All About Propecia

Women who have a mastectomy after being diagnosed with breast cancer seem have a similar quality of life in the long term whether they have breast reconstruction surgery or not, a research review suggests.

Many women who undergo mastectomy have breast reconstruction performed, either at the same time as the mastectomy or at a later point. Breast reconstruction is generally thought to improve women’s quality of life in the long run, and some studies have suggested as much.

But in the new review, which looked at 33 studies of mastectomy patients’ own reports of their long-term well-being, researchers found that overall, women fared similarly whether or not they had reconstruction.

Of 11 studies of quality of life — measured by factors like physical functioning, emotional well-being and social life — seven found no differences, on average, between women who had reconstruction and those who did not.

Similarly, nine of 16 studies on body image showed no clear differences — including each of the three studies the researchers deemed to be “higher-quality.”

And of 12 studies that looked at sexual functioning, seven found no differences, while the rest were split; in two, women who had undergone reconstruction reported poorer sexual functioning than those who had not opted for the procedure.

Researchers led by Dr. Clara Lee, of the University of North Carolina Chapel Hill, report the findings in the Journal of American College of Surgery.

The results point to average differences between women who chose to have or not have breast reconstruction, and they do not necessarily predict how any one woman will fare. Many factors, Lee’s team writes, can affect a woman’s satisfaction with reconstruction.

The researchers also point out that women who choose breast reconstruction may differ from those who do not in terms of quality of life, body image, and sexuality, which could affect how they perceived and reported the effects of reconstruction.

Finally, none of the studies looked at the “appropriateness” of patients’ decisions to have breast reconstruction. Some women, for example, might have undergone reconstruction even if they were not convinced they truly wanted it — something that could affect their long-term satisfaction with the choice.

A new bone-building drug has worked well in a trial of men whose bones were weakened by the hormone therapy they were taking for prostate cancer, researchers report.

The drug, denosumab (Prolia), is a monoclonal antibody that Amgen Inc. hopes to market for fracture prevention, not only in men with prostate cancer but also for postmenopausal women who are taking hormone therapy for breast cancer. An advisory panel of the U.S. Food and Drug Administration is scheduled to meet this week to consider the Amgen application.

Results of the trial, reported online Aug. 11 in advance of publication in the Aug. 20 issue of the New England Journal of Medicine, will be part of the evidence submitted to the FDA panel. Anywhere from one-third to one-half of the 2 million American men receiving hormone-blocking therapy as treatment for prostate cancer are potential users of denosumab, said study author Dr. Matthew R. Smith, director of genitourinary medical oncology at Massachusetts General Hospital.

Denosumab blocks the activity of a molecule that causes destruction of bone cells. It thus counters the bone loss that results from lack of hormones, both male and female. The drug is given by intravenous injection, just once every six months.

The prostate cancer study was pioneering because “there have been no prior, large-scale fracture-preventing studies in men,” Smith said. It enrolled more than 900 men being treated at 156 medical centers in the United States and Europe.

Over 24 months, bone density increased 5.6 percent in men who got denosumab and decreased 1 percent in men given a placebo, the researchers found. The 36-month incidence of spinal fractures was 1.5 percent among those receiving denosumab, while it was 3.9 percent among those given placebo.

Although denosumab is an “important” drug and “clearly effective based on the two studies that have been published (the other was in postmenopausal women),” its place in prostate cancer therapy has yet to be established, said Dr. Sundeep Khosla, a professor of medicine in the Endocrine Research Unit at the Mayo Clinic, who wrote an accompanying editorial.

A number of other drugs now are being used to help prevent fractures in men treated for prostate cancer, Khosla said. “Given other drugs that perhaps have similar efficacy, just where this drug will fit is unclear,” he noted.

The main contender against denosumab appears to be a relatively new member of the bone-building bisphosphonate family, zoledronic acid (Zometa), Khosla said. It, too, is given intravenously, with only one injection a year required, he said. But zoledronic acid must be given by a physician, while denosumab can potentially be self-administered, he noted.

Cost can be an issue with these new drugs, Khosla said. A generic bisphosphonate can cost as little as $100 a year, while the wholesale price of zoledronic acid is $1,300 a year. It’s not known yet what Amgen would charge for denosumab, Khosla said.

