30 June 2018
SATURDAY, June 30, 2018 (HealthDay News) — During the summer when people trade in their jackets and jeans for flip flops and bathing suits, more skin is exposed to the sun’s harmful UV rays. Dr. Katherine Gordon, assistant professor of dermatology at UT Southwestern Medical Center in Dallas, said summer is the perfect time for people to get in the habit of checking their skin for signs of cancer. “We recommend that everyone get in the habit of checking for signs of skin cancer at regular intervals year-round, though understandably people are more likely to be thinking about skin cancer in the hot summer months,” Gordon said in a medical center news release. “You’ll want to check your skin from head to toe, including areas like the scalp and between your toes, so it’s helpful to have a partner to help you,” she added. When performing a skin cancer self-exam, however, it’s important for people to be able to spot signs of trouble. Gordon advised people to check for the following: Moles that are changing, have irregular shapes or uneven edges. Moles that are multi-colored, such as brown, tan and black. Moles that are raised. Moles that are large, or have a diameter larger than the size of a pencil eraser. Scales, itchiness, tenderness or pain around a mole. A sore that does not heal or recurs. Brown or black streaks under a nail. Older people and those with light-colored skin are at greater risk for skin cancer, but anyone can develop the disease. Gordon noted that men are more likely to develop melanoma, which is the deadliest form of skin cancer. Black people are also more likely to develop skin cancer in places that usually don’t get much sun exposure, such as the palms of the hands and soles of the feet, inside the mouth and under the nails. “While the five-year survival rate for skin cancer that has metastasized is low, if melanoma is caught before it has spread to the lymph nodes, the survival rate is 99 percent,” Gordon said. “So I urge everyone to inspect their skin thoroughly this summer.” More information The American Cancer Society has more on skin cancer self-exams.
26 June 2018
TUESDAY, June 26, 2018 (HealthDay News) — Flight attendants may face higher-than-average risks of breast and skin cancers, a new study finds — though the reasons why aren’t yet clear. Harvard researchers found that compared with women in the general U.S. population, female flight attendants had a 51 percent higher rate of breast cancer. Meanwhile, their rates of melanoma and non-melanoma skin cancers were about two to four times higher, respectively. The study, which included over 5,300 U.S. flight attendants, is not the first to find heightened cancer risks among airline crews. But it’s one of the largest and most comprehensive to look at the issue, according to lead researcher Eileen McNeely. What’s still unclear is why the pattern is being seen. And because it’s what’s called an observational study, it could not prove cause and effect. Flight crews have a number of exposures that could potentially play a role, said McNeely, an instructor in environmental health at the Harvard School of Public Health. “There’s been a lot of speculation about exposure to cosmic ionizing radiation,” she said. That refers to radiation that comes from outer space. At flight altitudes, people are exposed to higher levels of it. The U.S. National Institute for Occupational Safety and Health (NIOSH) says that of all U.S. workers exposed to radiation, aircrew have the highest average levels. But no one knows for sure whether cosmic radiation is to blame for flight attendants’ higher cancer risks, McNeely said. Aircrews can also come in contact with a number of chemicals, she noted. And before smoking bans went into effect, they were habitually breathing secondhand smoke. Plus, McNeely said, flight crews deal with constant time-zone changes and irregular sleep schedules — which means many disruptions to the body’s circadian rhythm, or “internal clock.” Circadian disruptions from shift work have been linked to increased risks of obesity and diseases like diabetes and heart disease. “It’s hard to tease out which of those factors might be more important than others, or whether it’s a combination of all of them,” McNeely said. However, it’s also possible that there are factors unrelated to flight attendants’ jobs, said Dr. Paolo Boffetta, a professor of oncology and environmental medicine at Mount Sinai’s Icahn School of Medicine, in New York City. “For example, they may have more UV [sun] exposure because of their opportunity to travel,” said Boffetta, who was not involved in the study. In addition, he said, women on aircrews may put off having children or have fewer kids, compared with other women. And reproductive factors like that are associated with the risk of