Europe should shift focus to bowel cancer screening to save lives: scientists

By Kate Kelland

AMSTERDAM (Reuters) - European governments should divert funds to routine bowel cancer tests from less effective breast and prostate screening programs, scientists said on Saturday, presenting what they called "irrefutable" evidence that bowel screening saves lives.

Many governments devote significant funds to breast cancer screening, but studies in recent years have found that routine breast mammograms can also lead to so-called "over-diagnosis" when tests pick up tumors that would not have caused a problem.

The risk of over-diagnosis in bowel cancer screening is very low, while gains in terms of reducing deaths are large - making routine testing cost-effective, Philippe Autier, a professor at France's International Prevention Research Institute, told the European Cancer Conference in Amsterdam.

"There is now an irrefutable case for devoting some of the resources from breast and prostate cancer screening to the early detection of colorectal (bowel) cancer," he said.

A large European study published last year found that breast screening programs over-diagnose about four cases for every 1,000 women aged between 50 and 69 who are screened.

Colorectal cancer kills more than 600,000 people a year worldwide, according to the World Health Organization. In Europe some 400,000 people are diagnosed with the disease each year.

Results of a study conducted by Autier using data from 11 European countries between 1989 and 2010 showed that the greater the proportions of men and women routinely screened for bowel cancer, the greater the reductions in death rates.

In Austria, for example, where 61 percent of those studied reported having had colorectal screening tests, deaths from this form of cancer dropped by 39 percent for men and 47 percent for women over the decade.

Meanwhile in Greece, where only 8 percent of males had had bowel cancer screening, death rates rose by 30 percent for men.

In the light of the results, Cornelis van de Velde, an oncologist at Leiden University Medical Centre in the Netherlands and president of the European Cancer Organisation, said it was "very disappointing" there are such wide differences in European governments' approaches to colorectal screening.

"People over 50 should be informed of the availability of the test, and pressure should be put on national health services to put more effort into organizing screening programs," he told the conference.

Screening for early signs of bowel cancer involves either a faecal occult blood test, which checks a sample of feces for hidden blood, or endoscopy, where a tiny camera is introduced into the large bowel to look for the polyps that can be a precursor of cancer.

In some European countries, such as France, Germany and Austria, many men and women over the age of 50 have regular colorectal screening examinations, while in others, such as The Netherlands and Britain, screening is much less common.

(Editing by Louise Ireland)

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Americans living longer, more healthy lives

Sep. 12, 2013 — Thanks to medical advances, better treatments and new drugs not available a generation ago, the average American born today can expect to live 3.8 years longer than a person born two decades ago. Despite all these new technologies, however, is our increased life expectancy actually adding active and healthy years to our lives? That question has remained largely unanswered -- until now. In a first-of-its-kind study, researchers at the University of Massachusetts Medical School (UMMS) have found that the average 25-year-old American today can look forward to 2.4 more years of a healthy life than 20 years ago while a 65-year-old today has gained 1.7 years.

Synthesizing data from multiple government-sponsored health surveys conducted over the last 21 years, Allison Rosen, MD, associate professor of Quantitative Health Sciences at UMMS, Susan Stewart, researcher at the National Bureau of Economic Research, and David Cutler, professor of economics at Harvard University, were able, for the first time, to measure how the quality-adjusted life expectancy (QALE) of all Americans has changed over time. The study's findings are described in a paper published today in the American Journal of Public Health.

"QALE tells us more than how long a person can expect to live," said Dr. Rosen, senior author on the study. "It tells us what the relative quality of those added years are in terms of physical, emotional and mental well-being. Though many studies have measured this in different ways, this is really the first time we've been able to capture this type of information across the whole U.S. population over an extended period."

The data shows that Americans are living longer, reporting fewer symptoms of disease, have more energy and show fewer impairment in everyday tasks such as walking than a generation ago. According to the study authors, a 25-year-old person today can expect to live 6 percent or 2.4 quality years longer than their 1987 counterpart. Meanwhile, a 65-year-old person will gain 1.7 quality years, a 14 percent increase from a generation ago.

Thanks to improvements in health care, many conditions are far more treatable today than 25 years ago, Rosen said. Heart disease, for instance, was potentially much more debilitating a generation ago and patients often suffered a decline in quality of life as a result. "Today, it is far less likely that a patient recovering from a heart attack will become institutionalized or need around-the-clock care the way they once might have," Rosen said. They also found that health gains made as a result of smoking cessation programs were being off-set, in part, by increases in obesity.

Today, Americans are more likely to see quality of life declines related to chronic, degenerative diseases such as Alzheimer's and dementia, while younger Americans appear to be experiencing problems related to a sedentary lifestyle.

The authors also identified some troubling health trends. Among these was an increase in anxiety among young and middle-aged people beginning in 2001. Problems with walking have increased significantly among non-elderly over the last decade.

