today.

Researchers looked at 164,770 UK adults aged 40 to 69 years of age who took hearing tests between 2007 and 2010 when they joined UK Biobank, a national project to improve health.

Dr Piers Dawes, from the Centre for Human Communication and Deafness at The University of Manchester who led the research, said: "Given around 20% of the UK population smoke and up to 60% in some countries, smoking may represent a significant cause of hearing loss worldwide.

"We found the more packets you smoke per week and the longer you smoke, the greater the risk you will damage your hearing."

The link between smoking and hearing loss is still unclear but many smokers also often had heart disease.

Dr Dawes added: "We are not sure if toxins in tobacco smoke affect hearing directly, or whether smoking-related cardiovascular disease causes microvascular changes that impact on hearing, or both."

The increased risk among passive smokers -- higher than that for smokers -- could be because smokers were compared to both complete non-smokers and passive non-smokers but passive smokers were only compared to non-smokers.

This means the association with smoking and hearing loss maybe under estimated, the researchers say.

Dr Ralph Holme, Head of Biomedical Research at Action on Hearing Loss, said "Hearing loss affects 10 million people in the UK and with an aging population is set to become a major public health issue.

"Hearing loss is often viewed as an inevitable consequence of aging, but as the research published today shows, this may not always be the case. Giving up smoking and protecting your ears from loud noise are two practical steps people can take today to prevent hearing loss later in life."

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Story Source:

The above story is based on materials provided by Manchester University. Note: Materials may be edited for content and length.

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Journal Reference:

1. Piers Dawes, Karen J. Cruickshanks, David R. Moore, Mark Edmondson-Jones, Abby McCormack, Heather Fortnum, Kevin J. Munro. Cigarette Smoking, Passive Smoking, Alcohol Consumption, and Hearing Loss. Journal of the Association for Research in Otolaryngology, 2014; DOI: 10.1007/s10162-014-0461-0