Exercise Combats Cancer Fatigue (HealthDay News - 18/04/2008)


Exercise may help improve fatigue caused by cancer and its treatments, new research says. "A lot of time, the medical response to patients is that they should expect to be fatigued, that it is a normal side effect. If patients are told that fatigue is just a side effect and to accept it, what they are not getting is any advice or support to help them cope," review lead author Fiona Camp, a lecturer at the University of the West of England in Bristol, said in a prepared statement. Camp and her colleagues examined data on more than 2,000 cancer patients in 28 studies, which tested exercise programs that lasted from three weeks to eight months. The typical duration was 12 weeks. Walking and stationary bike riding were the most common types of exercise in the studies. The researchers found that exercise is more effective at combating cancer-related fatigue than the usual care provided to patients. "Exercise shouldn't be used in isolation but should definitely be included as one of the components in the package of interventions used during and after treatment," Camp said. She said a clearer "exercise prescription" for cancer patients can be developed after experts learn more about what intensity, frequency, duration and kinds of exercise best suit cancer patients. Until then, available evidence shows that exercise therapists, physical therapists and exercise physiologists need to part of cancer patients' treatment teams, she added. The review was published in the current issue of The Cochrane Library.

The first step in treating cancer-related fatigue is to check for any underlying medical conditions (such as anemia or an underactive thyroid) that can cause fatigue-like symptoms, said exercise researcher Karen Mustian, an assistant professor in the department of radiation oncology at the University of Rochester School of Medicine. She was not involved in the review. "There will still be a fair amount of patients dealing with fatigue after we get other situations under control," Mustian said in a prepared statement. "I think it's safe to say at this point that the sort of generalized guidelines of walking 30 minutes a day three to five times a week generally help patients. We can't say what specific doses are best. With the evidence currently out there, we can't say much beyond that," she said. 

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Roche, Novartis Cancer Drugs Too Expensive for Asian Countries ( Yahoo News - 23/03/3008)


Newer cancer drugs, including those from Roche Holding AG and Novartis AG, are too costly for most Asian governments, and buying them would deprive patients of more cost-effective care, said Sir Michael Rawlins, chairman of the U.K.'s National Institute for Clinical Excellence. The recommendation is based on an analysis by the U.K. government's panel, known as NICE, of the economics of prescribing newer medicines that target the biological mechanisms underlying cancer. These drugs offer doctors and patients alternatives to toxic chemotherapies and include Roche's Herceptin and Avastin, and Gleevec from Novartis. ``For many Asian countries, the modern anti-cancer drugs are completely cost ineffective,'' Rawlins said yesterday in an interview in Singapore, where he spoke at the Lancet Asia Medical Forum. ``By using them, many other people would be deprived of cost-effective care.''  Asia is on the brink of a cancer epidemic, fueled by a swelling population of retirees, tobacco use and increasing rates of obesity, researchers say. The World Health Organization estimates Asia's annual death toll from cancer, now at about 4 million, may reach 6.4 million by 2030. It costs close to $50,000 in Great Britain to treat a patient using Herceptin, which generated $3.2 billion in sales last year for Roche and its partner Genentech Inc. In comparison, per capita government expenditure on health was $4 in Bangladesh, $7 in India, $11 in Indonesia and $22 in China in 2003, according to data compiled by the Geneva-based WHO. In the Asia-Pacific region, only Japan, where the government spent $2,158 per person on health in 2003; Australia, which spent $1,699; New Zealand, which spent $1,267; and Singapore, which spent $348, could afford to buy so-called biological cancer drugs, Rawlins said. 

`Can't Afford Them All' 

``And even then, they can't afford them all and neither can we in Britain,'' he said. The new treatments, known as biologicals, are much more complicated and expensive to manufacture than traditional chemotherapies, and there are no cheaper, generic versions of them as yet. ``Most Asian countries have to do what they think is best for their people as a whole bearing in mind that most of these drugs' effectiveness is very modest -- it prolongs life by a month or two,'' Rawlins said. ``There are probably much more useful and helpful things that could be done with the money,'' including anti-smoking programs and providing palliative care for terminally ill patients, he said. Less than 1 percent of Asia's cancer patients receive morphine to dull their pain, said Cynthia Goh, head of palliative care at Singapore's National Cancer Center, which helps coordinate a network of hospice workers in the region. ``The ministers of health in some of these countries are going to have to make hard, rotten, difficult decisions,'' Rawlins said. ``That's the bottom line.'' 

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Asia's Cancer Rate May Pose Threat to Economic Growth ( Yahoo News - 23/04/2008) 


Asia's cancer rate may jump by almost 60 percent to 7.1 million new cases a year by 2020, straining the region's ill-prepared health systems, said Richard Horton, editor of the British medical journal Lancet. Aging populations, tobacco use and increasing rates of obesity are fueling the incidence of deadly tumors in Asian patients too poor to afford the most advanced treatments including Herceptin and Avastin, sold by Roche Holding AG, the drugmaker based in Basel, Switzerland, Horton said April 21 at an international cancer meeting in Singapore. Asia's prevalence of cancer deaths may climb 45 percent to 163 per 100,000 people by 2030 from about 112 per 100,000 in 2005, according to the World Health Organization. At that rate it would overtake the Americas, where cancer-related mortalities are expected to rise to 156 per 100,000 from 136 over the same period. Europe, which has the highest prevalence at 215 per 100,000, may increase about 9 percent to 234 per 100,000. ``There really is going to be an incredible pandemic of cancer like we've not seen -- we couldn't have imagined it -- over the next 20 years,'' Horton said in an interview in Singapore, where he spoke at the Lancet Asia Medical Forum. ``We barely have the health systems to handle infectious diseases, so how on earth are we going to deal with this?'' Cancer already kills more people worldwide than AIDS, tuberculosis and malaria combined. Spending to prevent and treat chronic diseases such as cancer and diabetes may slow the expansion of China and India, the world's two fastest-growing major economies, researchers said at the meeting in Singapore. 

`A Fortune' 

``It is going to cost them a fortune in terms of health care expenditure,'' Horton said, adding that it will ``eliminate a huge number of people from the labor market. We think AIDS is a disaster to the world now. You have seen nothing yet.'' It costs close to $50,000 in Great Britain to treat a breast cancer patient using Herceptin, which generated $3.2 billion in sales last year for Roche and its partner South San Francisco, California-based Genentech Inc. In comparison, per capita government expenditure on health was $4 in Bangladesh, $7 in India, $11 in Indonesia and $22 in China in 2003, according to data compiled by the WHO. Asia accounted for about half the 7 million cancer deaths worldwide in 2002, with 23 percent in China alone, D. Maxwell Parkin, a visiting research fellow at the University of Oxford's clinical trial service unit, told the two-day forum. 

