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Tampilkan postingan dengan label tests. Tampilkan semua postingan
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Minggu, 29 Januari 2012

Too many tests? Routine checks getting second look

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FILE - In this Feb. 6, 2009 file photo, a man sits on an ergometer during an electrocardiogram in a doctor's surgical office in Stuttgart, Germany. Some of the nuts-and-bolts tests administered during check-ups and non-emergency visits are getting a second look. Think twice about a routine EKG if you have no heart symptoms, or a chest X-ray just because you’re going in for knee surgery. Increasingly, groups that represent the very doctors who order the most common medical tests say they do so way too often, wasting money and sometimes harming people when false alarms spur unneeded follow-up care. (AP Photo/Thomas Kienzle, File) FILE - In this Feb. 6, 2009 file photo, a man sits on an ergometer during an electrocardiogram in a doctor's surgical office in Stuttgart, Germany. Some of the nuts-and-bolts tests administered during check-ups and non-emergency visits are getting a second look. Think twice about a routine EKG if you have no heart symptoms, or a chest X-ray just because you’re going in for knee surgery. Increasingly, groups that represent the very doctors who order the most common medical tests say they do so way too often, wasting money and sometimes harming people when false alarms spur unneeded follow-up care. (AP Photo/Thomas Kienzle, File)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); WASHINGTON (AP) — Recent headlines offered a fresh example of how the health care system subjects people to too many medical tests — this time research showing millions of older women don't need their bones checked for osteoporosis nearly so often.

Chances are you've heard that many expert groups say cancer screening is overused, too, from mammograms given too early or too often to prostate cancer tests that may not save lives. It's not just cancer. Now some of the nuts-and-bolts tests given during checkups or hospital visits are getting a second look, too — things like routine EKGs to check heart health, or chest X-rays before elective surgery. Next under the microscope may be women's dreaded yearly pelvic exams.

The worry: If given too often, these tests can waste time and money, and sometimes even do harm if false alarms spur unneeded follow-up care.

It begs the question: Just what should be part of my doctor's visit?

If you're 65 or older, Medicare offers a list of screenings to print out and discuss during the new annual wellness visit, a benefit that began last year. As of November, more than 1.9 million seniors had taken advantage of the free checkup.

For younger adults, figuring out what's necessary and what's overkill is tougher. Whatever your age, some major campaigns are under way to help. They're compiling lists of tests that your doctor might be ordering more out of habit, or fear of lawsuits, than based on scientific evidence that they are really needed.

"Too often, we order tests without stopping to think about how (if at all) the result will help the patient," wrote Dr. Christine Laine. She's editor of Annals of Internal Medicine, which this month published a list of 37 scenarios where testing is overused.

Not even physicians are immune when it comes to their own health care. Dr. Steven Weinberger of the American College of Physicians had minor elective surgery for torn knee cartilage about a year ago. The hospital required a pre-operative chest X-ray, an EKG to check his heart, and a full blood work-up — tests he says aren't recommended for an otherwise healthy person at low risk of complications.

Weinberger should know: He led the team that compiled that new list of overused tests. All three examples are on it.

"If anyone should have objected, I should have objected, but I took the easy way out. I didn't want to be raising a fuss, quite frankly," he says.

The college of physicians' push for what it calls "high-value, cost-conscious care" — and similar work being published in the Archives of Internal Medicine — aims to get more doctors to think twice so their patients won't be put in that uncomfortable position. Another group, the National Physicians Alliance, is studying whether training primary care doctors in parts of Connecticut, California and Washington about the most overused care will change their habits.

Medical groups have long urged patients not to be shy and to ask why they need a particular test, what its pros and cons are, and what would happen if they skip it. This spring, a campaign called Choosing Wisely promises to provide more specific advice. The group will publish a list of the top 5 overused tests and treatments from different specialties. Consumer Reports will publish a layman's translation, to help people with these awkward discussions.

For now, some recent publications offer this guidance:

—No annual EKGs or other cardiac screening for low-risk patients with no heart disease symptoms. That's been a recommendation of the U.S. Preventive Services Task Force for years. Yet a Consumer Reports survey of more than 8,000 people ages 40 to 60 found 44 percent of low-risk, people with no symptoms had undergone an EKG or similar screening. Simple blood pressure and cholesterol checks are considered far more valuable.

—Discuss how often you need a bone-density scan for osteoporosis. An initial test is recommended at 65, and Medicare pays for a repeat every two years. A study published last week found that a low-risk woman whose initial scan is healthy can wait up to 15 years for a repeat; those at moderate risk might need retesting in five years, high-risk women more often.

—Women under 65 need that first bone scan only if they have risk factors such as smoking or prior broken bones, say the two new overtesting lists.

—Most people with low back pain for less than six weeks shouldn't get X-rays or other scans, Weinberger's group stresses.

—Even those all-important cholesterol tests seldom are needed every year, unless yours is high, according to the college of physicians. Otherwise, guidelines generally advise every five years.

—Pap smears for a routine cervical cancer check are only needed once every three years by most women. So why must they return to the doctor every year to get a pelvic exam (minus the Pap)? For no good reason, the Centers for Disease Control and Prevention reported last month. Pelvic exams aren't a good screening tool for ovarian cancer, and shouldn't be required to get birth control pills, the report says.

Yes, simple tests can harm. Cleveland Clinic cardiology chief Dr. Steven Nissen cites a 52-year-old woman who wound up with a heart transplant after another doctor ordered an unneeded cardiac scan that triggered a false alarm and further testing that in turn punctured her aorta.

