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May 18 (HealthDay News) — The first national survey in a generation to look at Americans’ feelings on cancer prevention finds widespread confusion about the disease.

“We found that almost half of the American public believes that ‘it seems that almost everything causes cancer,’ about one in four feel there’s not much one can do to lower the chances of getting cancer, and three out of four felt there were so many recommendations, it’s hard to know which ones to follow,” said study author Jeff Niederdeppe, a Robert Wood Johnson Foundation Health & Society Scholar at the University of Wisconsin, Madison.

“We took this as evidence that there is widespread confusion and helplessness in the American adult population in terms of cancer prevention — even though we know quite a bit about prevention,” he said.

And that sense of helplessness can leave people unable to take steps to reduce their cancer risk, experts say.

The findings are published in the May 17 issue of Cancer Epidemiology, Biomarkers and Prevention.

About half of all men and one-third of all women will develop some type of cancer during their lifetime, experts say.

It’s also estimated that almost one-third of U.S. cancer deaths are attributable to smoking, while 14 percent to 20 percent are attributable to being overweight or obese.

Research shows that you can reduce your risk for the disease: by quitting smoking, eating more fruits and vegetables and maintaining a normal weight.

The last survey to examine beliefs around cancer prevention was conducted in 1986. It found about half of the U.S. population believing that “everything causes cancer” and that “there’s not much a person can do to prevent cancer.”

The current survey involved more than 6,000 adults interviewed by phone in 2003.

Nearly half of the respondents (47.1 percent) agreed that “It seems like almost everything causes cancer;” 27 percent agreed that “There’s not much people can do to lower their chances of getting cancer;” and 71.5 percent agreed that “There are so many recommendations about preventing cancer, it’s hard to know which ones to follow.”

The beliefs were stronger in people who were less educated; they were weaker among both blacks and Hispanics compared to whites.

People who held at least one of these fatalistic beliefs were less likely to exercise weekly and to eat five or more servings of fruits and vegetables each day as recommended for cancer prevention.

Those who believed that “it’s hard to know” what to do were more likely to smoke, the survey found.

And people with a family history of cancer were more likely to believe that “everything causes cancer” than people without such histories.

The study did not specifically address where the confusion comes from, but Niederdeppe had some theories.

“Cancer, as a word, evokes lots of fear among the American public,” he said. Then you “combine this with cancer being a difficult thing to talk about, because it refers to 50 or more different diseases.” For example, “things we know reduce the risk of breast cancer may not reduce the risk of lung cancer,” Niederdeppe said.

There’s also a tension between science and the media — the former valuing the accumulation of solid evidence over time, and the latter trumpeting the results of perhaps only one particular study. “At times, what gets lost in translation is some of the nuance,” Niederdeppe said.

The real question is whether these beliefs can be changed.

“There is some evidence that they are [changing],” Niederdeppe said. “How could we change them? One source would be to encourage doctors and nurses to do a better job in educating patients about lifestyle habits. If a doctor just asks whether or not a patient smokes and advises them to quit, that has a tremendous impact on subsequent attempts to quit.”

“Patients can educate themselves by either talking with doctors, or the Internet can be very useful resource,” he added. “Very trustworthy sites include the National Cancer Institute and the American Cancer Society. They aren’t changing their recommendations based on every new study.”

But the Internet has its own biases. Another study, this one in the May 2007 issue of the Journal of Oncology Practice, found that people with lower education levels and lower household incomes were less likely to seek Internet-based information about their health. The amount of information a patient gathers on his or her own can affect communication with their health care provider, the researchers said.

SOURCES: Jeff Niederdeppe, Ph.D., Robert Wood Johnson Foundation Health & Society Scholar, University of Wisconsin, Madison; May 17, 2007, Cancer Epidemiology, Biomarkers and Prevention; May 17, 2007, Journal of Oncology Practice Publish Date: May 18, 2007

May 18 (HealthDay News) — Women at high risk for the pregnancy complication preeclampsia can lower their odds by 10 percent by taking daily aspirin, a new study suggests.

Preeclampsia is a potentially fatal obstetric complication that can lead to sudden high blood pressure and irregular blood flow. This can activate platelets and the clotting system, which in turn slows blood flow.