breast cancer. Still, McNeely said, her team found some evidence that the longer flight attendants had been on the job, the higher their cancer risk was. Among women, the risk of non-melanoma skin cancer rose in tandem with job tenure. That supports the theory that job exposures are the culprit, McNeely said. The findings, published June 25 in the journal Environmental Health, are based on 5,366 flight attendants who were part of an ongoing Harvard study begun in 2007. They were surveyed about their health in 2014-15, when they were an average age of 52 years old. McNeely’s team compared their cancer rates with a nationally representative sample of 2,729 adults with similar demographics. Overall, 3.4 percent of female attendants had been diagnosed with breast cancer, versus 2.3 percent of other U.S. women. Meanwhile, 2.2 percent had been diagnosed with melanoma, compared with just under 1 percent of other women. The biggest difference was seen in rates of non-melanoma skin cancers — which are highly curable. Over 7 percent of female flight attendants had been diagnosed with those cancers, compared to just under 2 percent of other women. Male flight attendants had higher rates of skin cancers than other men. But the differences were not significant in statistical terms. According to McNeely, the findings will “not be news” to aircrews. They’ve long been aware their occupation may be linked to increased cancer risks. The question is, if the causes are unclear, what can be done? McNeely noted that the European Union has already taken a step — requiring that aircrews be monitored for their radiation exposure. If it reaches a certain level, their work schedules are adjusted. There are no official radiation limits for U.S. aircrews, according to NIOSH. Boffetta said that regardless of the reasons, the higher rates of skin and breast cancers among flight attendants underscore an important point: They should get recommended cancer screenings. The potential risks to flight crews bring up another question: What about passengers who fly frequently? McNeely said it’s not clear whether they face any health risks. “We study workers first, because they have the greatest exposures,” she noted. “They’re like the canary in the coal mine.” More information The U.S. Centers for Disease Control and Prevention has more on radiation from air travel.
26 June 2018
TUESDAY, June 26, 2018 (HealthDay News) — Giant hogweed is much like a Dr. Seuss nightmare — a towering, invasive plant with toxic sap that burns the skin and eyes upon contact. But the noxious weed is not imaginary, with a dozen states now on the lookout to eradicate any patches of giant hogweed that might crop up, experts say. The plant grows 8 to 14 feet tall, with a green hollow stem rising up to branches of small white flowers clustered in “umbrellas” about 2.5 feet across, said Naja Kraus, a research scientist with the New York State Department of Environmental Conservation. The plant releases sap containing toxic organic chemicals called furanocoumarins that cause severe burns and painful blisters on human skin, as well as eye irritation, Kraus said. Perspiration and sun exposure enhance the reaction. “If people get sap on their skin, the best thing is to go home and wash up with a lot of soap and water,” said Jordan Metzgar, a curator with Virginia Tech’s Massey Herbarium in Blacksburg. “Then stay out of the sun or wear sunblock for the last couple of days.” Giant hogweed is federally listed as a noxious weed, Kraus said. It is currently shown as active in 12 states, mainly in New England, the Mid-Atlantic region and the Pacific Northwest. The weed is native to the Caucasus mountain region of Eurasia, but its massive size and odd appearance led U.S. botanists to import it as an ornamental plant for arboretums and private gardens in the early 1900s, Kraus said. “It was brought over to be planted in a garden in New York, so it was brought for ornamental reasons,” Metzgar said. “Up until 15 or 20 years ago, that was all it was really doing, then it started to spread more in the northeastern U.S.” Brushing up against the plant with bare skin can cause a reaction that begins as soon as 15 minutes after contact. Burns and blisters can occur, particularly if the person exposes the skin to sunlight, Kraus said. Each plant on average produces 20,000 seeds, which makes controlling its spread a real challenge, Kraus said. Most seeds fall within 30 feet of the parent plant, but if the plant grows near a stream the seeds will float downstream, she said. “That becomes a harder job to tackle, because you have to find all the places where the new plants are growing,” Kraus said. Giant hogweed is most prevalent in New York state, Metzgar said. It has been identified there in 49 counties, mainly in central and