U.S. Panel Backs Routine Lung CT Scans for Older, Heavy Smokers

Yearly testing will prevent some lung cancer deaths, experts conclude

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Older than the newly diagnosed breast cancer patients between high damage.

Many older with newly diagnosed breast cancer women struggling is going to be affected disproportionately African-Americans through the everyday tasks. They're new research to be published soon survey results case Western Reserve University School of medicine, Cleveland (case Comprehensive Cancer Center home ）, cancer researchers from University hospitals case Medical Center online American Cancer Society peer-reviewed journal is. We can benefit from the research results to improve physical function of many breast cancer patients treated.

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Diabetes Drug Metformin May Cut Breast Cancer Risk in Older Women

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MONDAY, June 11 (HealthDay News) -- A widely prescribed drug, metformin, may lower the risk of invasive breast cancer in postmenopausal women with diabetes, a new study indicates.

The research, published online June 11 in the Journal of Clinical Oncology, echoes other recent studies that have suggested the diabetes drug may help cut the chances of prostate, pancreatic, liver and oral cancer, as well as certain forms of melanoma.

The researchers found that the incidence of invasive breast cancer was 25 percent lower in women with diabetes who were taking metformin than it was in women who weren't taking the drug.

Approximately 25.8 million people in the United States have diabetes, according to the U.S. Centers for Disease Control and Prevention. Between 90 percent and 95 percent of these cases are type 2 diabetes, in which the body's ability to make and use insulin deteriorates.

"Type 2 diabetes is a disease of insulin resistance," said study co-author Dr. Rowan Chlebowski, a medical oncologist with the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, in Torrance, Calif.

Insulin is a hormone that helps regulate the level of glucose (sugar) in the body. With type 2 diabetes, the body manufactures larger quantities of insulin to maintain normal levels of glucose in the blood.

Metformin, commonly used to treat type 2 diabetes, increases insulin sensitivity and improves the control of blood sugar. "It makes the insulin you have more effective," Chlebowski explained. The drug, approved in the United Kingdom in 1958 and in Canada in 1972, was introduced in the United States in 1994.

The new research looked at relationships among diabetes, metformin use and breast cancer among over 68,000 women between 50 and 79 years old in the national Women's Health Initiative project. In this group, 3,401 had diabetes and 3,273 invasive breast cancers were diagnosed during the study.

Because of the design of the Women's Health Initiative trials, detailed information was available for this large and diverse population in many areas, including breast cancer risk factors, baseline mammograms, clinical breast exams and verification of breast cancers when they occurred. Researchers were also able to know which participants had diabetes -- along with their use of diabetes medication.

The trials excluded women who had already had breast cancer. Women who had developed diabetes before adulthood (suggesting they were type 1 diabetics) were also excluded from the study.

How can a drug that treats people with high blood sugar play a role in reducing breast cancer risk? Chlebowski suggested that metformin "may inhibit the master regulator of the cell, 'mTOR,' changing critical pathways involved in cancer."

The mTOR pathway is affected by a wide range of cellular signals, including growth factors, hormones such as insulin, nutrients including glucose and amino acids, cellular energy levels and stress. A key cell pathway associated with mTOR is critically involved in cell reproduction and survival.

Chlebowski and other experts cautioned against looking to metformin as a cancer prevention drug just yet.

"It's too soon to change clinical practice," said Jennifer Ligibel, a medical oncologist in the Women's Cancer Program at the Dana-Farber Cancer Institute in Boston. "While a number of other studies have suggested metformin has a role in preventing breast cancer and its recurrence, I would not recommend women take metformin for breast cancer prevention based on the data we have now."

As to the question of whether metformin could ever be used more broadly beyond diabetic patients to reduce the risk of breast cancer, Chlebowski said the answer is unclear and more studies are necessary to further analyze the linkage.

While the study uncovered an association between metformin use and lower breast cancer risk in diabetic postmenopausal women, it did not prove a cause-and-effect relationship.

The U.S. Food and Drug Administration has issued warnings about metformin in recent years. It requires product inserts for physicians and patients to say that the drug has been associated with increased cardiovascular risks, including heart attack and stroke, and lactic acidosis, which causes fatigue, muscle pain, difficulty breathing and other symptoms. The FDA also stipulates that the drug literature include a warning that the drug should only be used by patients with type 2 diabetes who cannot control their blood sugar with lifestyle or other medications.

More information

The U.S. National Library of Medicine has more on type 2 diabetes.