The use of aspirin may help counter this effect, according to a report in the May 16 online issue of The Lancet.

“Preeclampsia complicates between about 2 and 8 percent of all pregnancies, and is associated with approximately 10 to 15 percent of the half-million maternal deaths [worldwide] that occur each year,” said lead researcher Lisa Askie, a research fellow in the School of Public Health at the University of Sydney, Australia.

Although the benefits of antiplatelet therapy such as daily aspirin are modest, they are important if given to women at risk of preeclampsia, Askie said. “They could potentially result in many thousands less women who experience a bad pregnancy outcome. Hence, particularly for women at high risk of preeclampsia, a more widespread use of antiplatelet agents may be worthwhile,” she said.

In the study, Askie and colleagues in the Perinatal Antiplatelet Review of International Studies (PARIS) group looked at the results of 31 preeclampsia prevention trials that included almost 33,000 women and their babies. Women who took aspirin in these trials typically took between 50 milligrams to 150 milligrams of the drug per day.

The researchers found the risks of developing preeclampsia dropped 10 percent among women taking aspirin or other antiplatelet medications. In addition, these women also had a lower risk of delivering before 34 weeks and of having other pregnancy problems.

Moreover, aspirin had no significant effect on the risk of death of the fetus or baby. It didn’t boost the risk of bleeding for either mothers or their infants, nor did it raise risks for underweight newborns.

Askie’s team said no particular group of women was more or less likely to benefit from aspirin.

“Women at risk of preeclampsia should discuss the potential benefits and harms of this treatment with their doctor,” Askie advised.

But one expert was less than impressed with the findings.

“The results of this study were, to a large extent, disappointing,” said Dr. James Roberts, the director of the Magee-Womens Research Institute at the University of Pittsburgh, and author of an accompanying editorial.

Roberts had hoped the study would have shown a larger protective effect — especially in the women who are at the greatest risk for the problem. “It’s difficult to determine if it’s more beneficial in any subset of women or at what dose,” he said.

“In very high-risk women, the use of aspirin is justified,” Roberts said.

Women who are at the highest risk for preeclampsia are those who have high blood pressure and have also suffered preeclampsia in previous pregnancies. This group “are almost certain to develop it,” he said. Women at risk because of high blood pressure, pre-pregnancy diabetes or preeclampsia in one previous pregnancy have about a 20 percent risk of developing preeclampsia, Roberts noted.

“For these women, you would have to treat 50 with aspirin to prevent one case of preeclampsia,” Roberts said. “For a woman, whether benefits outweigh the risks is a decision that she has to work out with her doctor,” he said.

SOURCES: Lisa Askie, Ph.D., M.P.H., research fellow, School of Public Health, University of Sydney, Australia; James Roberts, M.D., director, Magee-Womens Research Institute, University of Pittsburgh; May 16, 2007, The Lancet online Publish Date: May 18, 2007

May 18 (HealthDay News) — Women at high risk for the pregnancy complication preeclampsia can lower their odds by 10 percent by taking daily aspirin, a new study suggests.

Preeclampsia is a potentially fatal obstetric complication that can lead to sudden high blood pressure and irregular blood flow. This can activate platelets and the clotting system, which in turn slows blood flow.

The use of aspirin may help counter this effect, according to a report in the May 16 online issue of The Lancet.

“Preeclampsia complicates between about 2 and 8 percent of all pregnancies, and is associated with approximately 10 to 15 percent of the half-million maternal deaths [worldwide] that occur each year,” said lead researcher Lisa Askie, a research fellow in the School of Public Health at the University of Sydney, Australia.

Although the benefits of antiplatelet therapy such as daily aspirin are modest, they are important if given to women at risk of preeclampsia, Askie said. “They could potentially result in many thousands less women who experience a bad pregnancy outcome. Hence, particularly for women at high risk of preeclampsia, a more widespread use of antiplatelet agents may be worthwhile,” she said.

In the study, Askie and colleagues in the Perinatal Antiplatelet Review of International Studies (PARIS) group looked at the results of 31 preeclampsia prevention trials that included almost 33,000 women and their babies. Women who took aspirin in these trials typically took between 50 milligrams to 150 milligrams of the drug per day.

