Health & Fitness (206)
SAN ANTONIO (AP) -- Tens of thousands of women each year might be able to skip at least some of the grueling treatments for breast cancer - which can include surgery, heavy chemo and radiation - without greatly harming their odds of survival, new research suggests.
The research is aimed at curbing overtreatment, a big problem in cancer care. Treatments help many women beat the disease, but giving too many or ones that aren't really needed causes unnecessary expense, trauma and lifelong side effects, such as arm swelling and heart troubles. Radiation can even raise the risk of new cancers.
Several studies presented Wednesday at the San Antonio Breast Cancer Symposium, an international conference on the disease, identify groups of patients who might be able to safely forgo certain treatments.
One found that many older women can skip radiation after surgery for early-stage tumors. Two others suggest that surgery may not help patients whose cancer has already spread widely. A fourth study tested a "light chemo" combination that could become a new standard of care.
The trend is "less and less therapy" for certain cancer types, said one conference leader, Dr. C. Kent Osborne of Baylor College of Medicine.
Breast cancer is already widely spread in 5 to 20 percent of newly diagnosed patients, and at that point is usually incurable. The main treatment is chemotherapy or hormone treatments that attack cancer throughout the body. Sometimes doctors also remove the breast tumor in hope of prolonging survival, but this has not been put to a hard test.
Dr. Rajendra Badwe, director of the Tata Memorial Hospital in Mumbai, India, led a study of 350 women with widely spread cancers that had shrunk after initial chemotherapy. Half were given surgery to remove the breast or the lump plus any cancerous lymph nodes. The rest did not have surgery.
After about two years, 40 percent of both groups were alive, suggesting that medicines are enough and that these women can be spared the ordeal of having all or part of a breast removed.
A second study by Dr. Atilla Soran of the University of Pittsburgh Medical Center of nearly 300 women in Turkey also suggests surgery is not helping, though there were hints that some groups did better or worse. Surgery seemed to help if cancer had spread just to bone, and it appeared to do harm if it had spread to the liver or lungs.
"These are incredibly important, big-deal studies," said Dr. Claudine Isaacs, a breast specialist at Georgetown University's Lombardi Comprehensive Cancer Center. Many doctors jumped on earlier, less rigorous studies and advised women to have surgery, and this should be a warning against that, she said.
The results also may spur interest in a U.S. study on the topic. Dr. Seema Khan of Northwestern University in Chicago has had so much trouble recruiting participants that she lowered her goal and may not be able to answer the question.
"There's a huge amount of bias" among doctors and patients about what is best, she said.
Most breast cancers are found at an early stage, and many women are treated with surgery followed by hormones or chemotherapy, plus radiation. But cancer medicines have gotten so good at lowering the risk of a recurrence that doctors wonder whether the radiation is still needed. It can cause heart and other problems, especially in older women, and three or four weeks of daily treatments can be a burden.
Dr. Ian Kunkler of the University of Edinburgh in Scotland led a study of 1,326 patients 65 or older with early-stage cancers whose growth was driven by hormones. This is the most common form of the disease and the age group that accounts for most cases. Half were given radiation and half skipped it.
After five years, roughly 96 percent of both groups were alive, and most deaths were not from breast cancer. About 1 percent of those given radiation had cancer recur in the treated breast versus 4 percent of those who skipped radiation.
For every 100 women given radiation, "one will have a recurrence anyway, four will have a recurrence prevented, but 95 will have had unnecessary treatment," Kunkler said. Since radiation did not affect survival or the risk of cancer spreading, skipping it "is a reasonable option."
Doctors are unsure how to treat women with small tumors involving the gene that the drug Herceptin targets. Those tumors are low risk because they're still confined to the breast, but high risk because the gene is thought to make them more aggressive. Some women get heavy-duty chemo, including drugs that can damage the heart.
Dr. Eric Winer of the Dana-Farber Cancer Institute in Boston led a study of 406 women given "light chemo" - paclitaxel plus Herceptin for 12 weeks, followed by nine months of Herceptin alone. More than three years later, only four had cancer recur in the same breast, and two had recurrences in other places.
"This is likely to become a new standard," Winer said.
The cancer conference is sponsored by the American Association for Cancer Research, Baylor and the UT Health Science Center.
Marilynn Marchione can be followed at HTTP://TWITTER.COM/MMARCHIONEAP
JEFFERSON CITY, Mo. (AP) -- The slow rollout of a new federal health insurance marketplace may be deepening differences in health coverage among Americans, with residents in some states gaining insurance at a far greater rate than others.
The demarcation may be as simple as Democrat and Republican.