In the past, researchers have had a difficult time measuring population health beyond simple life expectancy because quality of life incorporates so many variables -- physical well-being, mental health, pain, vitality, energy, emotional state -- that it's difficult to bring all these things together cohesively into a single number. Making it even more challenging, the surveys that measure quality of life are rarely consistent with each other because they all define health and quality of life differently.

Using multiple national surveys that asked Americans about their health in various ways over the last 21 years, the authors solved this problem by identifying areas where the studies overlapped, allowing them to build a single, large data set which covered the entire adult population over more than two decades.

"Comprehensive measures of the overall health of the nation are practically nonexistent," said Rosen. "This study shows how existing national data can be used to systematically measure whether the population is getting healthier -- not just living longer."

As the Affordable Care Act goes into effect in 2014, the value of a single, consistent way of measuring improvements in health over a large population will be invaluable in assessing the impact of these pending changes according to the authors.

"Having a consistent measure of population health represents a major advance in our ability to measure the impact of health care reform on the health -- not just the health care use -- of all Americans," said Rosen. "The bottom line in assessing the success of the ACA is whether or not we are getting the most health from our investment of increasingly limited resources. Are we getting the most health bang for our bucks?"

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Heart technique 'could save lives'

11 September 2013 Last updated at 10:07 GMT By Eleanor Bradford BBC Scotland Health Correspondent Every year 25,000 people in the UK have the kind of heart attack which is treated with an angioplasty A new, relatively simple way of treating heart attacks could save thousands of lives, according to specialists at a Clydebank hospital.

It involves clearing all narrowed arteries when someone is admitted with a heart attack, rather than just the one which is completely blocked.

A trial, involving the Golden Jubilee National Hospital, was so successful that the research was stopped early.

Jubilee heart specialist Prof Colin Berry said the results were "striking".

Fatty deposits

Another cardiologist, Prof Keith Oldroyd, said: "At the moment when patients come in with a heart attack they have an emergency angiogram and we usually only treat the artery that has caused the heart attack.

"Many of these patients have additional narrowings in other arteries. We're treating all the narrowed arteries at the same time to see if that confers additional benefit."

Every year 25,000 people in the UK have the kind of heart attack which is treated with an angioplasty.

This involves inserting a stent, or thin tube, to open an artery and restore the blood flow.

Arteries become narrowed by fatty deposits, so although a blood clot may have only blocked one artery, other narrowed arteries are common.

Current UK recommendations advise specialists only to treat the artery which is completely blocked.

"Most cardiologists thought it wasn't safe to treat a second or third artery at the same time as the first artery," Prof Oldroyd said.

"Sometimes the patients would be brought back several weeks later or sometimes only medication would be used. The results of this trial suggest that this recommendation should be revisited."

Reducing costs

The trial involved 465 patients in five specialist heart centres around the UK. In addition to the Golden Jubilee, they were the London Chest Hospital, Morriston Hospital in Swansea, Freeman Hospital in Newcastle, and Norfolk and Norwich University Hospital.

Half of the trial participants had all their arteries cleared, the rest were treated in the conventional way.

Prof Keith Oldroyd said most patients had narrowings in more than one artery

The researchers found that the new technique reduced the combined risk of dying, having another heart attack or being left with angina by two-thirds - such a significant finding that the trial was stopped early.

It also only added an average of 20 minutes to each treatment.

The results have been published in the New England Journal of Medicine and were presented at an international conference in Amsterdam earlier this month.

Prof Colin Berry, heart specialist at the Golden Jubilee and the University of Glasgow, said: "They were some of the most striking results for a treatment that I have ever seen. The results of this trial really challenge clinical practice."

Heart specialists are now keen that even larger studies get under way as quickly as possible.

In the past, it has taken a decade or more for the latest evidence to be adopted into frontline medical care.

Prof Berry added: "It's appealing because it's a form of usual care that can be readily adopted across the UK.

"On the other hand there are logistical considerations and cost considerations. However, we would argue that reducing the likelihood of further cardiac events, potentially reducing the heart failure admissions to hospital, is going to reduce costs overall and this should be implemented as soon as possible."

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Advocates: HIV prevention pill could save lives

AppId is over the quota
AppId is over the quota

CHICAGO (AP) — A pill to prevent HIV infection is already being given to some healthy people, but without government approval, it remains out of reach and too costly for many who need it.

Doctors, patients and advocates say that would change if the Food and Drug Administration takes a landmark step and allows the pill, Truvada, to be marketed for prevention. The drug has been used for some time as a treatment for those already infected with the AIDS virus.

"This is a pretty radical step, but I think it's a necessary step," said Dr. Lisa Sterman of San Francisco, who prescribes the drug for already infected patients and those who are healthy but at risk of getting the virus from their partners or through risky sex.