Whatever the price, “in certain subsets of patients it would be a good option,” he said. Khosla agreed with Smith’s estimate that one-third to one-half of all men getting hormone-blocking therapy could be in that subset.

Some concern about possible effects of denosumab on the immune system have been raised, Khosla noted, because the molecule it blocks plays a role in the immune response. A study of postmenopausal women noted some immunity-related problems, such as an increase in the incidence of eczema, he noted, but “I don’t think there is any concern significant enough to warrant not approving the medication, although it warrants surveillance.”

Improvements in cancer screening and better treatments have resulted in steady declines in cancer death rates over the past three decades, U.S. researchers said on Thursday.

They said younger adults — those aged 35 to 45 years old — have experienced the steepest declines in cancer death rates, but all age groups have shown some improvement.

“Essentially, the younger you are, the faster your rates are declining,” said Dr. Eric Kort of the Helen DeVos Children’s Hospital in Grand Rapids, Michigan, whose study appears in the journal Cancer Research.

The study uses a different way of looking at cancer death rates that measures improvements in cancer deaths by age.

U.S. government estimates suggest there had been little improvement in cancer death rates throughout the 20th century, with rates only beginning to improve in the mid-1990s, Kort said. But that does not tell the whole story, he said.

“The way that these statistics are traditionally reported is they have averaged all of the age groups together to get a composite rate,” Kort said in a telephone interview.

“The problem with that is because most cancer deaths occur in older Americans, the average heavily emphasizes the experiences of older people. It’s like watching the caboose of the train to tell when the train is changing direction,” he said.

Instead, Kort’s team looked at improvements in cancer deaths among groups of individuals born in five-year intervals starting in 1925.

Using that method, Kort said, “Everyone born since the 1930s has enjoyed a decreased risk of cancer death, at every age.”

People in the youngest age group — those aged 35 to 45 — had a greater than 25 percent decline per decade in cancer deaths, he said.

Kort said cancer prevention — including smoking cessation efforts — have played an important role in these trends.

“We’re also benefiting in profound ways from progress we’re making in early detection and better treatments. Some of these advances benefit younger people first,” he said.

In childhood cancers, advances in treatments for leukemia and lymphoma mean many more people can survive cancers that were once considered a death sentence.

And better screening for cancers that occur in older age, such as mammography in breast cancer and colonoscopy for colon cancer are spotting cancers at an earlier stage, when they are easier to treat.

Cancer remains the No. 2 killer of Americans, with about 560,000 deaths annually, topped only by heart disease, according to the American Cancer Society.

Cancer survivors who got radiation treatments as children have nearly twice the risk of developing diabetes as adults, U.S. researchers said on Monday.

They said children who were treated with total body radiation or abdominal radiation to fight off cancer appear to have higher diabetes risks later in life, regardless of whether they exercise regularly or maintain a normal weight.

The odds of surviving childhood cancer have improved with better therapies but several research teams have found that some treatments pose health risks later in life.

Dr. Lillian Meacham of Emory University in Atlanta and colleagues compared rates of diabetes in nearly 8,600 childhood cancer survivors diagnosed between 1970 and 1986, and nearly 3,000 of their siblings who did not have cancer.

After adjusting for other risk factors, including body mass index — a ratio of height and weight — they found the childhood cancer survivors overall were 1.8 times more likely to have diabetes.

And the more radiation that was used, the greater the diabetes risk. For those treated with total body radiation — a treatment often used before bone marrow transplants to treat childhood leukemia — the diabetes risk was more than seven times greater.

Cancer survivors already have higher risks of heart and kidney disease. A study last year found children who survive cancer while they are young are five to 10 times more likely than their healthy siblings to develop heart disease.

“It is imperative that clinicians recognize this risk, screen for diabetes and pre-diabetes when appropriate, and approach survivors with aggressive risk-reducing strategies,” the team wrote in the Archives of Internal Medicine.

They said more study was needed to understand how radiation could promote diabetes in cancer survivors.

Type 2 diabetes — the most common form of diabetes — develops when the body makes too much insulin and does not efficiently use the insulin it makes.

(Reporting by Julie Steenhuysen, Editing by Patrick Rucker)