A close relationship with a primary care doctor who knows you well enough to personalize care maximizes your chances of getting only the tests you really need — without wondering if it's all just about saving money, says Dr. Glen Stream of the American Academy of Family Physicians.

"The issue is truly about what is best for patients," he says.

___

EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

___

Online:

Medicare preventive services list: http://1.usa.gov/aiOTnS

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Rabu, 09 November 2011

Hit reset on cancer screening: 'Tests not perfect'

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WASHINGTON (AP) — It turns out that catching cancer early isn't always as important as we thought.

Some tumors are too slow-growing to ever threaten your life. Some are so aggressive that finding them early doesn't make much difference. And today's treatments are much better for those somewhere in the middle.

Those complexities are changing the longtime mantra that cancer screening will save your life. In reality, it depends on the type of cancer, the test and who gets checked when.

"We can find cancer early. We can reduce the burden of the disease. But along the way, we're learning our tests are not as perfect as we'd like," says the American Cancer Society's Dr. Len Lichtenfeld, a longtime screening proponent. "We're learning that we're now finding cancer that would in fact never cause harm."

Now cancer specialists are struggling to find a new balance: to quit over-promising the power of early detection and to help people understand that the tests themselves have risks — while not scaring away those who really need it.

Least controversial are cervical and colorectal cancer screenings. They can spot pre-cancerous growths that are fairly easy to remove, although even some of those tests can be used too frequently. More serious questions surround other cancers — like which men, if any, should get a PSA blood test to check for prostate cancer, and whether women should start mammograms in their 40s or wait until they're 50.

Also in question is whether doctors will be able to head off another looming controversy: Just which smokers and ex-smokers should get a pricey CT scan that can detect lung cancer but also is prone to false alarms? A recent study found the scans could save some lives. But guidelines aren't due out until early next year that would decide who is at enough risk to outweigh the test's potential harm — such as a risky, invasive biopsy to tell if a suspicious spot is cancer or just an old smoking scar.

Yet already people like 80-year-old Fred Voss of Sunderland, Md., are seeking out the tests.

"It was a big relief, and it gave me something to watch," says Voss, who participated in the CT study but wanted to get tested again to make sure nothing had changed.

Today, guidelines for how to handle some of the most common cancer screenings conflict. And, they're written for the average patient when many people may need a more customized decision, says Dr. Jeanne Mandelblatt of Georgetown University. She has studied breast cancer risk for a government panel that recommends most women not begin screening for the disease until age 50.

Consider this, she says: The average woman has a 3 percent lifetime risk of dying of breast cancer, a low risk for a disease that women find so scary. But the chances of getting breast cancer do gradually increase with age and other circumstances.

So if you're 40 and have several risk factors — like dense breasts and close relatives with the disease — then you have the same risk as an average 50-year-old, not an average 40-year-old, and might consider earlier mammograms, Mandelblatt says. Few primary-care doctors have the time to go into that kind of detail.

Adding to the confusion are testimonials from cancer survivors that a screening saved their lives. Dartmouth researchers recently studied how often that's true for mammograms, and estimated that about 13 percent of women in their 50s whose breast cancer is detected by the tests survive as a result.

What else plays a role? Treatments have dramatically improved in recent years, saving more lives. Also, increasingly powerful mammograms are detecting more low-risk tumors, the kind that probably wouldn't have threatened a woman's life in the first place.

Still, mammograms are "not perfect, but they're the best we have," cautions Mandelblatt. She thinks the Dartmouth estimate is somewhat low.

PSA tests for prostate cancer are a much tougher call. Last month, a government panel recommended an end to routine PSA screenings, a step further than other major medical groups that urge men to weigh the pros and cons and decide for themselves. But the U.S. Preventive Services Task Force found limited, if any, evidence that screening average men improves survival. That's largely because so many men are diagnosed with slow-growing tumors that never would have killed them; still, they have treatments that can cause incontinence, impotence or even lead to death.

"We really — underline the word 'really' — have to pull back the messaging on prostate cancer," says the cancer society's Lichtenfeld, who himself isn't sure of the test's net worth. PSA testing took off on the basis of "blind faith" that they would work, not science, he says.

What really worries Lichtenfeld is that ever more powerful cancer screenings are being developed, before doctors have a way to tell exactly which early tumors should be removed.

"We have cells in our body that are abnormal all the time, and our bodies deal with it," he says. "Our technology takes us further and further down the early-detection path, and we need to sort through all this."

___

EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press.

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Sabtu, 29 Oktober 2011

When breast cancer tests get it wrong

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Kathleen Maxian says her cancer could have been prevented, and now she's angry. Kathleen Maxian says her cancer could have been prevented, and now she's angry. Myriad Genetics owns the patent on breast cancer genesMyriad offers one test that catches most abnormalities, then charges $700 for secondCompany defends BART test, based on separate technology

(CNN) -- Imagine going in for a cancer screening, and the technician turns to you and says, "We're finished, but if I push this button over here, the machine can detect even smaller cancers. But here's the hitch: You have to pay $700 if you want me to push this button."

"You'd be enraged," says Ellen Matloff, director of cancer genetic counseling at Yale University Cancer Center. "You'd want to know why you have to pay extra to push that button. Why didn't they just do it right the first time?"

Doctors and genetic counselors interviewed by CNN say that Myriad Genetics in Utah is doing something very similar with tests that determine if a woman has a potentially dangerous genetic abnormality linked to breast cancers.

