Women over 75 who learned more about the risks and benefits of mammogram screenings were less likely to go through with the test in a new study.
Women should have a mammogram — an X-ray of the breast tissue scanning for early signs of cancer — every two years between ages 50 and 74, according to the U.S. Centers for Disease Control.
According to the U.S. Preventive Services Task Force, a government-backed expert panel, there isn't enough evidence to recommend for or against mammograms for older women.
A woman's choice to have a mammogram past the age of 75 should be based on her life expectancy, risk of disease and personal preference, study author Mara A. Schonberg, M.D., said.
"Approximately, 20 percent of U.S. women 75 and older have less than five year life expectancy and these women should not be screened since they are very unlikely to benefit and can really only be harmed," she said.
"About two thirds of women 75 and over have less than 10 year life expectancy and some experts would argue that these women are also unlikely to benefit. About one third of women have more than 10-year life expectancy and it probably makes sense to recommend screening to these women."
Dr. Schonberg studies patient decision making at Beth Israel Deaconess Medical Center in Brookline, Massachusetts.
For the study, 45 women over age 75 who had been regularly having mammograms, as recommended by their doctors, but had not had one in the previous 5 months were given the decision aid — a packet of information on the risks and benefits of screening for women in their age group — before deciding at a doctor's appointment whether or not to schedule another screening.
The women filled out an experience survey before reading the packet and again after their doctor's appointment.
The packet included information on breast cancer risk for women over 75 and the risks of screening including false positives and costly and stressful follow up testing.
For older women, many tumors that a mammogram would find would actually grow too slowly to harm the woman in her lifetime, Dr. Schonberg said. But nearly all women with breast cancer are treated for it, and the risks of treatment increase with age.
Based on the two surveys, women tended to be more informed about the benefits and risks after reading the packet than before.
Before reading the decision aid, 37 of the 45 women planned on having a mammogram, compared to 25 out of 45 who planned to do so after reading it.
According to medical records, 26 of the women had a mammogram in the two years following the study.
Dr. Schonberg thinks it would be feasible to give this type of decision aid to all women over 75 as they make screening decisions, but "it requires our health care system placing greater value and resources in decision support for patients."
Giving the decision aid to women over 75 before a visit with their primary care doctor seemed to work well in the study, but in the real world it would take resources to identify these women and send them the information, she said.
"In practice, it may be faster for a physician to simply recommend a mammogram than to discuss patients' preferences around screening," she said. Doctors should be compensated for spending time discussing this issue with patient, she said.
"In addition, most of the educational materials regarding mammography screening have been uniformly positive. It takes a change in culture to acknowledge that there are both benefits and risks to screening and that each woman should be allowed to make an informed decision for herself."
All women should be informed of the risks and benefits of screening, she said, but especially those over 75, since there are more risks and uncertain benefits for this group.
The study did not follow the women to determine which, if any, were later diagnosed with breast cancer.
"Most women over age 75 should not get mammograms," H. Gilbert Welch, M.D., a professor of medicine at the Dartmouth Institute for Health Policy & Clinical Practice in Hanover, New Hampshire, said. "But this is not unique to mammography, or women," he said.
Dr. Welch authored another study on the risks of mammography screening for older women in the same issue of JAMA Internal Medicine. In it, he estimates that for 1,000 women who get annual mammograms starting at age 50 for 10 years, "0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly."
"As people get older — closer to death — there is less reason to look for cancer early," he said. "Most people, men and women, over age 75 should not be screened for cancer."
Wednesday, January 8, 2014
Panel Backs Yearly Scans for Older, Heavy Smokers
A highly influential government panel of experts says that older smokers at high risk of lung cancer should receive annual low-dose CT scans to help detect and possibly prevent the spread of the fatal disease.
In its final word on the issue published Dec. 30, the U.S. Preventive Services Task Force (USPSTF) concluded that the benefits to a very specific segment of smokers outweigh the risks involved in receiving the annual scans, said co-vice chair Dr. Michael LeFevre, a distinguished professor of family medicine at the University of Missouri.
Specifically, the task force recommended annual low-dose CT scans for current and former smokers aged 55 to 80 with at least a 30 "pack-year" history of smoking who have had a cigarette sometime within the last 15 years. The person also should be generally healthy and a good candidate for surgery should cancer be found, LeFevre said.
Editor's Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
About 20,000 of the United States' nearly 160,000 annual lung cancer deaths could be prevented if doctors follow these screening guidelines, LeFevre said when the panel first proposed the recommendations in July. Lung cancer found in its earliest stage is 80 percent curable, usually by surgical removal of the tumor.
"That's a lot of people, and we feel it's worth it, but there will still be a lot more people dying from lung cancer," LeFevre said. "That's why the most important way to prevent lung cancer will continue to be to convince smokers to quit."
Pack years are determined by multiplying the number of packs smoked daily by the number of years a person has smoked. For example, a person who has smoked two packs a day for 15 years has 30 pack years, as has a person who has smoked a pack a day for 30 years.
The USPSTF drew up the recommendation after a thorough review of previous research, and published them online Dec. 30 in the Annals of Internal Medicine.
"I think they did a very good analysis of looking at the pros and cons, the harms and benefits," Dr. Albert Rizzo, immediate past chair of the national board of directors of the American Lung Association, said at the time the draft recommendations were published in July. "They looked at a balance of where we can get the best bang for our buck."
The USPSTF is an independent volunteer panel of national health experts who issue evidence-based recommendations on clinical services intended to detect and prevent illness.
The task force has previously ruled on mammography, PSA testing and other types of screening. It reports to the U.S. Congress every year and its recommendations often serve as a basis for federal health care policy. Insurance companies often follow USPSTF recommendations as well.
Weighing heavily in the task force's latest decision were the results from the U.S. National Cancer Institute's 2011 National Lung Screening Trial. That study, which involved more than 53,000 smokers across the United States, found that annual low-dose CT screenings could prevent one of five lung cancer deaths.
The guidelines revolve around who is at highest risk for lung cancer and who would be able to benefit most from early detection.
Smoking is the biggest risk factor for lung cancer, and causes about 85 percent of lung cancers in the United States. The risk for developing lung cancer increases with age, with most lung cancers occurring in people aged 55 and older.
However, the task force decided to limit CT screenings just to people who either still smoke or quit smoking within the past 15 years. "If you quit more than 15 years ago, because the risk of lung cancer goes down every year from the time you quit smoking, we would take you out of that high-risk category," LeFevre said.
The task force also had to weigh the benefits of early cancer detection against the potential harm caused by regular exposure to radiation from the CT scans, said recommendation co-author Dr. Linda Humphrey, a professor of medicine and clinical epidemiology at Oregon Health & Science University and associate chief of medicine at the Portland VA Medical Center.
"The radiation associated with low-dose CT is on the order of the radiation associated with mammography," Humphrey said earlier this year. "It's not a short-term risk, it's a long-term risk."
She added that there are a fair number of false positives involved in CT scans for lung cancer. These can be resolved through screening, but that adds to the number of radiation exposures a patient will receive.
Editor's Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
The panel also had to weigh whether their recommendation would send the message to smokers that they now don't have to quit because screening measures will prevent their death from lung cancer.
"The main message of all this should be that you should stop smoking," said former lung association board chair Rizzo, who is section chief of pulmonary/critical care medicine at Christiana Care Health System in Newark, Del.
"If you have started and you can't quit, there is an ability to screen for that early lung cancer, but the screening does not mean we're going to catch the cancer before it does you harm," Rizzo said. "This is not an excuse for people to keep smoking, simply because they think they can get screened adequately."
In its final word on the issue published Dec. 30, the U.S. Preventive Services Task Force (USPSTF) concluded that the benefits to a very specific segment of smokers outweigh the risks involved in receiving the annual scans, said co-vice chair Dr. Michael LeFevre, a distinguished professor of family medicine at the University of Missouri.
Specifically, the task force recommended annual low-dose CT scans for current and former smokers aged 55 to 80 with at least a 30 "pack-year" history of smoking who have had a cigarette sometime within the last 15 years. The person also should be generally healthy and a good candidate for surgery should cancer be found, LeFevre said.
