HEALTHCARE & LAW
Legal Experts Offer Predictions on Fate
of Health-Reform Legislation
Provision that adults must have insurance seen at risk during
Supreme Court review, but maybe not the whole law.
Now comes the hard part.
Following three days of
arguments that ended Wednesday over the constitutionality of the health-reform
legislation passed by Congress in 2010, the nine justices of the U.S. Supreme
Court will settle in to decide whether the entire law -- or key provisions --
can stand.
Their decision is expected
in June.
Equally hard is trying to
predict just how the justices -- typically described as four conservatives,
four liberals and one "swing" member -- will vote on the polarizing
legislation.
Twenty-six states have
challenged the constitutionality of the law, primarily over two provisions -- a
requirement that most adults have health insurance by 2014 or face a penalty,
and an expansion of Medicaid, the government-run insurance program for
lower-income individuals.
Arguments over those
provisions dominated much of this week's hearing before the high court.
"It's very hard to
tell what can happen as a result of the oral arguments. [Justice Samuel] Alito
has moved firmly into my 'no' vote column. But I think [Chief Justice John]
Roberts and [Justice Anthony] Kennedy are still possible votes to uphold the
statute," said Renee Landers, a professor at Suffolk University Law School
in Boston, who wrote a recent commentary on the law in the New England
Journal of Medicine.
"I think we learned
from the oral arguments that definitely the four Democratic appointees --
[Justice Ruth Bader] Ginsburg, [Justice Stephen] Breyer, [Justice Sonia]
Sotomayor and [Justice Elena] Kagan -- will definitely vote to uphold every
part of the statute," she said.
But another legal expert
said it can be risky to read too much into what the justices had to say this
week.
"Before the arguments
started, if you asked me my prediction, I would have told you that I thought it
would be a very close case and I would put my money on the court upholding the
law by a 5-4 decision -- and that's still what I would say," said Gregory
Magarian, a professor at Washington University School of Law in St. Louis.
Still, Magarian had this
caution: "It's hard to look at it and say it's a slam-dunk that they're
going to uphold the thing."
Even before this week's
arguments, Stephen Presser, a professor of legal history at Northwestern University
School of Law, predicted that the Supreme Court would find the health-reform
law unconstitutional.
Now, "it's even more
likely than I thought it was before," Presser said. "What we've got
is five justices, ones we suspected -- Roberts, Alito, Scalia, [Clarence]
Thomas and Kennedy -- all expressing skepticism and, indeed, all five perhaps
hinting that throwing out the whole Affordable Care Act is the right move in
this case," he added.
"The clear message is
that the 10th Amendment [which concerns the division of powers between the
federal and state governments] still has some teeth," Presser said.
Allison Orr Larsen, an
assistant professor of law at the College of William & Mary in
Williamsburg, Va., said she expected the hearings to be "spirited and lengthy"
and she wasn't disappointed. But, she added, "What seems like a surprise
is that the press should be calling [the court's decision] already, which seems
a dubious endeavor. It's hard to predict Supreme Court opinions based on oral
arguments alone."
The Patient Protection and
Affordable Care Act is the most ambitious government health-care initiative
since the Medicare and Medicaid programs of the 1960s. Key provisions of the
2,409-page law include:
·
The so-called -- and highly
controversial -- individual mandate, which requires almost all adults to have
health insurance by 2014 or pay a penalty. Up to 16 million people are
projected to join the rolls of the insured under the mandate.
·
Medicaid expansion. This
would increase eligibility to all people under age 65 with annual incomes up to
133 percent of the federal poverty level -- about $14,850 for a single adult
and $30,650 for a family of four in 2012. Another 16 million people are
estimated to gain insurance under the expansion. The 26 states challenging the
law contend that this expansion is a coercive move by the federal government
and one that states can't afford.
·
State-run insurance
exchanges. They will be created to help small businesses and individuals buy
insurance through a more organized and competitive market.
Individual mandate appears
to be at risk
One thing became very clear
during this week's legal challenges -- the provision that almost all adult
Americans have health insurance or face a financial penalty may be in jeopardy.
Robert Field, a professor
of law in the department of health management and policy at Drexel University's
School of Public Health, said the individual mandate seems at greater risk than
it did prior to this week's arguments before the court.
"One of the
interesting aspects of the oral arguments is -- this one anyway -- it's more
important what the justices revealed to us than what the lawyers revealed to
the justices," Field said.
Regarding Justice Kennedy,
considered the swing vote, Field said: "Based on [Tuesday's arguments], I
predict he would rule against it [the mandate]. Of course, I have to preface
that by saying that predictions are always dangerous."
He added, however, "I
would predict that they will not rule against the act as a whole. There's just
too much there that is clearly unrelated to the mandate."
Landers thinks the mandate
itself might survive. "I don't think all bets are off yet," she said.
"Reports of its demise are premature."
Supporters of the
individual mandate argue that without the requirement that people have
insurance coverage while they're healthy, there won't be enough money in the
risk pool to pay to take care of them when the need for health care eventually
-- and inevitably -- arises.