Health Insurance 

``Historically in developing countries, people died before they could get cancer,'' said You-Lin Qiao, a professor of cancer epidemiology at the Chinese Academy of Medical Sciences in Beijing. ``Now they are living longer, we're seeing more cancer'' and degenerative diseases of the brain, he said. The majority of China's rural dwellers don't have health insurance, Qiao said in an interview. The cost of treatment, therefore, is borne by the entire family. Attacks on China's medical personnel almost doubled last year to 9.83 million cases, with 5,519 staff injured, causing 200 million yuan ($26 million) in costs, the official Xinhua News Agency reported last week, citing Vice Minister of Health Chen Xiaohong. The violence reflects the growing frustration in China over a health system struggling to provide affordable medical care, said Tony Mok, professor of clinical oncology in Hong Kong's Prince of Wales Hospital, who consults in the southern Chinese city of Guangzhou. 

Doctor Shortage 

``The doctor treats the patient,'' Mok said. ``The family thinks it is going to work. They get all their money, sell their cow, sell their house, and then the patient dies. They get very angry.'' About 1.1 million doctors and nurses are urgently needed in Southeast Asia alone, where shortages of health-care workers exist in six of the region's 11 countries, according to the WHO's 2006 World Health Report. Developing countries make up 85 percent of the world's population, but have a third of the world's radiotherapy machines, which are used to treat cancer. ``If nothing happens, there will be a disaster,'' said Franco Cavalli, president of the Geneva-based International Union Against Cancer. ``For the time being, governments don't realize, or do not want to realize, that this is a bomb which is going to explode.'' Developing nations in Asia have little access to anti- cancer drugs now, with the U.S., Europe and Japan absorbing 95 percent of the global supply, Cavalli said. 

`Westernization' of Diets 

Lung cancer, Asia's biggest cancer-killer and driven by tobacco-smoking, may increase 42 percent to almost 1 million deaths a year between 2005 and 2015, the Geneva-based agency reports. Stomach cancer, the second-biggest type of the disease in Asia, may grow 25 percent to 1.2 million deaths a year over the same period, the WHO says. Still the ``Westernization'' of Asian diets, including rising consumption of alcohol and red meat, is causing higher rates of breast, colon and rectum cancer, Oxford's Parkin said. Pursuing sophisticated drugs and technologies for treating cancer patients ``is incredibly high-cost and probably beyond the bounds of most countries'' in Asia, the Lancet's Horton said. Instead, priority should be given to a campaign to stop smoking, increase exercise and consumption of fruit and vegetables, prevent obesity and reduce salt. ``These seem simple things, but they would eradicate a vast proportion of the potential cancer burden,'' he said. 

To contact the reporters on this story: Simeon Bennett in Singapore at sbennett9@bloomberg.net ; Kanoko Matsuyama in Tokyo at at kmatsuyama2@bloomberg.net 

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Psychosocial support for cancer survivors needs strengthening (John Wiley & Sons, Inc. - 14/05/2007)

While one in four cancer survivors participates in a support group after diagnosis, use of support groups varies considerably by cancer type, and few survivors receive referrals to such programs from their physicians, according to a new study. Published in the June 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study finds that cancer survivors are more likely to attend a support group compared to people with other chronic conditions, but there is little active support for such use by treating physicians. Utilization among cancer survivors differs depending on factors such as gender, age, health insurance and other co-morbid conditions. The psychosocial burden of cancer is well recognized but seems to be poorly managed by many physicians. Support groups for a variety of cancers and other chronic conditions are widely available across the United States. They often are the only mental care and external disease information resource cancer patients have. While previous studies have shown about one in five women with early stage breast cancer use support services in the year following treatment (18 percent), little is known regarding participation in support groups and support group use among patients with different types of cancer and for cancer survivors. Dr. Jason Owen of Loma Linda University in Loma Linda, California and co-investigators sought to comprehensively characterize how patients with different types of cancers and other chronic medical conditions use support groups and who uses them. The study team analyzed survey data from 9,187 participants (1,844 with cancer and 4,951 with other chronic health problems).

Dr Owen and his team found that only one in seven (14 percent) patients with a non-cancer, chronic medical condition accessed support groups while almost one in four (23 percent) cancer patients did. Only 11 percent of cancer patients used a cancer-specific support group. Patients with blood malignancies and breast cancer were more likely to report participation in a support group compared to those with lung and skin cancers. Interestingly, predictors of use were similar across various cancer sites and included female gender, Caucasian race, higher education level, and symptoms of depression or anxiety. Younger age and urban residence did not predict support group use. While physical functional status did not predict use among cancer patients, it did among patients with other chronic conditions. Dr. Owen also found that while physicians passively supported patient use of support groups, only one in ten cancer patients in this study had received a physician recommendation. Dr. Owen concludes, "This study sheds light on which individuals with cancer use these services." This study will help clinicians recognize the importance of support groups for cancer patients. "Assistance in identifying and accessing support groups, should be a standard of care for all patients receiving curative, follow-up, or palliative care for cancer," Dr. Owen recommends.

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Fears over NHS cancer drug costs ( Health News)

Many cancer charities are concerned about the issue of drugs. Cancer doctors have told the BBC they fear the NHS will not be able to afford the new generation of cancer drugs. Specialists are already arguing that patients may have to pay for more drugs themselves, with the issue becoming pressing as new drugs are developed. But some patients offering to pay for a cancer drug are being told they would have to meet all their care costs. It is due to different interpretations of contracts and policies designed to separate private from NHS-funded care. The issue is becoming more critical as the number of new cancer drugs being developed grows. In all, 180 specialist cancer doctors told the BBC they were worried or very worried about the situation, in response to a questionnaire submitted by the BBC. The drugs in the pipeline are going to cause even more pressure. Around half the drugs submitted to the English NHS advisory body NICE are for the treatment of cancer. 
Some, like Herceptin for breast cancer, have won NICE backing as being cost effective for the health service. Others like Tarceva, which can extend the life of lung cancer patients, have been turned down. Specialists like Nick James, professor of clinical oncology in Birmingham, believe the gap between what the NHS can fund and what is available is going to get bigger. "The drugs in the pipeline are going to cause even more pressure. I think politicians need to be honest and say this gap is going to be there and we need to look at ways of filling it," he said. He believes it is inevitable that patients will make a bigger contribution themselves, but is worried NHS policy stands in the way. Some patients who offer to pay for a cancer drug recommended by their doctor are told they will have to transfer completely to private care. This can have the effect of doubling bills which already run into many thousands. 


Professor James works in one of a number of trusts which interpret policy more flexibly, effectively allowing patients to pay for cancer drugs and continue to receive other NHS care. Stephen Allen is one patient to benefit from that, although that still leaves him paying £3,000 every six weeks for the drugs alone. Mr Allen is terminally ill with kidney and lung cancer and had been told he only had six months to live. 
Stephen Allen is paying for his own drugs. NHS funding for the drug recommended for him was refused, with letters explaining the health service has limited resources and faces very tough decisions. He said: "I didn't realise we had to pay for certain drugs. If they'd said from the start there are certain drugs on the list which aren't available to you, we probably would have understood a little bit easier the situation they're in." So Mr Allen is spending savings he wanted to leave for his wife in the hope of living to see the first birthday of his youngest grandchild, two-month-old Annabelle. We need to have an honest debate about how we're going to have to fund these things 

Dr Jesme Fox 

In England, the official policy of the Department of Health is that allowing patients to contribute towards NHS care - known as co-payment - is against the principles and values of the NHS. The government says it could lead to a two tier system. In Scotland a different picture is emerging. Earlier this year Scotland's Chief Medical Officer issued much more nuanced advice to the health service there. 