Editor's Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
About 20,000 of the United States' nearly 160,000 annual lung cancer deaths could be prevented if doctors follow these screening guidelines, LeFevre said when the panel first proposed the recommendations in July. Lung cancer found in its earliest stage is 80 percent curable, usually by surgical removal of the tumor.
"That's a lot of people, and we feel it's worth it, but there will still be a lot more people dying from lung cancer," LeFevre said. "That's why the most important way to prevent lung cancer will continue to be to convince smokers to quit."
Pack years are determined by multiplying the number of packs smoked daily by the number of years a person has smoked. For example, a person who has smoked two packs a day for 15 years has 30 pack years, as has a person who has smoked a pack a day for 30 years.
The USPSTF drew up the recommendation after a thorough review of previous research, and published them online Dec. 30 in the Annals of Internal Medicine.
"I think they did a very good analysis of looking at the pros and cons, the harms and benefits," Dr. Albert Rizzo, immediate past chair of the national board of directors of the American Lung Association, said at the time the draft recommendations were published in July. "They looked at a balance of where we can get the best bang for our buck."
The USPSTF is an independent volunteer panel of national health experts who issue evidence-based recommendations on clinical services intended to detect and prevent illness.
The task force has previously ruled on mammography, PSA testing and other types of screening. It reports to the U.S. Congress every year and its recommendations often serve as a basis for federal health care policy. Insurance companies often follow USPSTF recommendations as well.
Weighing heavily in the task force's latest decision were the results from the U.S. National Cancer Institute's 2011 National Lung Screening Trial. That study, which involved more than 53,000 smokers across the United States, found that annual low-dose CT screenings could prevent one of five lung cancer deaths.
The guidelines revolve around who is at highest risk for lung cancer and who would be able to benefit most from early detection.
Smoking is the biggest risk factor for lung cancer, and causes about 85 percent of lung cancers in the United States. The risk for developing lung cancer increases with age, with most lung cancers occurring in people aged 55 and older.
However, the task force decided to limit CT screenings just to people who either still smoke or quit smoking within the past 15 years. "If you quit more than 15 years ago, because the risk of lung cancer goes down every year from the time you quit smoking, we would take you out of that high-risk category," LeFevre said.
The task force also had to weigh the benefits of early cancer detection against the potential harm caused by regular exposure to radiation from the CT scans, said recommendation co-author Dr. Linda Humphrey, a professor of medicine and clinical epidemiology at Oregon Health & Science University and associate chief of medicine at the Portland VA Medical Center.
"The radiation associated with low-dose CT is on the order of the radiation associated with mammography," Humphrey said earlier this year. "It's not a short-term risk, it's a long-term risk."
She added that there are a fair number of false positives involved in CT scans for lung cancer. These can be resolved through screening, but that adds to the number of radiation exposures a patient will receive.
Editor's Note:Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
The panel also had to weigh whether their recommendation would send the message to smokers that they now don't have to quit because screening measures will prevent their death from lung cancer.
"The main message of all this should be that you should stop smoking," said former lung association board chair Rizzo, who is section chief of pulmonary/critical care medicine at Christiana Care Health System in Newark, Del.
"If you have started and you can't quit, there is an ability to screen for that early lung cancer, but the screening does not mean we're going to catch the cancer before it does you harm," Rizzo said. "This is not an excuse for people to keep smoking, simply because they think they can get screened adequately."
Many Women Still in Pain One Year After Breast Cancer Surgery
One year after breast cancer surgery, many women continue to experience pain, according to a new study.
Researchers revealed that the factors associated with the women's pain included chronic pain and depression before surgery, chemotherapy and radiation therapy.
"Persistent pain following breast cancer treatments remains a significant clinical problem despite improved treatment strategies," Dr. Tuomo Meretoja, of Helsinki University Central Hospital, and colleagues wrote in the report.
"Data on factors associated with persistent pain are needed to develop prevention and treatment strategies and to improve the quality of life for breast cancer patients," the study authors added.
The research, published in the Jan. 1 issue of the Journal of the American Medical Association, involved 860 women younger than 75 years of age who had undergone surgery for breast cancer that had not spread to other parts of their body.
The women were treated at the Helsinki University Central Hospital between 2006 and 2010. Of these women, most experienced some degree of pain up to one year after their operation, the authors noted in a university news release.
The researchers asked the women to complete a questionnaire 12 months after surgery to determine if they continued to experience pain following their treatment. If so, the women were asked to rate the severity of their discomfort.
The study revealed that one year after surgery, about one-third of the women reported no pain. The investigators found, however, that nearly 50 percent did experience mild pain, 12 percent had moderate pain, and almost 4 percent felt severe pain.
"These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment. To identify patients who would benefit from preventive interventions, a risk assessment tool is needed," Meretoja and colleagues concluded.
Researchers revealed that the factors associated with the women's pain included chronic pain and depression before surgery, chemotherapy and radiation therapy.
"Persistent pain following breast cancer treatments remains a significant clinical problem despite improved treatment strategies," Dr. Tuomo Meretoja, of Helsinki University Central Hospital, and colleagues wrote in the report.
"Data on factors associated with persistent pain are needed to develop prevention and treatment strategies and to improve the quality of life for breast cancer patients," the study authors added.
The research, published in the Jan. 1 issue of the Journal of the American Medical Association, involved 860 women younger than 75 years of age who had undergone surgery for breast cancer that had not spread to other parts of their body.
The women were treated at the Helsinki University Central Hospital between 2006 and 2010. Of these women, most experienced some degree of pain up to one year after their operation, the authors noted in a university news release.
The researchers asked the women to complete a questionnaire 12 months after surgery to determine if they continued to experience pain following their treatment. If so, the women were asked to rate the severity of their discomfort.
The study revealed that one year after surgery, about one-third of the women reported no pain. The investigators found, however, that nearly 50 percent did experience mild pain, 12 percent had moderate pain, and almost 4 percent felt severe pain.
"These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment. To identify patients who would benefit from preventive interventions, a risk assessment tool is needed," Meretoja and colleagues concluded.
Want to Quit Smoking? Here's Help
People who want to quit smoking cigarettes no longer have to suffer through cold-turkey withdrawal.
A number of options now exist, and though most have some side effects, experts generally believe that the benefits of quitting smoking far exceed the risks posed by side effects. Current options include:
Nicotine replacement therapy
A variety of nicotine replacement products have been approved by the U.S. Food and Drug Administration. They include the nicotine patch, gum, inhaler, lozenges and nasal spray, according to Hilary Tindle, director of the Tobacco Treatment Service at the University of Pittsburgh Medical Center.
Patches, gum and lozenges do not require a prescription. A doctor's prescription is necessary for nasal spray or the inhaler, according to the American Cancer Society.
Medications
Two medications can help smokers quit. One is bupropion (marketed as an antidepressant under the brand name Wellbutrin and as a quit-smoking aid under the brand name Zyban); the other is varenicline (Chantix). Tindle said that bupropion can be used in combination with nicotine replacement therapy, but that varenicline generally should not be, though she said there are rare exceptions to that rule. "Both varenicline and bupropion are effective," she said.
"Chantix has warnings for rare psychiatric side effects, but it's a very effective and wonderful drug that helps a lot of people quit smoking," said Dr. Gordon Strauss, a psychiatrist at Lenox Hill Hospital in New York City and founder of QuitGroups, a free smoking cessation service.
Alternative treatments
Alternative treatments also are available to help people quit smoking, including hypnosis and acupuncture. Tindle said there haven't been large trials on hypnosis or acupuncture so they're not included in national guidelines. But, she said that if the only downside to a treatment is the cost or the time involved, and someone really wants to try an alternative treatment, she doesn't discourage their use.
Social support
"The importance of social support has been minimized, but there are a lot of resources out there, like state quit lines," Strauss said. "It's a very important component of quitting."
Consider, for instance, 1-800-QuitNow, which connects you to your state quit line and guarantees five phone calls from a counselor to help you quit. Tindle said that people who called this number and took nicotine replacement therapy doubled their chances of successfully quitting smoking.
Electronic cigarettes
Although smoking cessation experts have yet to give e-cigarettes the green light, many consumers are already using them to become smoke-free. The devices use heat to turn nicotine and other chemicals into a vapor that's inhaled, much like smoking a cigarette. Most even look like a tobacco cigarette.