No agreement on whether the
law can survive without mandate
Landers believes that even
if the individual mandate were to fall, the rest of the law will still stand.
"Both Justice Kennedy
and Chief Justice Roberts made this point each a couple of times during the
arguments: there has to be deference to Congress, and the court is not in the
place of second-guessing the alternatives Congress has chosen," she said.
"The court overturning a congressional statute is a big deal."
But Northwestern's Presser
suggested that if the individual mandate is thrown out, some of the court's
four liberal justices might join with the conservatives in voting against the
whole act.
The Affordable Care Act has
been controversial since it was passed by Congress and signed by President
Barack Obama in March 2010. Numerous polls have found that Americans especially
don't like the individual mandate. But a recent Harris Interactive/HealthDay
poll found that people are starting to accept certain key provisions of the law
-- such as the ban on insurance companies turning away applicants with
preexisting health problems.
On Wednesday, the court debated
whether the health-reform law could function without the individual mandate.
Justice Scalia referred to it as the "heart" of the statute. And if
the mandate were ruled unconstitutional, Justice Ginsburg said the court would
be left with a choice between "a wrecking operation" and "a
salvage job," The New York Times reported.
But Landers said that the
law's three mechanisms to insure more Americans -- the individual mandate, the
expansion of Medicaid, and the government-run insurance exchanges -- don't
depend on one another.
"Would it be better if
all three worked in tandem? Yes," she said. "Does it totally
undermine what Congress is trying to do if one piece of it falls out? No."
Drexel's Field said
"the guts of the health reform plan are really the guaranteed issue
provision -- that insurers can't deny coverage for preexisting conditions --
and the community-rating provision saying that they have to charge rates that
are spread out over the community."
As for the Medicaid
expansion, Landers and Magarian believe that it's safe, unless the entire law
is ruled unconstitutional.
"Well, I don't want to
say that, because a couple of months ago I would have said the mandate is
fairly invulnerable," Field noted. "But I think the Medicaid
expansion rests on stronger ground. For one thing, it's been upheld by every
single lower court that's considered the issue."
More information
Visit George Washington
University School of Law to learn about the opinion-writing
process for the U.S. Supreme Court
.
(SOURCES: Renee M. Landers,
J.D., professor of law, Suffolk University Law School, Boston; Robert Field,
J.D., Ph.D., professor of law, department of health management and policy,
School of Public Health, Drexel University, Philadelphia; Gregory Magarian, J.D.,
professor of law, School of Law, Washington University in St. Louis; Stephen
Presser, J.D., Raoul Berger Professor of Legal History, Northwestern University
School of Law, Chicago; Allison Orr Larsen, J.D., assistant professor of law,
College of William & Mary, Williamsburg, Va.; The New York Times)
HEALTH & STROKE
NEWS
Heavier Baby Girls at Higher Risk for
Diabetes, Heart Woes as Adults
Study found that as teens, they have larger waist size, higher
blood levels of insulin, fat.
Overweight female babies
are at increased risk for cardiovascular disease and diabetes in adulthood, a
new study suggests.
Researchers looked at more
than 1,000 17-year-olds in Australia who had been followed since birth. The
goal was to examine whether birth weight and body fat distribution in early
childhood was associated with future health risk factors such as obesity,
insulin resistance and high blood pressure.
The study found that teen
girls with larger waist circumference, higher levels of insulin and
triglycerides (a type of fat found in the blood), and lower levels of
"good" HDL cholesterol were heavier from birth than other girls.
Birth weight and body fat
distribution in early childhood seemed to have no impact on these risk factors
in males, the authors noted.
The study will be published
in the June issue of the Journal of Clinical Endocrinology & Metabolism.
"What happens to a
baby in the womb affects future heart disease and diabetes risk when the child
grows up," lead author Dr. Rae-Chi Huang of the University of Western
Australia in Perth, said in a news release from the Endocrine Society.
"We found that female
babies are particularly prone to this increased risk, and females who are at
high risk of obesity and diabetes-related conditions at age 17 are showing
increased obesity as early as 12 months of age," Huang said.
Huang said the findings are
important because there are increasing rates of obesity and gestational
diabetes among pregnant women in Western nations. This means a rise in the
number of overweight female babies.
"Our results can be
applied to public health messages targeting both maternal health and measures
in early infancy regarding the prevention of childhood obesity and its
consequences," Huang said.
Although the study showed
an association between early obesity and increased risk of diabetes and
cardiovascular disease, it did not prove a cause-and-effect relationship.
More information
(SOURCE: The Endocrine
Society, news release, March 29, 2012)
YOUTH & VIOLENCE
Dating Violence Common by 7th Grade:
Survey
More than one-third report psychological abuse, 15 percent cite
physical abuse.
Psychological and physical
abuse is a common facet of dating for America's adolescents, a new survey
reveals.
Researchers who polled more
than 1,400 seventh graders found that more than 37 percent of 11- to 14-year olds
had been the victim of some form of psychological violence, and almost one in
six said they had fallen prey to physical violence while in an ongoing
relationship.