western New York. Other states fighting the pest include Maine, Massachusetts, Connecticut, Pennsylvania, North Carolina, Michigan, Illinois, Vermont, Virginia, Washington and Oregon, Kraus said. Officials beat back giant hogweed using a method called root cutting, in which they sever the plant root 5 inches below the soil, Kraus said. However, that’s only good for patches with fewer than 400 plants. Herbicides have to be deployed in larger patches, Kraus said. The job isn’t hopeless. Kraus noted that New York state workers have eradicated giant hogweed from more than 900 sites in recent years. “That’s amazing — 904 land owners don’t have giant hogweed on their property anymore, because we’ve been controlling it,” Kraus said. People who think they’ve got giant hogweed on their property should not approach it, Metzgar and Kraus said. “If you do think you’ve found it, take a good look at the leaves and stems and flowers, and then refer to a photo online for identification,” Metzgar said. Folks who are sure it’s giant hogweed should then take some good photographs and send them to their local extension agent, or environmental officials in your city, county or state, Metzgar and Kraus said. “It is very controllable,” Kraus said. “It’s important to report it if you have it, so you can get help.” More information The New York State Department of Environmental Conservation has more about giant hogweed.
26 June 2018
TUESDAY, June 26, 2018 (HealthDay News) — An ancient scourge — the polio virus — may be an unexpected friend to people battling one of the deadliest brain cancers, new research shows. The new therapy uses a tweaked, harmless form of the polio virus to significantly boost the chances patients with recurrent glioblastomas can survive over the long term. In the study from Duke University in Durham, N.C., 21 percent of patients who got the new treatment were still alive three years later, compared to just 4 percent of those who received standard therapy. “There is a tremendous need for fundamentally different approaches,” study senior author Dr. Darell Bigner, emeritus director of Duke’s brain tumor center, said in a university news release. “With the survival rates in this early phase of the polio virus therapy, we are encouraged and eager to continue with the additional studies that are already underway or planned.” Brain cancer expert Dr. Michael Schulder noted that the “results from this trial have been eagerly awaited after preliminary information was announced on 60 Minutes several years ago.” He helps direct neurosurgery at North Shore University Hospital in Manhasset, N.Y., but wasn’t involved in the new trial. The data on outcomes from the new study remain somewhat incomplete, Schulder said, so “we will have to await the availability of the full paper to assess the effectiveness of this new treatment for patients with glioblastoma.” As the Duke team explained, the new approach uses an altered, harmless form of the polio virus to target and destroy glioblastoma cells while triggering a powerful immune response. The initial study included 61 patients who received the genetically modified polio virus developed at the Duke Cancer Institute. Their outcomes were compared to the records of previous patients who had received standard treatment. Median overall survival was 12.5 months in the polio virus group and 11.3 months in the control group. But the gap between treatments widened for patients who lived longer, Bigner’s group noted. Survival rates at two years were 21 percent in the polio virus group and 14 percent in the group that didn’t get the therapy, and at three years they were 21 percent and 4 percent, respectively. The findings from the phase 1 trial were published June 26 in the New England Journal of Medicine and presented on the same day at the International Conference on Brain Tumor Research and Therapy, in Norway. The polio virus therapy was designated a “breakthrough therapy” by the U.S. Food and Drug Administration in 2016. Neurosurgeon Dr. Jason Ellis treats brain tumors at Lenox Hill Hospital in New York City. He called the new findings “exciting,” but agreed that more data are needed. “The preliminary data reported suggest that larger randomized studies should be performed to definitively determine whether this strategy will be effective in brain tumor patients,” said Ellis, who wasn’t involved with the study. Those trials may be on the way. And along with a phase 2 trial of the therapy for glioblastoma, the Duke team has started enrolling patients to test the therapy in treating brain tumors in children. Clinical trials of the therapy in breast cancer and melanoma skin cancer patients are also planned, according to the researchers. More information The American Brain Tumor Association has more on glioblastoma.