Two-tier system 

He points out that if a patient opts to pay for a particular drug not available from the NHS there is no law which allows health boards to make the patient pay for all aspects of their treatment. The letter sets out a framework for drawing up ways of allowing "the safe provision of concurrent treatment where appropriate". The NHS has received a record increase in funding in recent years, but it still has to set financial priorities within those limits. A government report published by the National Cancer director for England, Professor Mike Richards, said cancer care had improved, with faster access to treatment and money spent on new equipment. 

Campaigning 

Professor Richards, said demand for drugs would grow, and need had to be met on a fair basis. "We have got to look at whether we are using the current money on cancer in the NHS as effectively as we can." But he added: "There are limits to what the health service can pay." Dr Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation, said she was appalled some people spend the last few months of their life in a desperate fight for NHS funding. The average time from diagnosis to death for lung cancer patients is six months. "If they're not going to be allowed to access drugs that improve survival by a few months, or improve their quality of life, we need to have an honest debate about how we're going to have to fund these things." 

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Cancer Care Seeks to Take Patients Beyond Survival. RECOVERY Tanya Saunders survived cancer but suffers effects of her treatment.  ( The New York Times - 22/05/2007)


As a growing number of Americans are learning, surviving cancer can mean slipping into a rabbit hole of long-term medical problems — from premature menopause and sexual dysfunction to more debilitating side effects of chemotherapy and radiation, like heart disease and even new cancers. The realization that cancer and its aftermath can go on for years has given rise to a medical specialty known as survivorship. At several major hospitals around the country, survivor programs financed by the Lance Armstrong Foundation are focusing on life after cancer. “It’s no longer sufficient to say, ‘Well, you survived,’ ” said Mary S. McCabe, who directs the program at Memorial Sloan-Kettering Cancer Center in New York. “We need to maximize their recovery and quality of life.” Cancer treatment and research are expanding to incorporate long-term postcancer care. With the number of survivors up to 10 million in the United States, from 3 million in the 1970s, cancer is increasingly being treated as a chronic disease, like diabetes or multiple sclerosis. As the presidential candidate John Edwards said in March after his wife, Elizabeth, learned that her breast cancer had returned and spread, the disease was “no longer curable” but “completely treatable.” At U.C.L.A. Medical Center in Los Angeles, Dr. Patricia A. Ganz is helping patients like Tanya Saunders close gaps in their medical care. Staying healthy has become a full-time job for Ms. Saunders, who has endured one complication after another in the 15 years since she received her diagnosis of Hodgkin’s disease as a college student.

Radiation and chemotherapy thrust her into menopause. After a recurrence and a second round of treatments, she developed congestive heart failure. Last year, the bone tissue in one of her hips collapsed, forcing her to undergo a hip transplant. Now 36, Ms. Saunders takes 11 medicines a day. She exercises three days a week with other cardiac patients, sees a much-loved psychotherapist (who is treating her free of charge) once a week and takes pottery and sailing classes. She lives on disability payments and qualifies for Medicare. “It’s a kind of a renewal of spirit I would say I’m looking for while I try to get my strength back,” Ms. Saunders said. Another patient of Dr. Ganz’s, Karen Huner, credits her with diagnosing and treating the hypothyroidism that was causing exhaustion and headaches months after she was cured of breast cancer. Other doctors had told her that the symptoms were effects of chemotherapy and that she should “just get used to it,” said Ms. Huner, a 44-year-old yoga and pilates instructor. In fact, she added, it was the radiation she received that probably disrupted her thyroid function. She recently developed lymphodema, the painful swelling and water retention that can happen in the arm where lymph nodes were removed. “My lymphodema doctor said to me, ‘Be happy you’re alive,’ ” Ms. Huner said. “I almost strangled her.”

The potential side effects of radiation and chemotherapy have been known for years, especially among survivors of childhood cancers. But the big push for awareness and support followed a strongly worded report in 2005 from the Institute of Medicine, part of the National Academy of Sciences. “The transition from active treatment to post-treatment care is critical to long-term health,” it concluded. “If care is not planned and coordinated, cancer survivors are left without knowledge of their heightened risks and a follow-up plan of action.” Insurers, it added, “should recognize survivorship care as an essential part of cancer care.” Another problem is that survivors may shy away from doctors, and not just because of the cost. Dr. Anna T. Meadows, a pediatric oncologist who directs the survivors’ program at the Children’s Hospital of Philadelphia, said people who got their diagnoses as children or teenagers were often wary of care that would force them to revisit a painful part of their past. These survivors do not necessarily need a cancer specialist for routine checkups and screening, she said, but rather someone who understands their previous treatment and its risks. “A lot of cancer survivors have nothing wrong with them,” Dr. Meadows said. “But what is important is for anybody who’s had cancer is to know what treatment they received and what it’s likely to lead to in the future.” The program is adding two primary care doctors to encourage follow-up visits.

In the largest study so far of survivors of childhood or adolescent cancer, published last October in The New England Journal of Medicine, researchers documented a high rate of illness because of chronic conditions caused by life-saving treatments. The study tracked the health of nearly 10,400 adults now in their 20s, 30s and 40s who were treated for cancer between 1970 and 1986. More than 62 percent of those survivors had at least one chronic condition; nearly 28 percent had a severe or life-threatening one. The survivors were more than three times as likely as their siblings to have a chronic health condition, and women were at greater risk than men. Survivors of bone tumors, central nervous system tumors and Hodgkin’s disease had the highest risk of a serious chronic condition. The good news is that almost 80 percent of children and teenagers who get diagnoses of cancer today become long-term survivors. Moreover, treatments have changed to minimize the risks; the lowest effective doses of drugs and radiation are used. “The silver lining of this is that we know what to expect a reasonable amount of the time,” said Dr. Kevin C. Oeffinger of Sloan-Kettering, a lead author of the report. While young cancer patients are more vulnerable to damage because their organs are still growing, Dr. Oeffinger said, the study has obvious implications for adults. Age and type of treatment play a huge role in the experience of cancer survivors, several experts said. Many experience no side effects at all. Others, especially women of child-bearing age, face infertility and early menopause. 

