Prostate cancer test saves lives, risks remain

Men who get a controversial blood test that looks for signs of prostate cancer appear to have a reduced risk of death from the malignancy, according to a new analysis by an international group of researchers.

The analysis re-examined data from two earlier studies that had led experts to recommend against routine use of the test, which measures levels of prostate-specific antigen (PSA).

“The trials taken together indicate there is an important benefit,” said Ruth Etzioni, who is the senior author of the analysis from the Fred Hutchinson Cancer Research Center in Seattle, Washington.

A flaw of the earlier trials is that some men who were assigned to a no-screening group actually did get the PSA test on their own, making it difficult to identify differences between the screening group and the no-screening group.

The unclear results - and the risk that the blood tests could lead to unnecessary biopsies and treatments - led the government-backed U.S. Preventive Services Task Force (USPSTF) to recommend against PSA screening.

The new analysis attempts to clear up the confusion by reexamining the data in computer models, to account for the men who got PSA tests when they weren’t supposed to. Etzioni’s team compared men in the two trials based on the intensity of screening they received.

In one of the trials, PSA testing was tied to a 25 percent to 31 percent reduced risk of death from prostate cancer, the researchers report in the Annals of Internal Medicine.

In the other trial, PSA testing was tied to a 27 percent to 32 percent reduced risk of death from prostate cancer, they found.

Etzioni said the new results don’t mean all men should be screened for prostate cancer.

In the U.S., about one in seven men will be diagnosed with prostate cancer, according to the American Cancer Society, but most men with the slow-growing cancer won’t die from it.

As a result, it’s often reasonable to monitor prostate cancers instead of treating them, since the side effects of treatment - which can include incontinence and impotence - may be more harmful than helpful.

In a proposed update to its recommendation, the USPSTF suggests that men ages 55 to 69 should be able to decide if they want PSA testing based on a discussion with their doctors about the possible benefits and risks, such as biopsies and unneeded treatment.

“This finding confirms or reinforces what everybody has been moving to over the last 5 to 8 years,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. “There is some benefit to prostate cancer screening and there are some harms associated with it.”

Brawley, who wasn’t involved in the new analysis, told Reuters Health that the benefits of screening are becoming more apparent as doctors move away from aggressively treating all prostate cancers and instead decide to monitor the many that will likely never advance and cause death.

In an editorial published with the new analysis, Dr. Andrew Vickers of Memorial Sloan Kettering Cancer Center in New York City identified ways to help ensure the benefits of prostate cancer screening outweigh the harms.

For example, he advises shared decision-making between doctors and patients, carefully selecting which men to biopsy and not screening elderly men, who are unlikely to benefit.

“The controversy about PSA-based screening should no longer be whether it can do good but whether we can change our behavior so that it does more good than harm,” wrote Vickers.

source: news.abs-cbn.com

Menopause symptoms? Here are safe, effective remedies

Many women with severe menopausal symptoms are not being treated for them even though safe, effective remedies are available, a study from Australia suggests.

The findings may be applicable to other countries, too, according to senior author Dr. Susan R. Davis from Monash University in Melbourne.

"From my interactions with colleagues from across the globe, I do not believe that what we have observed is Australian-specific," she told Reuters Health by email. "The management of menopause has been relatively similar in the UK, the USA and in Australia."

Up to half of women in menopause experience so-called vasomotor symptoms, such as hot flashes and night sweats. Hormone replacement therapy (HRT), which generally combines estrogen plus progestin, is very effective. But after the initial findings of the Women’s Health Initiative study showed that HRT can increase the risk of breast cancer, stroke and other serious problems, many women stopped using it.

As reported in the journal Menopause, in 2013 and 2014 Davis and her team analyzed survey responses from nearly 1,500 women ages 40 to 65.

Seventeen percent were having moderate to severe vasomotor symptoms, and 18 percent reported moderate to severe sexual symptoms.

