Presidential Healthcare center

We provide the same Preventive Executive Physical Program as received by the President of the United States.


Leave a comment

Report: Pancreatic Cancer to Become Second Most Deadly by 2030

Pancreas

Pancreas

By 2030, the top cancer killers in the United States will be lung, pancreas and liver, according to a new report published Monday in the American Association for Cancer Research’s journal.

Lung cancer is already the top killer overall, but pancreatic and liver cancer will surpass the cancers currently considered the second and third leading causes of death, researchers say. Right now, second most dangerous is breast cancer for women and prostate cancer for men; and third is colorectal cancer for both men and women.

Researchers looked at trends in cancer incidence and death rates between 2006 and 2010, and used that data — combined with expected U.S. demographic changes — to predict numbers for 2030.

Overall, the cancer-related death rate has been decreasing, researchers say, as a result of improved screening and treatment options. Yet while deaths from breast, prostate and colon cancers are projected to drop, deaths caused by liver, pancreatic, bladder and leukemia cancers are expected to increase.

In fact, liver and pancreatic cancers will surpass breast and prostate to become the second and third-leading causes of cancer-related deaths, the researchers say.

“We’ve been able to turn the tide in other cancers, with an investment in (research),” said lead author Lynn Matrisian, vice president of scientific and medical affairs at the Pancreatic Cancer Action Network, which funded the study. “We’re hoping that with increased effort … we will be able to impact and change those projections.”

The rate of pancreatic cancer has been slowly increasing for the past 15 years, says Dr. Otis Brawley, chief medical officer of the American Cancer Society. Some of that rise can be attributed to the prevalence of obesity and diabetes.

“Many Americans are not aware that the combination of obesity, high-caloric intake and lack of physical activity is the second-leading cause of cancer in the U.S.,” Brawley said. “It is linked to at least 12 types of cancer, of which these are two. This is an American problem … the rise in pancreatic cancer is not as severe as in Europe where obesity is less of an issue.”

Overall, the number of cancer cases is expected to increase over the next 16 years, due to the rapidly aging population. In 2010, the United States had about 1.5 million cases of cancer; in 2030, researchers expect that number to reach 2.1 million.

“We’re living much longer in the United States, so the number of people 65 age and older will be much greater,” Matrisian said. “And that’s, of course, one of the biggest risk factors for cancer: Age.”

Lung, breast, prostate and colorectal cancers are currently the most common in the United States. Known as the “big four,” these cancers have the highest incidence rates and receive the most research funding from the National Cancer Institute.

This is unlikely to change by 2030, the researchers say, except for colorectal cancer, which is expected to be surpassed by thyroid, melanoma and uterine cancers in total number of cases.

“The decrease in colorectal cancer, falling from the top four incidence and top two in deaths, seems to be primarily the result of advances in colorectal cancer screening,” the report authors write.

The dramatic increase in thyroid cases is not a new epidemic, they say, but simply an increase in the number of cases being diagnosed. And while thyroid cancer has a 98% five-year survival rate, only 6% of pancreatic cancer patients are alive five years after diagnosis.

The pancreas is difficult to scan with current imaging technologies, Matrisian says, because of its location in the body. And pancreatic tumors are often surrounded by dense tissue that render drugs useless. Surgery is the only treatment known to cure pancreatic cancer, but less than 20% of cases are operable, the report says.

“If we want to change the death rate for these diseases, it is necessary to increase the investment in understanding them and identifying early detection strategies,” the report says.

Source: CNN

 


Leave a comment

The Vegetables Most Americans Eat Are Drowning In Salt And Fat

Unknown-6

Popeye and our parents have been valiantly trying to persuade us to eat our veggies for decades now.

But Americans just don’t eat as many fruits and vegetables as we should. And when we do, they’re mainly potatoes and tomatoes — in the not-so-nutritious forms of french fries and pizza, according to a report from the U.S. Department of Agriculture.