Newly released federal figures show more people are picking private insurance plans or being routed to Medicaid programs in states with Democratic leaders who have fully embraced the federal health care law than in states where Republican elected officials have derisively rejected what they call "Obamacare."
On one side of the political divide are a dozen mostly Democratic leaning states, including California, Minnesota and New York. They have both expanded Medicaid for lower-income adults and started their own health insurance exchanges for people to shop for federally subsidized private insurance.
On the other side are two dozen conservative states, such as Texas, Florida and Missouri. They have both rejected the Medicaid expansion and refused any role in running an online insurance exchange, leaving that entirely to the federal government.
The new federal figures, providing a state-by-state breakdown of enrollment in the new health care program through November, showed that the political differences among leaders over the initiative are turning into differences in participation among the uninsured.
Even though many conservative states have higher levels of poverty and more people without health coverage, fewer of them may receive new insurance, said Dylan Roby, an assistant public health professor at the Center for Health Policy Research at the University of California, Los Angeles.
With the patchwork implementation of the federal health care law, "the gap will exacerbate," Roby said
The U.S. Health and Human Services Department reported this week that 364,682 people had signed up for private coverage through the new health insurance marketplaces as of Nov. 30 and an additional 803,077 had been determined eligible for Medicaid.
But the rate of residents gaining health coverage was more than three times as great in the states embracing the federal health care law than in those whose leaders have resisted it.
In the dozen states embracing the overhaul, more than 50 percent of those who applied for coverage picked an insurance plan or were eligible for Medicaid. That rate was barely 15 percent in the two dozen states that aren't cooperating in the implementation of the federal health care law.
"It's very frustrating," said U.S. Sen. Claire McCaskill, a Missouri Democrat who voted for the federal law only to see it twice rebuffed in a statewide vote and repeatedly rejected by her home state's Republican-led state Legislature.
"The political point has trumped the services that Missourians need," McCaskill said.
In Texas, which has the highest rate of uninsured residents in the U.S., the GOP-controlled state Legislature opted not to create a state-run insurance marketplace and Republican Gov. Rick Perry also declined to expand Medicaid to cover more of the working poor. As of the end of November, just 14,000 Texans had signed up for insurance through the federally run marketplace and fewer than 17,000 of the nearly 245,000 applicants on the exchange had been determined to be eligible for Medicaid.
State Rep. Trey Martinez Fischer, a Democrat from San Antonio who chairs the Mexican American Legislative Caucus, said he nonetheless remains optimistic about the meager numbers.
"To know that there are people who, despite those odds, are still enrolling is encouraging," Fischer said.
In California, which also has a high uninsured rate, more than 107,000 people had picked an insurance plan through the state-run marketplace as of the end of November, and nearly 182,000 others had been determined eligible for Medicaid. That means nearly two-thirds of the 448,133 individuals who applied through the insurance exchange could gain some sort of coverage.
Federal grants in California have helped finance TV and radio commercials, billboards, bus signs and town hall meetings encouraging people to participate in the new health insurance marketplace.
That sort of promotion has been lacking in many of the states that have refused to run their own insurance marketplaces.
In Missouri, where a law forbids the government from implementing an insurance exchange, a coalition supporting the marketplace delayed its promotional campaign because of the technical troubles that marred the launch of the federal website.
"We didn't want to drive people to a frustrating experience," said Thomas McAuliffe, a policy analyst at the nonprofit Missouri Foundation for Health.
Now, advocates for the federal law face a steep challenge to implore people to sign up by Dec. 23, which is the deadline to be covered by health insurance policies that take effect in January.
"When we look at enrollment numbers, we're obviously going to lag behind, because in many parts of the state there's still a sense that Obamacare is not going to help me - even by the people it's going to help the most," McAuliffe said.
Heather McCabe, an assistant professor of social work at Indiana University-Purdue University Indianapolis, said the low enrollment numbers in many states raise questions about whether people are turned off by the problematic website, don't know they're eligible to use the exchange or have found the policies unaffordable.
"If the answer is that people still don't understand what the exchange is and how to use it, then the answer is we need to do education and help people better access the system," she said. "But if the answer is that the premiums are too high, then we have an issue that's a little more difficult to deal with."
Associated Press writers Will Weissert in Austin, Texas, and Rick Callahan in Indianapolis contributed to this report.
PHILADELPHIA (AP) -- Need a hand lifting something? A robotic device invented by University of Pennsylvania engineering students can help its wearer carry an additional 40 pounds.
Titan Arm looks and sounds like part of a superhero's costume. But its creators say it's designed for ordinary people - those who need either physical rehabilitation or a little extra muscle for their job.