Most breast cancers do not seem to be genetic. Instead, they're the result of cells gone wild for no apparent reason. However, some women get breast cancer because a bad gene runs in their families. When testing shows that a woman carries such a gene, she has a much higher chance of getting breast cancer. These women usually then get more frequent MRIs, ultrasounds and mammograms to detect a cancer, and sometimes even choose to remove their breasts to prevent a cancer from growing in the first place.

Myriad owns the patent on breast cancer genes and so is the only company that can test for them. It offers one test that catches most, but not all, abnormalities, and then charges nearly all patients $700 for a second test that catches the rest.

If a woman can't afford the $700 fee, she may miss an abnormality, which could mean the difference between life and death.

"What Myriad's doing -- charging extra for this test -- is really sleazy," Matloff says. "They're collecting blood money off my patients."

Myriad defends the $700 charge for its second test, called BART, even though many patients can't afford it and insurance won't pay for it.

"The BART test is based on different and separate technology," Rebecca Chambers, a Myriad spokeswoman, wrote in an e-mail to CNN. "[It's] based on a sophisticated new technology developed exclusively by Myriad."

She added that Myriad is trying to persuade insurance companies to pay for the test and that it offers financial assistance to patients who meet certain criteria, and monthly interest-free payments to those why do owe the $700 fee.

"Myriad's mission is to improve the patient's quality of life and to save lives," she added in the e-mail.

Understanding the furor

To understand the anger and bitterness that patients, doctors and genetic counselors harbor toward Myriad, it's important to know the basics of genetic testing.

In 1996, Myriad offered its first test for breast cancer genetic abnormalities. Known as the BRCA test, it's been revolutionary and has saved countless lives: If the test reveals that a woman has a genetic abnormality, it means she has a very high chance of getting breast cancer in the future, and some women then opt to remove their breasts as a pre-emptive strike against cancer.

Women who test positive for BRCA also sometimes opt to have their ovaries removed, since having a breast cancer gene abnormality gives them a higher-than-normal chance of getting ovarian cancer as well.

"Genetic testing has been a godsend for so many women," Matloff says.

Myriad calls its test the Comprehensive BRACAnalysis, but it soon became clear that it wasn't truly comprehensive. It did not catch all genetic abnormalities linked to cancer, and so in 2006, the company began selling BART, the newer test that catches genetic defects that the original test misses. Doctors and counselors expected Myriad to offer BART as part of its original test, but instead the company offers it separately and charges nearly everyone $700 to take it.

"This is so irresponsible of Myriad," says Molly Klein, director of genetic counseling at Piedmont Hospital in Atlanta.

She and other genetic counselors have been fighting to get Myriad to stop the $700 charge. They say they worry that women who tested negative under the first test feel assured that they don't have a bad gene when in fact they might, and wouldn't know they're at increased risk for getting breast cancer.

Klein and other genetic counselors say that when Myriad came up with an improvement in its colon cancer test, it wrapped it into its original screening at one price. The counselors say they think Myriad handled the breast cancer test differently, charging a separate fee, because it has no competition.

"From a business perspective, I guess I understand why Myriad is doing what they're doing, because this is a good chunk of money for them," says Kristen Shannon, the senior genetic counselor at the Massachusetts General Hospital Cancer Center. "But I feel really strongly that Myriad is doing the wrong thing."

"That accusation is incorrect," Chambers wrote in an e-mail to CNN.

"I'm so angry"

For Eileen Kelly and Kathleen Maxian, money wasn't the issue.

The two sisters were stunned three years ago when Kelly was diagnosed with breast cancer at age 40. They breathed a sigh of relief when Kelly tested negative for the BRCA gene using Myriad's original test. This meant Kelly's cancer was a fluke, and not something her sister or other relatives needed to worry about.

Then two years later, at the age of 47, Maxian found out she had ovarian cancer. Surgeons removed her ovaries and found the cancer had spread to her abdomen. After chemotherapy, the cancer came back a year later.

"I told my surgeon my sister had genetic testing, but it came back negative," Maxian says. "My surgeon just hung her head down and shook it back and forth. I was like, 'What? How weird is that?' "

The surgeon told Maxian that her sister's test might have been incomplete. She instructed Maxian to ask her sister, who lives in Atlanta, to find out if she'd received the second test, BART, in addition to the original breast cancer genetic test.

Kelly found out she had not had not received BART. She went back to Piedmont Hospital to have it done, and the test was positive. Maxian and her father then had BART, and it turns out that they, too, carry a genetic abnormality.

Women who have genetic abnormalities like Maxian's have a 50% to 85% chance of getting breast cancer, and a 10% to 40% chance of getting ovarian cancer. She says that if her sister had had BART from the beginning, she also would have taken the test, and the positive result would have made her remove her breasts and ovaries "in a minute."

"If BART had been done from the beginning, it could have saved Kathleen from getting ovarian cancer," says Dr. Nefertiti duPont, Maxian's surgeon at the Roswell Park Cancer Institute in Buffalo, New York.

"It could have prevented my cancer, or at least caught it early," Maxian adds. "Now my cancer is so advanced, I have only a 20% chance of being alive five years from now. I'm so angry."

Klein, the genetic counselor at Piedmont Hospital, says she never mentioned BART to Kelly, nor to most of the women who came in for testing at that time. She says information from Myriad led her to believe that BART mutations were extremely rare among women like Kelly without an extremely strong family history of breast or ovarian cancer. When some women do have a very strong family history, Myriad will do a BART analysis for free as part of its original test, and has spent $20 million on these tests.