"Issues of dating
abuse among young teens are much more pervasive than I imagine many families
believe," said Peter Long, president and CEO of Blue Shield of California
Foundation, which co-sponsored the survey with the Robert Wood Johnson
Foundation and the organization Futures Without Violence.
Long said he was startled
to see that three-quarters of the students reported they had a boyfriend or
girlfriend by their middle-school years.
"That's a big number,
and it means that this is the age when many kids are forming their views of
what it is to have a relationship," Long said. This indicates that this is
the appropriate age to intervene, he added, saying, "High school may even
be too late."
The finding that 31 percent
of these middle school kids is "experiencing some kind of electronic
aggression or pressure such as provocative or insistent texting should be a
warning sign for us," Long said, "as is the fact that 15 percent have
experienced some kind of physical abuse while dating."
According to U.S. Centers
for Disease Control and Prevention questionnaires, 10 percent of American high
school students say they have been physically abused by their boyfriend or
girlfriend. But clear insight regarding younger teens has been less well
investigated, the researchers said.
To address that issue,
between 2010 and 2012 surveys were conducted in eight middle schools in five
U.S. cities: Los Angeles; Bridgeport, Conn.; Indianapolis; San Diego, and
Saginaw, Mich.
The average age of the
1,430 students polled was 12, and boys and girls were equally represented.
About one-quarter were white; 30 percent, black; 34 percent, Hispanic and 12
percent were a combination of other races.
The survey defined teen
dating violence as any form of physical, sexual or emotional violence occurring
within the context of dating. Psychological violence includes controlling
behaviors, such as not allowing a girlfriend or boyfriend to do things with
other people. Electronic violence covers bullying and name-calling online or
via texts, and physical violence includes pushing, grabbing or kicking one's
partner.
Asked about these and other
behaviors in the previous six months:
·
Thirty-seven percent said
that they had seen boys or girls being physically abusive towards their dating
partner. About one-quarter had a male or female friend who was physically
violent to a partner, and more than 20 percent had a friend whose partner was
physically violent to him or her.
·
Forty-nine percent said
they had been sexually harassed, either physically or verbally, by being
touched inappropriately or joked about.
·
Seven percent strongly
agreed that it was okay for a boy to hit his girlfriend under certain
circumstances, such as "a girl who makes her boyfriend jealous on
purpose." Interestingly, 50 percent strongly agreed that it was OK for a
girl to hit her boyfriend in the same siutation.
·
Sixty-three percent agreed
with what the pollsters considered a "harmful stereotype" about
gender, such as "girls are always trying to get boys to do what they
want" or "With boyfriends and girlfriends, boys should be smarter
than girls."
"But the good
news," Long said, "is that nearly three-quarters of the students reported
that in the last six months they have talked to their parents about dating. Not
necessarily about dating abuse, but about dating. Which means the door is
open for parents to talk to their children about relationships. So, on the one
hand we have real serious issues here. But, on the other hand, we also have a
real opportunity for parents to engage."
A California mother of two,
Alexandra Preston, 35, encourages parents of teens to take the survey findings
to heart.
"There's a tendency to
read about a study like this and think, 'That can't be true.' Because we want
our kids to be safe and happy, and we don't want it to be true, right?"
"But I think it's
important that parents acknowledge that understanding and establishing and
respecting boundaries is something all of us have to struggle with throughout
life, at every age," said Preston, who added that she herself was a victim
of domestic violence in a prior marriage.
Preston, whose children are
13 and 10, is finance and operations manager for a non-profit agency that works
with Robert Wood Johnson's Start Strong program, which aims to combat dating
abuse in middle school. She said her own experiences have led her to be
proactive with her children regarding healthy relationships.
Her son "remembers
what happened in our home," she said, explaining she tries "to make
sense of it, without demonizing the people who do it, and making sure they know
it's not their fault."
Preston said this study
could be helpful in raising awareness about dating issues, and encouraging
parents to listen to their children.
More information
911 Dispatchers May Suffer From
Post-Traumatic Stress
Indirect exposure to disturbing events can cause psychological
disorders, study says.
Answering 911 calls for help may cause emergency
dispatchers to experience symptoms of post-traumatic stress disorder, or PTSD,
a new study has found.
Even indirect exposure to
traumatic events could lead to psychological disorders, whether a person
personally knows the victims or not, according to a report published in the
March issue of the Journal of Traumatic Stress.
"Post-traumatic
psychological disorders are usually associated with frontline emergency
workers, such as police officers, fire fighters or combat veterans," study
author Dr. Michelle Lilly, assistant professor of psychology at Northern
Illinois University in DeKalb, Ill., said in a journal news release.
"Usually, research
considers links between disorders and how much emotional distress is
experienced on the scene of a traumatic event," Lilly said. "However,
this is the first study on emergency dispatchers, who experience the trauma
indirectly."