In technical terms, the apparatus is an untethered, upper-body exoskeleton; to the layman, it's essentially a battery-powered arm brace attached to a backpack. Either way, Titan Arm's cost-efficient design has won the team accolades and at least $75,000 in prize money.
"They built something that people can relate to," said Robert Carpick, chairman of Penn's mechanical engineering department. "And of course it appeals clearly to what we've all seen in so many science-fiction movies of superhuman strength being endowed by an exoskeleton."
The project builds on existing studies of such body equipment, sometimes called "wearable robots." Research companies have built lower-body exoskeletons that help paralyzed people walk, though current models aren't approved for retail and can cost $50,000 to $100,000.
The Penn students were moved by the power of that concept - restoring mobility to those who have suffered traumas - as well as the idea of preventing injuries in those who perform repetitive heavy-lifting tasks, team member Nick Parrotta said.
"When we started talking to physical therapists and prospective users, or people who have gone through these types of injuries, we just kept on getting more and more motivated," said Parrotta, now in graduate school at the university.
So for their senior capstone project last year, Parrotta and classmates Elizabeth Beattie, Nick McGill and Niko Vladimirov set out to develop an affordable, lightweight suit for the right arm. They modeled pieces using 3-D printers and computer design programs, eventually making most components out of aluminum, Beattie said.
The final product cost less than $2,000 and weighs 18 pounds - less than the backpack that Beattie usually carries. A handheld joystick controls motorized cables that raise and lower the arm; sensors measure the wearer's range of motion to help track rehab progress.
Since its unveiling, Titan Arm has won the $10,000 Intel Cornell Cup USA and the $65,000 James Dyson Award. The resulting publicity generated a slew of interest from potential users, including grandparents who find it hard to lift their grandchildren.
"We found out that some people can't even lift a cast-iron pan to cook dinner," McGill said.
Experts say the aging population represents a potentially big customer base for exoskeletons, which originally were researched for military applications.
"There is certainly a market, but it's slowly emerging because the systems are not perfect as yet," said Paolo Bonato, director of the Motion Analysis Lab at Spaulding Rehabilitation Hospital in Boston.
Titan Arm's design impressed Yong-Lae Park, an assistant professor of robotics at Carnegie Mellon University in Pittsburgh who watched a video demonstration. He noted, though, that its low cost represent parts only, not the salaries or marketing built into the price of other products.
Park's research is focused on making exoskeletons less noticeable - "more like a Spider-Man suit than an Iron Man suit," he said.
The Titan team hopes to refine its prototype, although three members are now busy with graduate studies at Penn and one is working on the West Coast.
Among the considerations, Parrotta said, are different control strategies and more innovative materials and manufacturing.
And, of course, a second arm.
AMSTERDAM (AP) -- The European Food Safety Authority has found that the artificial sweetener aspartame is safe for people to consume at the levels currently used in diet soft drinks.
After conducting a major review of evidence, the agency said Tuesday it has ruled out any "potential risk of aspartame causing damage to genes and inducing cancer."
The finding will be welcome news to Coca Cola Co., which recently launched an advertising campaign to dispel fears about Diet Coke after other studies showed that aspartame might be dangerous, leading to a fall in sales.
Aspartame, the sweetener used in Diet Coke, is also known under the brand name NutraSweet.
The ESFA, the European Union's food risk assessment agency, is based in Parma, Italy.
MONTEVIDEO, Uruguay (AP) -- Uruguay's plan to set up a legal, regulated marijuana market has reached its final legislative stage, with the Senate expected to approve the plan by late Tuesday and send it to President Jose Mujica for his signature.
Senators prepared for a long day and night of speeches after debate begins Tuesday morning. The body is dominated by Mujica's ruling Broad Front coalition, which wants to make Uruguay the world's first nation to put the government at the center of a legalized marijuana trade.
Congress' lower house already passed it, and the Senate rejected all proposed amendments, so Senate passage would put the law on the desk of Mujica, who is one of the plan's biggest boosters despite saying he's never tried pot himself.
"This is a plague, just like cigarettes are a plague," Mujica told reporters recently.
Polls say two-thirds of Uruguayans oppose the plan, despite a national TV campaign and other lobbying efforts funded by billionaire currency speculator and philanthropist George Soros, whose Open Society Foundation and Drug Policy Alliance campaigned for the proposal.
Hannah Hetzer, a lobbyist for the Alliance, moved to Montevideo for the campaign, and celebrated the Senate's expected passage. "It's about time that we see a country bravely break with the failed prohibitionist model and try an innovative, more compassionate, and smarter approach," she said in a statement Monday night.
Mujica says the goal is to get organized crime out of marijuana dealing, not to promote the use of pot. The government hopes that when licensed growers, providers and users can openly trade in the drug, illegal traffickers will be denied their profits and go away.