Americans eat 1.5 cups of vegetables daily, on average, the USDA finds. But the national nutrition guidelines recommend 2 to 3 cups a day for adults. And more than half our veggie intake comes from potatoes and tomatoes, whereas only 10 percent comes from dark green and orange veggies like spinach, carrots and sweet potatoes.

Of course, potatoes are great on their own — they’re a good source of potassium. But most Americans eat them with a hefty side of fat and sodium. According to the USDA’s handy chart, at home, most people get their potato fix in the form of chips. And when eating out, about 60 percent of the potatoes we consume are fried. Baked potatoes are also popular, but most people don’t eat the skin — a great source of fiber that fills you up

Tomatoes start out healthy as well, and they’re a good way to boost your vitamin A and C intake. Tomato sauce, on the other hand, can pack in a lot of hidden sugar and salt. While a cup of raw tomato has about 9 milligrams of sodium, canned tomato sauce can contain more than 1,000 milligrams of sodium per cup, according to the USDA.

And even potatoes and tomatoes in their healthy forms don’t make for a complete, balanced diet. Americans eat far less fiber than they should, the researchers say, and fiber is found in dark green and orange veggies. As we’ve reported, fiber can make you gassy, but it’s essential to a healthy microbiome.

After a 2002 government nutrition report found that higher fruit consumption correlated with a lower body mass index but not vegetable consumption, USDA researchers decided to look more into how Americans are getting their vegetables.

“We started thinking about it, and realized it’s quite common to just pick up a piece of fruit and eat it as-is,” says Joanne Guthrie, a nutritionist at the USDA’s Economic Research Service who co-authored the report. “But that wasn’t the case for vegetables.” Vegetables often need to be peeled, cut and cooked, so they’re just not as handy.

So maybe this tomato and potato finding isn’t a huge shocker. Just a few years ago public health experts were debating whether school lunch programs should get to count a slice of pizza as a serving of vegetables, and fries have garnered their share of negative publicity in recent school lunch battles, too.

But, as Guthrie sats, the report is a reminder that we need to pay more attention to how we prepare our vegetables. “We all want to have a healthful diet,” she says. So mind the sugar and sodium, and branch out from pizza and french fries.

Source: NPR


1 Comment

Sleep Apnea Linked To Hearing Loss In New Study

Unknown-5

People with sleep apnea may have a higher risk of hearing loss, according to a new study.

The research, which was presented at the American Thoracic Society’s 2014 International Conference, found that of the 13,967 participants sampled, about 10 percent had at least moderate sleep apnea. These patients had a 31 percent increased risk of high frequency hearing impairment, a 90 percent increased risk of low frequency hearing impairment and a 38 percent increased risk in combined high and low frequency hearing impairment after controlling for other causes of hearing loss and potentially confounding factors like age and sex.

“The mechanisms underlying this relationship merit further exploration,” lead author Dr. Amit Chopra, M.D., of the Albany Medical Center in New York, said in a statement. “Potential pathways linking sleep apnea and hearing impairment may include adverse effects of sleep apnea on vascular supply to the cochlea [part of the inner ear] via inflammation and vascular remodeling or noise trauma from snoring.”

Snoring is caused by relaxed throat muscles narrowing the airways during sleep, leading to sound-causing vibrations. Sleep apnea, while it may also include some snoring, results in temporary pauses in breathing, sometimes up to hundreds of times a night.

Chopra pointed out that people with sleep apnea “are at an increased risk for a number of comorbidities, including heart disease and diabetes,” both good reasons to seek treatment for the condition. The current study did not account for how sleep apnea treatment might affect the link to hearing loss.

Researchers at the conference also presented findings linking acute respiratory failure to sleep apnea. They found that the majority of acute respiratory failure patients, defined as having needed mechanical ventilation for at least 48 hours, met sleep apnea criteria.

