Breast cancer stigma endangers poorer women

WASHINGTON - Nurses were training women in rural Mexico to examine their breasts for cancer when one raised her hand to object. If she lost her breast, Harvard public health specialist Felicia Knaul recalls the woman saying, "My man would leave me" — and with him, the family's income.

International cancer specialists meet this week to plan an assault on a troubling increase of breast cancer in developing countries, where nearly two-thirds of women aren't diagnosed until it has spread through their bodies.

Adding to the problem, some worrisome data suggests that breast cancer seems to strike women, on average, about 10 years younger in poor countries than it does in the U.S. No one knows why.

Younger women at risk
"Today in most developing countries you see a huge bulge of young, premenopausal women with breast cancer," says Knaul, who heads Harvard's Global Equity Initiative and was herself diagnosed at age 41 while living in Mexico.

"We should help them to know what they have and to fight for their treatment."

But from Mexico to Malawi, stigma like Knaul witnessed a few weeks ago may prove as big a barrier as poverty.

"One of the trainers said, 'If he'd leave you for that, he's not worth having,'" says Knaul. But she acknowledged that will be a hard message for some women's economic realities.
"It's not a trivial consideration," agrees Dr. Lawrence Shulman of the Dana Farber Cancer Institute, who is part of a team working to begin cancer care in parts of Africa where "the women are often seen as really either vessels for producing children or as sex slaves."

But some success in treating HIV and tuberculosis in those areas has him "hopeful we can make a difference. I don't think it's a pipe dream."

Tuesday, Knaul and Shulman bring together international task force of health specialists and prominent charities to begin planning a two-pronged approach.

First, train midwives and other rural health providers to perform regular breast exams, using the power of touch in places where mammography machines simply are too expensive. That won't catch the very smallest tumors, but specialists agree it could improve diagnosis dramatically in some areas.

Second, the task force will start negotiating lower prices for generic chemotherapy for poor countries, following the same model that has helped transform AIDS care in parts of Africa.

You don't need in-country cancer specialists to administer that chemo, says Shulman — just a network of oncologists who can provide help or instruction to local health officials by e-mail or phone, as he has advised colleagues in Malawi.

Considered a problem for the wealthy
Breast cancer long has been considered a cancer mostly of wealthier countries. Indeed, about 192,000 new cases are expected in the U.S. this year, where long-term survival is high thanks in part to good screening.

The true prevalence in most developing countries is unknown, because of poor diagnosis and bad record-keeping. But new Harvard research estimates they'll be home to 55 percent of the world's 450,000 expected breast cancer deaths this year.

The report predicts the poorest countries will experience a 36 percent jump in breast cancer by 2020.

One problem: In wealthy countries, earlier diagnosis can lead to breast-saving surgery instead of breast removal. Even countries like Rwanda and Malawi have clinics that perform mastectomies if patients can travel to the capitals, Shulman says. But few have radiation equipment, making breast-conserving surgery there not an option yet. (He is hunting a radiation unit for Rwanda but says that's in the very earliest stages of planning.)

Mexico is a mixed situation, with radiation, other treatments and diagnostic mammography available in some places. That's how Knaul — whose husband is a former health minister of Mexico — was diagnosed, early enough that mastectomy and chemotherapy give her good odds.

But she fumes that while Mexico's poor and rural women often get Pap smears to check for cervical cancer, "no one even suggests they check your breasts" at the same visit. She founded an advocacy group — Cancer de Mama — to help, noting that Mexico's insurance program for the poor covers breast cancer care but they must get diagnosed first.

Low cholesterol may ward off prostate cancer

A new study suggests that men may be able to lower their risk of getting the most aggressive form of prostate cancer by keeping their cholesterol in a healthy range.

Men whose cholesterol was under 200 had less than half the risk of developing high-grade prostate tumors compared to men with high cholesterol, researchers report. The information comes from about 6,000 men who were in a big federal cancer prevention study.

Doctors say it is premature to advise men to take statin drugs like Lipitor or Crestor in the hope of preventing prostate cancer, but these medicines are already widely used to ward off heart disease.

The new research is published in the journal Cancer Epidemiology Biomarkers & Prevention.

Obesity causes 100,000 U.S. cancer cases a year

WASHINGTON - Obesity causes more than 100,000 cases of cancer in the United States each year — and the number will likely rise as Americans get fatter, researchers said on Thursday.

Having too much body fat causes nearly half the cases of endometrial cancer — a type of cancer of the uterus — and a third of esophageal cancer cases, the American Institute for Cancer Research said.

Cancer is the second-leading cause of death in the United States after heart disease. The American Cancer Society projects that 1.47 million people will be diagnosed with cancer this year and 562,000 will die of it.

More than 26 percent of Americans are obese, defined as having a body mass index of 30 or higher. BMI is equal to weight in kilograms divided by height in meters squared. A person 5 feet 5 inches tall becomes obese at 180 pounds (82 kg).

Additionally, nearly a third of Americans are overweight, defined as having a BMI of 25 to 30.

The study combined findings from AICR research linking diet, physical activity and fatness with cancer risk with national surveys on obesity and cancer incidence.

"We then worked out the percentage of those specific cancers that would be prevented if everyone in the United States maintained a healthy weight," the group said in a statement.

Here are some of its estimates of cancer types that could be prevented annually if Americans stayed slender:

• Esophageal - 35 percent of cases or 5,800 people
• Pancreatic - 28 percent or 11,900
• Gallbladder - 21 percent or 2,000
• Colon - 9 percent or 13,200
• Breast - 17 percent or 33,000
• Endometrium - 49 percent or 20,700
• Kidney - 24 percent or 13,900

In July, federal and other researchers estimated that obesity-related diseases account for nearly 10 percent of all medical spending in the United States or an estimated $147 billion a year.

Men more likely to leave spouse who has cancer

A cancer diagnosis can strain any relationship. But when a woman gets news of a life-threatening illness, her husband is six times more likely to leave her than if the tables were turned and the man got the bad news, according to new research.