"E-cigarettes have been such a blessing in my life," said Elizabeth Phillips, a Philadelphia resident and former smoker. "I tried patches, gums and pills, and nothing worked. E-cigarettes combined with perseverance and the desire to quit helped me quit."
The bottom line?
Tindle and Strauss both emphasized that people shouldn't be discouraged if their first quit attempt isn't successful. For most people, it takes more than one try.
"Set a quit date, and realize that failure is part of the process," Strauss said. "Some people take up to 10 times to quit. Dieters know that when they're losing weight, it will take time. One day you may have a piece of apple pie, but the next day you start again. Relapses happen; be easy on yourself."
And as Tindle said, "Remember, no matter what your age, you'll benefit from quitting."
A number of options now exist, and though most have some side effects, experts generally believe that the benefits of quitting smoking far exceed the risks posed by side effects. Current options include:
Nicotine replacement therapy
A variety of nicotine replacement products have been approved by the U.S. Food and Drug Administration. They include the nicotine patch, gum, inhaler, lozenges and nasal spray, according to Hilary Tindle, director of the Tobacco Treatment Service at the University of Pittsburgh Medical Center.
Patches, gum and lozenges do not require a prescription. A doctor's prescription is necessary for nasal spray or the inhaler, according to the American Cancer Society.
Medications
Two medications can help smokers quit. One is bupropion (marketed as an antidepressant under the brand name Wellbutrin and as a quit-smoking aid under the brand name Zyban); the other is varenicline (Chantix). Tindle said that bupropion can be used in combination with nicotine replacement therapy, but that varenicline generally should not be, though she said there are rare exceptions to that rule. "Both varenicline and bupropion are effective," she said.
"Chantix has warnings for rare psychiatric side effects, but it's a very effective and wonderful drug that helps a lot of people quit smoking," said Dr. Gordon Strauss, a psychiatrist at Lenox Hill Hospital in New York City and founder of QuitGroups, a free smoking cessation service.
Alternative treatments
Alternative treatments also are available to help people quit smoking, including hypnosis and acupuncture. Tindle said there haven't been large trials on hypnosis or acupuncture so they're not included in national guidelines. But, she said that if the only downside to a treatment is the cost or the time involved, and someone really wants to try an alternative treatment, she doesn't discourage their use.
Social support
"The importance of social support has been minimized, but there are a lot of resources out there, like state quit lines," Strauss said. "It's a very important component of quitting."
Consider, for instance, 1-800-QuitNow, which connects you to your state quit line and guarantees five phone calls from a counselor to help you quit. Tindle said that people who called this number and took nicotine replacement therapy doubled their chances of successfully quitting smoking.
Electronic cigarettes
Although smoking cessation experts have yet to give e-cigarettes the green light, many consumers are already using them to become smoke-free. The devices use heat to turn nicotine and other chemicals into a vapor that's inhaled, much like smoking a cigarette. Most even look like a tobacco cigarette.
"E-cigarettes have been such a blessing in my life," said Elizabeth Phillips, a Philadelphia resident and former smoker. "I tried patches, gums and pills, and nothing worked. E-cigarettes combined with perseverance and the desire to quit helped me quit."
The bottom line?
Tindle and Strauss both emphasized that people shouldn't be discouraged if their first quit attempt isn't successful. For most people, it takes more than one try.
"Set a quit date, and realize that failure is part of the process," Strauss said. "Some people take up to 10 times to quit. Dieters know that when they're losing weight, it will take time. One day you may have a piece of apple pie, but the next day you start again. Relapses happen; be easy on yourself."
And as Tindle said, "Remember, no matter what your age, you'll benefit from quitting."
E-Cig Secondhand Vapor Less Harmful Than Tobacco Smoke
People standing near someone using an e-cigarette will be exposed to nicotine, but not to other chemicals found in tobacco cigarette smoke, according to a new study.
E-cigarettes, or electronic cigarettes, create a nicotine-rich vapor that can be inhaled, or 'vaped.'
Researchers and regulators have questioned whether e-cigarettes are a smoking cessation aid or may lure more young people toward smoking, as well as what effects they have on health.
"There is ongoing public debate whether e-cigarettes should be allowed or prohibited in public spaces," study co-author Maciej Goniewicz told Reuters Health in an email.
Goniewicz is a cancer researcher in the Department of Health Behavior at the Roswell Park Cancer Institute in Buffalo, New York.
"E-cigarettes contain variable amounts of nicotine and some traces of toxicants. But very little is known to what extent non-users can be exposed to nicotine and other chemicals in situations when they are present in the same room with users of e-cigarettes," Goniewicz said.
He and his colleagues conducted two studies of secondhand exposure to e-cigarette vapors in a laboratory. Their results were published in Nicotine and Tobacco Research.
In the first study, the researchers used an electronic smoking machine to generate vapor in an enclosed space. They measured the amount of nicotine as well as carbon monoxide and other potentially harmful gases and particles in the chamber.
The second study included five men who regularly smoked both tobacco cigarettes and e-cigarettes. Each man entered a room and smoked his usual brand of e-cigarette for two five-minute intervals over an hour while the researchers measured air quality. The room was cleaned and ventilated and the experiment was repeated with tobacco cigarettes.
The researchers measured nicotine levels of 2.5 micrograms per cubic meter of air in the first study. Nicotine levels from e-cigarettes in the second study were slightly higher at about 3.3 micrograms per cubic meter. But tobacco cigarette smoking resulted in nicotine levels ten times higher at almost 32 micrograms per cubic meter.
"The exposure to nicotine is lower when compared to exposure from tobacco smoke. And we also know that nicotine is relatively safer when compared to other dangerous toxicants in tobacco smoke," Goniewicz said.
E-cigarettes also produced some particulate matter, but regular cigarettes produced about seven times more. E-cigarettes didn't change the amount of carbon monoxide or other gases in the air.
"What we found is that non-users of e-cigarettes might be exposed to nicotine but not to many toxicants when they are in close proximity to e-cigarette users," said Goniewicz.
"It is currently very hard to predict what would be the health impact of such exposure," he added.
He said more research is needed to find out how the current findings correspond to "real-life" situations, when many people might be using e-cigarettes in a room with restricted ventilation.
"This is an interesting piece and points in the direction that a number of other studies are pointing, though it begins to expand the evidence on the potential effects to others," Amy Fairchild told Reuters Health in an email.
Fairchild was not involved in the new research, but has studied how e-cigarette use might impact views on regular cigarettes at the Columbia University Mailman School of Public Health in New York.
She said the study suggests e-cigarettes are far safer, both in terms of toxins and nicotine, than tobacco cigarettes when it comes to the health effects on bystanders - although more research is needed to know for sure.
"In locales considering extending smoking bans to e-cigarettes, I think that these data weaken the case for more sweeping bans," Fairchild said. "And so this begins to answer the question about why e-cigarettes are considered better: they reduce risks to both the user and to the bystander when compared to tobacco cigarettes."
Fairfield said the concern about vaping ultimately revolves around whether e-cigarettes are going to change broader patterns of smoking at the population level.
"There are potential harms, including promoting continued smoking of cigarettes and renormalizing cigarette smoking behaviors," Goniewicz said. "Regulatory agencies around the world will need to make a number of regulatory decisions about product safety that could have major effects on public health."
Goniewicz has received funding from a drug company that makes medications to aid smoking cessation. Another study author has received funds from an e-cigarette manufacturer.
E-cigarettes, or electronic cigarettes, create a nicotine-rich vapor that can be inhaled, or 'vaped.'
Researchers and regulators have questioned whether e-cigarettes are a smoking cessation aid or may lure more young people toward smoking, as well as what effects they have on health.
"There is ongoing public debate whether e-cigarettes should be allowed or prohibited in public spaces," study co-author Maciej Goniewicz told Reuters Health in an email.
Goniewicz is a cancer researcher in the Department of Health Behavior at the Roswell Park Cancer Institute in Buffalo, New York.
"E-cigarettes contain variable amounts of nicotine and some traces of toxicants. But very little is known to what extent non-users can be exposed to nicotine and other chemicals in situations when they are present in the same room with users of e-cigarettes," Goniewicz said.
He and his colleagues conducted two studies of secondhand exposure to e-cigarette vapors in a laboratory. Their results were published in Nicotine and Tobacco Research.
In the first study, the researchers used an electronic smoking machine to generate vapor in an enclosed space. They measured the amount of nicotine as well as carbon monoxide and other potentially harmful gases and particles in the chamber.
The second study included five men who regularly smoked both tobacco cigarettes and e-cigarettes. Each man entered a room and smoked his usual brand of e-cigarette for two five-minute intervals over an hour while the researchers measured air quality. The room was cleaned and ventilated and the experiment was repeated with tobacco cigarettes.
The researchers measured nicotine levels of 2.5 micrograms per cubic meter of air in the first study. Nicotine levels from e-cigarettes in the second study were slightly higher at about 3.3 micrograms per cubic meter. But tobacco cigarette smoking resulted in nicotine levels ten times higher at almost 32 micrograms per cubic meter.
"The exposure to nicotine is lower when compared to exposure from tobacco smoke. And we also know that nicotine is relatively safer when compared to other dangerous toxicants in tobacco smoke," Goniewicz said.
E-cigarettes also produced some particulate matter, but regular cigarettes produced about seven times more. E-cigarettes didn't change the amount of carbon monoxide or other gases in the air.
"What we found is that non-users of e-cigarettes might be exposed to nicotine but not to many toxicants when they are in close proximity to e-cigarette users," said Goniewicz.
"It is currently very hard to predict what would be the health impact of such exposure," he added.
He said more research is needed to find out how the current findings correspond to "real-life" situations, when many people might be using e-cigarettes in a room with restricted ventilation.
"This is an interesting piece and points in the direction that a number of other studies are pointing, though it begins to expand the evidence on the potential effects to others," Amy Fairchild told Reuters Health in an email.
Fairchild was not involved in the new research, but has studied how e-cigarette use might impact views on regular cigarettes at the Columbia University Mailman School of Public Health in New York.
She said the study suggests e-cigarettes are far safer, both in terms of toxins and nicotine, than tobacco cigarettes when it comes to the health effects on bystanders - although more research is needed to know for sure.
"In locales considering extending smoking bans to e-cigarettes, I think that these data weaken the case for more sweeping bans," Fairchild said. "And so this begins to answer the question about why e-cigarettes are considered better: they reduce risks to both the user and to the bystander when compared to tobacco cigarettes."
Fairfield said the concern about vaping ultimately revolves around whether e-cigarettes are going to change broader patterns of smoking at the population level.
"There are potential harms, including promoting continued smoking of cigarettes and renormalizing cigarette smoking behaviors," Goniewicz said. "Regulatory agencies around the world will need to make a number of regulatory decisions about product safety that could have major effects on public health."
Goniewicz has received funding from a drug company that makes medications to aid smoking cessation. Another study author has received funds from an e-cigarette manufacturer.
Can Nail Polish Give You Cancer?
Questions about the health risks of chemicals in nail polish are gaining new attention, The New York Times reports.
Concerns about potentially risky substances in nail polish were raised in 2006 when public health advocates began a nationwide campaign to raise awareness about three compounds in leading product brands — formaldehyde, a known carcinogen used as a hardening agent, and two materials linked to developmental defects: toluene, to evenly suspend color, and the plasticizer dibutyl phthalate, or DBP, to add flexibility and sheen.
In response to the campaign, many companies voluntarily removed these compounds from their products, but a 2012 investigation by the California Department of Toxic Substances Control found some simply changed their labels but continued using them. In addition, the European Union banned the use of DBP in cosmetics, but the Food and Drug Administration has not taken any regulatory action.
Editor's Note: Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
Janet Nudelman, co-founder of the Campaign for Safe Cosmetics, an advocacy group, said the concern is that some people may be at risk from being exposed to such chemicals, but acknowledges most products are safe for consumers.
"No one is saying that occasional application of nail polish will cause long-term health consequences," she told The Times. But some researchers have suggested there may be concerns for those who work in nail salons and children, who are particularly susceptible to phthalates like DBP that pose developmental risks.
In fact, some pediatricians now warn against letting young girls, especially those young enough to chew on their fingers, wear polish.
Concerns about potentially risky substances in nail polish were raised in 2006 when public health advocates began a nationwide campaign to raise awareness about three compounds in leading product brands — formaldehyde, a known carcinogen used as a hardening agent, and two materials linked to developmental defects: toluene, to evenly suspend color, and the plasticizer dibutyl phthalate, or DBP, to add flexibility and sheen.
In response to the campaign, many companies voluntarily removed these compounds from their products, but a 2012 investigation by the California Department of Toxic Substances Control found some simply changed their labels but continued using them. In addition, the European Union banned the use of DBP in cosmetics, but the Food and Drug Administration has not taken any regulatory action.
Editor's Note: Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
Janet Nudelman, co-founder of the Campaign for Safe Cosmetics, an advocacy group, said the concern is that some people may be at risk from being exposed to such chemicals, but acknowledges most products are safe for consumers.
"No one is saying that occasional application of nail polish will cause long-term health consequences," she told The Times. But some researchers have suggested there may be concerns for those who work in nail salons and children, who are particularly susceptible to phthalates like DBP that pose developmental risks.
In fact, some pediatricians now warn against letting young girls, especially those young enough to chew on their fingers, wear polish.
Can E-Cigarettes Help You Quit Tobacco Smoking?
It's the new year, a time when a smokers' thoughts often turn to quitting.
Some people may use that promise of a fresh start to trade their tobacco cigarettes for an electronic cigarette, a device that attempts to mimic the look and feel of a cigarette and often contains nicotine.
Here's what you need to know about e-cigarettes:
What is an e-cigarette?
The U.S. Food and Drug Administration (FDA) describes an e-cigarette as a battery-operated device that turns nicotine, flavorings and other chemicals into a vapor that can be inhaled. The ones that contain nicotine offer varying concentrations of nicotine. Most are designed to look like a tobacco cigarette, but some look like everyday objects, such as pens or USB drives, according to the FDA.
How does an e-cigarette work?
"Nicotine or flavorings are dissolved into propylene glycol usually, though it's hard to know for sure because they're not regulated," explained smoking cessation expert Dr. Gordon Strauss, founder of QuitGroups and a psychiatrist at Lenox Hill Hospital in New York City. "Then, when heated, you can inhale the vapor."
The process of using an e-cigarette is called "vaping" rather than smoking, according to Hilary Tindle, an assistant professor of medicine and director of the tobacco treatment service at the University of Pittsburgh Medical Center. She said that people who use electronic cigarettes are called "vapers" rather than smokers.
Although many e-cigarettes are designed to look like regular cigarettes, both Tindle and Strauss said they don't exactly replicate the smoking experience, particularly when it comes to the nicotine delivery. Most of the nicotine in e-cigarettes gets into the bloodstream through the soft tissue of your cheeks (buccal mucosa) instead of through your lungs, like it does with a tobacco cigarette.
"Nicotine from a regular cigarette gets to the brain much quicker, which may make them more addictive and satisfying," Strauss said.
Where can e-cigarettes be used?
"People want to use e-cigarettes anywhere they can't smoke," Strauss said. "I sat next to someone on a plane who was using an e-cigarette. He was using it to get nicotine during the flight." But he noted that just where it's OK to use an e-cigarette -- indoors, for instance? -- remains unclear.
Wherever they're used, though, he said it's unlikely that anyone would get more than a miniscule amount of nicotine secondhand from an e-cigarette.
Can an e-cigarette help people quit smoking?
That, too, seems to be an unanswered question. Tindle said that "it's too early to tell definitively that e-cigarettes can help people quit."
A study published in The Lancet in September was the first moderately sized, randomized and controlled trial of the use of e-cigarettes to quit smoking, she said. It compared nicotine-containing e-cigarettes to nicotine patches and to e-cigarettes that simply contained flavorings. The researchers found essentially no differences in the quit rates for the products after six months of use.
"E-cigarettes didn't do worse than the patch, and there were no differences in the adverse events," she said. "I would be happy if it turned out to be a safe and effective alternative for quitting, but we need a few more large trials for safety and efficacy."