In conducting the study,
the researchers surveyed 171 emergency dispatchers currently working in 24
states across the United States. The dispatchers, who were primarily white
women averaging 38 years old with more than 11 years of experience, were
questioned about the type of calls they answer and the emotional distress they
endured as a result of those calls. They also were asked to rate the types of
calls that cause them the most distress and recall the worst call they ever
received.
The unexpected injury or
death of a child accounted for 16 percent of the calls dispatchers identified
as their worst trauma. Nearly 13 percent of the worst calls identified were
suicidal callers, about 10 percent were police-officer shootings and another 10
percent involved the unexpected death of an adult, the investigators found.
The study authors noted
that the dispatchers experienced a high level of distress following an average
of 32 percent of potentially traumatic calls. In addition, 3.5 percent of the
dispatchers reported symptoms severe enough to be classified as PTSD.
These new findings may
contribute to the debate over the definition of a "traumatic event,"
ahead of the publication of official guidelines next year, the news release
noted.
"Our research is the
first to reveal the extent of emotional distress experienced by emergency
dispatchers while on duty," researcher Heather Pierce, a former 911
dispatcher, said in the news release. "The results show the need to
provide these workers with prevention and intervention support as is currently
provided for their frontline colleagues. This includes briefings and training
in ways to handle emotional distress."
HEALTH & DEPRESSION
Stigma, Shame Can Worsen Depression in Lung
Cancer Patients
They may believe -- rightly or not -- that others blame them for
diagnosis.
Feelings of shame, social isolation and rejection can
heighten depression in lung cancer patients, a new study finds.
The findings may help
explain why depression is more common among lung cancer patients than among
patients with other kinds of cancer, according to the researchers at the
Moffitt Cancer Center in Tampa, Fla.
"Given its strong
association with tobacco use, lung cancer is commonly viewed as a preventable
disease," study co-author Paul Jacobsen said in a Moffitt news release.
"Consequently, patients may blame themselves for developing lung cancer
and feel stigmatized. Even lung cancer patients who have never smoked often
felt -- accurately or inaccurately -- that they were being blamed for their
disease by friends, loved ones and even health-care professionals."
For the study, the
researchers gave mental-health questionnaires to lung cancer patients and found
that 38 percent of them suffered from depression. Greater levels of perceived
stigma were associated with greater levels of depression.
The study was published in
the March issue of the journal Psycho-Oncology.
"Documenting this link
between stigma and depression is important because it adds further evidence to
the growing body of research suggesting a link between illness-related stigma
and the symptoms of depression," Jacobsen said. "For example, studies
on depression and HIV have found similar links between disease, stigma and
depression."
The findings suggest that
psychotherapeutic approaches might be useful in treating or preventing
depression in lung cancer patients, study co-author Brian Gonzalez said.
"Many approaches to
reducing perceived stigma focus on education of the public about lung cancer
inaccuracies and stereotypes, and replacing those inaccuracies with
facts," Gonzalez said in the news release.
"Instead, therapy that
focuses on altering the patient's thoughts and feelings associated with their
perceptions of stigma may prove effective in reducing depressive
symptoms," Gonzalez said. "For example, emphasizing the addictiveness
of tobacco products and the deception in tobacco-industry advertising could
help patients view themselves as being 'wronged' rather than as a
'wrongdoer.'"
HEALTH & AUTISM
U.S. Autism Rate Rises to 1 in 88
Children, CDC Reports
Boys have even higher risk; experts say part of increase may be
due to better diagnosis.
That's an increase from the
one in 110 estimate released by the CDC just two years ago. The newer data,
from 2008, also shows that autism is almost five times more common in boys than
girls, with one in 54 boys diagnosed with the condition.
Why the steady uptick in
cases? That's not entirely clear, experts said.
"We know that people
want answers to what's causing this increase, and so do we," Coleen Boyle,
director of CDC's National Center on Birth Defects and Developmental
Disabilities, said during a noon press briefing on Thursday.
"Some of the increase
is due to the way children are identified, diagnosed and served," she
said. "Although exactly how much is attributable to these factors is not
known."
Mark Roithmayr, president
of the national advocacy group Autism Speaks, theorized that about half of the
increase is accounted for by better diagnosis. But he agreed that the reasons
for the rest of the increase remain unknown.
According to CDC Director
Dr. Thomas Frieden, "Autism is a complex condition, and there remain many
unanswered questions." Speaking at the press conference, he said that
"we are learning more every day, but still have a great deal to
learn."
What is known, according to
Roithmayr, is that, "very clearly now, there is an autism epidemic in the
United States." And the increase in incidence -- about a 23 percent jump
every two years -- has been ongoing, he said.
The report was published
Thursday in the CDC's Morbidity and Mortality Weekly Report.
According to the new CDC
numbers, the rate of children being diagnosed with autism varies widely by
state: From one in 210 in Alabama to one in 47 in Utah. The biggest increase in
diagnoses was seen among Hispanics and blacks, according to the report.
The data show that about 11
in every 1,000 8-year-old children have now been diagnosed with autism, a 23
percent increase since the last report in 2009.