Source: Huffington Post

 


Leave a comment

Single Episode of Binge Drinking Linked to Gut Leakage and Immune System Effects

imagesCASKVD5J

A single alcohol binge can cause bacteria to leak from the gut and increase levels of bacterial toxins in the blood, according to a study funded by the National Institutes of Health. Increased levels of these bacterial toxins, called endotoxins, were shown to affect the immune system, with the body producing more immune cells involved in fever, inflammation, and tissue destruction.

Binge drinking is defined by NIAAA as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08g/dL or above. For a typical adult, this pattern corresponds to consuming five or more drinks for men, or four or more drinks for women, in about two hours. Some individuals will reach a 0.08g/dL BAC sooner depending on body weight. Binge drinking is known to pose health and safety risks, including car crashes and injuries. Over the long term, binge drinking can damage the liver and other organs.

“While the negative health effects of chronic drinking are well-documented, this is a key study to show that a single alcohol binge can cause damaging effects such as bacterial leakage from the gut into the blood stream,” said Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism, part of NIH.

The study was led by Gyongyi Szabo, M.D., Ph.D., Professor and Vice Chair of Medicine and Associate Dean for Clinical and Translational Sciences at the University of Massachusetts Medical School. .

In the study, 11 men and 14 women were given enough alcohol to raise their blood alcohol levels to at least .08 g/dL within an hour. Blood samples were taken every 30 minutes for four hours after the binge and again 24 hours later.

The researchers found that the alcohol binge resulted in a rapid increase in endotoxin levels in the blood and evidence of bacterial DNA, showing that bacteria had permeated the gut. Endotoxins are toxins contained in the cell wall of certain bacteria that are released when the cell is destroyed. Compared to men, women had higher blood alcohol levels and circulating endotoxin levels.

“We found that a single alcohol binge can elicit an immune response, potentially impacting the health of an otherwise healthy individual,” said Dr. Szabo. “Our observations suggest that an alcohol binge is more dangerous than previously thought.”

Earlier studies have tied chronic alcohol use to increased gut permeability, wherein potentially harmful products can travel through the intestinal wall and be carried to other parts of the body. Greater gut permeability and increased endotoxin levels have been linked to many of the health issues related to chronic drinking, including alcoholic liver disease.

About the National Institute on Alcohol Abuse and Alcoholism (NIAAA): The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems. NIAAA also disseminates research findings to general, professional, and academic audiences.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases.

Source: NIH


Leave a comment

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

The following cases of laboratory confirmed Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported from Jordan, Lebanon, the Netherlands, the United Arab Emirates, and the United States.

mers

Netherlands

On 14 May 2014, the National IHR Focal Point for the Netherlands notified WHO of the first laboratory confirmed case of MERS-CoV infection in the Netherlands. The patient is a 70 year-old male citizen of the Netherlands, with travel history to the Kingdom of Saudi Arabia between 26 April 2014 and 10 May 2014.

The patient developed first symptoms on 1 May 2014 while in Medina, Saudi Arabia. He was evaluated at an emergency care department in Mecca on 6 May and given antibiotics; he did not have respiratory symptoms while in Saudi Arabia. On return to the Netherlands, on 10 May, his condition deteriorated, including development of respiratory symptoms, and he was hospitalized on the same day. On 13 May, he tested positive for MERS-CoV. Currently, the patient is in the ICU in a stable condition.

The patient reports no contact with animals or consumption of raw animal products. Identification of close contacts, including flight contacts has been initiated.

United States of America

On 12 May 2014, the United States IHR National Focal Point reported the second laboratory confirmed MERS-CoV infection in the United States in a male health-care worker in his 40s, who lives and works in Jeddah, Saudi Arabia.

He travelled to the United States from Jeddah on 1 May 2014 on commercial flights via London Heathrow with travel from London to Boston, Massachusetts; from Boston to Atlanta, Georgia; and from Atlanta to Orlando, Florida.

He began feeling unwell on 1 May 2014 on the flight from Jeddah to London with a low-grade fever, chills, and a slight cough. On 9 May 2014, he was seen in an emergency room and hospitalized. The patient is in a stable condition.