Strauss noted that "although we can't say with certainty that e-cigarettes are an effective way to quit, people are using them" for that purpose. "Some people have told me that e-cigarettes are like a godsend," he said.
Former smoker Elizabeth Phillips would agree. She's been smoke-free since July 2012 with the help of e-cigarettes, which she used for about eight months after giving up tobacco cigarettes.
"E-cigarettes allowed me to gradually quit smoking without completely removing myself from the physical actions and social experience associated with smoking," Phillips said. "I consider my e-cigarette experience as a baby step that changed my life."
Are e-cigarettes approved or regulated by the government?
E-cigarettes are not currently regulated in a specific way by the FDA. The agency would like to change this, however, and last April filed a request for the authority to regulate e-cigarettes as a tobacco product.
The attorneys general of 40 states agree that electronic cigarettes should be regulated and sent a letter to the FDA in September requesting oversight of the products. They contend that e-cigarettes are being marketed to children; some brands have fruit and candy flavors or are advertising with cartoon characters. And, they note that the health effects of e-cigarettes have not been well-studied, especially in children.
Are e-cigarettes dangerous?
"It's not the nicotine in cigarettes that kills you, and the nicotine in e-cigarettes probably won't really hurt you either, but again, it hasn't been studied," Strauss said. "Is smoking something out of a metal and plastic container safer than a cigarette? Cigarettes are already so bad for you it's hard to imagine anything worse. But, it's a risk/benefit analysis. For a parent trying to quit, we know that secondhand smoke is a huge risk to kids, so if an electronic cigarette keeps you from smoking, maybe you'd be helping kids with asthma or saving babies."
But on the flip side, he said, in former smokers, using an e-cigarette could trigger the urge to smoke again.
The other big concern is children using e-cigarettes.
"More and more middle and high school kids are using e-cigarettes," Tindle said. "Some are smoking conventional cigarettes, too. The latest data from the CDC found the rate of teens reporting ever having used an e-cigarette doubled in just a year. We could be creating new nicotine addicts. We don't know what the addictive properties of e-cigarettes are," she added.
Some people may use that promise of a fresh start to trade their tobacco cigarettes for an electronic cigarette, a device that attempts to mimic the look and feel of a cigarette and often contains nicotine.
Here's what you need to know about e-cigarettes:
What is an e-cigarette?
The U.S. Food and Drug Administration (FDA) describes an e-cigarette as a battery-operated device that turns nicotine, flavorings and other chemicals into a vapor that can be inhaled. The ones that contain nicotine offer varying concentrations of nicotine. Most are designed to look like a tobacco cigarette, but some look like everyday objects, such as pens or USB drives, according to the FDA.
How does an e-cigarette work?
"Nicotine or flavorings are dissolved into propylene glycol usually, though it's hard to know for sure because they're not regulated," explained smoking cessation expert Dr. Gordon Strauss, founder of QuitGroups and a psychiatrist at Lenox Hill Hospital in New York City. "Then, when heated, you can inhale the vapor."
The process of using an e-cigarette is called "vaping" rather than smoking, according to Hilary Tindle, an assistant professor of medicine and director of the tobacco treatment service at the University of Pittsburgh Medical Center. She said that people who use electronic cigarettes are called "vapers" rather than smokers.
Although many e-cigarettes are designed to look like regular cigarettes, both Tindle and Strauss said they don't exactly replicate the smoking experience, particularly when it comes to the nicotine delivery. Most of the nicotine in e-cigarettes gets into the bloodstream through the soft tissue of your cheeks (buccal mucosa) instead of through your lungs, like it does with a tobacco cigarette.
"Nicotine from a regular cigarette gets to the brain much quicker, which may make them more addictive and satisfying," Strauss said.
Where can e-cigarettes be used?
"People want to use e-cigarettes anywhere they can't smoke," Strauss said. "I sat next to someone on a plane who was using an e-cigarette. He was using it to get nicotine during the flight." But he noted that just where it's OK to use an e-cigarette -- indoors, for instance? -- remains unclear.
Wherever they're used, though, he said it's unlikely that anyone would get more than a miniscule amount of nicotine secondhand from an e-cigarette.
Can an e-cigarette help people quit smoking?
That, too, seems to be an unanswered question. Tindle said that "it's too early to tell definitively that e-cigarettes can help people quit."
A study published in The Lancet in September was the first moderately sized, randomized and controlled trial of the use of e-cigarettes to quit smoking, she said. It compared nicotine-containing e-cigarettes to nicotine patches and to e-cigarettes that simply contained flavorings. The researchers found essentially no differences in the quit rates for the products after six months of use.
"E-cigarettes didn't do worse than the patch, and there were no differences in the adverse events," she said. "I would be happy if it turned out to be a safe and effective alternative for quitting, but we need a few more large trials for safety and efficacy."
Strauss noted that "although we can't say with certainty that e-cigarettes are an effective way to quit, people are using them" for that purpose. "Some people have told me that e-cigarettes are like a godsend," he said.
Former smoker Elizabeth Phillips would agree. She's been smoke-free since July 2012 with the help of e-cigarettes, which she used for about eight months after giving up tobacco cigarettes.
"E-cigarettes allowed me to gradually quit smoking without completely removing myself from the physical actions and social experience associated with smoking," Phillips said. "I consider my e-cigarette experience as a baby step that changed my life."
Are e-cigarettes approved or regulated by the government?
E-cigarettes are not currently regulated in a specific way by the FDA. The agency would like to change this, however, and last April filed a request for the authority to regulate e-cigarettes as a tobacco product.
The attorneys general of 40 states agree that electronic cigarettes should be regulated and sent a letter to the FDA in September requesting oversight of the products. They contend that e-cigarettes are being marketed to children; some brands have fruit and candy flavors or are advertising with cartoon characters. And, they note that the health effects of e-cigarettes have not been well-studied, especially in children.
Are e-cigarettes dangerous?
"It's not the nicotine in cigarettes that kills you, and the nicotine in e-cigarettes probably won't really hurt you either, but again, it hasn't been studied," Strauss said. "Is smoking something out of a metal and plastic container safer than a cigarette? Cigarettes are already so bad for you it's hard to imagine anything worse. But, it's a risk/benefit analysis. For a parent trying to quit, we know that secondhand smoke is a huge risk to kids, so if an electronic cigarette keeps you from smoking, maybe you'd be helping kids with asthma or saving babies."
But on the flip side, he said, in former smokers, using an e-cigarette could trigger the urge to smoke again.
The other big concern is children using e-cigarettes.
"More and more middle and high school kids are using e-cigarettes," Tindle said. "Some are smoking conventional cigarettes, too. The latest data from the CDC found the rate of teens reporting ever having used an e-cigarette doubled in just a year. We could be creating new nicotine addicts. We don't know what the addictive properties of e-cigarettes are," she added.
Combo Therapy Boosts Ovarian Cancer Survival
Women with recurrent ovarian cancer who are treated with a drug called decitabine before undergoing chemotherapy and a cancer vaccine fare better than those who receive a single therapy alone, new research has found.
According to a new study published in the journal Cancer Immunology Research and reported by Medical News Today, the combination of "chemoimmunotherapy" could give patients with ovarian cancer a new treatment option for the often fatal disease.
The research, led by Kunle Odunsi, M.D., of the Roswell Park Cancer Institute in Buffalo, indicates the combination boosts the immune system's ability to target a tumor antigen — a foreign protein present in cancer cells — called NY-ESO-1.
Dr. Odunsi said NY-ESO-1 is "one of the few tumor antigens that have restricted expression in normal tissues but become aberrantly expressed in epithelial ovarian cancers and other solid tumors."
The team recruited 12 women with epithelial ovarian cancer who did not benefit from multiple chemotherapy treatments. The women were given various doses of the drug decitabine and tracked to see if the medication would reprogram NY-ESO-1 and therefore trigger "vaccine-induced immunity."
Doxorubicin — a chemotherapy drug — was also given to the women after a week, while a cancer vaccine — made up of the NY-ESO-1 protein, montanide, known to boost the immune system and other proteins — after two weeks.
At the end of the study, more than half of the women were found to benefit and lived longer than expected.