25 June 2018
MONDAY, June 25, 2018 (HealthDay News) — For many diabetics, one of the most dreaded aspects of managing their condition is the need to inject insulin multiple times a day. But Harvard researchers have discovered a way to deliver insulin in a pill, and it appears to work well — at least in rats. A lot of questions remain: What is the proper dose compared to injected insulin? Will it be delivered uniformly? And, the biggest, will it work well in people, too? That’s why more research is needed, said the study’s senior author, Samir Mitragotri, a professor of bioengineering at Harvard University. “What we have shown is that we can deliver insulin, and that it is safe in the intestine. This would be a non-invasive, patient-friendly, easy-to-use treatment,” he said. Insulin is a hormone that helps usher the sugar from foods you eat into cells for use as fuel. People with diabetes often lack enough insulin to meet the body’s needs, though the exact cause varies depending on the type of diabetes. An oral insulin hasn’t been available, because insulin gets digested in the stomach, Mitragotri said. But injectable forms — which can be delivered by a needle or through a small tube inserted under the skin and attached to an insulin pump — are painful, which can lead people to skip their medication, he noted. To develop an oral insulin, the researchers had a number of challenges. If an oral insulin got past the stomach’s acid, the intestines presented another issue. Insulin is a large molecule, and the intestinal wall is a barrier for most large molecules, the researchers explained. The first step in moving past these barriers was to put insulin in an ionic liquid, which Mitragotri likened to liquid salts. The insulin-ionic liquid combination was then covered with a coating that allows the pill to pass through the stomach intact. It’s then dissolved in the small intestine. From there, the oral insulin travels to the large intestine. With the help of the ionic liquids, the insulin molecules can get through the intestinal wall into the bloodstream. One benefit to this form of insulin is that it’s more shelf-stable than injectable insulin. Current insulins are good for about 28 days once they’re out of the fridge. But the oral insulin is good for at least two months, and probably longer, Mitragotri said. The current study reported on a trial of the oral insulin in rats. The researchers found a sustained drop in blood sugar (glucose) of up to 45 percent in the animals. “It lowered blood glucose for at least 12 hours,” Mitragotri said. Any time someone takes insulin, there’s a risk of taking too much and causing a dangerous drop in blood sugar levels (hypoglycemia). But Mitragotri said because it takes a while for oral insulin to be released, the risk is reduced. More studies will need to be done, including in larger animals, before human trials could begin. But if all goes well, Mitragotri said that he expects human trials could begin in three to five years. It’s hard to estimate what the cost of oral insulin might be, he added. But the ionic liquid and coating materials aren’t expensive, so he expects it would be similar in cost to current insulins. Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, reviewed the findings. “It’s good that people are trying to find the holy grail of oral insulin, and we would always welcome a novel delivery system for insulin. The current results on rodents are much better than I’ve seen in the past,” Zonszein said. “But the problems we have are many,” Zonszein added. It’s hard to know how this insulin could be used because the release of the insulin is too variable, he said. The report was published online June 25 in the Proceedings of the National Academy of Sciences. More information Learn more about insulin and diabetes from the American Diabetes Association.