The Division of Global Migration and Quarantine (DGMQ) from the US Centers for Disease Control and Prevention (CDC) continues to work with local, state, and international partners, as well as with the airlines to obtain the passenger manifests from the flights to help identify, locate, and interview contacts.

United Arab Emirates

On 11 May 2014, the National IHR Focal Point of the United Arab Emirates reported nine additional MERS-CoV cases residing in Abu Dhabi. Two are UAE nationals, one is an Omani national, and six are of different nationalities but residing in Abu Dhabi.

  • A 51-year old male Omani national, residing in Al Buraimi, Oman, developed fever on 18 April 2014. He was admitted to the hospital on 20 April 2014. On 23 April 2014 he tested positive for MERS-CoV. He is currently in hospital in isolation in a stable condition. The patient has comorbidities, no history of travel, no contact with animals, and no history of contact with a laboratory confirmed case of MERS-CoV. The IHR NFP for Oman was already informed about this case.
  • A 39-year-old female health-care worker, residing in Abu Dhabi, who was screened as part of contact investigation. She was asymptomatic; MERS-CoV was confirmed by the laboratory on the 25 April 2014. She has a history of exposure to a confirmed case of MERS-CoV notified to WHO on 18 April 2014. She has no comorbidities, no history of travel, and no contact with animals.
  • A 30-year old male UAE national, residing in Abu Dhabi. On 24 April 2014, he went to the emergency room with cough and shortness of breath, but he was clinically stable, and was treated as an outpatient. On 25 April, he tested positive for MERS-CoV. He is currently in hospital in a good general condition. The patient had reported comorbidities, no history of recent travel, no history of animal contact, and no history of contact with a laboratory confirmed case of MERS-CoV.
  • A 42-years old male UAE national, residing in Abu Dhabi, who was asymptomatic and was screened as a contact of the first case in this notification. On 25 April 2014, he tested positive for MERS-CoV. He has no history of travel and no history of contact with animals.
  • A 30-year old female health-care worker residing in Abu Dhabi. She had a sore throat on 15 April 2014; a sputum sample was taken on 16 April 2014 as part of a general screening of health-care workers following a cluster of cases in the hospital. She tested positive for MERS-CoV on the 17 April 2014 and was admitted to hospital the same day. She was discharged on the 22 April 2014. She has no comorbidity, no significant travel history, and no contact with animals.
  • A 44-year old male health-care worker residing in Abu Dhabi. He had a mild sore throat that started on the 19 April 2014. He had contact on 13 April at a social gathering with a confirmed case reported to WHO on 17 April 2014. The patient tested positive for MERS-CoV on 21 April 2014 and was admitted to hospital on 22 April 2014. He was discharged on 1 May 2014. He has no comorbidities, no significant travel history, and no contact with animals.
  • A 41-year old male hospital employee residing in Abu Dhabi. He was asymptomatic, but was screened without having contact with any case as part of a general screening at his work place. On 21 April, he tested positive for MERS-CoV and was admitted to hospital on 22 April. He was discharged on 27 April 2014. He has no comorbidities, no significant travel history, and no contact with animals
  • A 68-year old male hospital employee residing in Abu Dhabi. He was asymptomatic, but was screened without having contact with any case as part of a general screening at his work place. On 23 April, he tested positive for MERS-CoV and was admitted to hospital on 24 April 2014 for isolation. He was discharged on 30 April 2014. He has reported comorbidities, has no significant travel history, and no contact with animals.
  • A 45-year old male hospital employee residing in Abu Dhabi. He was asymptomatic, but was screened without having contact with any case as part of a general screening at his work place. On 26 April, he tested positive for MERS-CoV and was admitted to hospital on the same day for isolation. He was discharged on 1 May 2014. He has no comorbidities, no significant travel history, and no contact with animals.