"We've come as far as we can with condom use and safe sex strategies," Sterman said.

A panel of advisers to the Food and Drug Administration late Thursday endorsed using Truvada as a preventive.

In the 30-year battle against AIDS, "it's the first time we have talked about a medication for prevention of HIV," Sterman said.

Doctors are allowed to prescribe Truvada "off-label" for prevention, but FDA approval would formally allow the pill's maker Gilead Sciences to market it for that use. It would probably lead many more insurance companies to pay for the costly drug. The FDA usually follows advisers' recommendations and a decision is expected by June 15.

The panel's action "is a huge step forward," said Nick Literski, a federal worker in Seattle who has been taking Truvada for HIV prevention for more than a year. His partner has the AIDS virus. Literski's insurance covers his preventive treatment. The pill's annual cost ranges from just under $11,000 up to $14,000.

Using the drug for prevention "is really allowing people to make educated choices about their health," Literski said.

An estimated 1.2 million Americans have HIV and many more worldwide. AIDS can develop unless the virus is treated with antiviral drugs. The success of such medicines has helped make the disease more manageable and allows patients to live much longer than when the epidemic began 30 years ago.

About 50,000 new HIV infections are diagnosed in the U.S. each year — a number that has held steady for about 15 years.

"We're going to have to take some radical steps in order to stop this epidemic," Sterman said.

Truvada is marketed by Gilead Sciences Inc. of Foster City, Calif. Studies have shown daily use is highly effective at preventing HIV infections.

Some Truvada prevention studies took place in Africa, and the drug is available as an HIV treatment there and in poor nations elsewhere, but Gilead is seeking approval for using it for prevention in the United States only, a company spokeswoman said.

A September editorial in the medical journal Lancet raised concerns about using HIV treatments for prevention when many HIV infected people globally lack access to effective treatments.

James Loduca, a spokesman for the San Francisco AIDS Foundation, praised the advisory panel's action.

"With this recommendation, we're nearing a watershed moment in our fight against HIV," Loduca said. "We know this isn't a magic bullet, and it's not going to be the right prevention strategy for everyone, but it could save thousands of lives in the United States and potentially millions around the world."

Not everyone in the HIV community is so gung-ho about using Truvada for prevention.

Michael Weinstein, president of the AIDS Healthcare Foundation, is among the most vocal opponents. His Los Angeles-based group bills itself as the nation's largest provider of medical care for HIV and AIDS, and Weinstein's main concern is that patients won't take the drug as directed — a pill a day plus the use of condoms. Misuse could create drug-resistant HIV strains, and lead to more infections.

The FDA panelists acknowledged that concern, and said people should be tested to make sure they don't have HIV before starting Truvada. Patients who already have the virus and begin taking Truvada could develop a resistance to the drug, making their disease even more difficult to treat.

Justin Terry-Smith, a Washington-area writer with HIV, has different concerns. He took Truvada for four years to suppress his infection. He said he has friends with the AIDS virus in other cities who can't find the drug, and he worries that making it widely available for prevention could result in shortages and pose problems for patients who need it for treatment.

"There has to much more production of this drug for this to actually go forward," he said.

His doctor recently put him on another drug regimen — switching medicines is a common tactic in HIV treatment. But unlike his other HIV medicines, Truvada had no side effects, and he said it needs to remain available for already infected patients.

Sterman said approval of Truvada for prevention would be unlikely to lead to shortages because the drug would be recommended only for people at high risk for getting the virus.

"I don't think demand for it is going to be that high," she said.

Truvada's costs are another concern. But supporters of the drug note that the lifetime cost of treating one person diagnosed with the AIDS virus has been estimated at more than $600,000.

"It's much more cost-effective to prevent a new infection than it is to treat someone for their lifetime," Loduca said. "Of course the ultimate goal is a vaccine and a cure but we're many years away from that."

Jim Pickett, director of prevention advocacy and gay men's health at the AIDS Foundation of Chicago, has had the AIDS virus since 1995. He says his medical costs, mostly covered by health insurance, have continually increased since then; his HIV medicines alone cost $30,000 a year.

He took Truvada for a while for HIV treatment and had no complications. Side effects from long-term use are unclear, but some of the more serious complications linked with Truvada include kidney and liver problems.

The potential for those problems shouldn't be dismissed, but it's not a reason to reject using the drug for prevention, said Pickett, whose group is not affiliated with the San Francisco foundation.

For some people, the risk of kidney problems "10 years down the line may be less than the risk for acquiring HIV, which is significantly more problematic and can be fatal," Pickett said.

"We need options for people. This is one option. It wouldn't be an option for everybody. It's not meant for everybody," Pickett said.

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AP Health Writer Matthew Perrone contributed to this story from Washington.

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Online:

FDA: http://www.fda.gov

AIDS: http://www.aids.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner