Study: Weightlifting helps breast cancer survivors

Breast cancer survivors have been getting bum advice.

For decades, many doctors warned that lifting weights or even heavy groceries could cause painful arm swelling. New research shows that weight training actually helps prevent this problem.

"How many generations of women have been told to avoid lifting heavy objects?" Dr. Eric Winer, breast cancer chief at the Dana-Farber Cancer Center in Boston, lamented after seeing the surprising results of the new study. "Women who were doing the lifting actually had fewer arm problems because they had better muscle tone."

The study was led by Kathryn Schmitz, an exercise scientist at the University of Pennsylvania, and funded by the federal government. Results are in Thursday's New England Journal of Medicine.

More than 2.4 million Americans are breast cancer survivors, and the study could mean a big difference in their quality of life. Cancer treatment-related arm swelling now appears to be one of many ailments made better by exercise - not worse, Schmitz said.

"Fifty years ago we told people who had a heart attack not to exercise anymore," and people with sore backs to heal with bed rest, Schmitz said. "It was well-meaning advice but it was polar opposite of the truth."

Women who have had radiation to the armpit, or lymph nodes removed to check for cancer, can suffer lymphedema - a buildup of fluids that causes painful and unsightly swelling of the arms or hands.

To avoid it, doctors have advised women to avoid using the affected arm to lift toddlers, carry a heavy purse or scrub floors. Even activities like golf and tennis raised concern.

Women think, "Oh, my God, I need to baby the arm," Schmitz said.

Lifting weights - which boosts mood, muscle mass, bone strength and weight control - was thought to be a bad idea for women prone to lymphedema.

Schmitz challenged that notion with a small study several years ago, finding that weight training did not make lymphedema worse.

Her new study is the first one large and long enough to give clear proof that this is so, and even suggests that weightlifting can help.
It involved 141 breast cancer survivors who had suffered lymphedema. Half were told not to change their exercise habits. The rest were given 90-minute weightlifting classes twice a week for 13 weeks at community gyms, mostly YMCAs.

They wore a custom-fitted compression garment on the affected arm and gradually worked up to more challenging weights and repetitions. For the next 39 weeks, they continued these exercises on their own.

The women's arms were measured monthly. After one year, fewer weightlifters had suffered lymphedema flare-ups - 14 percent versus 29 percent of the others. Weightlifters reported fewer symptoms and greater strength. Rates of change in arm size due to swelling were similar in both groups.

"I found it was really very effective. It not only gave me strength and mobility but it improved my balance and coordination," said one participant, Clare Faber, 66, of suburban Philadelphia. "It really does offer women hope."

Another participant, Gay McArthur, 56, of Smithfield, N.J., has continued weightlifting on her own since the study ended.

"When I first got diagnosed with lymphedema, they said I couldn't lift more than five pounds," she said. But weight training caused no problems and has made her feel better, she said.

It also should save money, though the study did not measure this, Wendy Demark-Wahnefried, of the University of Texas M.D. Anderson Cancer Center in Houston, wrote in an editorial in the medical journal. In the study, the group of weightlifters made only 77 visits to doctors or physical therapists for lymphedema flare-ups versus 195 visits for the others, she noted.

Another part of the study is evaluating whether weight training can prevent a first case of lymphedema in breast cancer survivors; results are expected soon, Schmitz said.

Breast cancer survivors should not rush into weight training - that could trigger problems. Schmitz suggests:

* Have a certified fitness professional teach you how to do the exercises properly.
* Start slow, with a program that gradually progresses.
* Wear a well-fitting compression garment during workouts.
Source: http://www.northjersey.com/news/health/Study_Weightlifting_helps_breast_cancer_survivors.html

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Tanning Beds Pose Serious Cancer Risk, Agency Says

Article date: 2009/07/28
By Rebecca V. Snowden

Tanning beds pose a greater cancer risk than previously believed, according to the International Agency for Research on Cancer (IARC), the World Health Organization (WHO) agency that developed the most widely used system for classifying carcinogens. The group has elevated tanning beds to its highest cancer risk category – "carcinogenic to humans" (Group 1). Tanning beds had previously been classified as "probably carcinogenic to humans."

IARC's decision was based on a comprehensive review of current research, which shows tanning bed use raises the risk of melanoma of the skin by 75% when use starts before the age of 30. The agency also found a link between tanning bed use and risk of melanoma of the eye. Melanoma accounts for less than 5% of skin cancer cases but causes a large majority of skin cancer deaths.

The findings are published in The Lancet Oncology.

Most skin cancers are caused by too much exposure to ultraviolet (UV) rays. Much of this exposure comes from the sun, but it also comes from manmade sources, such as tanning beds. Because of the popularity of tanning among young people, both the World Health Organization and the International Commission on Non-ionizing Radiation Protection recommend that the use of indoor tanning should be restricted in anyone under the age of 18.

The American Cancer Society recommends people avoid tanning beds altogether.

"This new report confirms and extends the prior recommendation of the American Cancer Society that the use of tanning beds is dangerous to your health, and should be avoided," says Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society. "Young women in particular are the heaviest users of tanning beds, and, as noted in the report, are at the greatest risk of causing harm to themselves."

The report also puts to rest the argument that tanning with UVA light is safe, Lichtenfeld says.

"Previously, the cancer-causing effects of ultraviolet light were thought to be primarily related to UVB, or ultraviolet B radiation. This new report now extends the cancer-causing effects of solar or sun-related radiation to UVA light, as well," he says. In the past 30 years, the IARC has evaluated the cancer-causing potential of more than 900 likely candidates, placing them into one of five groups, with Group 1, carcinogenic to humans, being the highest risk.
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TNF Blockers May Increase Cancer Risk in Kids

Article date: 2009/08/05
By Rebecca V. Snowden

Kids and teens treated with drugs called tumor necrosis factor (TNF) blockers may be at an increased risk for lymphoma and other cancers, according to the US Food and Drug Administration (FDA), which is updating black box warnings for the drugs.

The FDA's decision is based on a yearlong review of the childhood cancer risk associated with TNF blocker drugs, which are used to treat rheumatoid arthritis, Crohn's disease, and other inflammatory diseases.

These drugs -- which include adalimumab (Humira), etanercept (Enbrel), certolizumab pegol (Cimzia), golimumab (Simponi), and infliximab (Remicade) -- work by blocking tumor necrosis factor, a protein that's overproduced in some immune system diseases. The FDA started investigating the drugs in 2008 after evidence suggested that interfering with TNF may also increase the risk of some life-threatening infections and certain cancers.


This analysis found children and teens taking these drugs had an increased risk of cancer, with cases occurring on average after 30 months of treatment. About half were lymphomas, and some were fatal.

The FDA said it was working with TNF drug manufacturers, including Johnson & Johnson, Abbott, and Wyeth, to better understand the childhood cancer risk associated with these drugs.

If your child is taking or considering taking a TNF blocker, discuss the risks and potential benefits with your doctor.

Cancers in children often are hard to recognize. Parents should be sure that their children have regular medical check-ups and watch for any unusual signs or symptoms that do not go away. These may include:
* an unusual lump or swelling
* unexplained paleness and loss of energy easy bruising
* an ongoing pain in one area of the body
* limping
* unexplained fever or illness that doesn't go away
* frequent headaches, often with vomiting
* sudden eye or vision changes
* sudden unexplained weight loss

These symptoms are more likely to be caused by something other than cancer, but they should be checked out by your child’s doctor.

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Vietnam's A/H1N1 flu situation

Vietnam confirmed 33 more cases of A/H1N1 influenza, raising the total number of flu patients in the country to 1,211, said a report of the website of Vietnam's Ministry of Health on Wednesday.

Among the newly-reported cases, one patient was a seller of a supermarket in the central Gia Lai province of Vietnam. This is the first supermarket in the country reported A/H1N1 flu case, according to local newspaper Liberty Saigon on Wednesday.

The flu continues speeding wide in schools in Hanoi, the capital city of Vietnam, said the ministry.

So far, 883 patients have recovered and been discharged from hospitals. The rest are being quarantined and treated, said the report.

Vietnam confirms 2nd death of A/H1N1 influenza

The Vietnamese Ministry of Health confirmed that a 52-year-old woman in Ho Chi Minh City died of A/H1N1 influenza, becoming the country's second death of the flu, local newspaper the New Hanoi reported Thursday.

The woman was admitted to the Hospital No. 115 on Aug. 6 after having high body temperature, coughing and vomiting, said the newspaper. Her sample was tested positive to A/H1N1 influenza later.

The patient was transferred to Pham Ngoc Thach Hospital on Aug.10 because her condition deteriorated. She died on the same day due to respiratory failure, said the newspaper.

The ministry on Thursday confirmed 64 more cases of A/H1N1 influenza, raising total number of flu patients in the country to 1,275. Vietnam confirmed the country's first death of A/H1N1 influenza in the central province of Khanh Hoa last week.