On 8 May 2014, the National IHR Focal Point for the United Arab Emirates (UAE) reported an additional four laboratory-confirmed cases of infection with MERS-CoV.

  • A 37 year-old male expatriate construction worker in Abu Dhabi who became ill on 23 April 2014 and was hospitalized on 29 April 2014. He tested positive for MERS-CoV on 1 May 2014 and is currently in the intensive care unit (ICU) in a critical but stable condition. He is reported to have no comorbidities, no history of travel, and no contact with laboratory confirmed cases or with animals.
  • A 38 year-old female administrative officer in a health clinic from Abu Dhabi who became ill on 20 April 2014. She was admitted to hospital on 26 April 2014. Initial laboratory tests for MERS-CoV were negative for the virus, but a follow-up test on 27 April 2014 returned positive on 1 May 2014. Currently, the patient is in the ICU in a critical but stable situation. She has several comorbidities, but is also to have no history of travel, no contact with laboratory confirmed cases or with animals, and no history of raw camel milk consumption.
  • A 61 year-old male expatriate tailor shop owner residing in Abu Dhabi. He has been hospitalized since 18 March 2014 as a case of atrial fibrillation and chronic obstructive pulmonary disease (COPD). Samples collected on 29 April 2014 and sent to the laboratory tested positive for MERS-CoV on 1 May 2014. Currently, he is in the ICU in a critical but stable condition. He is reported have no history of travel, no contact with laboratory confirmed cases or with animals, and no history of raw camel milk consumption.
  • A 34 year-old female expatriate residing in Abu Dhabi. She is asymptomatic. She was detected through mass screening of her work place without being in contact with any known case. Samples collected on 29 April 2014 and sent to the laboratory tested positive for MERS-CoV on 1 May 2014. She is reported to have no comorbidities, no history of travel, and no contact with laboratory confirmed cases or with animals. She is a vegetarian and consumes only pasteurized dairy products.

One additional case not previously reported was provided to WHO on 8 April 2014 by the National IHR Focal Point for UAE:

  • A 59 year-old male farm employee residing in Abu Dhabi. The patient had onset of symptoms on 28 March 2014 with febrile illness. On 30 March 2014, he was admitted to hospital and was being treated in the ICU. On 3 April 2014, he was laboratory confirmed with MERS-CoV. He is reported to have had contact with an admitted laboratory confirmed case of MERS-CoV.

Public health authorities continued to carry out contact tracing and an epidemiological investigation. Further developments will be communicated when available.

Jordan

On 11 May 2014, the National IHR Focal Point for Jordan reported to WHO an additional case of MERS-CoV.

The case is a 50 year-old male health-care worker, Jordanian citizen, and resident of Zarka Governorate. He presented with symptoms on 7 May 2014. On 10 May his condition worsened and he was diagnosed with pneumonia after performing a chest X-ray. He was admitted to hospital the same day and tested positive for MERS-CoV. The patient has a history of contact with two MERS-confirmed cases. He is in a stable condition. He is reported to have no history of travel and no history of contact with animals.

Tracing and screening of six family members and 24 health-care workers for MERS-CoV is currently ongoing.

Lebanon

On 8 May, 2014, the National IHR Focal Point (NFP) of Lebanon reported the first laboratory-confirmed case of MERS-CoV infection.

On 22 April 2014, a 60 year-old male health-care worker and national of Lebanon complained of high-grade fever. On 27 April 2014, he was diagnosed with pneumonia and was admitted to the hospital on 30 April 2014. His symptoms included fever, dyspnoea, and productive cough. On 2 May 2014, he tested positive for MERS-CoV. He is reported to have comorbidities. He was in a stable condition in hospital and was released on 7 May 2014.

The patient is reported to have no contact with laboratory confirmed cases or with animals and no history of raw camel milk consumption. No history of travel was reported in the 14 days prior to onset of symptoms.