The study included diagnoses of both cancer and multiple sclerosis and found an overall divorce rate of nearly 12 percent, which is similar to that found in the normal population.

But when the researchers looked at gender differences, they found the rate was nearly 21 percent when women were the patients compared with about 3 percent when men got the life-threatening diagnosis.

The researchers suggest men are less able to commit, on the spot, to being caregivers to a sick partner, while women are better at assuming such home and family responsibilities.

"Part of it is a sense of self-preservation," said study researcher Dr. Marc Chamberlain, director of the neuro-oncology program at the Seattle Cancer Care Alliance (SCCA). "In men that seems to operate very highly and they don't feel this codependence, this requirement to nurture their significant other who has this life-threatening illness, but rather decide what's best for me is to find an alternative mate and abandon my fatally flawed spouse."

Chamberlain is also a professor of neurology and neurosurgery at the University of Washington School of Medicine.

Life-threatening illness
The findings, announced today, come from a study of 515 patients who had enrolled in 2001 and 2002 at the SCCA, Huntsman and Stanford University School of Medicine. The researchers followed the participants until February 2006.

The men and women in the study (about evenly split) were divided into groups by diagnosis, with 214 having a malignant primary brain tumor, 193 with a solid tumor not related to the central nervous system, and 108 patients with multiple sclerosis.

Similar results were found for all diagnosis types, in which divorce was much more likely if the woman was the patient.

Cancer strain
Chamberlain realizes the enormity of a cancer diagnosis. "We find ourselves as a caregiver with someone with cancer, and that cancer isn't just affecting that patient but it affects profoundly that entire family," Chamberlain told LiveScience.

For instance, the patient may have been the sole provider or income or the person who maintained the home. In addition, with brain tumors and multiple sclerosis, Chamberlain says, a patient's personality can change. "That's not easy for caregivers."

Even so, sticking together could be what's best for the patient, the researchers found.

"We found patients who were divorced or separated had a much higher rate of hospitalization during their illness, which I think reflects lack of social support," Chamberlain said, adding such patients also were much less likely to participate in clinical trials, to seek alternative treatments or to even complete treatment regimens. They were also more likely than those who stayed in marriages to die at home.

The results will be detailed in the Nov. 15 issue of the journal Cancer.

Mammogram advice accurate but not ‘right’

Did you hear an enormous thud around 3 p.m. yesterday? That was the sound of Secretary of Health and Human Services Kathleen Sebelius throwing her scientists under a bus.

Earlier this week, the U.S. Preventive Services Task Force, the government's major medical advisory panel, announced that they could no longer support routine mammographies for women under the age of 50 who were not in a high risk group for breast cancer.

They said that the number of cancer cases detected from such screening was too low, and that too many biopsies and further tests were being done in women who had hard-to-interpret test results but who turned out not to have the disease.This new recommendation unleashed a tsunami of criticism from many breast cancer doctors, patient advocacy groups and women.

Emotional, snide — and even paranoid — accusations plagued the recommendation to end routine mammograms for women under 50. Some wondered why there were no true breast cancer experts on the panel. Still others suggested that the whole report was written with an eye toward the billions of dollars being spent on screening every year. And a few even wondered that if this was about men's health, rather than women's, would these scientists have been so quick to yank the plug on a screening test?

Critics of health reform sneered that this is what Obama has in mind for all of us if the government gets its cheap hands on health care — cutbacks in crucial medical benefits now enjoyed by those with private insurance.

By Wednesday, Sebelius cried uncle, bulldozed over the task force and told women under 50 to forget the new advice, keep doing what they had been doing and talk with their doctors about screening.

So how did the poor scientists of the U.S. Preventive Services Task Force go from being the "gold standard" for deciding what works in medical screening (this is according to the Web site of Sebelius' own agency!) on Monday, to a bunch of irrelevant nerds by Wednesday?

That's because data and evidence have not, do not and never will be the sole determinants of health coverage.

Data-driven health care
The mission of this task force is is to evaluate the benefits of preventive services based only on data in the peer-reviewed literature and input from experts at other federal agencies like the Centers for Disease Control and Prevention, the National Institutes of Health, Veterans Affairs and other professional medical groups.

They are instructed to make their recommendations about the value of screening tests, such as mammograms, with little attention to the economic cost to society.

The critics were right about one thing: It is true that the committee recommendations are the sort of thing the Obama administration has in mind as part of health reform. But not as a way to ration care for the insured. The administration has been talking endlessly about using better data to figure out what works and what to pay for.

In this case, the task force found that screening all women in their 40s led to too many false positives and too much unnecessary follow-up testing for the number of lives it saved. They did not say that no lives were being saved. They said not as many as everyone thought. And not enough to justify asking every woman under 50 to get a mammogram every year.

Well, women fear breast cancer. So do their husbands, brothers, sons and fathers. There is no way testing for an especially dread disease that is at least somewhat effective is going to be cut back without screaming protests.

What's accurate vs. what's right
The data does not tell us what to do in setting a standard for testing or paying for it — ever. We have to base these kinds of decisions on both data and values. How much do we fear getting a disease? How much are women willing to go through to avoid getting it? How much do we value saving younger lives and those of mothers of young children? These are as much ethics and policy question as they are issues of the facts.

Equally important, once a practice is firmly in place, such as screening for breast cancer, it is very hard to change beliefs and deeply held convictions overnight. If you tell women to get tested early and often for the better part of two decades, if you tout early detection as one of the triumphs of the "war on cancer" and if you stick breast self-examination cards into every shower stall in America then one day say, er, nevermind, forget it — don't expect that to go down very well.

Screening is what responsible and health-conscious women do to take control of their bodies and prevent disease. Those are commendable and powerful virtues, and — it seems —more compelling than a pile of bland data.

Doing the right thing and taking the time to protect yourself against breast cancer has moral weight that policy makers, as Secretary Sebelius found out, ignore at their peril.

There is no reason to doubt the accuracy of the scientists' finding that evidence does not support routine mammography for most women under 50. But there is every reason to doubt that the numbers they compiled will be sufficient to overturn a medical practice that carries so much ethical weight for women.

New guidelines: Pap smears can start at 21

WASHINGTON - Most women in their 20s can have a Pap smear every two years instead of annually, say new guidelines that conclude that's enough to catch slow-growing cervical cancer.

The change by the American College of Obstetricians and Gynecologists comes amid a completely separate debate over when regular mammograms to detect breast cancer should begin. The timing of the Pap guidelines is coincidence, said ACOG, which began reviewing its recommendations in late 2007 and published the update Friday in the journal Obstetrics & Gynecology. There have been widespread concerns that the government is trying to cut health costs by limiting cancer screening for women.

However, the recommendations have been in development for the last several years and the announcement of the new guidelines was coincidental, Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines, told The New York Times. The timing of the announcement was “an unfortunate perfect storm,” she told the newspaper, adding, “there’s no political agenda with regard to these recommendations.”

The recommendations are based on scientific evidence that suggests more frequent testing leads to overtreatment, which can harm a young woman's chances of carrying a child full term, according to Dr. Thomas Herzog of Columbia University in New York, who is chairman of an ACOG subcommittee on gynecologic cancers.

"Overtreatment of minor abnormal pap tests in young women and adolescents can lead to consequences such as preterm labor in some cases. It increases the risk," said Herzog.

Dr. Jennifer Milosavijevic, a specialist in obstetrics and gynecology at Henry Ford Health System in Detroit, supports the guideline changes. "Preterm delivery has become a huge problem in the United States that has potential serious consequences for the unborn fetus," she said.
The guidelines are unlikely to be met with the kind of rebellion that accompanied the mammogram guidelines this week, which were largely based on computer projections, Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said in a telephone interview.

"There is a lot more agreement about the science of cervical cancer screening," Lichtenfeld said.

Herzog said the new recommendations are based on studies that suggest starting screening earlier than age 21 causes more harm than benefit.

"We were overdiagnosing and overtreating adolescents and very young women," Herzog said in a telephone interview.

The guidelines also say:

• Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21.
• Women 30 and older should wait three years between Paps once they've had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait.
• Women with HIV, other immune-weakening conditions or previous cervical abnormalities may need more frequent screening.

But the updated guidelines reflect better understanding of HPV. Infection is high among sexually active teens and young adults. Women's bodies very often fight off an HPV infection on their own without lasting harm, although it can take a year or two. The younger the woman, the more likely that HPV is going to be transient.

Moreover, ACOG cited studies showing no increased risk of cancer developing in women in their 20s if they extended Pap screening from every year to every two years.

As for adolescents, ACOG said cervical cancer in teens is rare — one or two cases per million 15- to 19-year-olds — while HPV-caused cervical abnormalities usually go away on their own, and unnecessary treatment increases the girls' risk of premature labor years later.

Clearing up cancer screening confusion

Several doctors groups and advocacy groups set guidelines for cancer screening, and they update that advice periodically as new information emerges. Sometimes they agree, sometimes they don't. Last year, a number of groups got together and issued consensus guidelines for colon cancer.

The U.S. Preventive Services Task Force, a government-appointed, independent panel of doctors and scientists, also makes recommendations looked to by doctors groups, insurers and policy makers.

The latest advice from the major medical groups for routine screening — primarily for people who don't have a family history of a particular cancer or other risk factors:

Breast cancer:

• American Cancer Society: Mammograms yearly beginning at age 40; breast exam by doctor at least every three years in 20s and 30s, annually after 40; breast self-exam an option.
• American College of Obstetricians and Gynecologists: Mammograms every 1-2 years for women in their 40s; annual mammograms age 50 and older; breast exam by a doctor annually from age 19; breast self-exam can be recommended.
• U.S. Preventive Services Task Force: Mammograms every two years for women ages 50 to 74, after 75 the risks and benefits unknown; recommends against self-exam; value of exams by doctors unknown.

Cervical cancer:

• Cancer Society: Start Pap tests about three years after first intercourse but no later than 21; annually or every 2-3 years for women over 30 who have three normal tests; stop at 70 after at least three negative tests and no abnormal tests in last 10 years; discontinue after a total hysterectomy.
• ACOG: Start Pap tests at age 21 and then every two years; 30 years and older, every three years after three normal tests; reasonable to stop at age 65 or 70; discontinue after hysterectomy.
• Task Force: Start Pap tests within three years of sexual activity or by age 21; at least every three years, stop after 65 if negative tests and no high risk; discontinue after hysterectomy.

Prostate cancer:

• Cancer Society: No routine testing recommended; doctors should discuss benefits and limitations, and offer screening — a physical exam and blood test for a substance called PSA — to men beginning at age 50, with at least a 10-year life expectancy.
• Task Force: No recommendation for or against screening for men under 75; men over 75 should not be screened.
• American Urological Association: Men 40 and older should be offered a baseline PSA test and exam.

Colon cancer:

• Cancer Society and other major groups: Start screening at 50 with one of these tests: colonoscopy every 10 years; a sigmoidoscopy of the lower colon every five years; CT colonography or "virtual colonoscopy" every five years; barium enema every five years, stool blood test annually; stool DNA test, no interval given.
• Task force: Screen from age 50 to 75 with one of three tests: colonoscopy every 10 years; a sigmoidoscopy every five years, combined with a stool blood test every three years; a stool blood test every year.

Certain fertility drugs may pose cancer risk

Though the use of fertility drugs does not seem to generally increase uterine cancer risk, a Danish study identified small increases in risk from certain fertility drugs used for longer duration.

Dr. Allan Jensen, with the Danish Cancer Society in Copenhagen, and colleagues identified higher uterine cancer risk among women who used follicle-stimulating hormone and human menopausal gonadotropin (hMG) for more than 10 years.

They saw similar risk among women who ever took six or more cycles of clomiphene, an established treatment for women not ovulating normally, or when clomiphene did not work, when women were injected with six or more cycles of human chorionic gonadotropin (hCG).

In each of these scenarios, uterine cancer risk seemed about two times the usual risk, Jensen and colleagues report in the American Journal of Epidemiology.

Even so, "the absolute risk of developing uterine cancer is still not very high," Jensen emphasized in an email to Reuters Health.

From a group of 54,362 women treated for infertility between 1965 and 1998 and followed for 16 years on average, Jensen's team compared the use of fertility drugs among 83 who developed uterine cancer and 1,241 of similar age who did not develop cancer of the uterus.

Overall, 51 and 50 percent of the women who did and did not develop uterine cancer, respectively, used fertility drugs. Those with uterine cancer ranged from 28 to 67 years old (50 years on average) when diagnosed.

In analyses that allowed for number of births, the investigators did not find significant differences in uterine cancer risk.

Differences in risk, as noted, became evident in analyses of specific fertility drugs used and the length of use. These risks remained when the investigators further allowed for number of births, use of a single or multiple fertility drugs, causes of infertility, and any history of oral contraceptives.

The researchers are continuing to monitor the study group to more definitively assess ties between fertility drugs and uterine cancer risk.

They caution, however, that any unfavorable effects from fertility drugs need to be balanced against the physical and psychological benefits of pregnancies that may only be possible with the use of fertility drugs.

Kangaroo ‘dream cream’ may fight skin cancer

SYDNEY - Understanding how kangaroos repair their DNA could be the key to preventing skin cancer, according to Australian and Austrian researchers.

The teams are investigating a DNA repair enzyme found in kangaroos and many other organisms, but not humans, that is very effective in fixing a particular type of damage linked to many skin cancers.

The research is led by Dr Linda Feketeova and Dr Uta Wille from the ARC Center of Excellence for Free Radical Chemistry and Biotechnology at the University of Melbourne, along with scientists from the University of Innsbruck, Austria.

"As summer approaches, excessive exposure to the sun's harmful UV light will see more than 400,000 Australians diagnosed with skin cancer," Feketeova said in a statement.

"Other research teams have proposed a "dream cream" containing the DNA repair enzyme which you could slap on your skin after a day in the sun. We are now examining whether this would be feasible."

The groups are simulating kangaroo skin's exposure to harmful ultraviolet light in the laboratory, and then analyzing the DNA repair process, which Wille said resulted in a number of chemical by-products that have not been seen before.

"But there is still much to investigate before this "dream cream" will be available at the pharmacy, so don't throw out your sunscreen just yet," Feketeova added.

The research will be published in the upcoming edition of Chemical Communications.

Over-exposure to sunlight is to blame for at least two-thirds of cases of melanoma, a notoriously difficult to treat cancer of the skin, as DNA in sunburnt skin cells becomes damaged, leading to genetic mutations.

CT scans may predict colon cancer survival

CHICAGO - Doctors may be able use an advanced X-ray called a CT scan to see whether patients with advanced colorectal cancer are responding to treatment with Avastin and chemotherapy, U.S. researchers said on Tuesday.

Currently, there are no tools besides surgery to see if people with advanced colorectal cancer that has spread to the liver are responding to treatment with chemotherapy and Roche unit Genentech's cancer drug Avastin.

And many patients with this advanced form of cancer are poor candidates for surgery.

"For the patient, you would have to wait for the tumor to resurface to have a sense for whether the treatment was working," Dr Jean-Nicolas Vauthey of the University of Texas M.D. Anderson Cancer Center said in a telephone interview.

"We had no good tool to evaluate response," said Vauthey, whose study appears in the Journal of the American Medical Association.

He said the findings are preliminary and need to be confirmed in a much larger study, but they do suggest CT scans might help doctors offer more personalized treatment for their patients.

Vauthey, a surgeon, said most doctors rely on tumor shrinkage to see if patients are responding to treatment, but he said that is not always a good indicator of response.

In surgery patients, doctors could tell by examining changes in the size and structure of tumors whether a patient was responding to the drug combination — the standard of care for most patients with advanced colorectal cancer — and had a good chance at survival.

Working with radiology specialists, the team applied some of these same characteristics to develop screening characteristics for CT scans.

To test these, the researchers analyzed a total of 234 colorectal liver metastases from 50 patients who had their tumors removed after treatment with Avastin and chemotherapy between 2004 and 2007.

All patients had CT scans at the start and end of the treatment. Radiologists studied the images for changes in the shape and structure of the tumors. They noticed that in patients who had a good response, the tumors changed into almost cyst-like structures with well-defined borders.

And they found they could classify patients into one of three categories, with type 1 patients having a good response and the best chances of survival, and those with type 2 or type 3, having poorer or no response.

The team then analyzed data on 82 patients whose colon cancer was too advanced for surgery. In those patients whose CT scans suggested they had a good response, median survival rose to 31 months, compared with 19 months in those who had an incomplete or no response to the drug, Vauthey said.

"That is one year extra median survival. That is quite meaningful for patients who will never be cured from their disease," he said.

Clue hints at how breast cancer spreads

LONDON - Scientists who watched tumor cells spread in living mice said on Sunday they had found a gene signal controlling how cancer cells move, which could help companies design new drugs to fight the disease.

Scientists working for Cancer Research UK used hi-tech imaging techniques to watch how breast cancer cells spread in mice. They found that a genetic signal, known as TGF-beta, was crucial to whether cells moved as single entities or in clumps.

TGF-beta signaling is only active in singly moving cells, not in collectively moving cells. And in singly moving cells, the signal is on when they move and off when they stop in a new place to grow, they reported in the journal Nature Cell Biology.

"The results helped us to find the set of genes that are behind the spread of breast cancer -- and that the genes need to be first turned on and then off in order for single cancer cells to be able to relocate," said Erik Sahai, head of the tumor cell biology lab at Cancer Research UK's London institute.

He said several pharmaceutical firms were investigating how to stop TGF-beta from functioning, but stressed they were "very much in the development phase."

"As yet there is no new drug in the pipeline," said Sahai, "But because we now know what these cancer cells are actually doing, it gives us lots of new ideas about how to stop them."

A study published in May 2007 in the Journal of Clinical Investigation found that treating cancer with surgery, chemotherapy or radiation raised levels of TGF-beta and could actually cause tumors to spread.

But as yet, relatively little has been known about how cancer cells spread through the body because it is very difficult to track them when they are moving.

"In a medium-sized tumor there could be a billion cells — and only a small proportion might break away and spread. So it is like trying to find, and understand, a moving needle in a very big haystack," said Sahai.

Sahai and his team used two groups of fluorescently labeled breast cancer cells inside live mice and tracked them with a technique called multiphoton confocal microscopy.

When the TGF-beta signal was blocked, the tumor spread via clumps of cells in the lymphatic system — limiting how far it could go, the researchers said.

But cells that could receive the TGF-beta signal moved as single entities, and the TGF-beta signal was first turned on — allowing the cells to spread through the blood, and then turned off — allowing them to grow again in a new location.

"It seems they can't multitask," said Sahai. "They can't move and grow at the same time, they can only do one or the other."

Suzanne Somers questions chemo in new book

Suzanne Somers is at it again.

Less than a year after the former sitcom actress frustrated mainstream doctors (and cheered some fans) by touting bioidentical hormones on "The Oprah Winfrey Show," she's back with a new book. This one's on an even more emotional topic: Cancer treatment. Specifically, she argues against what she sees as the vast and often pointless use of chemotherapy.

Somers, who has rejected chemo herself, seems to relish the fight.

"Cancer's an epidemic," said the 63-year-old actress in an interview in a Manhattan hotel a day before Tuesday's release of "Knockout," her 19th book. "And yet we keep going back to the same old pot, because it's all we've got. Well, this is a book about options.

"I'm 'us'," Somers adds. "I'm not them. I've been on the other side of the bed. And it's powerful to have information."

"I am very afraid that people are going to listen to her message and follow what she says and be harmed by it," says Dr. Otis Brawley, the organization's chief medical officer. "We use current treatments because they've been proven to prolong life. They've gone through a logical, scientific method of evaluation. I don't know if Suzanne Somers even knows there IS a logical, scientific method."

More broadly, Brawley is concerned that in the United States, celebrities or sports stars feel they can use their fame to dispense medical advice. "There's a tendency to oversimplify medical messages," he says. "Well, oversimplification can kill."

Though she may be one of the most visible, Somers is hardly the only celebrity who's advocated alternative treatments recently.
Celebrity-endorsed health tips
Radio host Don Imus says he's eating habanero peppers and taking Japanese soy supplements to help treat his prostate cancer. The late Farrah Fawcett underwent a mix of traditional and alternative treatments, and made a poignant plea for supporting alternative methods in her film, "Farrah's Story." Actress Jenny McCarthy advocates a special dietary regime, supplements, metal detox and delayed vaccines to treat autism.

The issue goes beyond alternative medicine. Tennis great John McEnroe has been advocating widespread screening for prostate cancer, which Brawley and others say is not necessarily wise.

And comedian Bill Maher has made no secret of his disdain for flu shots, questioning why you'd let someone "stick a disease into your arm." He also said pregnant women shouldn't get the new swine flu vaccine, contradicting U.S. health officials who say pregnant women especially need it because they are at high risk for flu complications.

While it's hard to imagine a comedian like Maher influencing public health decisions, there have been cases where celebrities have been seen to influence the public, says Barron Lerner, a doctor who's looked at celebrity illnesses through history.

He recalls how some desperately ill cancer patients took their cues from Steve McQueen, the rugged actor who turned to unorthodox cancer treatment in 1980. When conventional medicine failed to halt his mesothelioma, a cancer of the lung lining, McQueen traveled to Mexico, where he was treated with everything from coffee enemas to laetrile, the now debunked remedy involving apricot pits.

"It's difficult to quantify his influence, but there was a lot of traffic to Mexico of end-stage cancer patients after his death," says Lerner, author of "When Illness Goes Public."

Celebrity-endorsed health tips
Radio host Don Imus says he's eating habanero peppers and taking Japanese soy supplements to help treat his prostate cancer. The late Farrah Fawcett underwent a mix of traditional and alternative treatments, and made a poignant plea for supporting alternative methods in her film, "Farrah's Story." Actress Jenny McCarthy advocates a special dietary regime, supplements, metal detox and delayed vaccines to treat autism.

The issue goes beyond alternative medicine. Tennis great John McEnroe has been advocating widespread screening for prostate cancer, which Brawley and others say is not necessarily wise.

And comedian Bill Maher has made no secret of his disdain for flu shots, questioning why you'd let someone "stick a disease into your arm." He also said pregnant women shouldn't get the new swine flu vaccine, contradicting U.S. health officials who say pregnant women especially need it because they are at high risk for flu complications.

While it's hard to imagine a comedian like Maher influencing public health decisions, there have been cases where celebrities have been seen to influence the public, says Barron Lerner, a doctor who's looked at celebrity illnesses through history.

He recalls how some desperately ill cancer patients took their cues from Steve McQueen, the rugged actor who turned to unorthodox cancer treatment in 1980. When conventional medicine failed to halt his mesothelioma, a cancer of the lung lining, McQueen traveled to Mexico, where he was treated with everything from coffee enemas to laetrile, the now debunked remedy involving apricot pits.

"It's difficult to quantify his influence, but there was a lot of traffic to Mexico of end-stage cancer patients after his death," says Lerner, author of "When Illness Goes Public."

Though his alternative treatments didn't work, the actor, who embodied a sense of rebellion and individualism, gave voice to an emerging feeling that mainstream medicine might not be enough, Lerner says.

Fast forward to the 21st century, where Somers, who played the ditzy blonde in TV's "Three's Company," has written a series of books making that point. In "Ageless," she argued that doctors don't understand women's bodies, especially those going through menopause.

With so-called "bioidentical" hormones — compounds that are custom-mixed by special pharmacies — Somers argued that women can restore youthfulness and vitality, energy and vigor, not to mention their sex drive.

The problem, for many doctors: These custom-compounded products are not approved by the Food and Drug Administration.

Oprah's support
Somers, whose hormone regimen involves creams, injections and some 60 supplements daily, got a huge boost earlier this year from Oprah Winfrey. "Many people write Suzanne off as a quackadoo," Winfrey said when Somers appeared on her show. "But she just might be a pioneer."

Yet Winfrey's tacit support of Somers gave her some of the worst press of her career. "Crazy Talk," Newsweek headlined an article on the talk show host earlier this year. Another headline, on Salon.com: "Oprah's Bad Medicine."

Winfrey responded in a statement that her viewers know that "the medical information presented on the show is just that — information — not an endorsement or prescription." But many doctors feel Winfrey has more of a responsibility to her viewers.

"Oprah, how could you? That's all I can say," says Dr. Nanette Santoro, a hormone specialist at the Albert Einstein College of Medicine in New York.

Somers is now hoping for a return invitation to Winfrey's hugely influential stage to discuss her cancer book. Her theories on chemotherapy did get one bit of attention she could have done without, though: The actress had to apologize recently when her offhand comment that chemo had likely killed actor Patrick Swayze, rather than his pancreatic cancer, made tabloid headlines.

"I shouldn't have said anything," Somers says now. "I apologized to his family. But she adds: "We all know that chemotherapy does nothing for pancreatic cancer."

In fact, Somers does view chemotherapy as effective for some cancers, but not for the most common, including lung and breast cancer. Diagnosed with breast cancer a decade ago, she had a lumpectomy and radiation, but declined chemotherapy, as she did more recently when briefly misdiagnosed with pervasive cancer.

One criticism sure to come up with Somers' cancer book is its reliance on several doctors who have controversial histories, including Dr. Stanislaw Burzynski in Houston, who has devised his own alternative cancer treatments and has had protracted legal battles with the FDA.

But Somers defends him passionately, as she does the other doctors interviewed in her book. As for herself, she says, she is at ease with her role as celebrity health guru.

"Celebrities are easy to pick on," Somers says. "But I don't have an agenda. I'm just a passionate lay person. And I'm using my celebrity to do something good for people."

Panel backs second cervical cancer vaccine

ATLANTA - A federal vaccine advisory panel has voted to recommend a second kind of vaccine against cervical cancer for girls and young women.

The government last week licensed the vaccine, Cervarix from GlaxoSmithKline, for marketing in the United States. Merck & Co. has had the vaccine Gardasil on the market since 2006.

The committee voted Wednesday to recommend Cervarix as an alternative. It did not state a preference of one vaccine over the other. But officials noted that while both protect against forms of the virus that cause cervical, vaginal and vulvar cancers, the older Merck vaccine also protects against forms that cause genital warts. Both shots are a three-dose series. The Merck series costs about $390 and Glaxo's costs about $385.

The CDC still has to adopt the new recommendation for it to become official.

Thousands race in Egypt to fight breast cancer

CAIRO - Thousands of runners and walkers have participated in the Middle East's first-ever international Race for the Cure to raise awareness about breast cancer.

Saturday's event took place near Egypt's legendary Great Pyramids at Giza and included participants from all over the world.

The event was organized by the Susan G. Komen for the Cure foundation and the Breast Cancer Foundation of Egypt.

The two groups said in a press release that the incidence of breast cancer is rising in Egypt and other countries in the Middle East and North Africa.

Family of teen who fled chemo wants court out

MINNEAPOLIS - The parents of a southern Minnesota teenager who once fled the state to avoid chemotherapy went before a judge Monday and asked for the court’s role in the case to end, saying they are following the advice of doctors and making sure their son gets the best medical care.

Daniel Hauser, 13, is undergoing radiation treatments for childhood Hodgkin’s lymphoma. He finished chemotherapy in early September, and his father said there is no sign of cancer.

“In all reality, he’s been in remission for quite some time already,” Anthony Hauser said in a telephone interview Monday. “I hope he stays in remission — that’s No. 1. And hopefully we can live our lives normally again.”

During a hearing in Brown County District Court, Judge John Rodenberg said that as long as no new issues arise, he would close the case after Daniel completes his 12 recommended sessions of radiation — which are expected to end Nov. 6, according to Joseph Rymanowski, an attorney for the parents.

“It’s time to let these people be. They’ve been through enough,” said Rymanowski, who was at Monday’s hearing in New Ulm.

Daniel, of Sleepy Eye, was diagnosed with childhood Hodgkin’s lymphoma in January and stopped chemotherapy after one round because it made him sick. He said it was poison, and his family opted instead for alternative treatments inspired by American Indian traditions. The issue ended up in court as a medical neglect case because doctors said Daniel’s type of cancer is highly curable with chemotherapy.

A judge ordered in May that Daniel see an oncologist and follow the recommended treatment. Daniel and his mother fled Minnesota and became subject of a search that extended into Mexico. They returned after about a week and said they would follow the court’s order.

Daniel resumed chemotherapy and the family also used alternative therapies, such as massage, herbs and other remedies, to complement the medical treatment, according to court documents. His tumor responded well and he finished chemo earlier than expected.

Family postponed radiation treatment
Doctors wanted Daniel to start radiation in the beginning of October, but the family postponed it to seek additional medical opinions. The Hausers had expressed fear that radiation would “melt” Daniel’s thyroid or cause thyroid cancer.

The family spoke with three more doctors, including two pediatric oncologists who agreed radiation was the best course.

“We did initially oppose radiation because of the concerns of the long term effects we sought second opinions to ensure Danny receive the best medical care,” Colleen Hauser wrote in a court affidavit. “We never opposed radiation on moral, ethical or religious grounds.”

She said the family will continue to follow doctors’ recommendations.

“What we will not do, is blindly follow one particular doctor’s advice ... without research and ... second opinions,” Colleen Hauser wrote.

Brown County Attorney James Olson said before Monday’s hearing that he sees no reason to keep the case open once Daniel finishes radiation. Phone messages left with a court-appointed attorney for Daniel and with attorneys for the guardian ad litem were not immediately returned.

Daniel has gained some weight but is skinnier than he was before he started chemo, his father said. His hair is growing back and he seems to be tolerating his daily radiation treatments. One change: Daniel now needs eyeglasses, which his dad attributes to effects of chemo.

“He’s more upbeat. When it’s over he’s going to really feel a lot better,” Anthony Hauser said.

When the radiation is done, Daniel plans to celebrate by going deer hunting.

Breast cancer stigma endangers poorer women

WASHINGTON - Nurses were training women in rural Mexico to examine their breasts for cancer when one raised her hand to object. If she lost her breast, Harvard public health specialist Felicia Knaul recalls the woman saying, "My man would leave me" — and with him, the family's income.

International cancer specialists meet this week to plan an assault on a troubling increase of breast cancer in developing countries, where nearly two-thirds of women aren't diagnosed until it has spread through their bodies.

Adding to the problem, some worrisome data suggests that breast cancer seems to strike women, on average, about 10 years younger in poor countries than it does in the U.S. No one knows why.

Younger women at risk
"Today in most developing countries you see a huge bulge of young, premenopausal women with breast cancer," says Knaul, who heads Harvard's Global Equity Initiative and was herself diagnosed at age 41 while living in Mexico.

"We should help them to know what they have and to fight for their treatment."

But from Mexico to Malawi, stigma like Knaul witnessed a few weeks ago may prove as big a barrier as poverty.

"One of the trainers said, 'If he'd leave you for that, he's not worth having,'" says Knaul. But she acknowledged that will be a hard message for some women's economic realities.
"It's not a trivial consideration," agrees Dr. Lawrence Shulman of the Dana Farber Cancer Institute, who is part of a team working to begin cancer care in parts of Africa where "the women are often seen as really either vessels for producing children or as sex slaves."

But some success in treating HIV and tuberculosis in those areas has him "hopeful we can make a difference. I don't think it's a pipe dream."

Tuesday, Knaul and Shulman bring together international task force of health specialists and prominent charities to begin planning a two-pronged approach.

First, train midwives and other rural health providers to perform regular breast exams, using the power of touch in places where mammography machines simply are too expensive. That won't catch the very smallest tumors, but specialists agree it could improve diagnosis dramatically in some areas.

Second, the task force will start negotiating lower prices for generic chemotherapy for poor countries, following the same model that has helped transform AIDS care in parts of Africa.

You don't need in-country cancer specialists to administer that chemo, says Shulman — just a network of oncologists who can provide help or instruction to local health officials by e-mail or phone, as he has advised colleagues in Malawi.

Considered a problem for the wealthy
Breast cancer long has been considered a cancer mostly of wealthier countries. Indeed, about 192,000 new cases are expected in the U.S. this year, where long-term survival is high thanks in part to good screening.

The true prevalence in most developing countries is unknown, because of poor diagnosis and bad record-keeping. But new Harvard research estimates they'll be home to 55 percent of the world's 450,000 expected breast cancer deaths this year.

The report predicts the poorest countries will experience a 36 percent jump in breast cancer by 2020.

One problem: In wealthy countries, earlier diagnosis can lead to breast-saving surgery instead of breast removal. Even countries like Rwanda and Malawi have clinics that perform mastectomies if patients can travel to the capitals, Shulman says. But few have radiation equipment, making breast-conserving surgery there not an option yet. (He is hunting a radiation unit for Rwanda but says that's in the very earliest stages of planning.)

Mexico is a mixed situation, with radiation, other treatments and diagnostic mammography available in some places. That's how Knaul — whose husband is a former health minister of Mexico — was diagnosed, early enough that mastectomy and chemotherapy give her good odds.

But she fumes that while Mexico's poor and rural women often get Pap smears to check for cervical cancer, "no one even suggests they check your breasts" at the same visit. She founded an advocacy group — Cancer de Mama — to help, noting that Mexico's insurance program for the poor covers breast cancer care but they must get diagnosed first.

Low cholesterol may ward off prostate cancer

A new study suggests that men may be able to lower their risk of getting the most aggressive form of prostate cancer by keeping their cholesterol in a healthy range.

Men whose cholesterol was under 200 had less than half the risk of developing high-grade prostate tumors compared to men with high cholesterol, researchers report. The information comes from about 6,000 men who were in a big federal cancer prevention study.

Doctors say it is premature to advise men to take statin drugs like Lipitor or Crestor in the hope of preventing prostate cancer, but these medicines are already widely used to ward off heart disease.

The new research is published in the journal Cancer Epidemiology Biomarkers & Prevention.

Bone drugs may ward off effects of radiation

Drugs commonly used to strengthen bones to prevent osteoporosis may protect people exposed to radiation against developing leukemia, U.S. researchers said on Sunday.

They said two compounds in a class of drugs called bisphosphonates delayed and in some cases prevented mice exposed to high doses of radiation from developing leukemia, a common long-term side effect of radiation exposure.

Alexandra Miller, a scientist at the Armed Forces Radiobiology Research Institute in Bethesda, Maryland, has been studying ways to protect military personnel and astronauts from radiation exposure.

But she said the findings, which she presented at the American Association for Cancer Research in Denver, Colorado, could also help cancer patients treated with radiation who later develop leukemia as a side effect of their treatment.

The compounds Miller studied are bisphosphonates known as ethane-1-hydroxy-1, 1-bisphosphonate or EHBP, which Miller said is chemically similar to Procter & Gamble's osteoporosis drug Didronel or etidronate.

The other was an experimental drug called CAPBP, which Miller said is similar to Roche's Boniva or ibandronate.

She picked the drugs because of studies in humans that suggest bisphosphonates may help prevent cancer from spreading to the bone. They also have been shown to remove uranium from the body.

Drug delayed, deterred leukemia in mice
Miller exposed lab mice to radiation strong enough to cause leukemia. She injected some of the mice with one of the two compounds and waited.

Typically, mice exposed to radiation developed leukemia and died 92 to 110 days later.

"With the drug, the animals were developing leukemia too, but it took much longer, 150 to 170 days," Miller said in a telephone interview.

"The total number that actually developed leukemia was significantly lower with both of the drugs," she said.

She said all of the untreated animals developed leukemia after radiation exposure, but only about half did in the treated group.

"It was very significant. We didn't have any toxic effects with the drug treatment," she said.

Miller said many more studies would be needed before the drugs could be used in humans, but she thinks the compounds show promise as a way of addressing one of the most toxic side effects of radiation exposure.

Vegetarians show reduced cancer risk

Vegetarians are 12 percent less likely to develop cancer than meat eaters and the advantage is particularly marked when it comes to cancers of the blood, British researchers said on Wednesday.

Past research has shown that eating lots of red or processed meat is linked to a higher rate of stomach cancer and the new study, involving more than 60,000 people, did confirm a lower risk of both stomach and bladder cancer.

But the most striking and surprising difference was in cancers of the blood — such as leukemia, multiple myeloma and non-Hodgkin lymphoma — where the risk of disease was 45 percent lower in vegetarians than in meat eaters.

"More research is needed to substantiate these results and to look for reasons for the differences," Tim Key, study author from the Cancer Research UK epidemiology unit at Oxford University, said.

Key and colleagues, who published their findings in the British Journal of Cancer, followed 61,000 meat eaters and vegetarians for over 12 years, during which time 3,350 of the participants were diagnosed with cancer.

The study, which looked at 20 different types of cancer, found the differences in risk were independent of other factors such as smoking, alcohol intake and obesity, which can all increase the chance of developing cancer.

Gene trigger for deadly skin cancer found

Up to 70 percent of melanoma skin cancers may be triggered by a gene mutation that causes cells to become cancerous after excessive exposure to the sun, researchers said on Monday.

The discovery could lead to better treatments for the most deadly form of skin cancer after scientists at Britain's Institute of Cancer Research established the BRAF gene mutation is often the first event in the cascade of genetic changes leading to melanoma.

Scientists already knew the BRAF gene was frequently damaged in patients with melanoma, but it was unclear if this was a cause or effect of the cancer.

The British institute published its findings in the journal Cancer Cell.

"Our study shows that the genetic damage of BRAF is the first step in skin cancer development," said lead author Richard Marais. "Understanding this process will help us develop more effective treatments for the disease."

The hope is that knowing the genetics behind skin cancer will lead to the development of targeted drugs that can fix the faulty genetic machinery.

While melanoma accounts for only a small percentage of skin cancers, it is responsible for most skin cancer deaths. The disease is characterized by the uncontrolled proliferation of pigment-producing skin cells called melanocytes.

Over-exposure to sunlight is to blame for at least two-thirds of cases as DNA in sunburnt skin cells becomes damaged, leading to the genetic mutations.

Where you live may impact cancer survival

A study of neighborhoods suggests that modifiable factors, not genetics, underlie the racial disparities that have been seen in survival of breast and prostate cancer.

While "large city" studies have shown considerable racial disparities in cancer survival, the new study shows that racial disparities virtually disappear in studies that focus on smaller populations, such as neighborhoods within larger cities.

In their study reported Monday in the journal Cancer, researchers led by Jaymie R. Meliker, of New York's Stony Brook University, asked the question: Do racial disparities in breast and prostate cancer survival seen in large counties persist in small cities and even smaller neighborhoods?

They studied geographic regions in Michigan, using the Michigan Cancer Surveillance Program, which compiled information from 1985 to 2002 on 124,218 breast cancer and 120,615 prostate cancer patients.

As the geographic scale gets smaller, they explain, the population becomes more homogenous in terms of income, access to medical care and other factors that may influence cancer survival. Therefore, the researchers hypothesized that if racial disparities in cancer survival diminished when smaller geographic areas were analyzed, modifiable factors, not genetics, may be responsible for the disparity.

In support of their hypothesis, the study revealed that whites had significantly higher survival rates of prostate and breast cancer compared with blacks when large geographic regions were analyzed. However, when smaller geographic areas were analyzed, such as legislative districts and neighborhoods, disparities diminished or virtually disappeared.

"When racial disparities vanish in small geographic areas, it suggests that modifiable factors are responsible for apparent racial disparities observed at larger geographic scales," Meliker and colleagues write.

It is unclear which modifiable factors are important, but the current findings suggest that genetic factors are not likely to play a large role in disparities of survival from prostate and breast cancer," they conclude.

Wine may help cancer patients handle radiation

A glass of wine a day may help breast cancer patients better tolerate radiation therapy and reduce its adverse effects, according to a new study by an Italian medical university.

The study, released on Wednesday, said polyphenols found in wine may help protect healthy tissues from the effects of radiation while combating cancerous cells.

The research was carried out on 348 women treated for breast cancer between 2003 and 2007 at the radiotherapy and palliative care unit of the Catholic University of Campobasso.

The study at the southern university showed that moderate daily consumption of wine was associated with a 75 percent reduction of skin lesions compared to those who did not drink wine.

"Our data are to be taken with caution as our study was an observational one," said Alessio Morganti, director of the radiotherapy unit.

"A formal randomized trial should now be performed. Establishing the role of wine and its non-alcoholic components is certainly a crucial issue that may open a new way for the preventive use of antioxidants," he said.

The full study is due to be published online in the International Journal of Radiation Oncology Biology Physics.