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Overview of the current Pandemic H1N1 2009 situation

Pandemic (H1N1) 2009 is continuing to spread throughout Viet Nam. The spread of the virus to all countries, worldwide, is considered inevitable.

It is important to note that this pandemic is currently referred to as of “moderate” severity based upon the global situation. The overwhelming majority of patients are recovering without the need for hospitalization or even medical care, the levels of severe cases are similar to the levels we expect for seasonal influenza, and the health care systems are able to cope with the number of people seeking care.

With the increasing spread of H1N1 in Viet Nam, we expect that there will be a number of people who have serious complications and some will die.

Experience from other countries shows there are certain groups considered to be at “high risk” of serious complications from Pandemic (H1N1) 2009. People with a chronic condition, such as cardiovascular disease, respiratory disease such as asthma, diabetes, and cancer are currently among the people considered to be at high risk of serious complications from influenza.


There is evidence that pregnant women are also at high risk for more severe disease – especially those in the second and third trimester. And, a recent report suggests obesity may be another risk factor for severe disease.

Any one who has one of these conditions should seek medical advice if they develop influenza like symptoms.

The symptoms of pandemic H1N1 are similar to seasonal influenza, such as fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea.

The virus is transmitted by inhaling infected droplets expelled by talking, coughing, or sneezing; or by touching contaminated hands or surfaces, the same as the normal seasonal flu.

The best protection measures for H1N1 are the SAME as for any influenza virus:

* Wash your hands with soap and water frequently and thoroughly. You may also use an alcohol-based hand sanitizer if soap and water are not available.
* Avoid touching your eyes, nose, and mouth without washing your hands first.
* Cover your mouth and nose when you cough and sneeze by using your sleeve, a tissue, or a mask.
* Avoid or reduce the time spent in close contact with people who appear unwell and/or have a fever and cough.
* Reduce the time spent in crowded settings if possible.
* Keep a distance of at least 1 meter between you and other persons especially if they have influenza-like symptoms.
* Improve airflow in your living space by opening windows.
* Practice good health habits including getting adequate sleep, eating nutritious food, and keeping physically active.
* STAY HOME IF YOU HAVE A FEVER, COUGH and/or SORE THROAT

NOTE: WHO no longer requires countries to report all cases of pandemic H1N1 and many countries are no longer routinely testing for the virus. However, countries are continuing to monitor changes in the virus that may be important for case management and vaccine development.

When there is sustained community transmission, the detection, laboratory confirmation and investigation of all cases, including those with mild illness, is extremely resource-intensive. In some countries, this strategy is absorbing most national laboratory and response capacity, leaving little capacity for the monitoring and investigation of severe cases and other exceptional events. Moreover, the counting of individual cases is no longer essential for monitoring the risk posed by the pandemic virus or to guide implementation of the most appropriate response measures. Despite these changes in reporting requirements.

Given the change in reporting requirements, we will only update the number of globally reported cases on a weekly basis. It is important to keep in mind that the number of cases reported will understate the real number of cases.

Source: http://www.wpro.who.int/vietnam/sites/dcc/h1n1/

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Public Knowledge of Benefits of Breast and Prostate Cancer Screening in Europe

Gerd Gigerenzer, Jutta Mata, Ronald Frank

Affiliations of authors: Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany (GG); Faculty of Human Kinetics, Technical University Lisbon, Lisbon, Portugal (JM); Gesellschaft für Konsumforschung Association, Nuremberg, Germany (RF)

Correspondence to: Gerd Gigerenzer, PhD, Harding Center for Risk Literacy, Max Planck Institute of Human Development, Lentzeallee 94, 14195 Berlin, Germany (e-mail: gigerenzer@mpib-berlin.mpg.de).

Making informed decisions about breast and prostate cancer screening requires knowledge of its benefits. However, country-specific information on public knowledge of the benefits of screening is lacking. Face-to-face computer-assisted personal interviews were conducted with 10 228 persons selected by a representative quota method in nine European countries (Austria, France, Germany, Italy, the Netherlands, Poland, Russia, Spain, and the United Kingdom) to assess perceptions of cancer-specific mortality reduction associated with mammography and prostate-specific antigen (PSA) screening. Participants were also queried on the extent to which they consulted 14 different sources of health information. Correlation coefficients between frequency of use of particular sources and the accuracy of estimates of screening benefit were calculated. Ninety-two percent of women overestimated the mortality reduction from mammography screening by at least one order of magnitude or reported that they did not know. Eighty-nine percent of men overestimated the benefits of PSA screening by a similar extent or did not know. Women and men aged 50–69 years, and thus targeted by screening programs, were not substantially better informed about the benefits of mammography and PSA screening, respectively, than men and women overall. Frequent consulting of physicians (r = .07, 95% confidence interval [CI] = 0.05 to 0.09) and health pamphlets (r = .06, 95% CI = 0.04 to 0.08) tended to increase rather than reduce overestimation. The vast majority of citizens in nine European countries systematically overestimate the benefits of mammography and PSA screening. In the countries investigated, physicians and other information sources appear to have little impact on improving citizens’ perceptions of these benefits.