“Our research shows that younger patients have a harder time, both physically and emotionally,” said Dr. Ganz, of U.C.L.A. “It’s not something they’ve expected.” At Sloan-Kettering, five social workers are assigned to concentrate exclusively on follow-up care for survivors. Part of the plan, at Sloan and other cancer centers, is to develop an online database of patient-care summaries — of the cancer treatment received, the potential risks and recommended follow-up care — that could be used by any physician. The hospital also plans to open an off-campus outpatient center devoted to cancer survivors’ physical rehabilitation, in part with a donation from the media entrepreneur Robert F. X. Sillerman, who was treated at Sloan-Kettering six years ago for tongue cancer. He received chemotherapy and radiation and later began to suffer pain and muscle spasms in his shoulders and back, as well as increasing weakness in his left arm. Today, Mr. Sillerman said, he has reversed the damage with a little bit of medication and a lot of physical therapy. He exercises six days a week with weights, bands and manual resistance, partly with a personal physical therapist whom he puts up in a Manhattan townhouse adjoining his family’s. He said he appreciated the fact that few have the same luxury. “I was two years out from my cure before I was able to find the right protocol and treatment,” said Mr. Sillerman, 59. “Our hope is to eliminate that and provide access to rehabilitation right away, initially in the New York metropolitan area and eventually to make that a template nationally.”

For premature menopause in patients who can safely use estrogen, Dr. Mercedes Castiel likes to give teenagers and young women birth control pills to control hot flashes and bone loss. “It’s nicer to say I’m on the pill like my peers instead of hormones like my grandmother,” said Dr. Castiel, director of the Barbara White Fishman Women’s Health Center at Sloan. Even sexual dysfunction, which for years was viewed as a small price to pay for survival, is now treated like any other side effect. Vaginal dryness and missed or blunted orgasms are among the most common complaints. “We look at it in terms of enhancing intimacy,” said Dr. Michael L. Krychman, Sloan’s expert on the subject. “They want things to get back to normal.”

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Cancer, Western habits expected to surge in Asia - (AP)


Asia is bracing for a dramatic surge in cancer rates over the next decade as people in the developing world live longer and adopt bad Western habits that greatly increase the risk of the disease. Smoking, drinking and eating unhealthy foods — all linked to various cancers — will combine with larger populations and fewer deaths from infectious diseases to drive Asian cancer rates up 60% by 2020, some experts predict. But unlike in wealthy countries where the world's top medical care is found, there will likely be no prevention or treatment for many living in poor countries. "What happened in the Western world in the '60s or '70s will happen here in the next 10 to 20 years as life expectancy gets longer and we get better control on more common causes of deaths," said Dr. Jatin P. Shah, a professor of surgery at Memorial Sloan-Kettering Cancer Center in New York, who attended a cancer conference last month in Singapore.


"The habit of alcohol consumption, smoking and dietary changes will increase the risk of Western world cancers to the Eastern world," Shah said. An estimated 40% of cancers worldwide can be prevented by exercise, eating healthy foods and not using tobacco, according to the World Health Organization. But more people in Asia are moving into cities and becoming overweight and obese from inactivity. They are replacing fruits and vegetables with fatty meals full of meat and salt, which is leading to increases in stomach and colon cancers. Meanwhile, traditional diseases like malaria are killing fewer people — building an aging population that's a prime target for cancer. The effect is already startling, with the Asia-Pacific making up about half of the world's cancer deaths and logging 4.9 million new cases, or 45%, of the global toll in 2002. That number is projected to leap to 7.8 million by 2020 if nothing changes, according to Dr. Donald Max Parkin, a research fellow at the University of Oxford who is a leading authority on global cancer patterns and trends. China alone, with its booming economy and 1.3 billion people, is home to about one-fifth of the world's new cases, compared to about 13% in the U.S. and 26% in Europe, Parkin said. Heart disease remains the top killer in China, but cancer is a close second.

Cancer deaths are slowly dropping in the United States, with slight declines recorded in 2003 and 2004. A decrease in smoking, coupled with early detection and better treatment of tumors is credited with the positive results — the first U.S. decline in cancer deaths since 1930. Smoking is on the rise in Asia, where it's common to see people lighting up in airports, restaurants and even hospitals. Lung cancer makes up the bulk of all cases regionwide, followed by stomach and liver cancers. It also remains the biggest cancer killer worldwide. "Lung cancer is the big one because of cigarette smoking. There are many tobacco advertisements — everywhere," said Dr. You-Lin Qiao from the Cancer Institute and Hospital in Beijing, who added that the odds are stacked against those diagnosed in China. "No matter if you're rich or poor, if you get lung cancer you die. There's no treatment at all." 
While Americans and Europeans have been abandoning smoking, an estimated 300 million men are puffing away in China — equal to the entire U.S. population. If nothing changes, a third of Chinese men under age 30 are predicted to die from tobacco, with lung cancer already the biggest cancer killer there. Smokeless tobacco is also a big problem in Asia's other giant, India, where many men 
and women chew some form of tobacco. Mouth cancer makes up half of all new cases in parts of the country. A lack of vaccines that prevent cancer-causing viruses is another obstacle for Asia, which is home to about three-quarters of the world's liver cancers, caused largely by Hepatitis B infections. A vaccine guarding against the virus has been available since the early 1980s and is routinely given to children in Western countries, but it is still not reaching large swaths of the Asia-Pacific.

Some experts worry it could take years before the new vaccine for the sexually 
transmitted human papillomavirus, or HPV, is available to women in developing 
countries. The three shots currently cost about $350 in the U.S. and are 70% effective against preventing HPV, the main cause of cervical cancer. It is already the No. 2 cause of cancer among women in Asia, after breast cancer. "The problem is so huge that it's very difficult for us to know where to start," said Dr. Franco Cavalli, president of the non-profit International Union Against Cancer. "All the new cancer treatments are so expensive, that already in the affluent countries we are not able to pay for them. ... So imagine what that means for low-income countries where you have$20 a year per person for health expenditures." Regular screening, such as Pap smears and mammograms, is too costly for many poor countries. Treatment with radiation or chemotherapy is unfathomable for most. And in Asia, many patients seek help from hospitals in the late stages of disease after traditional medicine has failed to cure them. Monika Bardhan of Malaysia's NCI Cancer Hospital has seen a dramatic increase in cancer patients over the past four years. "It's staggering. Every day I see a patient with breast cancer — I just hold my own and say a prayer."

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Top Five Cancer Misconceptions- (26/07/2007)


It's hard to keep up with all the latest news on cancer, and a new survey from the 
American Cancer Society (ACS) shows that many Americans still harbor potentially 
dangerous misconceptions about the disease. Not being fully informed about the risks could promote cancer-causing behaviors, says lead survey author Kevin Stein of ACS. To determine how cancer-savvy the U.S. public is, Stein and his team created 12 false or unsubstantiated statements about cancer risk and risk factors, then asked nearly 1,000 U.S. adults by phone whether they believed the statements to be true, false, or if they didn't know.

Below are the top five misconceptions from the survey, published in the Sept. 1 issue of Cancer.

1. The risk of dying from cancer in the United States is increasing.

About 68% of those surveyed believed this to be true, although the cancer mortality 
rate has actually been decreasing since the 1990s. Overall, thanks to more aggressive screening programs and better treatments, the five-year survival rate of all cancers taken together has been climbing for the past 30 years, from 51% between 1975 and 1977 to 67% in 2004.

2. Living in a polluted city is a greater risk for lung cancer than smoking a pack of 
cigarettes a day.

Almost 40% of adults who responded thought car and bus exhaust posed a greater hazard to their lungs than smoking. While some studies have begun to document an up to 12% greater risk of dying from lung cancer in urban residents, the strongest data consistently show that smoking is the leading cause of the disease. Anywhere from 80% to 90% of lung-cancer deaths can be attributed to lighting up.

3. Some injuries can cause cancer later in life.

Another 37% believed this to be true, despite the fact that most cancers can be traced to a progression of genetic changes that are independent of physical injuries.

4. Electronic devices, like cell phones can cause cancer in the people who use them.

Nearly 30% believed this, although there is no scientific evidence to prove or disprove the relationship between cell-phone use and brain cancer. The National Cancer Institute continues to study any possible links, but they note that the rapidly changing technology of cell phones (newer phones emit less potential cancer-causing radiation than older models) and the difficulty of documenting the duration of people's exposure could make a definitive answer difficult.

5. What someone does as a young adult has little effect on their chance of getting 
cancer later in life.

In spite of the fact that many of the more common cancers, including skin cancer and lung cancer, are associated with behaviors such as sunbathing and smoking early in life, 25% of respondents believed that such behaviors do not increase long-term cancer risk.

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Tobacco and poverty drive cancer in developing world By Maggie Fox-  (Reuters- 20/12/2007)


Rising tobacco use and poverty will fuel cancer across the developing world, more than doubling the number of new cases to 27 million by 2050, experts predicted on Thursday. Cancer is already the No. 2 cause of death globally, after heart disease and ahead of AIDS, malaria, tuberculosis and other causes. And as people live longer and adopt bad habits such as smoking, cancer cases will rise, said Dr. Nancy Davidson of Johns Hopkins University in Baltimore. "It accounts for 10 percent of deaths," said Davidson, who is president of the American Society of Clinical Oncology. She cited this week's report by the International Agency for Research on Cancer that 7.6 million people will die of cancer this year, 5 million of them in developing countries. The statistics contradict a perception that cancer is a disease of rich nations. Cancer deaths have fallen in the United States, dropping by more than 2 percent between 2002 and 2004. "There will be 12 million new cancer cases diagnosed worldwide in 2007. By 2050, this number will more than double to 27 million, even if the rates don't change," Dr. Lynn Ries of the U.S. National Cancer Institute said in a telephone briefing. Of these, 5.4 million cases will be in economically developed countries and 6.7 million in developing countries, Ries said. Cancer is caused by a mix of factors, including genes, diet, lack of exercise and, rarely, chemical exposure. But the No. 1 cause is smoking. And more people are using tobacco, said the National Cancer Institute's Deirdre 
Lawrence.

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10 MILLION SMOKING DEATHS


"According to World Health Organization current estimates, the annual number of 
tobacco-related deaths worldwide is projected to rise from 4.9 million in 2000 to more than 10 million by 2020, unless effective interventions take hold," Lawrence told the briefing. She said 70 percent of the deaths would be in the developing world. In 1970, 3.26 million cigarettes were smoked globally. In 2000, it was 5.7 million. The problem is notably clear in China, said Dr. Tony Mok of the Chinese University of Hong Kong. "China produced about 39 percent of the world's tobacco production," Mok told the briefing. About 6 percent of this was exported, meaning the rest was consumed in China. "In other words, we consume about 33 percent of world tobacco production," Mok said. "We smoke a hell of a lot of tobacco." Mok said 320 million people were smokers in China in 2004, a 4 percent increase from 2003. "Cancer prevention has not been a top priority in our country," he said. The same goes for India, said Dr. Ketayun Dinshaw, director of the Tata Memorial Centre in Mumbai. He said there are no organized screening programs in India. Nigeria tries but poverty intervenes, said Dr. Clement Adebamowo of the University of Ibadan. "There is limited availability of even basic diagnostic oncology facilities," Adebamowo said. "Chemotherapy drugs are available but are very expensive and not affordable to the majority of cancer patients." 

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Cancer Research- (Yahoo News- 27/07/2007)


While the pace of cancer research can be debated, new findings are reported 
almost daily, from all corners of the globe. What follows is a roundup of some of 
the most recent studies related to cancer and the quest to find new treatments 
and cures. Researchers at Ohio State University have determined the activity of a particular gene can identify people who have a more lethal form of acute myeloid leukemia. The scientists said the gene, called ERG, has been linked with breast and prostate cancer. The finding applies to acute myeloid leukemia patients with leukemia cells that have normal-looking chromosomes -- a feature that occurs in about half of such patients, the researchers said. 

Those with leukemia cells showing high ERG activity are nearly six times more 
likely to relapse or die within five years than are patients with low ERG 
expression following standard therapy. "Our study shows high ERG activity predicts a poor prognosis in these patients, even when other molecular markers are taken into consideration," said Dr. Guido Marcucci, associate professor. "The findings mean these patients require a stem-cell transplant or other aggressive therapy, and patients with low ERG activity can be treated using standard therapy." The research confirms a 2005 study led by the same Ohio State researchers in a completely independent set of patients, Marcucci said. The study was reported online in the Journal of Clinical Oncology. 

Three independent groups have found the first common genetic variant that seems 
to raise the risk of colorectal cancer. Scientists estimate the variation is found in half the world's population. The three groups separately identified a chromosomal region that doesn't contain any known genes but was previously linked to both prostate and breast cancer. The genetic material is known as a single-nucleotide polymorphism (SNP). The studies were led by researchers at Western General Hospital in Edinburgh, Scotland, and the Ontario Institute for Cancer Research in Toronto, Canada; the Institute of Cancer Research in Sutton, England; and the University of Southern California in Los Angeles. Scientists studied the DNA of thousands of people with and without colon cancer, looking for common strings of DNA bases, or SNPs. In each study, the same common SNPs kept popping up. 

One group also found an association between the strip of DNA and colorectal 
adenomas, which precede tumors. This suggests that the SNP might help initiate 
cancer rather than drive its progression. Although clinical applications might be far off, the new marker could help identify those at risk of colon cancer and even guide physicians to patients in the early stages of the disease. Colon cancer can usually be cured if detected early. All three studies appeared online July 8 in Nature Genetics. Researchers from the U.S. Food and Drug Administration found that there is very little scientific evidence for the anti-cancer properties of either tomatoes or 
lycopene. Their work was published in the current issue of the Journal of the National Cancer Institute. 

Earlier studies found that tomatoes and lycopene, is the antioxidant that makes 
them red, might reduce the risk of cancer. In recent years, lycopene became the 
fourth best-selling supplement in the United States. The FDA's review examined 64 separate studies that took place from 1989 to 2005. It found that tomatoes had no effect on the risk of lung, colorectal, breast, cervical or endometrial cancer. The team did find some limited evidence that tomatoes - but not lycopene alone - slightly reduced the risk of certain cancers, including prostate, ovarian, gastric and pancreatic cancer. And based on that, the FDA will continue to allow companies that market tomato products to advertise some possible cancer risk reduction.