One hopeful sign: there are
more early diagnoses, which can aid in treatment, experts noted. The CDC said
that more children are now being diagnosed by the age of 3. Among children born
in 1994, just 12 percent of cases were being diagnosed by that age, but for
children born in 2000 that number increased to 18 percent.
Of course, the severity of
an autism spectrum disorder can vary depending on the child. About 9 percent of
those with autism are what is called "high-functioning," about 44
percent have the most serious form of the condition and 47 percent have various
milder forms of autism, Roithmayr noted.
He added that there is a
panel, set up by the American Psychiatric Association, that is currently
looking at changing the definition of autism. Such a change could affect these
numbers and will be included in the next edition of the Diagnostic and
Statistical Manual of Mental Disorders, the "bible" of psychological
disorders used by psychiatrists worldwide.
Shrinking the definition of
autism is bound to meet with controversy, however. "It is imperative that
DSM5 not exclude anyone on the spectrum," Roithmayr said. "If it
does, we are going on a big offensive."
Autism has other costs,
too. According to Autism Speaks, the financial burden related to autism has
tripled over the past six years. Based on these new numbers, the group
estimated that the annual price tag for autism in the United States will reach $137
billion, he said. "This is a national emergency," Roithmayr said, and
he believes insurance companies must do more to help parents shoulder the cost
of caring for a child affected by autism.
All of this points to the
need for more funding for research on the genetic and environmental causes of
autism, he added.
"It's concerning that
there continues to be a steady increase in autism spectrum disorders,"
said Dr. Andrew Adesman, chief of developmental & behavioral pediatrics at
the Steven & Alexandra Children's Medical Center of New York, in New Hyde
Park.
Although there are some
children with autism who can show significant gains there are many who don't,
which highlights the long-term impact of the problem on both individuals and
society, Adesman added.
"This is a significant
problem from a public health standpoint," he said. "There is a need
for parents and clinicians to identify children with autism spectrum disorder
as early as possible in the hopes that it would maximize children's developmental
outcome."
|
Looking for the Warning
Signs of Autism
According to Dr. Rebecca Landa, director of
the Center for Autism and Related Disorders at the Kennedy Krieger Institute
in Baltimore, signs of concern include:
|
More information
(SOURCES: March 29, 2012
U.S. Centers for Disease Control and Prevention press briefing with Thomas
Frieden, MD, director, CDC, and Coleen Boyle, director, National Center on
Birth Defects and Developmental Disabilities, CDC; Mark Roithmayr, president,
Autism Speaks; Andrew Adesman, chief of developmental & behavioral
pediatrics at the Steven & Alexandra Children's Medical Center of New York
in New Hyde Park; March 29, 2012, report, Prevalence of Autism Spectrum
Disorders Autism and Developmental Disabilities Monitoring Network, 14 Sites,
United States, 2008, Morbidity and Mortality Weekly Report)
Health Tip: Diabetics, Avoid Too Much
Salt
High-sodium
foods can contribute to high blood pressure, which is a major risk factor for
stroke and heart attack. The issue is compounded for people with diabetes, who
are already at greater risk of heart attack and stroke.
The American Diabetes
Association suggests these healthier choices that can help you cut down on
salt:
·
Choose fresh fruits and
fresh vegetables over packaged offerings.
·
Opt for dried versions of
legumes, beans and peas instead of canned varieties.
·
Look for whole-grain foods
that aren't packed with sodium, including whole-grain barley, popcorn, brown
and wild rice and quinoa.
·
Choose seeds and nuts that
aren't salted.
Even a Little Drinking May Raise Breast
Cancer Risk: Study
·
Heavy consumption
increases risk up to 50 percent, new review finds.
Just one alcoholic drink a day can boost a woman's risk of breast cancer by about 5 percent, according to a new review of existing research.
·
Heavier drinking -- three
or more drinks a day -- can increase risk up to 50 percent, according to
researchers from Germany, France and Italy.
·
"Alcohol consumption
is causally related with breast cancer," the study authors concluded after
reviewing 113 prior studies. They attributed 2 percent of breast cancer cases
in Europe and North America to light drinking alone, and about 50,000 cases
worldwide to heavy drinking.
·
The research seems to
confirm the expert advice for women to minimize drinking, said study leader Dr.
Helmut Seitz, professor of medicine, gastroenterology and alcohol research at
the University of Heidelberg in Germany.
·
The findings suggest that
healthy women at average risk of breast cancer should not consume more than one
alcoholic drink a day, the authors said.
·
"Women at an elevated
risk for breast cancer should avoid alcohol or consume alcohol only
occasionally," the researchers wrote. Those at increased risk include
those with a family history of breast cancer.
·
The link between alcohol
and breast cancer was first suggested in the early 1980s, the authors said. To
update the research, they searched for studies published before November 2011.
They found more than 3,400 studies in all and narrowed their focus to 113 that
examined the effects of light drinking on breast cancer risk.
·
The review will be
published March 29 in the journal Alcohol and Alcoholism.
