All About Propecia

Cervical cancer screening intervals could be extended for women aged 30 and over if doctors used human papillomavirus (HPV) testing rather than smear tests, British scientists said on Wednesday.

Experts said research into different screening methods found that HPV tests were very accurate in picking up early signs of cervical cancer and detected more serious abnormalities than conventional smear tests in women aged 30 and over.

“Using HPV testing as the primary screening method for cervical cancer would not only mean women could be screened less often but it would also mean efficiency savings,” said Jack Cuzick, a professor of epidemiology at Queen Mary, University of London, who worked on the study.

Several companies, including Roche, Gen Probe Inc, Abbott and Qiagen make HPV tests.

HPV is the most common sexually transmitted infection in the world. There are more than 100 types of the virus, some of which cause only genital warts but others cervical cancer.

According to the World Health Organisation, cervical cancer is the second biggest cause of female cancer deaths worldwide with about 288,000 deaths each year.

Cervical screening programs are well established in many wealthy nations and immunization programs against HPV with vaccines such as Cervarix from GlaxoSmithKline and Gardasil from Merck & Co are also being rolled out.

Cuzick’s study, which was published in the British Journal of Cancer, involved 11,000 women in the UK. Two samples were taken from each woman and one analyzed using the conventional cytology method, while the other was sent for HPV testing.

ACCURACY

Cytology involves an analysis of cervical cells taken during a smear test.

The results showed that women with HPV negative results had a lower rate of developing pre-cancerous cells for at least six years compared with women who recorded a negative cytology result, showing that HPV testing was more accurate.

A second study conducted by Finnish scientists, published in the British Medical Journal, showed that HPV testing is also better than cytology at detecting severe pre-cancerous lesions.

In a telephone interview, Cuzick said the evidence now showed clearly that regular testing programs in all countries that conduct them should be swap to using HPV tests.

“There is now an overwhelming case for moving to HPV as the primary screening test,” he said. “If you have a test that gets it right the first time, you can also increase the gap between screens, saving doctors’ time.”

Current policy in Britain is to test using cytology every three years from age 30 to 50 and then every 5 years for older women. In the United States, smear tests are recommended every two years from age 21 to 30 and every three years beyond that.

Cervical cancer is a slow-growing cancer, which means that more accurate HPV screening would only need to be done about every five years to be effective, Cuzick said.

(Editing by Andrew Roche)

High-dose vitamin B therapy is dangerous for diabetics with kidney disease, and patients on this regimen should stop immediately, says a new study.

When the researchers began the study, they believed it would show that high-dose vitamin B therapy (folic acid, vitamin B6 and vitamin B12) would improve patients’ kidney function and reduce their risk of heart attack and stroke.

But it turned out that patients on high-dose vitamin B therapy had significant worsening of kidney function, and twice as many heart and stroke incidents as patients taking a placebo.

“Because B vitamins are water soluble, we suspect that while healthy people would excrete excess vitamins in urine, those with renal failure would not be able to do so, perhaps causing the adverse effects we have seen in this study,” Dr. David Spence, of the University of Western Ontario in Canada, said in a university news release.

“Vitamin B therapy may still be beneficial in people with normal kidney function, but this is clear evidence that high doses of vitamin B should not be given to those with kidney problems,” he added.

The study is published in the issue of the Journal of the American Medical Association.

More than 40 percent of people with diabetes develop kidney disease.

One common follicular problem that affects a disproportionate number of dark-skinned patients, particularly African-Americans, is pseudofolliculitis barbae (also known as razor bumps). Dr. Alexis noted that several studies have reported that pseudofolliculitis barbae affects an estimated 45 to 83 percent of African-American men. The cause of this condition stems from the structure of the hair follicle, which is curved in people with skin of color. Pseudofolliculitis barbae is aggravated by shaving, as it can cause the sharp tip of shaved hair to grow back into the skin and results in a bump.

Dr. Alexis advises patients affected by pseudofolliculitis barbae to discuss ways to modify their shaving habits with their dermatologist. He also noted that there are several effective treatment options available.