"Although clinical results were not a focus of this phase I trial, we saw evidence of clinical benefit in up to 60 percent of the patients with chemotherapy-resistant tumors," Dr. Odunsi said. "The combination of [decitabine], chemotherapy, and cancer vaccine may have enabled this remarkable effect."
Based on their findings, Dr. Odunsi said patients with ovarian cancer should "actively seek" similar combination therapies.
"Even though the majority of these types of therapies are experimental at this point, there is enough scientific and clinical evidence to indicate that they are likely to be beneficial," he added.
According to a new study published in the journal Cancer Immunology Research and reported by Medical News Today, the combination of "chemoimmunotherapy" could give patients with ovarian cancer a new treatment option for the often fatal disease.
The research, led by Kunle Odunsi, M.D., of the Roswell Park Cancer Institute in Buffalo, indicates the combination boosts the immune system's ability to target a tumor antigen — a foreign protein present in cancer cells — called NY-ESO-1.
Dr. Odunsi said NY-ESO-1 is "one of the few tumor antigens that have restricted expression in normal tissues but become aberrantly expressed in epithelial ovarian cancers and other solid tumors."
The team recruited 12 women with epithelial ovarian cancer who did not benefit from multiple chemotherapy treatments. The women were given various doses of the drug decitabine and tracked to see if the medication would reprogram NY-ESO-1 and therefore trigger "vaccine-induced immunity."
Doxorubicin — a chemotherapy drug — was also given to the women after a week, while a cancer vaccine — made up of the NY-ESO-1 protein, montanide, known to boost the immune system and other proteins — after two weeks.
At the end of the study, more than half of the women were found to benefit and lived longer than expected.
"Although clinical results were not a focus of this phase I trial, we saw evidence of clinical benefit in up to 60 percent of the patients with chemotherapy-resistant tumors," Dr. Odunsi said. "The combination of [decitabine], chemotherapy, and cancer vaccine may have enabled this remarkable effect."
Based on their findings, Dr. Odunsi said patients with ovarian cancer should "actively seek" similar combination therapies.
"Even though the majority of these types of therapies are experimental at this point, there is enough scientific and clinical evidence to indicate that they are likely to be beneficial," he added.
New Leukemia Drug Works in Trial
Pharmacyclics Inc said its cancer drug, Imbruvica, met its main goal of increasing patients' survival without their cancer worsening in a late-stage trial.
The company's stock rose 5 percent at $110.60 on Tuesday on the Nasdaq after the company said an independent safety committee recommended an early halt of the trial.
The drug was being tested in patients with chronic lymphocytic leukemia, a rare form of blood cancer that primarily affects people aged 65 and older.
Pharmacyclics said it informed the U.S. Food and Drug Administration of the committee's recommendations, while its partner, Johnson & Johnson unit Janssen had informed the European regulators.
The company's stock rose 5 percent at $110.60 on Tuesday on the Nasdaq after the company said an independent safety committee recommended an early halt of the trial.
The drug was being tested in patients with chronic lymphocytic leukemia, a rare form of blood cancer that primarily affects people aged 65 and older.
Pharmacyclics said it informed the U.S. Food and Drug Administration of the committee's recommendations, while its partner, Johnson & Johnson unit Janssen had informed the European regulators.
Are We Winning War on Cancer? Death Risk Down 20 Percent
The risk of dying from cancer has declined 20 percent over the past two decades, according to the American Cancer Society's annual report out Tuesday.
However, cancer, a complex disease that has largely eluded attempts at a cure, will remain a top killer in 2014, taking some 1,600 US lives per day, it warned.
The group's yearly report is based on data from the Centers for Disease Control and Prevention, the National Cancer Institute and the National Center for Health Statistics.
The most common cancers for women are breast, lung and colon cancer, while in men they are prostate, lung and colon cancer, it said.
Breast cancer is expected to account for 29 percent of new cancers in women.
Lung cancer remains the most lethal, and is responsible for one in four cancer deaths among men and women combined.
The report predicts there will be 1,665,540 new cancer cases and 585,720 cancer deaths in the United States in 2014.
Over the past 20 years, cancer death rates have continually declined, avoiding more than 1.3 million deaths from 1991 to 2010.
The gains have been wider among men (952,700 lives saved) than women (387,700) over that time span.
Women are still getting cancer at about the same rate, at least over the past five years for which data are available (2006-2010), while in men cancer incidence has declined 0.6 percent per year.
Cancer death rates have fallen 1.8 percent per year in men and 1.4 percent in women over that five-year span.
The greatest success against cancer has been seen in African-American men aged 40 to 49, with a 55 percent decline in cancer death rates from 1991 to 2010.
"The halving of the risk of cancer death among middle aged black men in just two decades is extraordinary, but it is immediately tempered by the knowledge that death rates are still higher among black men than white men for nearly every major cancer and for all cancers combined," said John Seffrin, chief executive officer of the American Cancer Society.
"The progress we are seeing is good, even remarkable, but we can and must do even better."
However, cancer, a complex disease that has largely eluded attempts at a cure, will remain a top killer in 2014, taking some 1,600 US lives per day, it warned.
The group's yearly report is based on data from the Centers for Disease Control and Prevention, the National Cancer Institute and the National Center for Health Statistics.
The most common cancers for women are breast, lung and colon cancer, while in men they are prostate, lung and colon cancer, it said.
Breast cancer is expected to account for 29 percent of new cancers in women.
Lung cancer remains the most lethal, and is responsible for one in four cancer deaths among men and women combined.
The report predicts there will be 1,665,540 new cancer cases and 585,720 cancer deaths in the United States in 2014.
Over the past 20 years, cancer death rates have continually declined, avoiding more than 1.3 million deaths from 1991 to 2010.
The gains have been wider among men (952,700 lives saved) than women (387,700) over that time span.
Women are still getting cancer at about the same rate, at least over the past five years for which data are available (2006-2010), while in men cancer incidence has declined 0.6 percent per year.
Cancer death rates have fallen 1.8 percent per year in men and 1.4 percent in women over that five-year span.
The greatest success against cancer has been seen in African-American men aged 40 to 49, with a 55 percent decline in cancer death rates from 1991 to 2010.
"The halving of the risk of cancer death among middle aged black men in just two decades is extraordinary, but it is immediately tempered by the knowledge that death rates are still higher among black men than white men for nearly every major cancer and for all cancers combined," said John Seffrin, chief executive officer of the American Cancer Society.
"The progress we are seeing is good, even remarkable, but we can and must do even better."
Drug Combo Helps Smokers Quit
Two drugs in combination might be better than one when it comes to helping hardcore smokers quit, at least in the short term, a new study suggests.
The drugs -- varenicline (sold under the brand name Chantix) and bupropion (Wellbutrin) -- taken together increase the rates of quitting over 12 weeks compared with Chantix alone, the researchers found. After a year, however, relapse rates were similar using both approaches.
"We believe this evidence strongly supports the idea that varenicline helps everybody quit," said lead researcher Dr. Jon Ebbert, a professor of medicine at the Mayo Clinic in Rochester, Minn. "But for heavier smokers and more dependent smokers, combination therapy with varenicline plus bupropion will increase quit rates more than varenicline alone."
"This is how we are going to treat patients," he said.
Combination therapy works better than a single medication because the two drugs act in different ways, Ebbert said.
"With any addiction there are multiple parts of the brain involved," he said. "These drugs have different effects on the brain. Perhaps one of the keys to treatment of any addiction may be to target different parts of the brain to increase success."
The study, published in the Jan. 8 issue of the Journal of the American Medical Association, found that although many quitters relapsed, a significant number who had combination therapy didn't take up the habit again.
"You're looking at a 30 percent quit rate [with combination therapy] versus a 24 percent quit rate [with one drug]," Ebbert said.
It's not surprising that many people eventually reached for cigarettes again, he said.
"Relapse is part of the addiction process," Ebbert said. "The important part of long-term treatment of these patients is to re-engage them in the quitting process and use different types of medication in combination with each other to increase quit rates."
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said breaking an entrenched smoking habit likely will take more than drug therapy.
"Behavioral therapies clearly need to be considered," Horovitz said.
Ebbert agreed, and said counseling to help patients overcome some behavioral aspects of tobacco addiction was offered to all of the study participants.