The patient is known to travel throughout the Gulf region, particularly to Kuwait, Saudi Arabia, and UAE; investigations into the patient’s travel history are ongoing. His most recent travel was five weeks prior to symptom onset to UAE and eight weeks prior to symptom onset to Jeddah where he visited one of the hospitals that had been facing an upsurge of MERS-CoV cases.

Globally, 572 laboratory-confirmed cases of infection with MERS-CoV have officially been reported to WHO, including 173 deaths. The global total includes all of the cases reported in this update (18), plus 58 laboratory confirmed cases officially reported to WHO from Saudi Arabia between 5 and 9 May. WHO is working with Saudi Arabia for additional information on these cases and will provide further updates as soon as possible.

WHO advice

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. Health-care facilities that provide for patients suspected or confirmed to be infected with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus from an infected patient to other patients, health-care workers and visitors. Health care workers should be educated, trained and refreshed with skills on infection prevention and control.

It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.

Droplet precautions should be added to the standard precautions when providing care to all patients with symptoms of acute respiratory infection. Contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection. Airborne precautions should be applied when performing aerosol generating procedures.

Patients should be managed as potentially infected when the clinical and epidemiological clues strongly suggest MERS-CoV, even if an initial test on a nasopharyngeal swab is negative. Repeat testing should be done when the initial testing is negative, preferably on specimens from the lower respiratory tract.

Health-care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations. All Member States are reminded to promptly assess and notify WHO of any new case of infection with MERS-CoV, along with information about potential exposures that may have resulted in infection and a description of the clinical course. Investigation into the source of exposure should promptly be initiated to identify the mode of exposure, so that further transmission of the virus can be prevented.

People at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating. For the general public, when visiting a farm or a barn, general hygiene measures, such as regular hand washing before and after touching animals, avoiding contact with sick animals, and following food hygiene practices, should be adhered to.

WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

Souce: World Health Organization


Leave a comment

Largest Prostate Screening Trial Still Shows It Saves Lives

31648

For the first time, updated results from the European Randomized Study of Screening for Prostate Cancer (ERSPC), the largest randomized prostate cancer screening trial in the world, show a significant survival advantage with prostate-specific antigen (PSA) screening for men from 50 to 74 years of age.

The new data come from a follow-up of 13 years, and were presented during a late-breaking abstract session here at the European Association of Urology 29th Annual Congress. An initial analysis of the ERSPC results, reported in 2009, provided the first proof that PSA screening saves lives from prostate cancer.

This update “offers the most robust data yet in support of the effectiveness of PSA-based early detection efforts to reduce prostate cancer metastases and mortality,” said Matthew Cooperberg, MD, MPH, associate professor of urology, epidemiology, and biostatistics at the University of California, San Francisco, who was asked by Medscape Medical News for comment.

According to Dr. Cooperberg, who was not involved in the research, the ERSPC, together with the Göteborg trial “provides the only contemporary insights on the question of benefits of early detection.”

He said that the screening study conducted in the United States — the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial — “is now broadly acknowledged only to address the question of annual vs opportunistic screening, given a screening rate of more than 75% in the usual care arm.”

The updated ERSPC results were presented by Jonas Hugosson, MD, professor of urology at the Sahlgrenska Academy, University of Gothenburg, in Sweden. He cautioned that screening with the PSA test “should not start too late,” emphasizing that the weight of screening benefits fall to men whose screening begins before the age of 60.

“In our data from the Göteborg Trial, the Swedish arm of ERSPC, we found a prostate cancer mortality reduction of 20% in men who started PSA screening after age 60, while men who started to screen before age 60 had a reduction of 50%,” Dr. Hugosson told Medscape Medical News.

The ERSPC, which began 20 years ago, was a randomized study of more than 180,000 men, only half of whom underwent regular PSA testing. Results from the 11-year follow-up of the ERSPC were published in 2012.

The gap between screened and unscreened groups is decreasing; the relative risk for prostate cancer between the screening and control groups at 9-year follow-up was 1.91, at 11-year follow-up was 1.66, and at a median of 13 years of follow-up was 1.57, Dr. Hugosson reported.

