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Fewer women in the United States are dying from breast cancer, but disparities in death rates still exist between whites and blacks, a new report shows.

Deaths from breast cancer have dropped more than 2 percent each year since 1990. And in the past decade that decline in deaths has been shared by black, Hispanic and white women. But black women still have a 40 percent higher death rate from breast cancer than white women, according to the report, Breast Cancer Facts & Figures 2009-2010, released Wednesday by the American Cancer Society.

“The breast cancer death rate continues to decrease since the 1990s in U.S. women because of improved treatments and increased mammography screening rates,” said Dr. Ahmedin Jemal, strategic director for cancer surveillance at the American Cancer Society.

The death rate from breast cancer peaked in 1989, Jemal said. “The most recent data from 2006 shows the breast cancer death rates have dropped nearly 30 percent,” he said. “That’s very good news.”

When this data is translated into the number of women with breast cancer who did not die, some 130,000 lives were saved, he noted.

Jemal said the decline in breast cancer deaths could be accelerated with more targeted treatment, more access to mammography, and more treatment for the poor and the uninsured.

Among uninsured women, only 30 percent had a mammogram during the past two years, compared with about 70 percent of insured women, he said.

All women should have regular screening for breast cancer, Jemal said. “If breast cancer is caught early, the five-year survival rate is 98 percent, but if you catch it late the survival rate is only 24 percent,” he added.

Another way to lower the risk of death from breast cancer is to promote prevention, Jemal said. This includes maintaining a healthy body weight, keeping fit through exercise, and limiting alcohol consumption, he said.

Dr. Harold J. Burstein, of the Dana-Farber Cancer Institute in Boston and an assistant professor of medicine at Harvard Medical School, said, “We are making real progress against breast cancer.”

“Sometimes there is a lot of nihilism. People worry that we are not winning the war on cancer,” he said. “In this particular battle, we are clearly winning. It is slow, hard progress, but we are winning.”

“We are not winning because we have a new secret weapon,” Burstein added. “We are winning because we have a better infrastructure, because we have educated patients and doctors, because we do have new tools becoming available, because we have new insights into the biology of the cancer — all those things are making a difference.”

Other highlights of the report include:
In 2009, some 192,370 American women will be diagnosed with breast cancer, accounting for more than one in four cancers diagnosed.
In 2009, an estimated 40,170 women will die from breast cancer; only lung cancer kills more women.
Data from 2006 — the most recent statistics available — showed that about 2.5 million American women have a history of breast cancer. Most of these women were cancer-free. Others were still undergoing treatment.
From 2002 to 2003, there was sharp decline in breast cancer rates, particularly for women aged 50 to 69. This reflects the drop in hormone replacement therapy by menopausal and postmenopausal women that began in 2002. Breast cancer rates have remained about the same since 2003.
Since 1990, breast cancer death rates have dropped steadily. The decline has been greater among women under 50 (3.2 percent per year) than among women over 50 (2 percent per year).
From 1997 to 2006, breast cancer deaths dropped by 1.9 percent a year among white and Hispanic women, 1.6 percent a year among black women, and 0.6 percent annually among Asian-American and Pacific Islander women. Death rates have stayed the same for American Indians and Alaska Natives.

SOURCES: Ahmedin Jemal, D.V.M., Ph.D., strategic director, cancer surveillance, American Cancer Society, Atlanta; Harold J. Burstein, M.D., Ph.D., Dana-Farber Cancer Institute, and assistant professor, medicine, Harvard Medical School, both in Boston; Sept. 30, 2009, American Cancer Society report, Breast Cancer Facts & Figures 2009-2010

If excess weight doesn’t kill you by old age, it could make your life miserable in the form of chronic health problems and impaired mental fitness.

According to a new study, women who are obese in middle age are almost 80 percent more likely to have multiple health problems by the time they reach age 70.

“Those who gained weight [in adulthood] actually suffered reduced odds of healthy survival,” said study author Dr. Qi Sun, a research associate at the Harvard School of Public Health’s department of nutrition.

“The key message is that women really need to keep a healthy weight from early adulthood to midlife to enjoy a healthy and long life,” he added.

Sun added, however, that the women in the study had nonetheless survived to their eighth decade, meaning they remained healthier than the general population.

The study findings were published in the Sept. 30 online edition of the journal BMJ.