25 June 2018
MONDAY, June 25, 2018 (HealthDay News) — Skin conditions are significantly impacted by your skin color, a dermatologist says. “Ethnicity and skin tone can make a big difference in terms of diagnosis and treatment options with a number of different skin conditions,” said Dr. Amy McMichael, chair of dermatology at Wake Forest Baptist Medical Center in Winston-Salem, N.C. The amount of melanin — the pigment that gives skin its color — can greatly influence a person’s risk of and reaction to many different skin conditions. For example, a fair-skinned person with a low level of melanin has a far higher risk of sunburn than someone with a melanin-rich dark complexion. But darker-skinned people aren’t totally protected from the sun’s ultraviolet rays. Also, their higher melanin levels make their skin more reactive to inflammation and injury, McMichael said. This can result in problems such as long-lasting or permanent dark spots (hyperpigmentation) at the sites of even relatively minor irritations, such as insect bites. “There are a lot of myths out there about which groups are or are not affected by certain conditions,” McMichael said in a medical center news release. She is the only black woman to chair a university dermatology department in the United States. “That African-Americans don’t get psoriasis is a big one. We’ve found that a number of people of African descent not only have it but that it can be a lot worse and a lot more extensive. And psoriasis is one of the conditions that can look so different in people with darker skin that it’s confusing and often not recognized by family physicians or even people trained in dermatology,” she added. The distinctions are important, McMichael noted, because the U.S. population by 2050 will have minorities in the majority. “This means that many [doctors] are going to be dealing with patients of all ethnicities, even ones we’re not necessarily familiar with,” she said. “We’ll have to be versatile, to take into consideration how their pigmentation or cultural practices affect their particular problem and how it can best be addressed.” More information The U.S. National Institutes of Health offers advice on keeping your skin healthy.
22 June 2018
FRIDAY, June 22, 2018 (HealthDay News) — Health insurers may have helped fuel the U.S. opioid epidemic by not encouraging use of less addictive pain medications, a new study contends. In 2016, more than 2.1 million Americans had an opioid addiction. And more than 42,000 died from opioid overdoses, government data show. “Our findings suggest that both public and private insurers, at least unwittingly, have contributed importantly to the epidemic,” said study senior author Dr. G. Caleb Alexander, of Johns Hopkins Bloomberg School of Public Health in Baltimore. Opioid-based painkillers like oxycodone (OxyContin) and hydrocodone (Vicodin) are just one tool in the pain management tool box, said Alexander, co-director of Hopkins’ Center for Drug Safety and Effectiveness. “Unfortunately, many of the plans that we examined didn’t have well-developed policies in place to limit their overuse,” he said in a university news release. Alexander’s team examined Medicare, Medicaid and large private insurers’ 2017 coverage policies for drugs to treat chronic lower-back pain. Chronic back pain is frequently linked to overuse of prescription opioids. The analysis included 30 prescription opioids and 32 non-opioid medications. Non-opioids included nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and pain relievers applied to the skin. The researchers concluded that the insurers’ drug coverage policies should have done more to get patients to use safer and more effective treatments than prescription opioids. Insurers can more strictly limit painkiller quantities and require use of less risky drugs before proceeding to powerful narcotics, the researchers said. They can also require the prescriber to obtain authorization from the insurer before ordering opioids for non-cancer pain, the study authors added. The study was published June 22 in the journal JAMA Network Open. Efforts by HealthDay to get a comment from the trade association America’s Health Insurance Plans were unsuccessful. More information The U.S. National Institute on Drug Abuse has more about prescription opioids.