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Inherited cancer fear 'unfounded' -(Yahoo News- 30/07/2007)

Most cancers are not passed on in the genes People worry unnecessarily about cancer in their family because they do not realise only a small number of cancers are hereditary, a survey suggests. The poll found 91% of more than 1,000 people polled falsely believed that if a relative has had cancer, they are at a greater personal risk of the disease. In fact, the likelihood of an increased risk is small, as nine out of 10 cancers appear by chance. The survey was carried out by information charity Cancerbackup. It is sad that people are not aware of the reality, that very few cancers are caused by a known inherited genetic link. 

The poll, conducted through the Genes Reunited website, found a quarter of people 
thought that between 50% and 100% of cancers are hereditary. The majority of people (74%) wrongly thought that if several members of their family have had different types of cancer, it means that there is a strong chance of an inherited genetic link in the family. It also found that 60% of people think family history is the biggest risk factor for cancer - only 15% realise that it is actually age. Two-thirds of cancer occurs in people over 65 years old. 

Dr Andrea Pithers, Cancerbackup genetic information manager, said: "Worrying 
about cancer can be very debilitating and it is sad that people are not aware of 
the reality, that very few cancers are caused by a known inherited genetic link. "At the same time people should know about how they can lower their risk with things they can actually change, like eating a healthy diet and exercise." Martin Ledwick, information nurse manager at Cancer Research UK ,said the results showed how important it was that people got accurate information about cancer risks. He said: "While most cancers are not strongly linked to family history, if people are worried they should speak to their GP for advice. "Half of all cancers could be prevented by changes to lifestyle." 

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Nanoparticles may aid cancer diagnoses- (UPI- 1/08/2007)


U.S. medical researchers have created gold nanoparticles capable of identifying 
marker proteins on breast cancer cells. The Purdue University scientists say using such tiny particles to better diagnose and treat cancer would be about three times cheaper than the most commonly used current method and might provide many times the quantity and quality of data. "We hope that this technology will soon play a critical role in early detection and monitoring of breast cancer," said Associate Professor Joseph Irudayaraj, leader of the study. "Our goal is to see it in commercial use in about four years."

The tiny rod-shaped gold particles, even smaller than viruses, are equipped with 
antibodies designed to bind to a specific marker on cell surfaces. Researchers 
analyze the surface markers -- proteins on a cell's exterior -- because they can 
contain valuable information about what type of cell they belong to or what state 
that cell may be in. "In cancer diagnosis, the ability to accurately detect certain key markers will be very helpful because certain types of cancers have specific surface markers," Irudayaraj said. The research is available online in the journal Analytical Chemistry.

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Cancer Docs' Bedside Manner Often Lacks Empathy -( HealthDay - 19/12/2007)

Most cancer specialists do not respond to the emotional concerns of their patients with verbal expressions of empathy and support, a new study reveals. The finding suggests that cancer patients' quality of life might be significantly improved if doctors were better trained to recognize and address patients' emotional concerns as they battle the disease. "We audio-recorded doctor-patient interactions, and we analyzed them, and what we found is that when patients expressed negative emotions, doctors did not always respond empathetically," said study author Kathryn L. Pollak, an associate professor at Duke University Medical Center's Community and Family Medicine Department, in Durham, N.C.

Pollak's team published its findings in the Dec. 20 issue of the Journal of 
Clinical Oncology. To assess the frequency of empathetic interactions in an oncology setting, the authors first surveyed 51 oncologists who were caring for a total of 270 cancer patients at Duke, the Durham Veterans Affairs Medical Center, or the University of Pittsburgh. The physicians, mostly white and male, were questioned about their level of confidence in addressing patient concerns; their sense of how various communication approaches might affect a patient; and their general comfort level with psycho-social types of conversation. As well, the doctors were asked if they felt they were more inclined toward the technological and scientific aspects of patient care or more disposed to focus on the social and emotional side of treatment.

The researchers also recorded almost 400 audiotapes of conversations that had 
taken place between physicians and patients. All the patients had advanced-stage cancer, and their physicians indicated that they would not be surprised if they ended up dying from their illness within a year. Almost three-quarters of the patients were white, and they averaged a little over 60 years of age. Most of the patients had established a relationship with their oncologist -- 90 percent said they had known their doctor for at least six months prior to the study. According to the researchers, more than two-thirds of the physicians said they were oriented toward the technical aspects of patient care, but most were also highly confident in their ability to deal with patient concerns. Most of the doctors also believed they were comfortable with emotionally charged conversations.

Yet, after reviewing all the tapes, Pollak and her colleagues determined that 
cases in which doctors responded to patients' concerns with empathy were rare. Fewer than 300 so-called "empathic opportunities" occurred during the almost 400 
conversations. Such opportunities were defined as points at which a patient had 
verbally expressed negative emotions -- such as fear or worry -- to which the doctor could respond as he or she saw fit. Female patients were more likely to express such feelings, particularly if their doctor was also female, the researchers observed.

When such emotions were expressed, almost three-quarters of the time doctors 
chose to "terminate" the conversation by offering, for example, blanket reassurance that time would solve the problem. Occasions in which doctors would empathetically promote "continuation" of the conversation by encouraging elaboration and/or expressing some form of understanding or support were far less frequent, occurring little more than a quarter of the time. Oncologists who offered more empathic statements were younger than those who didn't, and those who stayed longer to converse with the distressed patient were more likely to have described themselves as highly focused on the emotional dimension of patient care.

The research team concluded that oncologists need better education to recognize 
and respond appropriately to patients' emotions. "Oncologists clearly care about their patients," said Pollak. "They wouldn't go into oncology if they didn't. But oncology is a really challenging field, and, in general, oncologists have not been trained in how to communicate with patients. So, it's a pretty difficult situation for them." "The good news is that the ability to communicate is something that can be 
taught," she added. "I wouldn't say it's an innate skill. Many doctors who say 
they are less comfortable conveying emotions with patients suffer from a lack of 
training. What they need is to be taught how to verbalize how they feel, and 
there have been several programs around the world that have shown that this kind 
of communication training can produce good communicators."

Pollak noted that she and her team are now conducting a follow-up study to see 
how communication skills might improve if oncologists were given personalized 
CD-Roms to screen video of their own interactions with patient. Data from the 
study has yet to be analyzed. Another expert agreed that training could only help. "The emphasis in medical school is not usually focused on the emotional side of 
things," noted Kevin Ochsner, an assistant professor of psychology at Columbia 
University, New York City. "It's about being able to get the diagnosis right. But, in fact, it's as important to communicate that a patient's feelings matter and are an important part of the equation as it is to convey the probability that a certain procedure will or will not have a positive outcome." "Empathy," added Ochsner, "is the social glue that knits people together because the ability to connect with one another emotionally and to understand the feelings of one another promotes rapport and bonding. So, making patients feel that they're heard will help them feel secure and less anxious. It helps regulate their emotions, and this has all kinds of important mental and physical health effects."