Copyright c 2012?HealthDay. All rights reserved.

Johnson & Johnson diabetes drug tops older therapies in studies

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(Reuters) - An experimental treatment for type 2 diabetes developed by Johnson & Johnson demonstrated greater reduction in blood sugar than Merck & Co's Januvia and an older common treatment, glimepiride, according to data from a pair of late stage clinical trials.

The J&J drug, canagliflozin, also led to significantly greater weight loss than both of the other drugs and far fewer incidents of hypoglycemia, or potentially dangerous drops in blood sugar levels, than glimepiride, a member of the sulfonylurea class of medicines.

Weight loss is an especially attractive effect as obesity is a leading cause of type 2 diabetes and some older medicines cause weight gain.

Canagliflozin, belongs to a new class of diabetes treatments called SGLT2 inhibitors that work by blocking reabsorption of glucose by the kidney and increases glucose excretion in the urine to lower blood sugar.

The data from the two 52-week studies, presented on Saturday at the American Diabetes Association (ADA) meeting in Philadelphia, are part of a massive approval application J&J submitted to the U.S. Food and Drug Administration last week that comprised nine separate Phase III trials involving more than 10,000 patients. If approved it would be the giant healthcare conglomerate's first diabetes medicine.

"There are clearly some unmet needs in diabetes to get glucose control. Hypoglycemia is a big limitation and right now we don't have effective weight loss therapy, so this class of drugs clearly provides clinical benefits," said Dr. William Cefalu, the primary researcher on the glimepiride study.

"This would be another viable option, another tool in the tool box," Cefalu said of canagliflozin.

In the 755-patient study comparing 300 milligram once-daily canagliflozin to Januvia, the J&J drug provided statistically significant reductions in A1C levels -- a commonly used measure of blood sugar over time.

Canagliflozin led an average drop in A1C levels of 1 percent compared with a drop of 0.6 percent for Januvia, a DPP4 inhibitor known chemically as sitagliptin. Some 47 percent of canagliflozin patients got A1C down to the ADA guideline of 7 or less compared with 35 percent of Januvia patients, J&J said.

The J&J drug led to an average weight loss of 2.5 percent, or about 2.3 kilograms (5 pounds) compared with virtually no impact on weight for the Merck drug. The weight loss for canagliflozin was even more pronounced in the other study.

Patients in the study were already taking metformin -- the most common first treatment option after diet and exercise fails -- and a sulfonylurea.

The rate of hypoglycemia was similar and over 40 percent for both groups, likely largely due to the solfonylureas, which have been associated with high rates of hypoglycemia.

More patients dropped out of the study due to loss of glycemic control in the Januvia group -- 22.5 percent versus 10.6 percent. The rate of serious side effects was low and similar for both drugs, but discontinuation due to serious side effects was higher for canagliflozin -- 5.3 percent vs 2.9 percent.

STRIKING WEIGHT LOSS

The 1,450-patient canagliflozin versus glimepiride trial studied two doses of the J&J drug -- 100 mg and 300 mg -- in subjects already on maximally effective doses of metformin.

A1C reductions were nearly identical for glimepiride and the lower dose of the J&J drug. The 300 mg dose proved to be statistically superior with an average A1C reduction of 0.93 pct compared with 0.81 for glimepiride.

Glimepiride patients on average added about 1 percent to their weight after 52 weeks. The 100 mg canagliflozin led to a 4.2 percent weight reduction and there was a 4.7 percent weight reduction for 300 mg patients, or a difference of about 10 pounds (4.5 kg) versus the older drug.

There was also a big difference in incidence of hypoglycemia in the study. The percentage of patients with at least one episode of hypoglycemia was 4.9 for 300 mg dapagliflozin, 5.6 percent for 300 mg and 34.2 percent for glimepiride.

Aside from glucose control, "the other striking thing was the weight loss and the lack of hypoglycemia," said Cefalu, head of diabetes at the Pennington Biomedical Research Center at Louisiana State University.

In both studies, the J&J drug led to increases in both good and bad cholesterol and a small but favorable decrease in blood pressure.

Canagliflozin was also associated with higher rates of genital infections, urinary tract infections and need for increased urination.

Researchers, however, did not run into concerns over liver damage that contributed to the FDA rejection of dapagliflozin, a drug from AstraZeneca and Bristol-Myers Squibb that belongs to the same class as the J&J drug.

"We reported some favorable reduction in liver enzymes," Cefalu said.

(Reporting By Bill Berkrot; Editing by Bernard Orr)