21 June 2018
THURSDAY, June 21, 2018 (HealthDay News) — Could a vaccine from the early 1900s be the key to preventing serious diabetes complications? Maybe, say researchers from Harvard University and Massachusetts General Hospital. A little more than three years after getting two tuberculosis shots four weeks apart, about 50 people with type 1 diabetes saw their long-term average blood sugar levels drop significantly — and for at least five years. “The gold standard in treating diabetes is to lower blood sugar. Lowering blood sugar changes quality of life and reduces the risk of complications,” said the study’s senior author, Dr. Denise Faustman. “After 3.5 years we saw a pretty sharp drop in blood sugar to near normal, and it stayed down,” said Faustman, director of Mass General’s immunobiology laboratory. “We’re not claiming anyone will be insulin-free, but we lowered average blood sugar by more than 10 percent consistently for more than five years. And it’s affordable,” she added. Plus, the people in the study were adults with long-standing type 1 diabetes — for at least 10 years, Faustman said. The vaccine has U.S. Food and Drug Administration approval. It’s officially known as the bacillus Calmette-Guerin (BCG) vaccine. It has been used against tuberculosis for about 100 years, Faustman said. The researchers used a measure called hemoglobin A1C that estimates blood sugar levels over two to three months. To prevent complications, the American Diabetes Association recommends most healthy people keep A1C at 7 percent or lower. There was a total of 282 study participants; 52 had type 1 diabetes and were in the BCG group. At the start of the study, the average A1C for the vaccine group was 7.4. At the end of year five it was 6.2, and by the end of year eight it was 6.7. In a placebo group, there was no improvement in A1C, the study authors said. Type 1 diabetes is an autoimmune disease. That means the body’s immune system mistakenly attacks a healthy part of the body. In type 1 diabetes, the immune system attacks the insulin-producing beta cells in the pancreas. Someone with the condition needs to take insulin through injections or via a small tube inserted in the skin and attached to an insulin pump. Faustman said changes observed in two previous studies didn’t seem to come from any usual pathways, such as increased insulin production or less insulin resistance. So the investigators looked for other possibilities. They believe what’s happening is a process called aerobic glycolysis that causes cells to use up more sugar. The process appears to shut down when blood sugar levels drop, preventing blood sugar levels from falling too low, which can be a problem, too. Faustman said that this might mean the vaccine could be useful for people with type 2 diabetes as well. Two diabetes experts who were not involved with the study offered their take on the research. Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City, said one should take the current findings “with a grain of salt.” He said it’s too early to know how effective this vaccine might be for any type of diabetes. “We need more solid information,” Zonszein said. Dr. Mary Pat Gallagher is director of the Pediatric Diabetes Center at Hassenfeld Children’s Hospital at NYU Langone Health in New York City. “The design of the study doesn’t provide any information about the cause of the decrease in hemoglobin A1C seen in this small group of subjects, and it is possible that it may be related to other factors,” Gallagher said. She said there are a number of ways to significantly lower A1C, including going on an insulin pump or starting to use a continuous glucose monitor (CGM). This study, Gallagher added, “provides support for a potential mechanism through which BCG therapy might affect glucose control in people with type 1 diabetes, but it doesn’t have any new information regarding the efficacy of this treatment.” She noted that Faustman’s team has a clinical trial going on that may provide more answers. The study was published June 21 in the journal Vaccine. More information Learn more about type 1 diabetes from the U.S. Centers for Disease Control and Prevention.
20 June 2018
WEDNESDAY, June 20, 2018 (HealthDay News) — For women who have their breast removed while fighting cancer, using their own tissue for breast reconstruction is better than implants, a new study suggests. More than 60 percent of women who undergo breast removal to treat breast cancer decide to have breast reconstruction, and that rate is rising. But the researchers said that there has been little information about long-term satisfaction and quality of life after breast reconstruction. The study included more than 2,000 women in the United States who had breast reconstruction using either breast implants or their own skin, fat or muscle from elsewhere in the body (“autologous” reconstruction), such as the abdomen. Two years after breast reconstruction, women who had autologous reconstruction reported greater satisfaction with their breasts and better psychosocial and sexual well-being compared with those who underwent implant reconstruction. “Patient-centered data can best inform patients and clinicians about the potential risks and expected outcomes of breast reconstruction when making a decision between implant-based or autologous breast reconstruction,” said senior study author Dr. Andrea Pusic. She is chief of plastic and reconstructive surgery at Brigham and Women’s Hospital in Boston. “Given the personal and intimate nature of breast reconstruction, patient-centered data are arguably the best measures of outcomes,” Pusic said in a hospital news release. “An understanding of the expected satisfaction and quality of life is central to the decision-making process.” The study was published June 20 in the journal JAMA Surgery. More information The U.S. National Cancer Institute has more on breast reconstruction.