The researchers found the risks of developing preeclampsia dropped 10 percent among women taking aspirin or other antiplatelet medications. In addition, these women also had a lower risk of delivering before 34 weeks and of having other pregnancy problems.

Moreover, aspirin had no significant effect on the risk of death of the fetus or baby. It didn’t boost the risk of bleeding for either mothers or their infants, nor did it raise risks for underweight newborns.

Askie’s team said no particular group of women was more or less likely to benefit from aspirin.

“Women at risk of preeclampsia should discuss the potential benefits and harms of this treatment with their doctor,” Askie advised.

But one expert was less than impressed with the findings.

“The results of this study were, to a large extent, disappointing,” said Dr. James Roberts, the director of the Magee-Womens Research Institute at the University of Pittsburgh, and author of an accompanying editorial.

Roberts had hoped the study would have shown a larger protective effect — especially in the women who are at the greatest risk for the problem. “It’s difficult to determine if it’s more beneficial in any subset of women or at what dose,” he said.

“In very high-risk women, the use of aspirin is justified,” Roberts said.

Women who are at the highest risk for preeclampsia are those who have high blood pressure and have also suffered preeclampsia in previous pregnancies. This group “are almost certain to develop it,” he said.

Women at risk because of high blood pressure, pre-pregnancy diabetes or preeclampsia in one previous pregnancy have about a 20 percent risk of developing preeclampsia, Roberts noted.

“For these women, you would have to treat 50 with aspirin to prevent one case of preeclampsia,” Roberts said. “For a woman, whether benefits outweigh the risks is a decision that she has to work out with her doctor,” he said.

SOURCES: Lisa Askie, Ph.D., M.P.H., research fellow, School of Public Health, University of Sydney, Australia; James Roberts, M.D., director, Magee-Womens Research Institute, University of Pittsburgh; May 16, 2007, The Lancet online Publish Date: May 18, 2007

May 18 (HealthDay News) — An international study shows that the cervical cancer vaccine that received government approval in the United States last year also protects women against vulval and vaginal cancers.

The findings seem to confirm that human papillomavirus (HPV), which is responsible for virtually all cases of cervical cancer, is also responsible for many cases of vulval and vaginal cancer. HPV is present in 80 percent of the 6,000 cases of vulval and vaginal cancers diagnosed in the United States each year.

“We’ve spent a lot of time over the last 20 years trying to show that HPV was associated with vulval and vaginal cancers, so that’s very exciting,” said Dr. Leo Twiggs, professor and chairman of the department of obstetrics and gynecology at the University of Miami Miller School of Medicine. “It’s the answer to whether the cause is HPV.”

The findings appear in the May 19 issue of The Lancet; initial data was first presented at the American Society of Clinical Oncology meeting last year.

Although less common than cervical cancer, vulval and vaginal cancers are becoming more widespread in young women. The incidence of in situ vulval carcinoma increased more than 400 percent in the United States between 1973 and 2000. Invasive vulval cancer increased by 20 percent during the same period.

The Gardasil vaccine was developed to target four strains of HPV, two of which (HPV 16 and 18) are linked to cervical cancer and to vulval cancer, and two (HPV 6 and 11) which cause anogenital warts.

Unlike cervical cancer, there are no screening programs for vaginal or vulval cancer.

Recent research also found that HPV is probably the number one cause of throat cancer, which affects about 11,000 Americans each year.

The HPV vaccine has already been shown to be almost 100 percent effective in preventing HPV 16-related or HPV 18-related cervical lesions, which are precursors to cancer.

Here, the authors did a combined analysis of three randomized clinical trials involving, collectively, more than 18,000 women aged 16 to 26 in 24 countries around the world. The research was funded by Merck, which makes Gardasil.

Participants had been randomly assigned to receive either the vaccine or a placebo.

After three years of follow-up, the vaccine proved to be 100 percent effective against vulval and vaginal lesions related to HPV 16 or HPV 18 in women never previously exposed to the HPV virus.

The vaccine was 71 percent effective in women previously exposed to HPV. The vaccine reduced the risk of high-grade vaginal and vulval lesions by 49 percent, regardless of whether HPV was detected in the lesion.

“This is very impressive,” said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. “We’re having a paradigm shift. It’s very hard for a lot of people to recognize that we can actually prevent cancer, and it’s very hard for people to recognize that certain types of cancer are sexually transmitted. The vaccine is very good. It is not perfect. It does not protect against every viral infection from HPV, but it protects against the ones that are the most common.”

According to the Finnish study authors, the maximum effect of the vaccine would be expected in girls who are vaccinated in early adolescence, before any exposure to HPV.

“I would recommend it for my daughters and anybody else’s daughters,” Brooks said.

“I’ve been practicing medicine for 30 years and have seen patients die of cervical cancer and oftentimes younger patients who have kids at home,” Twiggs added. “It’s great that we can actually prevent it. It’s very important for us to get the word out there about how this could prevent cancer.”

SOURCES: Leo B. Twiggs, M.D., professor and chairman, obstetrics and gynecology, University of Miami Miller School of Medicine; Jay Brooks, M.D., chairman, hematology/oncology, Ochsner Clinic Foundation, Baton Rouge, La.; May 19, 2007, The Lancet Publish Date: May 18, 2007

May 17 (HealthDay News) — Postmenopausal women who take supplements with calcium and vitamin D gain slightly less weight than women not taking the supplements, researchers report.

While the effect on weight was small, it’s another reason women should be taking calcium and vitamin D, which can help prevent osteoporosis, the study authors said.

“There was a small effect in the prevention of weight gain, approximately 5 percent,” said lead researcher Bette Caan, a senior research scientist at Kaiser Permanente Northern California, in Oakland. “The effect was greatest at three years among women who had been taking less than the daily recommend amount [of calcium] before the trial. They were also more likely to stay stable or lose weight,” she said.

For the study, Caan’s team collected data on 36,282 postmenopausal women, ages 50 to 79. The women were part of the Women’s Health Initiative clinical trial. In the trial, 18,176 women were randomly selected to receive a daily dose of 1,000 milligrams of calcium plus 400 international units of vitamin D, while 18,106 women were given a placebo once a day. Then, their weight was checked each year for seven years.

By the end of the trial, the researchers found that women who took the supplements weighed an average of 0.28 pounds less than those who did not.

Women who received the supplements and were getting less than the recommended amount of calcium daily before the start of the study weighed an average of 0.42 pounds less than those who did not. In addition, these women had a lower risk of putting on weight in both small amounts (2.2 pounds to 6.6 pounds) and moderate amounts (more than 6.6 pounds). And they were more likely to maintain a stable weight (within 2.2 pounds of their starting weight) or losing weight (more than 2.2 pounds), the researchers said.

Caan does not recommend taking calcium and vitamin D for the purpose of slowing weight gain. “However, since 1,200 milligrams of calcium is already recommended for postmenopausal women for bone health, they should continue with that recommendation, and it may be an extra benefit if it also helps reduce the risk of weight gain,” she said. “They should not rely on calcium to prevent weight gain. It’s not a magic bullet.”

The study was published in the May 14 issue of the Archives of Internal Medicine.

One expert thinks calcium’s small effect on weight gain is not really an effective part of fighting obesity.

“The beneficial effects on weight gain peaked after just three years, and then plateaued,” said Dr. David Katz, director of the Yale University School of Medicine Prevention Research Center. The benefits of supplementation were reduced weight gain, not weight loss. Roughly 70 percent of the women in this trial were overweight at the start, and almost all gained weight throughout, he said.

“Calcium and vitamin D did not cause weight loss, or even prevent weight gain — they just slowed its relentless march a bit,” he said. “In the battle to control obesity and its adverse effects, this has contributed the equivalent of a pea shooter.”

SOURCES: Bette Caan, Dr.P.H., Kaiser Permanente Northern California, Oakland; David Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; May 14, 2007, Archives of Internal Medicine Publish Date: May 17, 2007

May 17 (HealthDay News) — Healthy eating and exercise helps ease cardiovascular disease risk in postmenopausal women who’ve stopped using hormone replacement therapy (HRT), a new U.S. study says.

It has been shown that HRT can reduce the likelihood of cardiovascular disease, but many women have stopped using HRT due to research that found it is associated with an increased chance of breast cancer and heart disease.

Researchers at the University of Pittsburgh Graduate School of Public Health looked at 240 women who were taking HRT at the start of the study: 134 of the women were put in a lifestyle change group, while the other 106 were put in a health education group. The women were followed for an average of 18 months. By the end of that time, 130 of the women had stopped HRT, while 110 were still on HRT.