Dr. Sidney Braman, a senior faculty member in pulmonary, critical care and sleep medicine at Mount Sinai Hospital in New York City, said most smokers who eventually quit have tried an average of six times to break the habit.
"Most trials of smoking cessation have shown that the long-term success rate is a tough nut to crack," he said.
Braman said he anticipates that significant advances in understanding -- and therefore treating -- addiction will be made in the near future.
Until then, Braman said, "You have to try again and again and again."
For the study, 315 smokers were randomly selected to take Chantix and Wellbutrin or Chantix and a placebo for 12 weeks.
Ebbert's team found that 53 percent of those taking both drugs had quit smoking after 12 weeks, compared with about 43 percent of those taking Chantix alone.
After about six months, 37 percent of people in the two-drug group remained smoke-free, compared with 28 percent of those who took Chantix alone.
After a year, however, the difference narrowed, with about 31 percent in the combination group and about 25 percent of those taking Chantix alone still not smoking, the researchers found.
More patients using the combination treatment reported anxiety and depression than those taking only Chantix. "Those are important symptoms to monitor, but we don't feel it's more than would occur with normal treatment," Ebbert said.
Smoking accounts for 62 percent of deaths among women smokers and 60 percent of deaths among men who smoke, the researchers said.
The drugs -- varenicline (sold under the brand name Chantix) and bupropion (Wellbutrin) -- taken together increase the rates of quitting over 12 weeks compared with Chantix alone, the researchers found. After a year, however, relapse rates were similar using both approaches.
"We believe this evidence strongly supports the idea that varenicline helps everybody quit," said lead researcher Dr. Jon Ebbert, a professor of medicine at the Mayo Clinic in Rochester, Minn. "But for heavier smokers and more dependent smokers, combination therapy with varenicline plus bupropion will increase quit rates more than varenicline alone."
"This is how we are going to treat patients," he said.
Combination therapy works better than a single medication because the two drugs act in different ways, Ebbert said.
"With any addiction there are multiple parts of the brain involved," he said. "These drugs have different effects on the brain. Perhaps one of the keys to treatment of any addiction may be to target different parts of the brain to increase success."
The study, published in the Jan. 8 issue of the Journal of the American Medical Association, found that although many quitters relapsed, a significant number who had combination therapy didn't take up the habit again.
"You're looking at a 30 percent quit rate [with combination therapy] versus a 24 percent quit rate [with one drug]," Ebbert said.
It's not surprising that many people eventually reached for cigarettes again, he said.
"Relapse is part of the addiction process," Ebbert said. "The important part of long-term treatment of these patients is to re-engage them in the quitting process and use different types of medication in combination with each other to increase quit rates."
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said breaking an entrenched smoking habit likely will take more than drug therapy.
"Behavioral therapies clearly need to be considered," Horovitz said.
Ebbert agreed, and said counseling to help patients overcome some behavioral aspects of tobacco addiction was offered to all of the study participants.
Dr. Sidney Braman, a senior faculty member in pulmonary, critical care and sleep medicine at Mount Sinai Hospital in New York City, said most smokers who eventually quit have tried an average of six times to break the habit.
"Most trials of smoking cessation have shown that the long-term success rate is a tough nut to crack," he said.
Braman said he anticipates that significant advances in understanding -- and therefore treating -- addiction will be made in the near future.
Until then, Braman said, "You have to try again and again and again."
For the study, 315 smokers were randomly selected to take Chantix and Wellbutrin or Chantix and a placebo for 12 weeks.
Ebbert's team found that 53 percent of those taking both drugs had quit smoking after 12 weeks, compared with about 43 percent of those taking Chantix alone.
After about six months, 37 percent of people in the two-drug group remained smoke-free, compared with 28 percent of those who took Chantix alone.
After a year, however, the difference narrowed, with about 31 percent in the combination group and about 25 percent of those taking Chantix alone still not smoking, the researchers found.
More patients using the combination treatment reported anxiety and depression than those taking only Chantix. "Those are important symptoms to monitor, but we don't feel it's more than would occur with normal treatment," Ebbert said.
Smoking accounts for 62 percent of deaths among women smokers and 60 percent of deaths among men who smoke, the researchers said.
Sex As Good As Sports for Burning Calories
If you're looking to drop a few pounds that you gained during the holidays and don't feel like heading to the gym, work it off in bed. According to an article published in London's Telegraph, a study at Canada's University of Quebec found that sex is as beneficial for burning calories as many forms of exercise, such as a vigorous uphill walk, and is a lot more fun!
The study involved 20 heterosexual couples who were asked to have sex once a week for a month and also to jog on a treadmill for 30 minutes. According to the Telegraph, they wore armbands during both activities to measure how much energy their bodies used. They also filled out questionnaires on how much they enjoyed both activities.
While subjects burned twice as many calories on the treadmill as they burned having sex, the number of calories burned was roughly the same during sex as playing tennis or walking uphill.
"These results suggest that sexual activity may potentially be considered, at times, as a significant exercise," the authors wrote. "Moreover, both men and women reported that sexual activity was highly enjoyable and more appreciated than the 30 min exercise session on the treadmill. Therefore, this study could have implications for the planning of intervention programs as part of a healthy lifestyle by health care professionals."
The study involved 20 heterosexual couples who were asked to have sex once a week for a month and also to jog on a treadmill for 30 minutes. According to the Telegraph, they wore armbands during both activities to measure how much energy their bodies used. They also filled out questionnaires on how much they enjoyed both activities.
While subjects burned twice as many calories on the treadmill as they burned having sex, the number of calories burned was roughly the same during sex as playing tennis or walking uphill.
"These results suggest that sexual activity may potentially be considered, at times, as a significant exercise," the authors wrote. "Moreover, both men and women reported that sexual activity was highly enjoyable and more appreciated than the 30 min exercise session on the treadmill. Therefore, this study could have implications for the planning of intervention programs as part of a healthy lifestyle by health care professionals."
Americans Living Longer Than Ever: CDC
Americans are living longer than ever and their life expectancy is increasing every year, federal health officials reported Monday.
People born in 2009 can expect to live 78.5 years. That's an increase from just a year before (when life expectancy at birth was 78.1 years). Since these data were collected, life expectancy has increased even more, according to the U.S. Centers for Disease Control and Prevention website, and now stands at 78.7 years.
"To the extent that we all want a bounty of years in life, this report conveys encouraging news. Life expectancy at birth in the U.S. is rising for all groups," said Dr. David Katz, director of the Yale University Prevention Research Center. He had no part in the report.
In the years covered by the current report, life expectancy increased for both men and women. For males, life expectancy went from 75.6 years for those born in 2008 to 76 years for those born in 2009. For females, it went from 80.6 years to 80.9 years, according to the report from the U.S. National Center for Health Statistics, part of the CDC.
Life expectancy also rose by race -- for whites from 78.5 years in 2008 to 78.8 years in 2009; for blacks, from 74 years to 74.5 years; and for Hispanics, from 81 years to 81.2 years, the researchers found.
"But there are some dark clouds swirling around the silver linings of data. Disparities in life expectancy persist, both between women and men, and between whites and blacks," Katz said.
Life expectancy in the United States is still lower than for many developed countries around the world, he said.
"More importantly, this report is only about years in life, not about life in years," Katz said, raising the question of quality of life.
A recent analysis by the Institute of Medicine suggests that increases in life span in the United States are not matched by increases in "health span" -- time spent living in good health, Katz said.
"A long life with a high burden of chronic disease -- such as diabetes, heart disease and chronic obstructive pulmonary disease (COPD) -- means more time living with illness and disability," he noted.
Life expectancy is greatly influenced by advances in medicine and the public health system, while the health span is most affected by lifestyle practices, in particular the quality of diet, physical activity and avoiding tobacco, Katz explained.
"The next chapter in medical advance will need to be as much about lifestyle as medicine if we are to add life to years along with years to life," he said.
People born in 2009 can expect to live 78.5 years. That's an increase from just a year before (when life expectancy at birth was 78.1 years). Since these data were collected, life expectancy has increased even more, according to the U.S. Centers for Disease Control and Prevention website, and now stands at 78.7 years.
