PSA test for prostate cancer not recommended: panel

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By Julie Steenhuysen

CHICAGO | Fri Oct 7, 2011 1:43pm EDT

CHICAGO (Reuters) - A U.S. government-backed panel recommended against routine prostate cancer screening on Friday because widespread screening for the disease causes more harm than good.

The U.S. Preventive Services Task Force had previously said there was not enough evidence to make a call on the use of prostate-specific antigen, or PSA, tests that measure levels in the blood of a protein.

The same panel caused a media storm in 2009 after it recommended doctors scale back on routine mammograms for women in their 40s and 50s.

The panel, which advises the government on health prevention measures, downgraded its recommendation on prostate cancer screening to a "D," which means it recommends against the service because "there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits."

The proposed guidelines are meant to discourage use of the test for healthy men who do not have any symptoms that might indicate prostate cancer. They do not apply to the use of PSA tests as part of a diagnostic strategy in men suspected of having prostate cancer.

High or increasing levels of PSA can indicate an increased risk for prostate cancer, but elevated PSA levels can be caused by other things too, such as infections, an enlarged prostate or even recent ejaculation.

Studies have shown that widespread use of PSA tests has resulted in high rates of false positives and overtreatment for an often slow-growing cancer that might never have caused harm.

And the treatments -- usually surgery and radiation -- are not benign. They frequently result in impotence and incontinence.

Simply being diagnosed with prostate cancer can cause anxiety and harm. A study by researchers at Harvard and Brigham & Women's Hospital in Boston last year found that being diagnosed with prostate cancer roughly doubles the risk of suicide or death from a heart attack.

MIXED RESULT ON PSA TEST EFFECTIVENESS

But prostate cancer is not harmless. It is the second-leading cause of cancer death in the United States behind lung cancer.

"The notion that prostate cancer is not a threat to the well being of men is simply wrong," said Dr. Herbert Lepor, a urology professor at New York University School of Medicine.

Results of studies looking at the benefits of widespread prostate cancer screening have been mixed, according to the conclusions of a review of studies set to be published next week but released early by the Annals of Internal Medicine.

That review, which is used by the task force to make its recommendations, noted that of the five screening trials it studied, the two largest and highest-quality studies reported conflicting results. One found screening was associated with reduced prostate cancer deaths compared with no screening in men age 55 to 69 after nine years.

The other found no statistically significant benefit after 10 years. And of the men who had three or four rounds of screening, the false positive rate was 12 to 13 percent.

"Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary," the report concluded.

But critics say the studies were not long enough to show a benefit and argued that there is evidence that PSA screening saves lives.

"The U.S. Preventive Services Task Force claims the screening studies fail to show benefits of screening. This is not accurate," Lepor said.

A Scandinavian study with 14 years of follow up showed prostate cancer screening cut prostate cancer deaths by 50 percent, Lepor said.

"The U.S. Preventive Services Task Force is a group of primary care physicians like pediatricians and OB/GYNs who never treat prostate cancer. They have simply misinterpreted the studies and have not seen men die of this fatal disease," Lepor said.

The guidelines had been scheduled to be released in the Annals of Internal Medicine on Monday, but leaks of the recommendations to news outlets forced the group to post the guidelines early. It was first reported by CNN on Thursday.

The recommendations will be available for a 30-day comment period before final treatment guidelines are released.

According to the American Cancer Society, about 1 man in 6 will be diagnosed with prostate cancer during his lifetime. More than 2 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

(Editing by Jackie Frank)

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Parents delaying, skipping recommended vaccines

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A health worker prepares a vaccine against measles at the Benito Juarez international airport in Mexico City July 22, 2011.

Credit: Reuters/Bernardo Montoya

By Genevra Pittman

NEW YORK | Mon Oct 3, 2011 9:30am EDT

NEW YORK (Reuters Health) - More than one in 10 parents use an "alternative" vaccination schedule for their young children, including refusing vaccines altogether, according to a U.S. survey.

Based on the findings, researchers worry that more parents may be refusing vaccines in the future, raising the risk that diseases like measles and whooping cough will spread in schools and communities.

"The vaccines that we recommend have been so effective in largely eliminating the vaccine-preventable diseases that most parents don't have first, second or even third-hand experience with these diseases," said Dr. Amanda Dempsey, one of the authors of a new report based on the survey from the University of Michigan in Ann Arbor.

(For an abstract of the study, see: here)

Whether or not to get their kids vaccinated "is more of a theoretical concern or concept for them," Dempsey told Reuters Health. "These are really real risks that are out there. None of these diseases are completely eradicated."

The Centers for Disease Control and Prevention's vaccination schedule for kids six and younger includes MMR (measles, mumps and rubella) shots, and vaccines to protect against whooping cough, chicken pox, hepatitis and seasonal flu, among others. (The full recommended schedule is on the CDC website here: 1.usa.gov/k23A6d)

The Internet survey included 748 parents of kids between the ages of six months and six years. Of those, 13 percent said they used some type of vaccination schedule that differed from the CDC recommendations.

That included refusing some vaccines or delaying vaccines until kids were older -- mostly because parents thought that "seemed safer."

Dempsey said there is no evidence for the safety or effectiveness of such alternative schedules.

In addition, two percent of parents refused any vaccination altogether, according to findings published in Pediatrics.

Even among parents who did follow the recommended schedule, about one-quarter said in the survey they thought delaying vaccines would be safer or that the expert-backed schedule wasn't the best one to follow.

Dempsey said there's extra concern that those parents will stop getting their kids the recommended vaccines. "It's really quite worrisome to me," she said. Vaccine refusal and delay, she added, "is not likely to go away anytime soon, and is likely to get significantly worse over time. We may just be seeing the tip of the iceberg right now."