Compared to the women in the health education group, those in the lifestyle change group showed significantly greater reductions in weight, body mass index, waist circumference, total cholesterol and LDL (“bad”) cholesterol. The women in the lifestyle change group were also more physically active and had healthier fat intake.

Women in the health education group who stopped HRT had an average increase of more than 22 mg/dL in total cholesterol and LDL cholesterol, while those who stayed on HRT had average increases of less than 4 mg/dL. No such differences were noted in the lifestyle change group.

The study is published in the June issue of the American Journal of Preventive Medicine.

“These results have important public health implications and suggest that that a non-pharmacological lifestyle approach is both safe and effective for cardiovascular disease risk factor reduction in postmenopausal women, especially those who discontinued HRT use,” study author Kelley K. Pettee said in a prepared statement.

SOURCE: American Journal of Preventive Medicine, news release, May 15, 2007 Publish Date: May 17, 2007

May 17 (HealthDay News) — Babies born early and underweight have a greater chance of developing insulin resistance, glucose intolerance and high blood pressure when they become young adults than normal-weight babies, a new study says.

These factors can put a person at higher risk for heart disease and other health problems.

“Most small premature infants live healthy lives as adults,” said study lead author Dr. Eero Kajantie, a pediatrician and senior researcher at the National Public Health Institute in Helsinki, Finland. “However, our findings indicate that they might be at a higher-than-average risk of common late-life disorders such as type 2 (adult) diabetes or cardiovascular disease.”

The goods news is that the risk of developing these problems can be reduced with a healthy lifestyle, one that incorporates physical activity and a healthy diet and maintaining a normal weight, Kajantie added.

Kajantie’s study is published in the May 17 issue of the New England Journal of Medicine.

Researchers have already established a link between small size at birth and glucose-regulation problems later in life. There is also a known association between preterm birth with very low birth weight and insulin resistance in childhood.

And research has shown that full-term babies with low birth weight have a higher risk of health problems such as hypertension, cardiovascular disease and type 2 diabetes when they reach young adulthood.

The question is whether insulin resistance, and therefore an elevated risk for various diseases, persists into adulthood in babies born premature and underweight.

The issue is a highly relevant one, given that advances in neonatal intensive care have drastically changed the prognosis for very-low-birth-weight infants. According to an accompanying editorial in the journal, in 1960, a baby born weighing 1,000 grams (2.2 pounds) had a 95 percent risk of dying. Today, that same child has as 95 percent chance of surviving.

As the new study noted, the first generation of infants who benefited from these improvements is now entering adulthood.

For the study, the researchers performed standard oral glucose tolerance tests in 163 young adults aged 18 to 27 who had been underweight at birth. They also performed the same tests in 169 people who had been born at term and at normal size. All participants also had blood pressure and blood lipid levels measured.

Body composition was measured in 150 adults who had been very-low-birth-weight babies and in 136 “normal” people.

The adults born with very low birth weights had a 6.7 percent increase in two-hour glucose concentration, a 16.7 percent increase in fasting insulin concentration, a 40 percent increase in two-hour insulin concentration, an 18.9 percent increase in the insulin-resistance index and an increase of 4.8 mm Hg in systolic blood pressure.

“We would simply encourage former preterm infants to follow a healthy lifestyle,” Kajantie said. “It is important that, in particular, doctors following up adults would be aware of their patient’s birth history. Preterm birth/very low birth weight may serve as an additional risk factor when deciding, for example, whether a workup of glucose tolerance or diabetes is needed in an individual patient.”

And researchers should continue following the issue, Kajantie said.

“Further research is certainly needed, for example, to establish specific guidelines for follow-up of children/adults with very low birth weight,” Kajantie said. “Moreover, this study actually tells us about infants who were treated at a neonatal intensive care unit over 20 years ago (1978 to 1985). There have been considerable developments in neonatal intensive care after that period.”

SOURCES: Eero Kajantie, M.D., Ph.D., pediatrician, senior researcher, National Public Health Institute, Helsinki, Finland; May 17, 2007, New England Journal of Medicine Publish Date: May 17, 2007