"We were left with the impression that BART wasn't necessary for families like Eileen's," Klein says. "It just didn't seem urgent."

But over time, it's become clear that Myriad might have been wrong about who needs BART testing, counselors say. Several studies, such as one done by Shannon at the Massachusetts General Hospital Cancer Center, show that a substantial number of women had BART mutations even without a very strong family history. Now, Klein and others offer BART to all their patients, but many can't do it because of the cost.

"This is all really frustrating," Klein says. "We know we're missing women out there with BART mutations because they can't afford to pay. If you miss just one BART mutation, that woman could be in danger, and so could her mother, her sisters and her other relatives."

"It's heartbreaking," says Mollie Hutton, Maxian's genetic counselor at the Roswell Park Cancer Institute. "It's so sad that now Kathleen is fighting for her life when something could have been done to avoid it. It's just crappy."

Chambers, the Myriad spokeswoman, says studies show "less than one percent of all women tested" have a BART mutation.

What to do when you get breast cancer genetic testing

If you're about to get breast cancer genetic testing, specifically ask if you'll receive BART testing.

If you've had breast cancer genetic testing, don't assume you received the BART test.

Also, don't assume that the place where you had the testing will get back in touch with you to let you know about BART. CNN contacted four genetic testing centers, each of which did something different: One center quickly contacted all patients to tell them about BART; another contacted only patients they considered high risk; the third contacted patients three years after BART became available; and the fourth still hasn't contacted patients to tell them about BART.

Genetic counselors recommend that you call the place where you had testing every year or so to see if there have been any improvements in the test.

Most women will have to decide whether they want to spend $700 to get BART testing.

Eileen Kelly wishes she'd had the opportunity to spend that money.

"I'm so mad at Myriad. It's even hard just to talk about it," Kelly says, starting to cry. "A test could have put the information in our hands that could have prevented my sister's cancer. It's frustrating and really hard to comprehend."

Aaron Cooper contributed to this report.



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Selasa, 25 Oktober 2011

Divide over when to use in-depth cholesterol tests

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Denny Fongheiser and his girlfriend Kim Adamis power-walk in Palisades Park in Santa Monica, Calif., Sunday, Oct. 23, 2011. More doctors are going beyond standard cholesterol counts, using another test to take a closer look at the bad fats, a count of particles that carry LDL through the blood. Fongheiser's usual 3-mile-a-day walk left him suddenly panting but his insurer wouldn't pay for a stress test because his cholesterol was normal. A month later, chest pain sent Fongheiser to the hospital where he needed a stent to unclog an artery. It turned out he had high particle levels, which his cardiologist now aims to get below the LipoScience-recommended level of 1,000 with cholesterol-lowering drugs. (AP Photo/Reed Saxon) Denny Fongheiser and his girlfriend Kim Adamis power-walk in Palisades Park in Santa Monica, Calif., Sunday, Oct. 23, 2011. More doctors are going beyond standard cholesterol counts, using another test to take a closer look at the bad fats, a count of particles that carry LDL through the blood. Fongheiser's usual 3-mile-a-day walk left him suddenly panting but his insurer wouldn't pay for a stress test because his cholesterol was normal. A month later, chest pain sent Fongheiser to the hospital where he needed a stent to unclog an artery. It turned out he had high particle levels, which his cardiologist now aims to get below the LipoScience-recommended level of 1,000 with cholesterol-lowering drugs. (AP Photo/Reed Saxon) Denny Fongheiser poses in Palisades Park in Santa Monica, Calif., Sunday, Oct. 23, 2011. More doctors are going beyond standard cholesterol counts, using another test to take a closer look at the bad fats, a count of particles that carry LDL through the blood. Fongheiser's usual 3-mile-a-day walk left him suddenly panting but his insurer wouldn't pay for a stress test because his cholesterol was normal. A month later, chest pain sent Fongheiser to the hospital where he needed a stent to unclog an artery. It turned out he had high particle levels, which his cardiologist now aims to get below the LipoScience-recommended level of 1,000 with cholesterol-lowering drugs. (AP Photo/Reed Saxon)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); WASHINGTON (AP) — For heart health, you're supposed to know your numbers: Total cholesterol, the bad LDL kind and the good HDL kind. But your next checkup might add a new number to the mix.

More doctors are going beyond standard cholesterol counts, using another test to take a closer look at the bad fats — a count of particles that carry LDL through the blood.

Cardiologists are divided over the usefulness of that approach. Proponents contend it might help them spot at-risk patients that regular checks might miss, or get more information about how aggressively to treat them.

But so far, guidelines from major heart organizations don't recommend these extra tests. They're pricier than regular cholesterol exams, although Medicare and many other insurers pay for them. And it's not always clear what the results mean.

"I see a lot of people being confused," says Dr. Nieca Goldberg of New York University Langone Medical Center and the American Heart Association. Especially when they're used on lower-risk people, "you don't know how to make sense of the information."

Yet up to half of patients diagnosed with heart disease apparently had normal levels of LDL cholesterol, and some doctors say particle testing might help find some of them sooner.

"For most people, the standard lipid profile is fine," says Dr. Michael Davidson of the University of Chicago. But "I get referred people who said, 'My cholesterol was fine, why do I have heart disease?' We're showing them, well, because your particle number's sky high and they were not aware that was a problem."

Davidson chaired a committee of the National Lipid Association which this month called the extra tests reasonable to assess which at-risk patients might need to start or intensify cholesterol treatment. That committee's meeting was paid for by a grant from eight pharmaceutical companies, including some makers of particle tests.

Cholesterol isn't the only factor behind heart disease. High blood pressure, smoking, obesity, diabetes or a strong family history of the disease can put someone in the high-risk category even if their cholesterol isn't a red flag. Some doctors also are testing for inflammation in arteries that may play a role, too.

On the cholesterol front, doctors have long focused on three key numbers:

—Total cholesterol should be below 200.

—An LDL or "bad" cholesterol level below 130 is good for healthy people, but someone with heart disease or diabetes should aim for under 100.

—For HDL, the "good" cholesterol that helps control the bad kind, higher numbers are better — 60 is protective while below 40 is a risk.

Where do particles come in? Scientists have long known that small, dense LDL particles sneak into the artery wall to build up and narrow blood vessels more easily than larger, fluffier particles. While overall LDL levels usually correlate with the amount of particles in blood, they don't always, just as a beach bucket of sand may weigh the same as a bucket of pebbles but contain more particles.

Only in recent years have commercial tests made particle checks more feasible — although there's no standard method, and different tests measure in different ways. The tests add another $100 to $150 to regular cholesterol checks.

But is knowing about your particles really useful, and if so when? That's where doctors are split.

A study published last spring used one particle test, from Raleigh, N.C.-based LipoScience, to analyze a database of more than 5,000 middle-aged people whose heart health was tracked for five years. Most people's overall LDL and particle counts correlated pretty well. But people had a higher risk of heart disease when their particle count was much higher than their LDL predicted — and, conversely, a lower risk if their particle count was lower than expected, says lead researcher Dr. David Goff Jr. of Wake Forest University.

"We could be treating some people who don't need to be treated ... and we may be missing some people who should be treated," Goff says. "But I'd also say that we haven't done all the research that needs to be done to prove that this will lead to better patient outcomes."

Many of those higher-risk patients could be caught by a closer look at standard tests "for no additional charge," says Dr. Roger Blumenthal of Johns Hopkins University and the American College of Cardiology.

Triglycerides, another harmful fat, are a good indicator, Blumenthal says. You're at risk despite a low LDL if your triglycerides are over 130, not to mention a low HDL, he said. People who are obese, diabetic of borderline diabetic also are at greater risk, because they often have higher LDL particle counts.

Another way to measure without an added test: Just subtract HDL from your total cholesterol number. The resulting bad-fat total should be no higher than 30 points above your recommended LDL level — and if they are, it's time for serious diet and exercise, adds Dr. Allen Taylor of Washington Hospital Center.

Still, even some doctors who don't think particle testing is for the masses say they use it sometimes to tip the scales on a borderline patient.

Others use it to guide therapy. Consider Denny Fongheiser of Santa Monica, Calif. At 52, his usual 3-mile-a-day walk suddenly left him panting, but his insurer wouldn't pay for a stress test because his cholesterol was normal.

A month later, chest pain sent Fongheiser to the hospital where he needed a stent to unclog an artery. It turned out he had high particle levels, which his cardiologist now aims to get below the LipoScience-recommended level of 1,000 with cholesterol-lowering drugs.

"I was basically a time bomb," Fongheiser says. He welcomes "being able to test this and know what's going on."

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Minggu, 23 Oktober 2011

Annual cancer screening tests urged less and less

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Annual cancer tests are becoming a thing of the past. New guidelines out Wednesday for cervical cancer screening have experts at odds over some things, but they are united in the view that the common practice of getting a Pap test every year is too often and probably doing more harm than good.

A Pap smear once every three years is the best way to detect cervical cancer, the U.S. Preventive Services Task Force says. Last week, it recommended against prostate cancer screening with PSA tests, which many men get every year.

Two years ago, it said mammograms to check for breast cancer are only needed every other year starting at age 50, although the American Cancer Society still advises annual tests starting at age 40. Earlier this week, a large study found more false alarms for women getting mammograms every year instead of every other year.

"The more tests that you do, the more likely you are to be faced with a false-positive test" that leads to unnecessary biopsies and possible harm, said Dr. Michael LeFevre, one of the task force leaders and a professor of family and community medicine at the University of Missouri. "We see an emerging consensus that annual Pap tests are not required for us to see the benefits that we have seen" from screening, he said.

Those benefits are substantial. Cervical cancer has declined dramatically in the United States, from nearly 15 cases for every 100,000 women in 1975 to nearly 7 per 100,000 in 2008. About 12,200 new cases and 4,210 deaths from the disease occurred last year, most of them in women who have never been screened or not in the past five years.

New proposed guidelines from the cancer society and other groups say using Pap smears together with tests for HPV, the virus that causes cervical cancer, every three to five years is the preferred way to screen women ages 30 to 65. But the government task force concluded the evidence is insufficient "to assess the balance of benefits and harms" of that.

Instead, more lives probably could be saved by reaching women who are not being adequately screened now, the task force says.

And despite what many people suspect, cost has nothing to do with the task force's stance, its leaders said.

"We don't look at cost at all. We really are most concerned about harms," said Dr. Evelyn Whitlock of Kaiser Permanente Northwest's Center for Health Research in Portland, Ore., who led an evidence review for the task force.

Here are some questions and answers about the cervical cancer guidelines.

Q. At what ages should screening start and end?

A. The task force recommends against screening women under 21 or older than 65. Very few cervical cancer cases occur in women under 21, so the old advice to start screening three years after the age of first intercourse has been changed. HPV tests are only approved for women after age 30 because transient infections that don't pose a cancer risk are more common at younger ages.

"We should not be screening teenagers. It's not helping, it's not finding any more cancers and it's creating way too many harms for them," said Debbie Saslow, the cancer society's director of breast and gynecologic cancer.

Q. Should anyone else not be screened?

A. Women who have had their cervix and uterus removed should not be tested, but check with your doctor — not all hysterectomies are complete; some leave the cervix.

Q. What does screening cost?

A. Paps cost $15 to $60; HPV tests run $50 to $100.

Q. Will insurance pay for HPV tests since the government panel doesn't endorse them?

A. Probably. They are included in preventive services that other federal advisers say should be covered under the Affordable Care Act, and the government has continued to pay for mammograms for women who want them even if it is sooner or more often than the task force recommends.

Q. What if I've had the HPV vaccine?

A. Doctors don't know how the vaccine will affect HPV test results or how long the vaccine lasts, so women should still be screened for cervical cancer if they are within the recommended screening ages.

Q. How can I comment on the guidelines?

A. The web sites below tell how. Comments are accepted for a month before guidance is adopted.

___

Online:

Task force advice: http://www.uspreventiveservicestaskforce.org/

Cancer society advice: www.asccp.org/practice-management/molecular-screening-symposium

and http://tinyurl.com/44gnadx

and http://tinyurl.com/257mnge

Cervical cancer science review: http://tinyurl.com/6lc2rzg

CDC on HPV tests: http://www.cdc.gov/hpv/Screening.html

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Associated Press

Technology



News

Jumat, 21 Oktober 2011

Annual cancer screening tests urged less and less

AppId is over the quota
AppId is over the quota
Annual cancer tests are becoming a thing of the past. New guidelines out Wednesday for cervical cancer screening have experts at odds over some things, but they are united in the view that the common practice of getting a Pap test every year is too often and probably doing more harm than good.

A Pap smear once every three years is the best way to detect cervical cancer, the U.S. Preventive Services Task Force says. Last week, it recommended against prostate cancer screening with PSA tests, which many men get every year.

Two years ago, it said mammograms to check for breast cancer are only needed every other year starting at age 50, although the American Cancer Society still advises annual tests starting at age 40. Earlier this week, a large study found more false alarms for women getting mammograms every year instead of every other year.

"The more tests that you do, the more likely you are to be faced with a false-positive test" that leads to unnecessary biopsies and possible harm, said Dr. Michael LeFevre, one of the task force leaders and a professor of family and community medicine at the University of Missouri. "We see an emerging consensus that annual Pap tests are not required for us to see the benefits that we have seen" from screening, he said.

Those benefits are substantial. Cervical cancer has declined dramatically in the United States, from nearly 15 cases for every 100,000 women in 1975 to nearly 7 per 100,000 in 2008. About 12,200 new cases and 4,210 deaths from the disease occurred last year, most of them in women who have never been screened or not in the past five years.

New proposed guidelines from the cancer society and other groups say using Pap smears together with tests for HPV, the virus that causes cervical cancer, every three to five years is the preferred way to screen women ages 30 to 65. But the government task force concluded the evidence is insufficient "to assess the balance of benefits and harms" of that.

Instead, more lives probably could be saved by reaching women who are not being adequately screened now, the task force says.

And despite what many people suspect, cost has nothing to do with the task force's stance, its leaders said.

"We don't look at cost at all. We really are most concerned about harms," said Dr. Evelyn Whitlock of Kaiser Permanente Northwest's Center for Health Research in Portland, Ore., who led an evidence review for the task force.

Here are some questions and answers about the cervical cancer guidelines.

Q. At what ages should screening start and end?

A. The task force recommends against screening women under 21 or older than 65. Very few cervical cancer cases occur in women under 21, so the old advice to start screening three years after the age of first intercourse has been changed. HPV tests are only approved for women after age 30 because transient infections that don't pose a cancer risk are more common at younger ages.

"We should not be screening teenagers. It's not helping, it's not finding any more cancers and it's creating way too many harms for them," said Debbie Saslow, the cancer society's director of breast and gynecologic cancer.

Q. Should anyone else not be screened?

A. Women who have had their cervix and uterus removed should not be tested, but check with your doctor — not all hysterectomies are complete; some leave the cervix.

Q. What does screening cost?

A. Paps cost $15 to $60; HPV tests run $50 to $100.

Q. Will insurance pay for HPV tests since the government panel doesn't endorse them?

A. Probably. They are included in preventive services that other federal advisers say should be covered under the Affordable Care Act, and the government has continued to pay for mammograms for women who want them even if it is sooner or more often than the task force recommends.

Q. What if I've had the HPV vaccine?

A. Doctors don't know how the vaccine will affect HPV test results or how long the vaccine lasts, so women should still be screened for cervical cancer if they are within the recommended screening ages.

Q. How can I comment on the guidelines?

A. The web sites below tell how. Comments are accepted for a month before guidance is adopted.

___

Online:

Task force advice: http://www.uspreventiveservicestaskforce.org/

Cancer society advice: www.asccp.org/practice-management/molecular-screening-symposium

and http://tinyurl.com/44gnadx

and http://tinyurl.com/257mnge

Cervical cancer science review: http://tinyurl.com/6lc2rzg

CDC on HPV tests: http://www.cdc.gov/hpv/Screening.html

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Associated Press

Technology



News

Jumat, 14 Oktober 2011

New tests for cosmetic surgery

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AppId is over the quota
Adina Campbell By Adina Campbell
Newsbeat reporter Sian Welsh says she was too young when she had breast implants at 18

New assessments are being introduced at some private clinics to try to stop people having cosmetic surgery they may later regret.

The test has been developed by psychologists who say patients are being put at risk by firms who don't carry out enough checks.

They are also being backed by the UK's biggest plastic surgery group.

Some clinics in The British Association of Aesthetic Plastic Surgeons (Baaps) have already started using the form.

Nigel Mercer, a consultant plastic surgeon and member of Baaps, says the questionnaires are easy to use and have a scoring system to help identify those who aren't suitable for cosmetic surgery or treatments.

"It's important we are aware of those patients who are vulnerable and that they are appropriately counselled. They need to be fully aware of what they're letting themselves in for if they go for surgery."

"These assessments should act as an aid for surgeons who have a responsibility to ask the right questions. Too many private clinics are more concerned about their bank balance and not their patients."

The test asks questions like how long a person spends looking in the mirror and how much the feature they want to change bothers them.

Nichola Rumsey, a psychologist in Bristol, helped develop the assessment.

"We've worked on this for a number of years. We thought there was a need to provide surgeons with a screening instrument to find out who looks like they will do well from cosmetic surgery and those that may go on to suffer psychological problems."

'Flat chest'

Twenty-two-year-old Sian Welsh from Oldham had breast implants when she was 18. Looking back she says the surgeon didn't give her enough time to think about whether she needed surgery.

"Before my boob job I was a double A cup and it always bothered me having a flat chest. I was really excited about having implants when I turned 18 because I thought it would give me more confidence."

"But looking back, I was definitely too young and probably needed counselling to make me feel better about myself."

Part of the surgery survey The patient must complete 11 questions on body image

"I don't regret the surgery but I should have waited. My surgeon didn't get to know me and never found out where I was psychologically."

The questionnaire takes up two sides of A4 and patients will need to answer the 10 questions before their first consultation with a surgeon.

There is a separate guide for surgeons which helps flag up those who aren't suitable for surgery and may need counselling instead.

It's claimed some patients who are desperate for surgery will able to cheat the test and give false answers.

Newsbeat gave Sian a copy of the questionnaire and she had mixed views.

"I think these assessments are a good idea and if it was around when I had surgery, the outcome may have been different for me.

"However, looking at these questions they're not very detailed and I think some people will put scores down that will guarantee they have surgery."

Nigel Mercer says the questionnaire is only supposed to be an aid for surgeons.

"Good surgeons will be able to tell when someone is lying and we are trained to pick out those who have deeper underlying issues."



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Career Advisor

Selasa, 27 September 2011

Japan finds radiation in rice, more tests planned

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AppId is over the quota
TOKYO (AP) — Japan is ordering more tests on rice growing near a crippled nuclear plant after finding elevated levels of radiation, government officials said Saturday.

A sample of unharvested rice contained 500 becquerels of cesium per kilogram, they said. Radioactive cesium was spewed from the Fukushima Dai-ichi nuclear power plant after it was damaged by a massive earthquake and tsunami on March 11.

Under Japanese regulations, rice with up to 500 becquerels of cesium per kilogram is considered safe for consumption.

Officials have tested rice from more than 400 spots in Fukushima prefecture. The highest level of cesium previously found was 136 becquerels per kilogram, prefectural official Kazuhiko Kanno said.

News of the elevated radiation level in rice from Nihonmatsu city, 55 kilometers (35 miles) west of the nuclear plant, set off alarm in the Japanese media.

The government has been testing vegetables and fish for radiation since the disaster, in which backup generators and cooling systems failed at the plant and the cores of three reactors melted.

Some nations have stopped importing some food products from Japan. Japanese consumers are nervous about radiation, but campaigns to buy from Fukushima have drawn support around the nation.

Associated Press

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Peliculas Online

Minggu, 25 September 2011

Japan finds radiation in rice, more tests planned

AppId is over the quota
AppId is over the quota
TOKYO (AP) — Japan is ordering more tests on rice growing near a crippled nuclear plant after finding elevated levels of radiation, government officials said Saturday.

A sample of unharvested rice contained 500 becquerels of cesium per kilogram, they said. Radioactive cesium was spewed from the Fukushima Dai-ichi nuclear power plant after it was damaged by a massive earthquake and tsunami on March 11.

Under Japanese regulations, rice with up to 500 becquerels of cesium per kilogram is considered safe for consumption.

Officials have tested rice from more than 400 spots in Fukushima prefecture. The highest level of cesium previously found was 136 becquerels per kilogram, prefectural official Kazuhiko Kanno said.

News of the elevated radiation level in rice from Nihonmatsu city, 55 kilometers (35 miles) west of the nuclear plant, set off alarm in the Japanese media.

The government has been testing vegetables and fish for radiation since the disaster, in which backup generators and cooling systems failed at the plant and the cores of three reactors melted.

Some nations have stopped importing some food products from Japan. Japanese consumers are nervous about radiation, but campaigns to buy from Fukushima have drawn support around the nation.

Associated Press

View the original article here



Peliculas Online

Group brain tests of athletes not as accurate

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AppId is over the quota
By Genevra Pittman

NEW YORK | Fri Sep 23, 2011 5:15pm EDT

NEW YORK (Reuters Health) - Testing young athletes' thinking and memory skills in group settings, as is typically done before every season, may be less accurate than doing the tests individually, a new study finds.

Such tests are important because when athletes get head injuries, doctors often compare post-injury scores with preseason ones to see when they are recovered and ready to return to play.

Letting them back on the field too soon puts them at risk for "second impact syndrome," a rare but dangerous condition that happens when a second head injury occurs before the first one has healed.

High schools that use the tests generally give them to athletes in groups at the start of the season, partly because that's a lot cheaper and quicker than administering them to each athlete individually.

In the new study, Summer Ott of the Methodist Hospital Concussion Center in Houston and her colleagues compared scores from high schoolers who took one type of computer-based test individually with students who took it in a school computer lab with up to 19 teammates.

That test measures athletes' attention and memory skills, as well as processing speed and reaction time. On all of those scales, the 164 teens who took the test in groups scored lower than the 167 who did it without any distracting peers.

The findings add to other studies challenging the brain tests' accuracy. According to Paul Comper, a concussion expert at the University of Toronto, they show that doctors and trainers need to use their own judgment -- and not just a number -- to decide when injured athletes are back to normal.

"It's not as simple as a young athlete taking a 25-minute test and then they get a concussion and then somebody can look at a score and they get a red light or a green light," Comper, who was not involved in the new research, told Reuters Health.

That doesn't mean the tests aren't useful, Comper and Ott agreed. But the more accurate an initial, pre-injury score is, the more a later score can tell doctors about an injured brain.

How focused athletes are while taking the test, as well as their mood and stress levels, affects scores of how well the brain is working, Comper said.

He pointed out that when the tests are done after an injury, it's never in a group setting. If athletes were distracted while taking their initial tests, doctors might not notice when post-concussion scores are lower than they should be.

Still, group testing shouldn't be done away with, Ott warned, because any pre-injury scores are better than none -- and individual testing isn't always feasible.

She and her colleagues suggest in The American Journal of Sports Medicine that schools should try to make group testing rooms as quiet and distraction-free as possible, space athletes apart at computers and make sure they're not tired when they're taking the tests. That means no testing after two-a-day practices, she said.

Comper said it's important that doctors consider any lingering symptoms and use their clinical judgment when interpreting post-injury tests and deciding whether athletes are ready to play again, regardless of how baseline testing was done.

Still, he said, "These tests are valuable, there's no doubt about it. We shouldn't lose that message."

SOURCE: bit.ly/nLihTu The American Journal of Sports Medicine, online August 9, 2011.



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Peliculas Online

Minggu, 18 September 2011

U.S. to develop chip that tests if a drug is toxic

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AppId is over the quota

WASHINGTON | Fri Sep 16, 2011 3:34pm EDT

WASHINGTON (Reuters) - U.S. government researchers plan to design a chip that can check whether new drugs are toxic before they are tested in people, potentially speeding up the development of new therapies.

The chip would lump together human cells from the liver, heart, muscles and other organs, then diffuse a drug through them. Multiple readouts would then show how different proteins, genes and other compounds in the cells react to the medicine.

"If things are going to fail, you want them to fail early," Dr. Francis Collins, the director of the National Institutes of Health (NIH), told Reuters on Friday. "Now you'll be able to find out much quicker if something isn't going to work."

Collins said a drug's toxicity is one of the most common reasons why promising compounds fail. But animal tests -- the usual method of checking a drug before trying it on humans -- can be misleading.

He said about half of drugs that work in animals may turn out to be toxic for people. And some drugs may in fact work in people even if they fail in animals, meaning potentially important medicines could be rejected.

The project aims to bring together new knowledge from engineering, biology and toxicology.

The cells in the chip will be grouped next to each other so they can interact, much as they would in a human body. The chip will be tested with drugs that are known to be safe, and those that are toxic, to look at how the readouts compare.

The Defense Advanced Research Projects Agency (DARPA) and the NIH will each spend up to $70 million over five years on their own separate programs to develop the chip.

They will also work with the Food and Drug Administration, the U.S. drugs regulator, which could potentially use the chip to test drugs during the approval process.

It takes an average of 15 years and more than $1 billion to get approval to sell a drug in the United States, according to the drug industry group PhRMA.

"We know the development pipeline has bottlenecks in it, and everyone would benefit from fixing them," Collins said.

(Reporting by Anna Yukhananov; editing by Tim Dobbyn)



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Peliculas Online

Minggu, 11 September 2011

HEALTH MANAGEMENT. ' TF beacons to illuminate way to the new Oncology tests and drugs

Scientists report development a long control desired new way that the activity of genes in the way are action to detect, which bind to the DNA in genes, proteins, cells, which normally cause everything from growing cancer often. Your report is in the journal of the American Chemical Society.
Kevin Plaxco, Francesco Ricci and colleagues found that more than 10 percent of the 25,000-30,000 instructions contain genes in the human body for this so called DNA-binding proteins. Most of these proteins are known as master regulators transcription factors (TFs). You start or stop the first step in this process, in which genes statements into action are implemented. TFs bind to DNA and genes, enable or disable. Understanding and measuring the activity of TFs is important, because they are involved with many in connection with cancer, health and disease, for example. With existing possibilities the activity of TFs is slow and cumbersome to recognize scientists, stated that barrier to overcome.
The scientists describe, development and successful testing fluorescent sensors, that they term "transcription factor lighthouses." The lamps signal the activity and the concentration of TFs directly in biological samples by moving from a dark State to a fluorescent State on binding on their specific TF. With TF beacons works easier and faster than current methods, and scientists say TF beacons of various applications in cancer, the search for new cancer drugs and other areas can have.