For example, lasers have evolved over the years and can now be safely used to reduce and remove hair in skin of color patients. Two lasers Dr. Alexis recommends for use with darker skin are the 810 nanometer (nm) diode laser and the 1064nm Nd:YAG laser. Topical creams and gels also are effective in treating pseudofolliculitis barbae, including topical retinoids, topical antibiotics, topical steroids and the topical prescription medication eflornithine.

“Women of color also can be affected by pseudofolliculitis barbae, as they often wax or shave unwanted hair on their chin and neck that can cause these bumps and skin discoloration,” said Dr. Alexis. “Many of these women are finding laser hair removal to be an effective treatment option for this problem.”

Hair loss is another dermatologic concern in patients with skin of color. Traction alopecia is a form of hair loss caused by hairstyles (such as braids) that put tension on the hair and is most common in African-American women. “The majority of cases of traction alopecia are reversible, but patients must be willing to style their hair differently to stop and reverse hair loss,” said Dr. Alexis. “Dermatologists also can administer injections of steroids into the affected areas, which we find can be quite effective if started early in the course of the condition.”

Another form of hair loss common in dark-skin individuals that can be more difficult to treat is central centrifugal cicatricial alopecia (CCCA). Although the cause of CCCA is unknown, it also is thought to be related to common hair care practices in African-American women. Often referred to as “hot comb alopecia”, this type of hair loss begins on the crown of the scalp and gradually spreads out to other areas of the scalp.

Dr. Alexis noted that once a hair follicle is scarred, it cannot produce hair any longer, but if caught early, hair loss can be treated with a variety of anti-inflammatory therapies, including injections into the affected areas of the scalp, topical steroids and oral antibiotics. Dr. Alexis added that minoxidil can be used in conjunction with anti-inflammatories to try to stimulate hair growth in healthy hair follicles.

Reversing Cosmetic Dermatologic Concerns Can Be Done Safely
Dr. Alexis explained that the water content of the skin decreases with age, especially when people enter their 60s. For people of color, this change in the water content of their skin can create an ashen look if they do not use moisturizers to help counteract the water loss. Other changes in the skin include textural irregularities, such as roughness, enlarged pores and dullness.

To help reverse some of these telltale signs of aging in darker-skinned individuals, a variety of topicals and non-invasive procedures can be used safely and effectively – including retinoids and other cosmeceuticals, chemical peels, and non-ablative laser resurfacing. Fillers can be used to correct nasolabial folds (lines around the mouth) and botulinum toxin is effective in softening wrinkles.

“It is important to note that injections of both fillers and botulinum toxin can be performed safely in darker-skinned patients, and these procedures are increasing in popularity with these patients to address aging skin,” said Dr. Alexis.

Another skin condition that is common in African-American patients as they age is dermatoses papulosa nigra (DPNs), also referred to as flesh moles. These small, brown moles are especially common in the cheek area and can be removed by a dermatologist who carefully will remove these skin growths to minimize any injury to the skin.

“While people of color are prone to many unique medical and cosmetic skin conditions, dermatologists are well equipped to treat them using a variety of safe and effective treatment options,” said Dr. Alexis. “The key is to seek treatment early.”

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.

According to projections from the United States Census Bureau, people with skin of color will comprise approximately half of the U.S. population by 2050. This group, which includes African-Americans, Asians, Latinos and other ethnicities, are more prone to certain dermatologic problems than those with lighter skin tones due to their genetic make-up and in some cases cultural practices. For that reason, dermatologists – who understand the nuances of different skin tones – are poised to help patients of color by diagnosing and treating these conditions.

Speaking today at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Andrew F. Alexis, MD, MPH, FAAD, assistant clinical professor of dermatology at Columbia University College of Physicians and Surgeons and staff member at St. Luke’s-Roosevelt Hospital Center, both in New York, discussed the leading medical and cosmetic dermatologic concerns in darker-skinned populations.

“Although people of color have more natural protection from ultraviolet (UV) radiation due to the increased amount of melanin in their skin, the cells that make melanin pigment tend to be more reactive to inflammation and injury, and therefore pigmentation problems are more common in skin of color,” said Dr. Alexis. “These natural genetic factors, coupled with cultural differences in their skin and hair care practices, can result in differences in the appearance of common dermatologic conditions and the frequency in which they can occur.”

Treating Pigmentation Disorders Takes Patience
The most common pigmentation problem (dyschromia) of the skin that can occur in people of color is post-inflammatory hyperpigmentation (PIH), which refers to increased pigmentation or dark spots at the sites of inflammation. Acne is one trigger for PIH, and the resulting dark spots often can be of equal or greater concern than the original pimples.

Dr. Alexis explained that although there are several effective treatments that can be used for PIH, none of these treatments are quick fixes and each requires time to take effect – from several weeks to several months in most cases. Common treatments include retinoid creams (vitamin A derivatives), bleaching creams (containing hydroquinone) and chemical peels.

“While in-office procedures, such as chemical peels or any skin resurfacing cosmetic treatment, can help correct pigmentation problems, they have to be administered with caution due to the higher risk of inducing other pigmentary abnormalities,” stated Dr. Alexis. “That’s why it is important to consult a dermatologist with an expertise not only in using these procedures, but in treating darker skin tones as well.”

Melasma, often referred to as the “mask of pregnancy,” is the second most common pigmentation problem occurring in skin of color patients. More women than men are affected by melasma, but the condition can occur independent of pregnancy and is commonly seen in people in their 40s, 50s and 60s. The cause of melasma is a combination of genetic and hormonal factors and UV exposure. Dr. Alexis added that melasma can be treated with the same topicals and in-office procedures used for PIH, and in some cases, lasers can be effective.

Since sun exposure can worsen dark spots, Dr. Alexis stressed that year-round sun protection is extremely important. “I recommend that my patients wear a moisturizer with sunscreen every day to protect their skin from further damage,” said Dr. Alexis.

Diets high in vegetables, fruits and soy might cut the risk of developing breast cancer by 30 percent, new research suggests.

In a study, Dr. Lesley M. Butler, of Colorado State University and colleagues, noticed a trend of “decreasing breast cancer risk with increasing intake of a vegetable-fruit-soy dietary pattern” in the 34,000 Chinese women studied.

Even though the researchers identified and analyzed dietary patterns among Chinese women from Singapore, Butler believes the findings are relevant for American women.

The diets “aren’t that different from patterns seen in US populations,” the lead investigator told Reuters Health.

“There’s usually a bad food pattern of meat and lots of starch and saturated fat. And then there’s the good pattern — a prudent pattern in our case — the vegetable-fruit-soy pattern,” she said.

For their study, reported in the American Journal of Clinical Nutrition, Butler and her colleagues used data collected between 1993 and 1995 from 63,257 men and women in the Singapore Chinese Health Study (SCHS).

The large health study used in-person interviews to gather information about diet, weight, education, smoking and exercise habits, and hormone use.

Previous research focusing on individual foods or nutrients has been inconsistent, the authors note.

The SCHS data, however, allowed Butler’s group to identify two dietary patterns: the meat-starch-saturated-fat based “meat-dim sum” pattern and the “vegetable-fruit-soy” pattern characterized by lots of cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, kale, cabbage, and bok choy.

Based on their self-reported intake of 165 foods, participants were assigned a score for the vegetable-fruit-soy and the meat-dim sum dietary patterns.

Butler’s group identified 34,028 women with no history of breast cancer in the data. All women were between the ages of 45 and 74. For the most part, they were thin, they exercised, had gone through menopause, and few smoked or used hormone replacement therapy.

By the end of 2005, 10 years after the enrollment interviews, 629 breast cancer cases had been identified in the Singapore Cancer Registry among study participants.

After analyzing the data, the study authors found that the greater the intake of vegetables, fruits and soy, the lower the breast cancer risk among post-menopausal women.

The researchers did not find an association between higher meat-dim sum consumption and increased breast cancer risk, as suggested in other studies. Butler cautioned, however, that Americans shouldn’t read too much into this finding because the discrepancy could be explained by the way meat is prepared.

Stir-fried meats don’t contain as many Heterocyclic Amines (HCAs) that result from cooking muscle meats at high temperatures. Researchers have identified 17 HCAs that may be associated with increased cancer risk. “The charred barbeque meat that we love contains a lot of these carcinogens,” Butler said.

Despite the cultural differences, Butler believes American women can learn from these study findings. “Eating a diverse diet that can be characterized as having a lot of fruits and vegetables, and possibly adding soy also, would be beneficial,” she said.

SOURCE: American Journal of Clinical Nutrition

National Institutes of Health (NIH) scientists investigating how prion diseases destroy the brain have observed a new form of the disease in mice that does not cause the sponge-like brain deterioration typically seen in prion diseases. Instead, it resembles a form of human Alzheimer’s disease, cerebral amyloid angiopathy, that damages brain arteries.

The study results, reported by NIH scientists at the National Institute of Allergy and Infectious Diseases (NIAID), are similar to findings from two newly reported human cases of the prion disease Gerstmann-Straussler-Scheinker syndrome (GSS). This finding represents a new mechanism of prion disease brain damage, according to study author Bruce Chesebro, M.D., chief of the Laboratory of Persistent Viral Diseases at NIAID’s Rocky Mountain Laboratories.

Prion diseases, also known as transmissible spongiform encephalopathies, primarily damage the brain. Prion diseases include mad cow disease or bovine spongiform encephalopathy in cattle; scrapie in sheep; sporadic Creutzfeldt-Jakob disease (CJD), variant CJD and GSS in humans; and chronic wasting disease in deer, elk and moose.

The role of a specific cell anchor for prion protein is at the crux of the NIAID study. Normal prion protein uses a specific molecule, glycophosphoinositol (GPI), to fasten to host cells in the brain and other organs. In their study, the NIAID scientists genetically removed the GPI anchor from study mice, preventing the prion protein from fastening to cells and thereby enabling it to diffuse freely in the fluid outside the cells.

The scientists then exposed those mice to infectious scrapie and observed them for up to 500 days to see if they became sick. The researchers documented signs typical of prion disease including weight loss, lack of grooming, gait abnormalities and inactivity. But when they examined the brain tissue, they did not observe the sponge-like holes in and around nerve cells typical of prion disease. Instead, the brains contained large accumulations of prion protein plaques trapped outside blood vessels in a disease process known as cerebral amyloid angiopathy, which damages arteries, veins and capillaries in the brain. In addition, the normal pathway by which fluid drains from the brain appeared to be blocked.

Their study, Dr. Chesebro says, indicates that prion diseases can be divided into two groups: those with plaques that destroy brain blood vessels and those without plaques that lead to the sponge-like damage to nerve cells. Dr. Chesebro says the presence or absence of the prion protein anchor appears to determine which form of disease develops.

The new mouse model used in the study and the two new human GSS cases, which also lack the usual prion protein cell anchor, are the first to show that in prion diseases, the plaque-associated damage to blood vessels can occur without the sponge-like damage to the brain. If scientists can find an inhibitor for the new form of prion disease, they might be able to use the same inhibitor to treat similar types of damage in Alzheimer’s disease, Dr. Chesebro says.
Scientists from the Veterinary Laboratories Agency in Scotland also participated in the study.

Scientists are making headway in finding ways to treat and detect stubborn forms of prostate cancer.

The new hope comes from three studies being presented this week at the annual Genitourinary Cancers Symposium in San Francisco.

“Genitourinary cancers include cancers of the prostate, kidney, bladder and testicles,” Dr. Nicholas J. Vogelzang, chairman and medical director of the developmental therapeutics committee at U.S. Oncology, explained at a Wednesday teleconference announcing the various findings. “The most common of these is prostate cancer, which is diagnosed in 192,000 men and claims 27,000 lives each year.”

The first study, led by Dr. Oliver Sartor of Tulane Cancer Center, New Orleans, found that a new investigational drug called cabazitaxel improved overall survival in men whose prostate cancer had progressed despite being treated with hormone therapy and docetaxel-containing chemotherapy.

Men receiving cabazitaxel plus mitoxantrone (a chemotherapy drug) lived 15.1 months compared to 12.7 months for patients who received mitoxantrone plus prednisone. This represents a 30 percent increase in survival, which may not seem long but is seen as significant for men with a poor prognosis.

“Advances in cancer therapy have always been incremental. We have only a few examples of massive improvements with one drug,” Vogelzang noted. “Three months is a major clinical advance.”

Other studies are looking at whether giving the drug earlier in the course of the cancer would improve survival even more.

“Until today, experimental agents have never been shown to have a survival advantage in this group of patients,” said Sartor, who is Piltz Professor for Cancer Research at Tulane. “This potentially represents a new therapy option for these patients who are very difficult to treat. We don’t know when this is going to the FDA [U.S. Food and Drug Administration] for approval, but we’re working very hard to prepare the submission.”

A second group of researchers reported that the PCA3 urine test, which measures levels of prostate cancer gene 3, can predict when a biopsy of the prostate gland will come out positive.

The PCA3 gene is overexpressed in men who have prostate cancer, but not in men with benign disease, raising the possibility that the finding may cut down on the number of unnecessary prostate biopsies.

According to study author Jack Groskopf, director of research and development in cancer diagnostics at Gen-Probe Inc., which makes the test, most prostate biopsies that are currently performed after elevated prostate-specific antigen (PSA) test results actually turn out to be negative for cancer.

“The ability of this test to predict biopsies positively could potentially be very helpful and may also may help us identify those more aggressive cancers, which we still do not have a great way to identify other than [with] repeat biopsies,” said Vogelzang.

The final prostate cancer study found that short-term hormone therapy — either before or during radiation therapy — could help men with intermediate-risk, early-stage prostate cancer live longer and live longer without a recurrence.

But the therapy did not seem to help men with low-risk, early-stage tumors.

Since that study was conducted, however, standard radiation doses to treat prostate cancer have become higher and more efficient, raising the question as to whether these results are applicable to modern-day procedures.

In addition, said study co-author Dr. Christopher Jones, a partner of Radiological Associates of Sacramento, Calif., “there are consequences from short-course hormone therapy such as hot flashes and impotence, and we don’t know the long-term effect on sexual function. We need to know if there’s a real benefit to the individual patient of adding hormones to radiation before adopting this as standard practice.”

A final study demonstrated that adding high-tech urine biomarker tests to regular cystoscopy was not cost-effective in detecting recurrences of bladder cancer. Adding the biomarker screen also increased the risk for false-positive results, the researchers found.

Cystoscopy involves looking at the inside of the bladder with a camera.

“This data suggest that cystoscopy alone remains the most cost-effective strategy,” said study author Dr. Jose Karam, a urologic oncology fellow at The University of Texas M.D. Anderson Cancer Center in Houston. “The addition of urine tests adds to the cost without detection of invasive disease, suggesting that we should be using these markers carefully and judiciously when surveying patients with bladder cancer.”

Both Vogelzang and Sartor disclosed numerous ties with pharmaceutical companies.

The Genitourinary Cancers Symposium is sponsored jointly by the American Society for Clinical Oncology, the American Society for Radiation Oncology and the Society of Urologic Oncology.

SOURCES: teleconference with Nicholas J. Vogelzang, M.D., chair and medical director, developmental therapeutics committee, U.S. Oncology; Oliver Sartor, M.D., Piltz Professor for Cancer Research, Tulane Cancer Center, New Orleans; Jack Groskopf, Ph.D., director of research and development in cancer diagnostics, Gen-Probe Inc., San Diego; Christopher Jones, M.D., partner, Radiological Associates of Sacramento; and Jose Karam, M.D., urologic oncology fellow, The University of Texas M. D. Anderson Cancer Center, Houston; study abstracts

Cholesterol-lowering statins significantly reduce prostate tumor inflammation, which may help lower the risk of disease progression, new study findings suggest.

Duke University Medical Center researchers found that the use of statins before prostate cancer surgery was associated with a 69 percent reduced likelihood of inflammation inside prostate tumors.

For the study, the researchers examined tissue samples of prostate tumors from 236 men undergoing prostate cancer surgery. The patients included 37 who took statins during the year prior to their surgery.

Overall, 82 percent of the men had inflammatory cells in their prostate tumors and about one-third had marked tumor inflammation. After they accounted for factors such as age, race and body-mass index (a measurement that is based on weight and height), the Duke team concluded that statin use was associated with reduced inflammation within tumors. They also determined that inflammation was more likely among older men with more advanced prostate cancer who’d waited a longer time between prostate biopsy and surgery.

The findings are published in the Feb. 22 online edition of the journal Cancer Epidemiology, Biomarkers & Prevention.

“Increasing evidence suggests that statins may reduce risk of prostate cancer progression, and some studies have even suggested that widespread statin use over the past 15 years has contributed to a decline in prostate cancer mortality,” lead author Dr. Lionel Banez, an assistant professor of surgery and urology, said in a Duke news release.

But that doesn’t mean that all prostate cancer patients should take statins, said study senior author Dr. Stephen Freedland, an associate professor of urology and pathology at the Duke Prostate Cancer Center.

“More studies have to be done before such a recommendation can be made. However, men taking statins for heart health may already be enjoying a beneficial side effect against prostate cancer,” Freedland said in the news release.

Testosterone deficiency in young male cancer survivors often causes low energy levels and reduced quality of life, and these patients may benefit from testosterone replacement therapy, a new study suggests.

About 15 percent of male cancer survivors experience testosterone deficiency, which is a late side effect of chemotherapy or radiation therapy.

In this study of 176 young male cancer survivors and 213 young men without cancer, English researchers looked at the association between testosterone levels, quality of life, self-esteem, fatigue and sexual function.

The young male cancer survivors reported reduced energy levels, impaired sexual function and a markedly reduced quality of life. These problems were most severe in those with testosterone deficiency.

However, the cancer survivors had no problems with self-esteem, sexual relationships or mental health.

“This is an important study demonstrating that low testosterone levels are common in male cancer survivors and associated with an impaired quality of life,” said lead investigator Dr. Richard Ross, of the University of Sheffield. “However, the relationship between testosterone levels and quality of life is complex and appears to depend on a threshold level rather than on a direct correlation. We now need interventional trials with testosterone to determine which young male cancer survivors will benefit from replacement therapy.”

Results are similar for men with prostate cancer whether they have open surgery or laparoscopic surgery, a new study has found.

Currently, open radical prostatectomy (ORP) is considered the standard treatment but the use of laparoscopic radical prostatectomy (LRP), with or without robotic assistance, is becoming more widespread.

In the new study, researchers at Memorial Sloan-Kettering Cancer Center in New York City compared ORP and LRP outcomes in nearly 6,000 men, age 66 or older, with localized prostate cancer.

After they adjusted for patient and tumor characteristics, the researchers found no differences in the rates of general medical/surgical complications, genital/urinary/bowel complications, or in use of postoperative radiation and/or androgen deprivation.

Patients in the LRP group had a 35 percent shorter hospital stay and a lower rate of bladder neck/urethral obstruction, the study authors noted.

“All men considering radical prostatectomy should be clearly informed about the differences between the two techniques and similarities in their expected outcomes, and make treatment decisions in collaboration with an experienced surgeon,” Dr. William T. Lowrance and colleagues wrote in their report, which is published in issue of the Journal of Urology.