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Cancer Care Advances in 2007 Offer Hope- (HealthDay - 18/12/2007) 

Advances in breast cancer screening and new treatments for liver, kidney, head and neck and lung cancers are among this year's most important breakthroughs in cancer care, the American Society of Clinical Oncology says in a new report. However, while treatment is improving the lives of many cancer patients, flat 
federal funding for research and clinical trials threatens to stall future progress, the report added. "Overall, this is a very hopeful picture," said Dr. Julie Gralow, director of 
breast medical oncology at the University of Washington School of Medicine and 
Fred Hutchinson Cancer Research Center in Seattle, and an executive editor of the 
report. "We have made advances and there is hope that we will make more advances as we enter this new molecular-targeted treatment era."

But, Gralow added, funding for cancer research has reached a critical point. "The only way we get new drugs approved, the only way we can study what's better 
or worse for patients is to do clinical trials," she said. "But where we have really struggled in the past seven years is in reductions in federal money for clinical trials."
Among gains cited by the ASCO report, titled Clinical Cancer Advances 2007: Major 
Research Advances in Cancer Treatment, Prevention, and Screening, is the first 
systemic treatment for liver cancer. A large study found that patients who took the targeted therapy sorafenib (Nexavar) for advanced liver cancer lived about 44 percent longer, compared with patients who didn't get the therapy. This is the first effective non-surgical treatment for liver cancer, the report said.

In a similar vein, treating kidney cancer with bevacizumab (Avastin) along with 
standard treatment nearly doubled patients' progression-free survival. The report also noted that this year, based on findings from several studies, new guidelines recommend for the first time that MRIs can be effective in screening the 1.4 million U.S. women at high risk for breast cancer. MRIs are still not yet recommended for most women as a breast cancer screening tool, the report added. Other important news: Two studies this year confirmed that the significant drop in breast cancer rates is linked to fewer menopausal women taking hormone replacement therapy, following the 2002 Women's Health Initiative finding that uncovered the connection.
"It's quite clear in breast cancer that we have had steady reductions in deaths 
due to breast cancer over the last decade," Gralow said. "We have metastatic 
patients living longer."

Also, two studies this year showed that the human papillomavirus (HPV), the virus 
present in almost all cervical cancers, may play a role in head and neck cancers. 
HPV was found in 72 percent of several types of head and neck cancers and, 
interestingly, the presence of the virus was linked to better treatment results. These findings suggest that the new HPV vaccine, which is recommended for 11- and 
12-year-old girls to prevent cervical cancer, may prevent head and neck cancers, 
but more research is needed, the report said. Also, for the first time, researchers found that "whole brain" radiation therapy, given to patients with advanced small cell lung cancer, reduces the risk of the cancer spreading to the brain by about two-thirds. This treatment was able to double the one-year survival rate, according to the report.

But the report's editors expressed concern that budgets for the U.S. National 
Institutes of Health and the U.S. National Cancer Institute have not changed in 
four years. This is the longest period of flat funding for cancer research in 
U.S. history, the report said. To address this problem, ASCO is calling for substantial increases in government funding that, at a minimum, would keep pace with inflation in medical care. "This has really been a decrease in funding, which has had an impact on the number of clinical trials and the number of patients enrolling in trials," Gralow said. "It's really a wrong message." The report also calls for public and private insurers to cover the costs of patients in clinical trails. Some insurers don't cover clinical trials because they are classified as "experimental." But some states have passed legislation or have agreements that require health plans to pay for routine medical care for patients in clinical trials. The report urges more states to do the same, and for Medicare to continue to cover patients' costs in clinical trials.

Dr. Otis Brawley, chief medical officer at the American Cancer Society, applauds 
the progress in the fight against cancer, but adds that much remains to be done. 
"These are important advances," Brawley said, citing those gains contained in the 
ASCO report. "But, I admit when I say that, it's a shame in many of those diseases we are talking about prolonging people's lives by months, sometimes weeks. We shouldn't rest on our laurels. We still need to do a lot of work." Brawley agrees that more money is needed for research. The flat National Institutes of Health budget "is negatively affecting our efforts to try to do better than improving survival by two or three months," he said. "Progress is slower than it could be. You delay findings substantially by not making the investment in clinical trials."

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Over 12 million cancer cases in 2007: study- (AFP- 17/12/2007) 

More than 12 million new cases of cancer will have been diagnosed around the world in 2007 and 20,000 people a day, or 7.6 million people, will have died from the disease, a new study said Monday. The projections are contained in the first ever report by the American Cancer Society, and are based on cancer and mortality rates in the Globocan 2002 database compiled by the International Agency for Research on Cancer. According to Monday's report "Global Cancer Facts and Figures," some 5.4 million cancer cases and 2.9 million deaths will occur in industrialized countries.

Here the most common kind of cancers are prostate, lung and colon cancer among 
men, and breast cancer and lung and colon cancer among women. Some 6.7 million cancer cases and 4.7 million deaths will take place in developing nations, with lung, stomach and liver cancer being most prevalent in men, and women suffering most from breast, uterine and stomach cancer. "The burden of cancer is increasing in developing countries as deaths from infectious diseases and childhood mortality decline and more people live to older ages when cancer most frequently occurs," said Ahmedin Jemal, an epidemiologist with the American Cancer Society and co-author of the report. About 15 percent of all cancers are linked to infections, such as stomach, liver and uterine cancers.

But in developing nations three times more cancer cases are linked to infections 
than in industrialized countries, some 26 percent compared with eight percent. "This cancer burden is also increasing as people in the developing countries adopt western lifestyles such as cigarette smoking, higher consumption of saturated fat and calorie-dense foods, and reduced physical activity," said Jemal. The report also contains a special focus on smoking called "The Tobacco Epidemic" which predicts that more than a billion people will die from smoking-related diseases in the 21st century -- most in developing countries. This compares to about 100 million deaths from smoking around the world in the 20th century.

About five million people died around the world from tobacco use in 2000, of 
which 30 percent 1.42 million contracted cancer, of whom 850,000 had lung cancer, 
the report said. The World Health Organization (WHO) estimates that about 84 percent of the world's 1.3 billion smokers live in developing nations. In China alone, the WHO estimates that there are more than 350 million smokers, more than the entire population of the United States. If the trend continues, there will be about two billion smokers around the world by 2030 of which half will die from smoking-related illnesses if they don't quit.