Previous research had focused on how excess weight affects survival, rather than how healthy that survival looks in older adults, said Sun.

The new study is well-timed, given that the U.S. population is not only aging rapidly but ballooning rapidly. Two-thirds of American adults are overweight or obese, up from 14.5 percent in 1976, when this study started.

The study authors analyzed data on 17,065 women participating in the Nurses’ Health Study. Volunteers were, on average, 50 years old when the study began with no major chronic conditions or major mental or physical problems.

Twenty years later, only about 10 percent of women had “healthy survival,” and obese women were 79 percent less likely to have healthy survival than the slim minority.

Overweight as early as age 18 affected healthy survival the most, although women who were lean in their late teens who later gained weight still had lower odds of healthy survival, the study found.

Every kilogram (2.2 pounds) of extra weight lowered the odds of healthy survival by 5 percent, according to the study.

“We typically see this struggle not only in middle age but even as teenagers. If you struggle as a teenager, you’re going to struggle for the rest of your life,” said Eugenio Lopez, a registered nurse with the Texas A&M Health Science Center Coastal Bend Health Education Center in Corpus Christi.

And women may be starting out at a disadvantage, Lopez added.

“We typically see more women than men in diabetes programs. Women outnumber men 4-to-1 or 5-to-1,” Lopez said. “They’re genetically predisposed to hold more fatty cells than men are.”

“The data is following common sense,” added Dr. Mitchell Roslin, chief of the bariatric surgery program at Lenox Hill Hospital in New York City. “Why do people die? Of cardiovascular disease and cancer, and women die of colon and breast cancer. What has been linked to obesity? Breast cancer, colon cancer and cardiovascular disease.”

The economic downturn may not be all bad. In fact, U.S. researchers say recessions may actually be good for health.

University of Michigan researchers looked at death rates during the Great Depression, the worst economic slump in the 20th century. From the stock market crash of 1929 through the early 1930s, economic activity fell sharply, dropping 14 percent in 1932, while unemployment hit 22.9 percent that same year.

Black and white images from the era of bread lines and migrant farmers make it easy to assume the economic misery would have affected public health.

But when the researchers looked at mortality rates among men, women and children from 1920 to 1940, they found death rates declined during years of falling economic activity and rose when times were better.

The study is in the Sept. 28 online edition of the Proceedings of the National Academy of Sciences.

During the two decades spanning the 1920s and 1930s, overall life expectancy increased by 8.8 years. But it wasn’t a steady rise, instead shooting up and falling back in a pattern that correlated with the rise and fall of economic activity.

Between 1921 and 1926, the so-called “Roaring 20s” and a time of robust economic growth, life expectancy for non-white men fell by 8.1 years. Yet between 1929 and 1933, the years of steepest economic decline, their life expectancy grew a similar amount.

Likewise, non-white women lost 7.4 years of life expectancy during the Roaring 20s, but they gained 8.2 years of life expectancy during the Depression.

Whites showed a similar pattern, though the loss in life expectancy wasn’t as extreme as for non-whites.

“The basic finding of the paper is that mortality rates tend to evolve in parallel to the economy,” said lead study author Jose Tapia Granados, an assistant research scientist at University of Michigan Institute for Social Research. “When the economy goes up, mortality tends to go up. When the economy goes down, mortality rates tend to go down, too.”

Researchers did find one exception. During the 1920s and 1930s, two-thirds of all deaths were caused by cardiovascular and renal diseases, cancer, influenza and pneumonia, tuberculosis, motor vehicle accidents and suicide.

All became less deadly during difficult economic times, with the exception of suicides. But suicides accounted for fewer than 2 percent of all deaths, not enough to alter the overall trend, the study authors added.

The country’s climb out of the Great Depression began in 1933. The economy grew by more than 10 percent annually from 1933 to 1936. Mortality again peaked in 1936, four years after the worst year of the Depression, even for children under age 4.

The surge in deaths in 1936 isn’t just attributable to lag time, the researchers noted. Deaths from motor vehicle accidents went up, in which lag time would not play a role.

So why would the return of good times be bad for health?

More economic activity means people have money to drive cars, meaning more die in auto wrecks, the researchers theorize. In the 1920s and 1930s, cars became objects of mass consumption.