But most were not receiving any kind of treatment. Only 11 percent reported use of HRT, and less than 1 percent were using any type of therapy that didn't involve hormones.

The women who did use hormones were mostly taking pills containing estrogen, rather than preparations that are absorbed into the skin and that are potentially safer, the researchers found.

"Extrapolating our findings to 3.7 million Australian women aged 40 to 64 years, we found that 455,000 women are likely to have moderate to severe vasomotor symptoms, with most women (385,000) remaining untreated," they write.

In addition, very few women were receiving vaginal estrogen therapy for sexual symptoms. Vaginal dryness is common with menopause and affects sexual functioning. Vaginal estrogen preparations are very safe and effective for this problem but were prescribed to less than 5 percent of the women, the authors say.

Why are so few women being treated?

"Overall, there is the uncertainty of women and of doctors as to what the options are, what is and is not safe, and of the safe options - what and how to prescribe them," Davis said.

There is also, she said, a complete lack of understanding that for most women, these symptoms are not fleeting.

"It isn't 'grin and bear it for a few months' and it will all pass, as many women suffer severe symptoms for five-plus years," she said. "Women and doctors simply are not aware that symptoms can last this long."

Finally, many women don’t realize that non hormonal options can be safe and effective, she added.

Dr. Wulf H. Utian, medical director of the North American Menopause Society, agrees that many reasons may underlie the lack of treatment. "It is partly 'fall out' from the controversy over hormone therapy," he told Reuters Health in an email.

But overall, he said, it is a combination of patients not wanting therapy or not having information about it, and also the provider not prescribing it.

source: www.abs-cbnnews.com

Child abuse linked to later depression for teens

Tough experiences before age six, like family instability or abuse, are tied to changes in brain structure and to a higher risk of anxiety or depression, according to a study of mother-son pairs in England.

“Early adversity increases later symptoms of depression or anxiety, which, in turn, can associate with variation in cortical structure,” said senior author Edward D. Barker of the Institute of Psychiatry, Psychology, and Neuroscience at King’s College London.

“Most children will experience a degree of adversity, but this is not necessarily harmful,” Barker told Reuters Health by email. “Our research suggests that children who experience many forms of adversity are at risk.”

His team followed almost 500 pairs of mothers and sons, starting during pregnancy, from 1991 or 1992.

When the children were eight, 21, 33, 47, 61 and 73 months old, roughly from infancy to age six, their mothers answered questions about 37 types of “adversity” in the home, including interpersonal loss, family instability, and abuse toward the child or mother.

When the boys were seven, 10 and 13 years old, their mothers reported on their symptoms of anxiety or depression.

Between age 18 and 21, the young men had magnetic resonance imaging of their brains.

According to the MRI scans, having experienced more types of adversity before age six was tied to lower gray matter volume in an area of the brain called the anterior cingulate cortex, which is involved in emotion, decision-making and empathy, and higher volume in the precuneus, which is involved with episodic memory.

“The relationship is likely similar for girls, but this needs to be confirmed,” Barker said.

Early adversity was also tied to lower volume in the right superior frontal gyrus of the brain, as were later symptoms of anxiety and depression, the researchers reported in JAMA Pediatrics.

The right superior frontal gyrus may be related to self-awareness.

Researchers are still learning what processes the precuneus is involved with and how that might be related to problems after early life stress, said Jamie L. Hanson of the Carolina Consortium on Human Development at Duke University who was not part of the new study.

“It can be difficult to know if an effect is a direct result of an experience (like early life stress) or caused by the other effects of an experience (indirect; early life stress is related to depression, and depression can affect the brain),” Hanson told Reuters Health by email. “This study found that differences in the superior frontal gyrus were related to these “indirect” effects.”

Child maltreatment, extreme poverty, or having a parent with major mental health issues happens to almost a million kids in the U.S. each year, Hanson said.