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Cancer Patients Hold Fast to Belief That Opioids Mean Death - (HealthDay- 12/12/2007)

Many cancer patients endure unnecessary suffering when they resist treatment with morphine and other opioid painkillers because they believe the use of these drugs signifies imminent death, a new British study suggests. "If we are to employ the range of available opioids in order to successfully manage pain caused by cancer, we must ensure that morphine does not remain inextricably linked with death. If this connection stays in place, then morphine will continue to be viewed as a comfort measure for the dying rather than a means of pain control for the living," study author Dr. Colette Reid, a consultant in palliative medicine at the Gloucester Royal Hospital, said in a prepared statement. Publishing online Dec. 11 in the Annals of Oncology, Reid and her team interviewed 18 people, aged 55 to 82, with metastatic cancer who took part in a cancer pain management trial. A central theme of morphine as a last resort for dying patients emerged from the interviews.

"We found that patients with cancer who were offered morphine for pain relief 
interpreted this as a signal that their health professional thought they were 
dying, because opioids were interventions used only as a 'last resort.' Because 
participants themselves were not ready to die, they rejected morphine and other 
opioids as analgesics, despite the pain experienced as a consequence," the study 
authors wrote. "Participants' descriptions of the role of professionals indicated that patients value professionals' confidence in opioids. Some patients may therefore become more frightened when offered a choice, since this indicates a lack of confidence in the opioid as an analgesic." Reid noted that World Health Organization guidelines for the management of cancer pain state that severity of pain, not patient prognosis, should be the basis for making painkiller treatment decisions. "So patients at all stages of cancer could have morphine if their pain is 
sufficient. In reality, the patients most likely to experience pain, and likely 
also to have the most severe pain, are those with metastatic disease, i.e., their 
cancer cannot be cured. These patients may yet have many months to live, but 
their quality of life is adversely affected by pain, since unrelieved pain leads 
to social isolation, loss of role and depressed mood," Reid said.

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The Asterisk on Cancer Deaths- (Yahoo News- 21/10/2007) 


There was good news about cancer last week, a report that death rates in the 
United States have begun falling by 2.1 percent a year, nearly twice the rate of 
previous declines. But the same report, by the American Cancer Society and other groups, also said certain cancers seem to be becoming more common — not hugely so, but noticeable. Among those increasing in men and women are myeloma and cancers of the thyroid and kidney. In women, melanoma and cancers of the bladder have increased; in men so have cancers of the liver and esophagus. 
Why? Experts point to a mixed bag of facts, theories and educated guesses. One 
overarching culprit may be America’s level of obesity, which has been linked to 
increased risk of several types of cancer, including tumors of the kidney, liver 
and esophagus. 

But there are much stronger risk factors for liver cancer. The major ones are the 
viruses that cause hepatitis B and C. In some people, those infections turn chronic and gradually lead to tumors. A vaccine that can prevent hepatitis B is used routinely in the United States. But not every country uses it, and liver cancer here may be rising in part because of cases among immigrants. Hepatitis C is more of a homegrown problem. There is no vaccine, and infections surged in the 1960s and 1970s among drug users who shared needles. The virus then spread into the blood supply and may have infected tens of thousands of transfusion recipients before a test was developed to screen donated blood. Liver cancer is still turning up in people infected decades ago. 

When it comes to thyroid cancer, researchers do not know whether the incidence of 
the disease is actually increasing, or simply being diagnosed more often because 
of improved tests. But it is a cause for concern. Increases in kidney cancer can 
probably be traced mostly to increased detection. As for melanoma, the increases 
probably come from both better detection and a real rise in cases due to sun 
exposure, researchers said. Smoking raises the risk of bladder cancer. Rates in women may be rising because they started smoking, and quitting, later than men did, said Elizabeth Ward, director of cancer surveillance for the American Cancer Society.There has been a similar trend with lung cancer. But over all, men have much higher rates of bladder cancer, possibly due to higher smoking rates and chemical exposures on the job. Trends in myeloma, a bone marrow cancer, have researchers puzzled. “It could be improvements in diagnosis,” Dr. Ward said. “It bears looking into, though, because it is more common in blacks than whites, and I don’t think we have a huge amount of knowledge about risk factors.” 

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Officials backpedal on Pa. cancer study- An abstract making an environmental link to the disease was released by mistake, they say. -(Associated Press)

Officials yesterday abruptly backpedaled on a federally funded health study that suggested an environmental link to a cluster of rare blood cancer cases in Northeastern Pennsylvania, saying an abstract that made the claim was mistakenly released to the public. The research is to be presented Monday at a medical conference in Atlanta. An abstract released in advance of the meeting said there was "significant evidence" that something in the environment caused an unusually large number of cases of polycythemia vera in Luzerne, Carbon and Schuylkill Counties. The abstract, submitted to the American Society of Hematology, also said people who had lived within 13 miles of a former toxic waste dump in northern Schuylkill County developed the blood cancer at a rate 4.5 times higher than people living in other parts of the three counties.

Steve Dearwent, a government epidemiologist, said that the abstract was written early in the summer and that subsequent analysis of the data did not support the conclusion of an environmental link, although he added that it still was a possibility. He said the abstract should have been revised before it was submitted. "We're going to have to retract the abstract to correct the record because it is erroneous information," said Dearwent, chief of health investigations for the Agency for Toxic Substances and Disease Registry, the federal agency that oversaw the study. "It was preliminary and hadn't been vetted, and unfortunately, it got submitted, unbeknownst to most people here."  Dearwent said additional research might prove an environmental link. And the study's lead researcher, Dr. Ronald Hoffman of the Mount Sinai School of Medicine in New York, said yesterday that the data do point to something in the environment.

"Based upon the data, there's significant concern that there is something in the environment leading to the development of polycythemia vera in that area. The nature of what's causing it is unknown at the moment and is going to require further study," he said. Dante Picciano, a lawyer and geneticist who is active in local environmental issues, said the data indicate a much larger problem than polycythemia vera. He wants study of a wide range of cancers and other diseases in the region. "This is the tip of the iceberg. It's inconceivable that you're going to have environmental exposures cause an increase in [only] one type of rare cancer," he said. Polycythemia vera, classified as a cancer, can lead to heart attack or stroke. About one case of polycythemia vera occurs each year for every 100,000 Americans. The cause is unknown. 

Local activists have raised suspicions about McAdoo Associates, about 80 miles northwest of Philadelphia, where a hazardous waste recycling business operated from 1975 to 1979 and accepted hundreds of thousands of gallons of paint sludge, waste oils, used solvents, PCBs, cyanide, pesticides, and many other known or suspected carcinogens. Environmental officials shut down the site in 1979, and it was later placed on the federal Superfund list and cleaned up. Residents fear that chemicals leached into the region's water supplies and polluted private wells and public reservoirs. State and federal environmental officials have said for years that the McAdoo site does not pose a health threat. Activists have also raised concerns about five power plants in Schuylkill County fueled by waste coal and about the practice of filling abandoned coal mines with ash created by coal-burning power plants. In October, officials from the Agency for Toxic Substances confirmed 38 cases of polycythemia vera in the region and said the rate was elevated. At the time, federal officials said there was no proof of an environmental cause, and that cases were scattered throughout the area in no predictable pattern - making the assertions in the abstract surprising. 

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