As motor vehicle use increases, so does pollution. Recent studies have linked particulate matter from cars and trucks and carbon monoxide with heart attacks and strokes.

During periods of growth, people have more money to spend on alcohol and cigarettes. And more economic activity means more factory orders, meaning people are working harder and longer and sleeping less.

Still, this is not to say that losing a job is good for your health. The study looks at the bigger picture — fewer cars, fewer people working overtime, less pollution — and how it may benefit public health as a whole.

A similar pattern may be at work during the current downturn, the authors suggested.

“My expectation is that mortality rates in 2008 will be lower than in 2007, and probably in 2009 will be lower than 2008,” Tapia said. “There is a general improvement, even though suicides are going up.”

Joshua Klapow, associate professor at the University of Alabama Birmingham’s School of Public Health, said he would be cautious about applying any of the findings to today’s recession.

Society has changed significantly in the past 60 to 80 years, he said. Medical advances enable people to live with chronic diseases for much longer nowadays. Infectious diseases, such as tuberculosis, kill fewer people today. Fewer people do manual labor, smoking has declined, and obesity has shot up.

“The only points of similarity are the economic factors,” Klapow said. “You can’t equate health status, health care, health costs or lifestyles with the 1920s or the 1930s. You have confounding factors right now that prevent us from drawing any reasonable conclusion about our current state.”

And during this downturn, studies show that many Americans are making poor health choices, such as cutting back on medications and putting off medical care because of costs.

“We have a lot of indicators during this economic turmoil that the health status of our population is not getting better,” Klapow said. “The study is fascinating, but we have to be very careful not to forecast a trajectory to our present day.”

The drug vorinostat is able to cross the blood-brain barrier and reduce the development of large metastatic tumors in mice brains by 62 percent when compared to mice that did not receive the drug, according to a new study. In humans, the drug has been approved by the U.S. Food and Drug Administration for the treatment of a cancer called cutaneous T-cell lymphoma but can be used experimentally to study its effectiveness against other cancers. This research, by investigators at the National Cancer Institute (NCI), part of the National Institutes of Health, and their collaborators, appears online Sept. 29, 2009, in Clinical Cancer Research.

For people, while various therapies are improving the survival of breast cancer patients, the incidence of breast cancer spreading to the brain is increasing. Brain metastases of breast cancer have proven to be largely untreatable because the blood-brain barrier, which arises from the specialized structure of blood capillaries in the brain, severely limits drug access and many drugs are actively transported out of brain at this barrier. Consequently, the one-year survival estimate for breast cancer patients after a diagnosis of brain metastasis is only about 20 percent.

Vorinostat has been found to slow the growth of primary tumors of several different types of cancer in mice. Previous studies have suggested that the drug can be taken up by the brain, although little was known about its effects on metastatic tumors. Therefore, to study the effect of vorinostat on the formation of brain metastases, scientists used a mouse model of human breast cancer. Human breast cells were cultured in the laboratory and were injected into mice with compromised immune systems. The breast cancer cells then migrated to the brain, forming metastases.

“Drugs that can cross the blood-brain barrier and reduce the size and incidence of metastatic tumors are urgently needed,” said Patricia S. Steeg, Ph.D., study author, Center for Cancer Research, NCI. The researchers found that vorinostat was absorbed readily into normal mouse brains, and accumulation of the drug was up to three-fold higher in some metastases treated with this drug when compared to surrounding brain tissue. Vorinostat also reduced the development of tiny tumors (micrometastases) in mice by 28 percent when compared with mice that did not receive this therapy.

The ability of vorinostat to reduce metastatic lesions in the brain was linked to a novel double-barreled mechanism — the drug can cause breaks in both strands of a DNA helix and can also lower the activity of a DNA repair gene called Rad52. The researchers hypothesize that the inability of the cancer cells to repair DNA damage would then slow the rate of tumor cell metastasis.

In June of this year, several researchers affiliated with this study published a paper in Molecular Cancer Therapeutics showing that vorinostat could enhance the effect of radiation therapy in mice with brain cancer metastasis. Mice that received implants of human breast tumors in their brains lived the longest after treatment with both vorinostat and radiation, demonstrating that the drug enhances the sensitivity of cancer cells to radiation therapy. “Taken together with our current finding, researchers have now established a preclinical basis for testing this drug in clinical trials in humans,” said Steeg.