·
In the United States, one
in eight women will develop breast cancer in her lifetime, experts estimate.
The increased risk associated with drinking is added to that starting risk.
·
Alcohol is thought to
increase estrogen levels, in turn, perhaps, increasing the risk of breast
cancer. Several studies have found alcohol more strongly linked to cancers
known as estrogen receptor positive, which require estrogen to grow.
·
Seitz said the team's
research controlled for various other factors that might affect risk, such as
obesity.
·
Two American experts put
the new report into perspective.
·
The association between
moderate alcohol use and a slightly increased risk of developing breast cancer
has been reported before, said Dr. Joanne Mortimer, director of Women's Cancer
Programs at the City of Hope Comprehensive Cancer Center in Duarte, Calif.
·
"This is an update of
the evidence linking alcohol to breast cancer," said Susan Gapstur, vice
president of the epidemiology research program at the American Cancer Society.
·
By including both newer
studies and older ones, Gapstur said, "we are basically getting to the
point where we can more precisely estimate the risk of light alcohol
consumption."
·
As the link between alcohol
and breast cancer strengthens, women may wonder how to strike a balance between
breast health and heart health, since moderate alcohol has been found to be
heart-healthy.
·
Follow the American Cancer
Society guidelines, Gapstur said.
·
"Our guidelines say,
for overall health, if you don't drink, don't start," she said. "If
you do, it's best to limit your consumption to one drink a day if you are a
woman."
·
If you are at high risk of
breast cancer, limiting consumption to even less may be wise, she said.
·
Mortimer, however, said
many women are at increased risk of breast cancer because of genetic factors.
·
"Lifestyle changes
won't impact much," she said.
·
Seitz has another opinion.
"The heart benefits hold true only for a subgroup of individuals," he
said. "Those who have more than one risk factor for coronary heart disease
and especially the elderly may benefit from small amounts of alcohol. Younger
people do not."
·
More information
·
(SOURCES: Susan Gapstur,
Ph.D., M.P.H., vice president, epidemiology research program, American Cancer
Society; Joanne Mortimer, M.D., director, Women's Cancer Programs and professor
of medical oncology and experimental therapeutics, City of Hope Comprehensive
Cancer Center, Duarte, Calif.; March 29, 2012 Alcohol and Alcoholism)
·
Report to the nation finds continuing declines in cancer
death rates since the early 1990s
·
Special feature highlights cancers associated
with excess weight and lack of sufficient physical activity
·
Death rates from all cancers combined for
men, women, and children continued to decline in the United States between 2004
and 2008, according to the Annual Report to the Nation on the Status of Cancer,
1975–2008. The overall rate of new cancer diagnoses, also known as incidence,
among men decreased by an average of 0.6 percent per year between 2004 and
2008. Overall cancer incidence rates among women declined 0.5 percent per year
from 1998 through 2006 with rates leveling off from 2006 through 2008.
·
The report is co–authored by researchers from
the Centers for Disease Control and Prevention, the North American Association
of Central Cancer Registries, the National Cancer Institute, and the American
Cancer Society. It appears early online in the journal CANCER, and will appear in
print in the May issue.
·
The special feature section highlights the
effects of excess weight and lack of physical activity on cancer risk.
Esophageal adenocarcinoma, cancers of the colon and rectum, kidney cancer,
pancreatic cancer, endometrial cancer, and breast cancer among postmenopausal
women are associated with being overweight or obese. Several of these cancers
also are associated with not being sufficiently physically active.
·
“This report demonstrates the value of cancer
registry data in identifying the links among physical inactivity, obesity, and
cancer,” said CDC Director Thomas R. Frieden, M.D. “It also provides an update
of how we are progressing in the fight against cancer by identifying
populations with unhealthy behaviors and high cancer rates that can benefit
from targeted, lifesaving strategies, and interventions to improve lifestyle
behaviors and support healthy environments.”
·
For more than 30 years, excess weight,
insufficient physical activity, and an unhealthy diet have been second only to
tobacco as preventable causes of disease and death in the United States.
However, since the 1960s, tobacco use has declined by a third while obesity
rates have doubled, significantly impacting the relative contributions of these
factors to the disease burden. Excess weight and lack of sufficient physical
activity have been linked to increased risk of cardiovascular disease,
hypertension, diabetes, and arthritis, as well as many cancers.
·
“In the United States, 2 in 3 adults are
overweight or obese and fewer than half get enough physical activity,” said
John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society.
“Between children and youth, 1 in 3 is overweight or obese, and fewer than 1 in
4 high school students get recommended levels of physical activity. Obesity and
physical inactivity are critical problems facing all states. For people who do
not smoke, excess weight and lack of sufficient physical activity may be among
the most important risk factors for cancer.”
·
The Report to the Nation was first issued in
1998. In addition to drops in overall cancer mortality and incidence, this
year's report also documents the second consecutive year of decreasing lung
cancer mortality rates among women. Lung cancer death rates in men have been
decreasing since the early 1990s.