However, he noted, “we still have a 57% increased incidence of prostate cancer in the screening group, compared with the control group.”

This is one of the downsides of PSA screening — the risk for overdiagnosis of prostate cancer that might not affect the individual’s health in the time he has left to live. However, once it is detected, it might be treated, or at least followed with further screening.

The most recent update from the trial shows that the absolute difference in prostate cancer mortality per 1000 patient-years has increased from 9 years (0.31 vs 0.37) to 11 years (0.35 vs 0.46) to 13 years (0.43 vs 0.54). However, the difference in the relative risk for mortality has stabilized in favor of screening; it was 0.85 at 9 years, 0.78 at 11 years, and 0.79 at 13 years.

The number of men needed to invite for screening to prevent 1 prostate cancer death has decreased from 979 at 9 years and is 781 at 13 years. The number needed to diagnose to prevent 1 death has decreased from 35 at 9 years to 27 at 13 years.

As previously reported by this group, large differences between centers in prostate cancer mortality persist.

“For example, in Finland, our largest center has a 9% mortality reduction, whereas Sweden, our neighbor with the same kind of healthcare system, has more than a 4-fold better mortality reduction (38%),” he said. “The largest mortality reduction was seen in Spain (46%), but an increase in mortality was seen in Switzerland (–14%).

An initial analysis suggested that these differences in outcomes between centers stem from differences in screening protocols, such as rate of biopsy, median PSA per invited man, and duration of screening, which ranged from 4 to 10 years.

“It seems like the intensity of screening is very closely related to the effect of prostate cancer mortality reduction,” he said.

Dr. Cooperberg predicts that the benefits from PSA screening will increase with longer follow-up, and he noted that “for a man in his 50s, the relevant time horizon is 30 years or more, not 13 years.”

“The risk of overdiagnosis with screening is still, of course, very salient,” he explained. “The solution is to focus early detection efforts on the detection of high-risk prostate cancer, with broad implementation of active surveillance as the default strategy for low-risk disease.”

Dr. Cooperberg said he disagrees with efforts to stop or reduce PSA screening in healthy men. “A policy of discouraging all early detection efforts runs counter to the growing body of high-quality evidence, and puts thousands of men at risk of avoidable suffering and early mortality,” he said.

Referring to the 2012 recommendation from the US Preventive Services Task Force (USPSTF) against PSA screening for prostate cancer,he noted that “the USPSTF will update its evidence review in the near future to reflect the increasingly incontrovertible message of the ERSPC: that PSA-based early detection saves lives, period.”

Source: Medscape


Leave a comment

Off the Lifestyle Hook with Statins? Study Shows Weight Gain, More Calories Consumed

statins

Individuals prescribed statin therapy for high cholesterol levels have increased their caloric intake by nearly 10% and their intake of fat by 14% over a recent 10-year period, while no changes in eating habits have been observed among statin nonusers, a new study shows.

In addition, researchers report that individuals prescribed a statin had a larger increase in body-mass index (BMI) than those who weren’t taking the lipid-lowering medication.

Presenting their findings April 24, 2014 here at the Society of General Internal Medicine Meeting , the researchers say the study showed that statin users were consuming an extra 192 kcal per day in 2009–2010 than they were in 1999–2000, and this could have contributed to the increase in BMI, which was the equivalent of a 3- to 5-kg weight gain.

“Since the guideline recommends that patients should prevent weight gain, the observed increase in caloric intake and more rapid increase in BMI among statin users are of concern,” write Dr Takehiro Sugiyama (University of Tokyo, Japan) and colleagues in JAMA: Internal Medicine, where the study was published to coincide with the presentation. “According to the guidelines, people who receive statin therapy also should take steps to reduce fat intake, but we did not observe a pattern of combining statin use with dietary control.”