NOT A BENIGN CHOICE

Parents who skip or delay vaccines typically cite safety concerns, researchers said, including the now debunked idea of a link between vaccines and autism.

What they miss is the risk of the disease they aren't vaccinating against, said Saad Omer, an infectious diseases researcher at Emory University in Atlanta.

"Parents often have this perception that it's a benign choice, whether to vaccinate or not," Omer, who was not involved in the new research, told Reuters Health.

He said parents who refuse vaccines tend to cluster together in certain areas -- increasing the risk of a local disease outbreak, even in kids who have been vaccinated.

Because no vaccine protects 100 percent of kids who get it, epidemiologists rely on "herd immunity" to make sure enough kids are well enough protected to keep a disease from spreading. But that immunity gets thrown off when there are more youngsters who haven't had their recommended vaccines.

"Infectious diseases are somewhat unique in a way in that others' behavior directly influences you or your child's risk of disease," Omer said.

He said vaccine refusal already has increased the risk of whooping cough spreading in communities, for example.

"We're seeing schools having to close because of pertussis," Dempsey said, adding that measles cases have also spiked recently.

With some diseases, such as polio, the risk of getting sick in the United States, even if you aren't vaccinated is pretty low. But "when a bad outcome happens to your family, it's 100 percent," Dempsey said. "You can't ever say it's not going to be your kid."

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HEALTH MANAGEMENT. Change the trans fat labelling recommended by experts

Not all trans fats are the same and it is time for nutrition labels according to this reality, says a University of Alberta-nutrition expert.
After a scientific evaluation carried out by Spencer Proctor, Canadian and international colleagues natural trans fats from ruminant animals such as dairy produced and cattle are not harmful to health. In fact, they show significant positive health effects and some evidence left also this natural trans fats to lower risk of cardiovascular disease and cancer.
A different fatty acid profile as industrial trans fatty acids has naturally occurring after the review, trans fat, what its different physiological effects. Ruminant trans fat is naturally occurring and meat and dairy products, while industrial trans fatty acids is a component of partially hydrogenated vegetable oils have been strongly associated with cholesterol and coronary heart disease.
Consumers are on a regular basis about what she should and do not eat bombed. The primary goal to avoid what is often fat and trans fats in particular have a negative reputation.
"A change in the appearance of trans fat information on nutritional information would be a big step forward," says Proctor, a researcher in the Department of agriculture, food and nutrition, is Director of the metabolic and heart circulation diseases lab at the U A. "right now, in Canada and the United States, a significant part of the natural trans fats, the content in the diet name trans fats calculation is included, which is misleading for the consumer." "We need reflect a reset in our approach, what tells us the new science."
Spencer adds that natural trans-fatty acids in the nutrition label calculation is not included in some European countries. Another approach might be separate entries for industrial trans fats and natural trans fats have.
Researchers evaluated an evidence from numerous studies in the review. On the basis of the promising results so far are plans for new studies, continue to study the health effects of the natural ruminant of derived trans fats dynamics.
A leading scientific program under the direction of Proctor was recently one million US dollar research funding from the Alberta livestock and meat agency this line of study in the next few years further approved.
"With industry, the science, regulatory authorities and other major groups in this area work together we can continue to steps up out to public better understand the health effects of the natural ruminant trans fats, to help", says Proctor.

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HEALTH MANAGEMENT. Operations (Rivaroxaban) recommended for patients with non-valvular atrial fibrillation, United States

Anticoagulant Rivaroxaban (rivaroxaban) has been recommended by the FDA's cardiovascular Renal Drugs Advisory Committee for the prevention of systemic embolism and stroke in patients with non-valvular AF (atrial fibrillation). The Committee, also known as the Panel, voted 9 to 2 in favour, with 1 abstention.
The FDA (food and Drug Administration) is expected to make a final decision on September 8th. The Panel's verdict is not binding; the FDA can ignore the recommendation if it so wishes. However, this rarely happens.
Bayer Healthcare holds the rights to sell rivaroxaban outside the United States, while Janssen Pharmaceuticals, Inc. has the rights to market it inside the United States. Janssen is a Johnson & Johnson company.
Janssen had submitted to the NDA (new drug application) for rivaroxaban in the United States on January 5th this year for the prevention of stroke and systemic embolism in individuals with non-valvular AF.
Bayer has submitted rivaroxaban for market authorization for the same indication as well as DVT treatment and the prevention of recurrent DVT and PE to the European Medicines Agency (EMA). A submission has also been presented to Japanese authorities.
Rivaroxaban was approved recently for blood clot prevention after some orthopedic surgical procedures. Having approval for stroke will give access to a much greater number of patients Janssen.
Warfarin has been used for stroke prevention for over 50 years. With warfarin, doctors need to regularly measure its levels in the bloodstream, which is not the case with Rivaroxaban. However, warfarin is far cheaper.
According to Bayer and Janssen, Rivaroxaban is more convenient for patients, and has fewer side effects.
The heart has two upper chambers - the atria, and two lower chambers - the ventricles. The atria consist of a right and left atrium, and the ventricles are called the left and right ventricle. When the atria contract too rapidly and / or may, the patient has atrial fibrillation. Atrial fibrillation is the most common type of arrhythmia, which is caused when there is a disorder in the heart's electrical system. Arrhythmia is a problem with the speed or rhythm of the heartbeat.
AT affects over 6 million Europeans, more than 2.3 million Americans, and approximately 800,000 patients in Japan.
AT patients are vulnerable to the formation of blood clots in the atria. The clot can make its way through the bloodstream to the brain, where it can cause a stroke. Strokes can lead to brain damage, which in turn can result in serious physical and behavioral problems and even death.
On individual with AT is five times more likely to have a stroke compared to the general population. In fact, about one-third of AT patients do suffer a stroke.

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