·
Colorectal cancer incidence rates also
decreased among men and women from 1999 through 2008. Breast cancer incidence
rates among women declined from 1999 through 2004 and plateaued from 2004
through 2008. Incidence rates of some cancers, including pancreas, kidney,
thyroid, liver, and melanoma, increased from 1999 through 2008.
·
“The continued declines in death rates for
all cancers, as well as the overall drop in incidence, is powerful evidence
that the nation′s investment in cancer research produces life–saving approaches
to cancer prevention, screening, diagnosis, and treatment,” said NCI Director
Harold E. Varmus, M.D. “But, it is also important to note that investments we
make today are critical if we hope to see these declines in incidence and death
from cancer reflected in future Reports to the Nation.”
· Among children aged 19 years or younger,
cancer incidence rates increased 0.6 percent per year from 2004 through 2008,
continuing trends from 1992, while death rates decreased 1.3 percent per year
during the same period. These patterns mirror longer–term trends.
·
Among racial and ethnic groups, the highest
cancer incidence rates between 2004 and 2008 were among black men and white
women. Cancer death rates from 2004 through 2008 were highest among black men
and black women, but these groups showed the largest declines for the period
between 1999 and 2008, compared with other racial groups. The differences in
death rates by racial/ethnic group, sex, and cancer site may reflect
differences in risk factors, as well as access to and use of screening and
treatment.
·
“While the sustained decline in cancer
mortality rates is good news, the persistence of disparities among racial and
ethnic groups continues to concern us,” said Betsy A. Kohler, executive
director of NAACCR. “The collection of comprehensive cancer surveillance data
on all patients may provide clues to understanding these differences and
addressing them.”
·
The report notes that continued progress against
cancer in the United States will require individual and community efforts to
promote healthy weight and sufficient physical activity among youth and adults.
·
Reference: Eheman
C, Henley SJ, Ballard–Barbash R, Jacobs EJ, Schymura MJ, Noone AM, Pan L,
Anderson, RN, Fulton JE, Kohler BA, Jemal A, Ward E, Plescia M, Ries LAG,
Edwards BK. Annual Report to the Nation on the Status of Cancer, 1975–2008,
Featuring Cancers Associated with Excess Weight and Lack of Sufficient Physical
Activity. CANCER;
Published Early Online: March 28, 2012 [DOI: 10.1002/cncr.27514].
·
To view the full Report, go to http://wileyonlinelibrary.com/journal/cancer–report2012
·
For a Q&A on this Report, go to www.cdc.gov/cancer/dcpc/research/articles/arn_7508qa.htm
·
For Spanish translation of this press
release, go to http://www.cdc.gov/spanish/CDC_servicio/2012/p0328_Cancer_tasasmuertes.html
·
For Spanish translation of the Q&A, go to
www.cdc.gov/spanish/cancer/dcpc/research/articles/arn_7508qa.htm
·
CDC′s Division of Cancer Prevention and
Control: http://www.cdc.gov/cancer;
National Program of Cancer Registries: http://www.cdc.gov/cancer/npcr;
and the National Vital Statistics System: http://www.cdc.gov/nchs/nvss.htm
·
ACS: http://www.cancer.org
·
NCI: http://www.cancer.gov
and SEER (NCI′s Surveillance, Epidemiology, and End Results program): http://www.seer.cancer.gov
·
NAACCR: http://www.naaccr.org
·
CDC works 24/7 saving lives,
protecting people from health threats, and saving money through prevention.
Whether these threats are global or domestic, chronic or acute, curable or
preventable, natural disaster or deliberate attack, CDC is the nation′s health
protection agency.
·
The American Cancer Society saves lives and
creates a world with less cancer and more birthdays by helping you stay well,
helping you get well, by finding cures and fighting back. As the nation′s
largest non–governmental investor in cancer research, contributing about $3.4
billion, we turn what we know about cancer into what we do. To learn more about
us or to get help, call 1–800–227–2345 or visit www.cancer.org
·
The National Cancer Institute (NCI) leads the
National Cancer Program and the NIH′s efforts to dramatically reduce the burden
of cancer and improve the lives of cancer patients and their families, through
research into prevention and cancer biology, the development of new
interventions, and the training and mentoring of new researchers. For more
information about cancer, please visit the NCI Web site at http://www.cancer.gov
or call NCI's Cancer Information Service at 1–800–4–CANCER (1–800–422–6237).
·
The North American Association of Central
Cancer Registries, Inc. (NAACCR, Inc.), is a professional organization that
develops and promotes uniform data standards for cancer registration; provides
education and training; certifies population–based registries; aggregates and
publishes data from central cancer registries; and promotes the use of cancer
surveillance data and systems for cancer control and epidemiologic research,
public health programs, and patient care to reduce the burden of cancer in
North America.
First Bedside Gene Test Shows
Promise
Study found it
spotted which heart patients should not take blood thinner Plavix.
For the first time, a genetic test done at a
patient's bedside helped doctors choose the right medicine, Canadian
researchers report.