Dr Rita Redberg (University of California, San Francisco), the editor of JAMA: Internal Medicine, said she has treated many patients with statins over the years and has observed a “false reassurance” among those who receive the cholesterol-lowering medications. There is a perception, she writes, that “statins can compensate for poor dietary choices and a sedentary life.” The new data raise concerns of a potential hazard with statins, where the focus on “cholesterol levels can be distracting from the more beneficial focus on healthy lifestyle to reduce heart-disease risk,” suggests Redberg.

Using data from the National Health and Nutrition Examination Survey (NHANES), Sugiyama and colleagues examined the temporal trend in food intake among statin users and nonstatin users between 1999 and 2010. During this time period, the proportion of patients taking statins increased from 7.5% in 1999 to 16.5% in 2010. Statin users tended to be older, male, and white and have less education, a diagnosis of diabetes, and a higher BMI than their counterparts not taking statins.

In 1999–2000, statin users consumed 2000 kcal/day and ate 71.7 g/day of fat, both of which were significantly less than that consumed by individuals not taking statins. By 2009–2010, however, there was a significant increase in the number of calories consumed and the amount of fat eaten by statin users, whereas dietary habits were unchanged among those not taking the cholesterol-lowering medications. In 2009–2010, there was no significant difference in the amount of food consumed by statin users and nonusers, nor was there any difference in the amount of fat consumed. Similar findings were observed when the researchers restricted the analysis to saturated fat and cholesterol intake.

Regarding obesity, there was a 1.3-kg/m2 increase in BMI from 1999–2000 to 2009–2010 in the statin users and a 0.4-kg/m2 increase among statin nonusers.

Although the paper is limited by its cross-sectional design, Sugiyama and colleagues state that it is reasonable to conclude the average American treated with statins is eating more calories and more fat than the average American taking statins was doing a decade ago. At present, they can only speculate as to the reasons for this.

“One possibility is that statin use may have undermined the perceived need to follow dietary recommendations. Patients who recognized that their LDL-cholesterol levels were lowered drastically by statins may have lost the incentive to pursue dietary modifications,” write the researchers. “Physicians might have contributed to this process by shifting the focus of consultations from diet to statin regimen adherence once statin treatment had begun.”

Dr Mahesh Patel (Duke University School of Medicine, Durham, NC), who was not affiliated with the study, said the new analysis is interesting because it explores something that is rarely studied in medicine, that being the interaction between medication and lifestyle habits. However, he is cautious about making firm conclusions based on the data.

“It is tempting to conclude that patients prescribed statins adopted a more liberal diet than the individuals who were not taking the drugs, but the study only reflects population averages” and does not track the same patients over the 10-year period, he told heartwire .

Dr Sekar Kathiresan (Massachusetts General Hospital Heart Center, Boston) agreed with the need for caution. The analysis, which is based on a somewhat “sexy hypothesis,” tends to fit with people’s preconceived notions about the ill effects of medication use. The lament often heard is that people will simply abandon moderation when it comes to diet because they are now being treated with a statin.

“The flaw is that this is a nonrandomized, observational study, and the statin use might simply be marking a subset of patients who ate more over a 10-year period,” Kathiresan told heartwire . As such, the observational nature of the NHANES analysis makes it impossible to imply causality, whereby taking a statin had the unintended effect of people eating more. Like Patel, Kathiresan noted that the researchers did not follow the same group of patients from 1999 to 2010, a major limitation of the data.

Previous studies have shown that the use of statins is associated with a modestly increased risk of diabetes. Kathiresan said that an increased BMI might be one of the possible reasons for this association but again urged restraint about reading too much into the data.

Both Patel and Kathiresan agreed that physicians need to be vigilant in getting patients to understand their risk factors. To heartwire , Patel said that patients should be reminded “they are not off the hook because they’re on a statin and their LDL-cholesterol levels are better” and that physicians should not “let off the gas” once their patients are treated with a moderate- or high-dose statin as recommended by the clinical guidelines.

Source: Medscape