"To the extent that we all want a bounty of years in life, this report conveys encouraging news. Life expectancy at birth in the U.S. is rising for all groups," said Dr. David Katz, director of the Yale University Prevention Research Center. He had no part in the report.
In the years covered by the current report, life expectancy increased for both men and women. For males, life expectancy went from 75.6 years for those born in 2008 to 76 years for those born in 2009. For females, it went from 80.6 years to 80.9 years, according to the report from the U.S. National Center for Health Statistics, part of the CDC.
Life expectancy also rose by race -- for whites from 78.5 years in 2008 to 78.8 years in 2009; for blacks, from 74 years to 74.5 years; and for Hispanics, from 81 years to 81.2 years, the researchers found.
"But there are some dark clouds swirling around the silver linings of data. Disparities in life expectancy persist, both between women and men, and between whites and blacks," Katz said.
Life expectancy in the United States is still lower than for many developed countries around the world, he said.
"More importantly, this report is only about years in life, not about life in years," Katz said, raising the question of quality of life.
A recent analysis by the Institute of Medicine suggests that increases in life span in the United States are not matched by increases in "health span" -- time spent living in good health, Katz said.
"A long life with a high burden of chronic disease -- such as diabetes, heart disease and chronic obstructive pulmonary disease (COPD) -- means more time living with illness and disability," he noted.
Life expectancy is greatly influenced by advances in medicine and the public health system, while the health span is most affected by lifestyle practices, in particular the quality of diet, physical activity and avoiding tobacco, Katz explained.
"The next chapter in medical advance will need to be as much about lifestyle as medicine if we are to add life to years along with years to life," he said.
Colon Cancer: Online Test Reveals Your Risk
The Cleveland Clinic has developed an online tool that provides a quick, accurate estimate of the risk of developing colorectal cancer.
The so-called CRC-PRO tool — short for Colorectal Cancer Predicted Risk Online — is designed to help patients and physicians alike determine when screening for colorectal cancer is appropriate. Current guidelines recommend patients be screened at the age of 50 with a colonoscopy and other procedures.
Editor's Note: Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
But the new tool can help physicians better identify who is truly at risk and when screenings for patients are necessary, based on individual risk factors — including family history of the disease, gender, and race.
"Creating a risk calculator that includes multiple risk factors offers clinicians a means to more accurately predict risk than the simple age-based cutoffs currently used in clinical practice," said Brian Wells, M.D., of the Department of Quantitative Health Sciences in Cleveland Clinic's Lerner Research Institute, who helped develop the tool. "Clinicians could decide to screen high-risk patients earlier than age 50, while delaying or foregoing screening in low-risk individuals."
To create the calculator, Dr. Wells and his team analyzed data on more than 180,000 patients from a study conducted at the University of Hawaii. Patients were followed for up to 11.5 years to determine which factors were highly associated with the development of colorectal cancer.
In a report on the project, published in the Journal of the American Board of Family Medicine, Dr. Wells said the new, user-friendly calculator will help improve the efficiency of colorectal cancer screenings and lower healthcare costs by cutting down on unnecessary testing.
"The development of risk prediction calculators like the CRC-PRO is vital for improving medical decision-making," said Michael Kattan, chairman of the Department of Quantitative Health Sciences in Cleveland Clinic's Lerner Research Institute. "Tools like this represent another step toward personalized medicine that will ultimately improve efficiency, outcomes and patient care."
Cleveland Clinic researchers are involved in the creation of numerous risk prediction tools, including heart disease and cancers of the breast, prostate, and thyroid — in addition to the new colorectal cancer test. All are available online here.
Editor's Note: Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
The so-called CRC-PRO tool — short for Colorectal Cancer Predicted Risk Online — is designed to help patients and physicians alike determine when screening for colorectal cancer is appropriate. Current guidelines recommend patients be screened at the age of 50 with a colonoscopy and other procedures.
Editor's Note: Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
But the new tool can help physicians better identify who is truly at risk and when screenings for patients are necessary, based on individual risk factors — including family history of the disease, gender, and race.
"Creating a risk calculator that includes multiple risk factors offers clinicians a means to more accurately predict risk than the simple age-based cutoffs currently used in clinical practice," said Brian Wells, M.D., of the Department of Quantitative Health Sciences in Cleveland Clinic's Lerner Research Institute, who helped develop the tool. "Clinicians could decide to screen high-risk patients earlier than age 50, while delaying or foregoing screening in low-risk individuals."
To create the calculator, Dr. Wells and his team analyzed data on more than 180,000 patients from a study conducted at the University of Hawaii. Patients were followed for up to 11.5 years to determine which factors were highly associated with the development of colorectal cancer.
In a report on the project, published in the Journal of the American Board of Family Medicine, Dr. Wells said the new, user-friendly calculator will help improve the efficiency of colorectal cancer screenings and lower healthcare costs by cutting down on unnecessary testing.
"The development of risk prediction calculators like the CRC-PRO is vital for improving medical decision-making," said Michael Kattan, chairman of the Department of Quantitative Health Sciences in Cleveland Clinic's Lerner Research Institute. "Tools like this represent another step toward personalized medicine that will ultimately improve efficiency, outcomes and patient care."
Cleveland Clinic researchers are involved in the creation of numerous risk prediction tools, including heart disease and cancers of the breast, prostate, and thyroid — in addition to the new colorectal cancer test. All are available online here.
Editor's Note: Knowing these 5 cancer-causing signs is crucial to remaining cancer-free for life
Obesity Rates Grow Faster in Poor Countries Than Rich Ones
Obesity rates are rising worldwide, but are increasing faster in poorer developing countries than in wealthy ones, researchers from the Overseas Development Institute say.
In a report titled "Future Diets," Sharada Keats and Steve Wiggins found that obesity rates tripled in developing countries between 1980 and 2008, while rates only climbed 1.7 times in high-income countries during the same period, the Huffington Post reported.
"The evidence is well-established: obesity, together with excessive consumption of fat and salt, is linked to the rising global incidence of non-communicable diseases including some cancers, diabetes, heart disease and strokes, " the report summary reads. "What has changed is that the majority of people who are overweight or obese today can be found in the developing, rather than the developed, world."
Researchers found that North Africa, the Middle East, and Latin America now have almost the same percentage of overweight or obese people as Europe, the researchers found.
"In countries with higher average incomes, more attention is being paid to the quality of the diet, and in particular whether it contains enough micronutrients and whether there is a good balance between the major food groups," they said.
Even so, one in three adults around the world is obese or overweight, the researchers found.
"Even in high-income countries, people on low incomes may struggle to eat diets rich in fresh fruits and vegetables. Very often, the cheapest foods are processed and are high in fats and sugars, with a high energy content per dollar spent, but they are low in micronutrients," they wrote.
"In Seattle, for instance, those who spent less on their food had diets that were nutritionally inferior, which may explain why those on lower incomes do not tend to follow dietary guidelines and have the highest rates of diet-related chronic disease."
In a report titled "Future Diets," Sharada Keats and Steve Wiggins found that obesity rates tripled in developing countries between 1980 and 2008, while rates only climbed 1.7 times in high-income countries during the same period, the Huffington Post reported.
"The evidence is well-established: obesity, together with excessive consumption of fat and salt, is linked to the rising global incidence of non-communicable diseases including some cancers, diabetes, heart disease and strokes, " the report summary reads. "What has changed is that the majority of people who are overweight or obese today can be found in the developing, rather than the developed, world."
Researchers found that North Africa, the Middle East, and Latin America now have almost the same percentage of overweight or obese people as Europe, the researchers found.
"In countries with higher average incomes, more attention is being paid to the quality of the diet, and in particular whether it contains enough micronutrients and whether there is a good balance between the major food groups," they said.
Even so, one in three adults around the world is obese or overweight, the researchers found.
"Even in high-income countries, people on low incomes may struggle to eat diets rich in fresh fruits and vegetables. Very often, the cheapest foods are processed and are high in fats and sugars, with a high energy content per dollar spent, but they are low in micronutrients," they wrote.
"In Seattle, for instance, those who spent less on their food had diets that were nutritionally inferior, which may explain why those on lower incomes do not tend to follow dietary guidelines and have the highest rates of diet-related chronic disease."
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