The test,
which can be done by nurses and others, was able to identify patients in whom
the blood thinner Plavix might be ineffective, putting the patients at risk for
heart attacks or strokes.
"One of
the shortcomings we have in medicine right now is that there isn't a quick and
effective way of identifying these genetic variants," said lead researcher
Dr. Derek So, from the University of Ottawa Heart Institute.
"We have
created the world's first point-of-care genetic test," he said. "We
now have the means of selecting the right drug for the right patient."
The report was
published in the March 29 online edition of The Lancet.
To prove the test
works, So's team randomly assigned 200 patients to either receive screening for
a gene called CYP2C19*2 using the gene test, or to regular care.
All of the
patients had undergone a procedure called angioplasty to open a blocked heart
artery and had a stent placed there to keep the vessel open.
Standard care
after the procedure is to give patients Plavix to prevent clotting. However,
many patients have this gene mutation, which makes the drug ineffective and
patients more likely to develop a clot that could result in a heart attack or
stroke.
Among those
with European ancestry, about 30 percent have this mutation, and among Asians
it's as high as 50 percent, the researchers noted.
Normally,
after starting a patient on Plavix, a platelet function blood test is done to
see how the patient reacts to the drug.
In this study,
those getting the gene test were given a low dose of Plavix and the others
received a regular dose. Both groups were given the drug so the researchers
could judge the accuracy of the rapid gene test using the platelet function
test as confirmation.
The
researchers found the gene test accurately identified all the patients with the
gene mutation. Patients who had the mutation were switched to a newer drug
called Effient, which is not affected by this mutation.
After one
week, 30 percent of those in the standard group were identified by the platelet
function test as having a raised risk for clotting, while none of those in the
gene test group showed an increased risk for clotting, So said.
"This is
the first step required for personalized medicine," So said. "Ours is
a proof-of-concept study. Now that we have this tool we can apply this same
technology to different groups of patients and alter patient's therapy. We have
taken bench to bedside."
One expert,
Dr. Kirk Garratt, the clinical director of interventional cardiovascular
research at Lenox Hill Hospital in New York City, thinks more proof is needed
of the benefits of this particular test, but its real value is its potential.
"Before
anybody can get too worked up about the application of this technology in the
clinic, we will have to see evidence that acting on the information provided
actually yields benefit," Garratt said.
"There is
one really dazzling benefit," he added. "These researchers have now
shown that you can take a minimally trained allied health person and do
accurate genotyping on patients in the clinic -- that is really big news."
The test is
given by taking a swab from the patient's cheek, putting it in a machine and
getting a result in about an hour. The test can be done by people who have
never done genetic testing after just 30 minutes of training, So said.
Larger trials
will be needed to see if the test makes a difference in patient outcomes, So
noted. Spartan Biosciences, which makes the test used in the study, funded the
trial.
In terms of
cost, the machine goes for about $10,000 and each test kit is about $300, So
said. That's relatively inexpensive if it prevents patients from getting the
wrong drug.
One advantage
is that the test can be given before patients receive their first dose of
Plavix, So pointed out.
In addition,
as Plavix (clopidogrel) becomes a generic drug -- as it is in Canada -- its
cost goes down, while the newer drugs like Effient (prasugrel) and Brilinta
(ticagrelor) are very expensive and are associated with an increased risk of
bleeding, he noted.
Commenting on
the study, Dr. Amber Beitelshees, an assistant professor of medicine at the University
of Maryland School of Medicine in Baltimore and author of an accompanying
journal editorial, said that "for the first time, a point-of-care genetic
test has been developed which can be used to rapidly screen individuals who
carry a particular gene and may benefit from an anti-platelet drug other than
Plavix."
Beitelshees
added that "this is important because rapid genotyping is necessary in
order for genotype-guided therapy to be incorporated into clinical care of
patients undergoing coronary interventions outside of clinical trials."
However,
another expert thinks much more needs to be shown about the value of this test
before it can start to be widely used.
Dr. Gregg
Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of
the UCLA Preventative Cardiology Program in Los Angeles, said that "there
has been great interest in using genetic testing information to guide selection
of medications and dosing, yet to date there has been little evidence that this
testing can improve clinical outcomes."
However,
Fonarow continued, "as neither genetic testing for variant CYP2C19 or
platelet-function testing has been demonstrated to improve clinical outcomes
and routine use of these tests are not currently recommended, further studies
demonstrating any clinical utility, if any, are needed."
More
information
(SOURCES:
Derek So, M.D., University of Ottawa Heart Institute, Ottawa, Canada; Amber
Beitelshees, Pharm.D., assistant professor, medicine, University of Maryland
School of Medicine, Baltimore; Kirk Garratt, M.D., clinical director,
interventional cardiovascular research, Lenox Hill Hospital, New York City;
Gregg Fonarow, M.D., director, Ahmanson-UCLA Cardiomyopathy Center, and
co-director, UCLA Preventative Cardiology Program, Los Angeles; March 29, 2012,
The Lancet, online)
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