“Research suggests that the experiences early in life really matter, especially before the age of five,” Hanson said. “This isn’t to say that if a child experiences stress during this period, that they will definitely have physical or mental health issues. Stress during infancy and early childhood, however, does increase the risk for many different problems.”

“Young children are dependent on their caregivers, whereas teenagers have a greater range of experience and autonomy,” Barker said.

Dr. Martin H. Teicher, associate professor of psychiatry at Harvard Medical School in Boston, told Reuters Health that early life adversity plays an important role in risk for substance abuse, personality disorders, anxiety disorders and even psychotic disorders.

“We do not yet know if there are actions that can be taken later in childhood or during adolescence that would preempt the consequences of early exposure,” Teicher, who was not part of the study, wrote by email.

Social programs where registered nurses visit low-income first-time mothers have had strong positive effects, Hanson said. “These programs start during pregnancy and typically continue for two years following a child’s birth, and really help maternal and child health outcomes.”

source: www.abs-cbnnews.com

Depressed adolescents face increased heart disease risk

Adolescents with major depression or bipolar disease face an increased risk of early heart disease and may need early intervention to prevent it, according to a scientific statement from the American Heart Association (AHA).

“We expect that the statement itself will come as quite a surprise to most,” said Dr. Benjamin I. Goldstein from Sunnybrook Health Sciences Center in Toronto, who chaired the committee that issued the report.

“This is precisely what makes the statement so important and potentially impactful; it takes a largely unrecognized and under-appreciated body of evidence, and positions it squarely on center stage,” Goldstein told Reuters Health in an email.

Goldstein and his coauthors say major depression affects nearly 9 percent of U.S. adolescents. Bipolar disorder, the fourth most disabling condition, affects about 2.6 percent of U.S. adolescents.

The National Institute of Mental Health explains on its web site that people with major depression have persistent severe symptoms that interfere with their ability to work, sleep, study, eat, and enjoy life. In bipolar disorder, which is less common, people have mood changes that go back and forth between extreme highs (e.g., mania) to extreme lows (e.g., depression).

In developing the new scientific statement, Goldstein and his colleagues evaluated the existing data at the behest of the AHA’s Council on Cardiovascular Disease in the Young.

Although research on the association between these mood disorders and heart disease is limited, what is available shows a significant increase in traditional heart disease risk factors in adolescents with major depression or bipolar disorder, the team reported in the journal Circulation.

These risk factors include obesity, high blood pressure, and unhealthy cholesterol levels.

Childhood maltreatment, sleep disorders, physical inactivity, and smoking – factors common in adolescents with depression and bipolar disorder – can also contribute to an increased heart disease risk.

Even the treatments (antidepressants and mood-stabilizing medications) can cause weight gain and other metabolic changes that increase the risk of heart disease, the statement points out.

Based on the available data, the authors say, these adolescents should be considered to be at moderate risk for early heart disease.

Prevention efforts should focus on maintaining a healthy weight and blood pressure, healthy levels of cholesterol, and blood sugar in the normal range. The first step in achieving these targets is intensive lifestyle management that emphasizes regular physical activity, a healthy-heart diet, and, if necessary, weight loss.

“When considering cardiovascular risk among youth with mood disorders, screen more and take action earlier and at lower thresholds,” Goldstein advised.

Dr. Viola Vaccarino from Rollins School of Public Health at Emory University in Atlanta, who wasn’t involved in developing the statement, told Reuters Health, “It is time to end the traditional separation between mental health and physical health. Stigma from mental disorders remains widespread and results in low recognition and management of psychiatric problems outside of mental health clinics. But cardiovascular disease and depression are linked conditions; they both rank highest as causes of disability in the United States, and (are) also rapidly growing worldwide.”

“Cardiovascular disease is a chronic, progressive condition that starts in youth, even if the disease becomes clinically manifest later in life,” Vaccarino concluded. “This is why identification of risk conditions such as depression early in life provides an important opportunity for cardiovascular disease prevention.”

source: www.abs-cbnnews.com