During its hearings, the Senate Health Commission received extensive arguments from educators, psychiatrists and pharmacists urging it to back away from the plan.
Psychiatrists predicted a rise in mental illness. Pharmacists said selling pot alongside prescription drugs would harm their professional image.
Marijuana's negative impact on learning is well known, and "is related to educational failure, behavioral problems and depressive symptoms," teacher Nestor Pereira testified, representing the National Public Education Administration.
But Senate committees sent the proposal for a floor vote without changes, hoping to avoid a return trip to the lower chamber, where it passed by a single vote.
Socialist Deputy Julio Bango, who co-authored the proposal, told The Associated Press: "This is not a law to liberalize marijuana consumption, but rather to regulate it. Today there is a market dominated by drug traffickers. We want the state to dominate it."
The project includes a media campaign, launched Friday, aimed at reducing pot smoking by warning of its dangers to human health.
Uruguay's drug czar, Julio Calzada, said no pharmacist or other business will be forced to sell the drug.
Calzada said his office will have 120 days to craft regulations following adoption. Mujica pledged that his government will work through the traditional southern summer holidays to make the rules as precise as possible.
"There will be much to discuss and to work on. We'll spend the summer working. There's nothing magic about this," the president said.
As for concerns that Uruguay could become a mecca for marijuana tourism, Mujica stressed that the measure would restrict the legal sale of pot only to licensed and registered Uruguayan adults.
Marijuana grower Marcelo Vazquez told the AP he can't wait to pay taxes on the weed he's grown illegally for 20 years. After repeated police raids and arrests, he's optimistic. He has a greenhouse of marijuana plants growing outside Montevideo and is thinking about creating a business catering to licensed growers who lack space in their own homes.
"This is a huge opportunity and we have to take advantage of it," Vazquez said. "My lifelong dream has been to legally cultivate marijuana, and to live off this, to pay my taxes."
HONG KONG (AP) -- Hong Kong reported its second human case of H7N9 bird flu just days after the first, raising fears that the virus is spreading beyond mainland China.
The Health Department said late Friday that an 80-year-old man being treated for a chronic illness in the hospital was found to have the bird flu strain.
Authorities in the Asian financial and transport hub have been monitoring H7N9 closely since it was first identified in April. Infectious diseases are a particular concern in Hong Kong, where a decade ago the Sars virus killed 299 people. Hundreds in other countries also died.
H7N9 has sickened about 140 people and killed 45, almost all of them in mainland China. Taiwan has had one case.
The virus appears to have stalled since Chinese authorities cracked down on live animal markets following the initial outbreak. Medical authorities say it doesn't appear to be easily contagious between humans.
Health officials said that the second patient lived in Shenzhen, the mainland Chinese city across the border from Hong Kong, and sought treatment in the hospital. Authorities were looking for people who may have been in contact with him, including relatives, hospital staff and the taxi driver who brought him to the hospital.
Officials have stepped up border checks and raised the alert level after the first case, an Indonesian maid, was reported on Monday.
ATLANTA (AP) -- There's more evidence that U.S. births may be leveling off after years of decline.
The number of babies born last year only slipped a little, and preliminary government figures released Friday indicate that trend continued through the first six months of this year.
U.S. births rose after the late 1990s and hit an all-time high of more than 4.3 million in 2007. But then they started dropping each year, and in 2011 the number was as low as it had been in the 1990s.
The decline was widely attributed to the nation's economy. Experts believed that many women or couples who were out of work or had other money problems felt they couldn't afford to start or add to their family.
Last year, the number of babies born - a little shy of 4 million - was only a few hundred less than in 2011, which some saw as a signal that the decline may be bottoming out.
The Centers for Disease Control and Prevention's latest figures show the number of births from July 2012 through last June were essentially the same as the previous 12 months, suggesting the trend is continuing.
"Perhaps it's because the economy - knock wood - has bottomed out" and improved, said Gretchen Livingston of the Pew Research Center in Washington, D.C. Livingston researches birth trends.
Earlier this week, another CDC report showed a decline not only in women giving birth but in getting pregnant. In 2009, the pregnancy rate dropped to its lowest level in 12 years. Of the nearly 6.4 million estimated pregnancies, about 4.1 million resulted in births, more than 1.1 million ended in abortions and about 1 million were miscarriages. Abortions accounted for 18 percent of pregnancies, down from 24 percent in 2009, said that report's lead author, CDC statistician Sally Curtin.
The highest pregnancy rates have shifted from women in their early 20s to those in their late 20s. That parallels a shift in the average age that women first get married.
CDC report: HTTP://WWW.CDC.GOV/NCHS