CONTEXT AND CAVEATS

Prior knowledge

Given the harms that can ensue from cancer screening procedures, people’s decisions as to whether to undergo cancer screening should be based on a realistic knowledge of its benefits.

Study design

Face-to-face-interviews were conducted among a representative sample of men and women in nine European countries, who were asked to choose among estimates of the number of fewer cancer-specific deaths (per 1000 individuals screened) by prostate-specific antigen and mammography screening, respectively. Participants were also queried as to their sources of medical information.

Contribution

This study found dramatic (by an order of magnitude or more) overestimation of the benefits (absolute cancer-specific mortality reduction) of mammography and prostate-specific antigen testing in the vast majority of women and men, respectively, in all countries surveyed. Frequent consultation of sources of medical information (including physicians) was not associated with more realistic knowledge of the benefits of screening.

Implications

A basis for informed decisions by people about participation in screening for breast and prostate cancer is largely nonexistent in Europe, suggesting inadequacies in the information made available to the public.

Limitations

The influence of the public's overestimation of screening benefits on actual participation in screening was not addressed in this study, and the work was restricted to European countries.

From the Editors

Fore more details: http://jnci.oxfordjournals.org/cgi/content/abstract/djp237

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Ovarian cancer: Women in early stages can have surgery without losing fertility, study finds

Young women diagnosed with an early stage of ovarian cancer may be able to have surgery for the disease without losing their fertility.

Traditionally, treatment of ovarian cancer involves removal of both ovaries and the uterus, which puts younger women into menopause and ends their chances of bearing a child. But a study published Monday in the journal Cancer, by researchers at Columbia University College of Physicians and Surgeons, showed that five-year survival rates for stage 1 ovarian cancer patients were the same for women who had both ovaries removed and women who had just the cancerous ovary removed.

The five-year survival rates were also similar among women who had the uterus removed compared to those who didn't.


"If the woman is young, premenopausal and is considering future childbearing, she does not need a hysterectomy and she does not need to be completely castrated," said Dr. Beth Karlan, director of the Women's Cancer Research Institute at Cedars-Sinai Medical Center. She was not involved in the research. "It is safe to do a conservation procedure and still effect cure and allow the woman to appreciate her life goals. ... With stage 1, cure is a very realistic goal."

Ovarian cancer, the fifth-leading cause of cancer deaths in women, occurs most often in postmenopausal women and is often detected only after it's advanced. However, up to 17 percent of ovarian cancers occur in women 40 or younger. With rates of the disease in that age group believed to be rising, more attention is being paid to options that preserve fertility.

Freezing eggs or embryos before the removal of the ovaries is one avenue for women who want to preserve the option of having children. However, removal of the ovaries and uterus is unappealing for reasons other than fertility, said Dr. Jason Wright, the lead author of the study and an assistant professor of women's health. The loss of hormones produced by these organs can increase a woman's chances of developing some other diseases and diminish quality of life.

It is not clear yet whether premenopausal women who have completed childbearing would benefit from organ-preserving surgery for early-stage ovarian cancer.

By Shari Roan Tribune Newspapers
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Calcium curious: How much is enough?

We seem to get more mail about calcium than any other single nutrient. The questions and comments vary, but many reflect the same exasperation. On the one hand, we've been told to take calcium pills to keep bones strong, prevent osteoporosis and reduce the risk of fracture. On the other, information seems to keep popping up that calls into question the value of calcium -- and even suggests that large amounts might be counterproductive. Throw in the occasional query about calcium absorption and which calcium pills to take, and the mailbag -- or, more literally, the e-mail inbox -- gets full.

Here are some of the questions we get most often:

QHow much calcium should I be getting on a daily basis??

AThe official recommendation is 1,000 milligrams a day for adults ages 19 to 50 and 1,200 mg for those past the half-century mark. Those amounts include calcium from all sources: dairy products, other food and drinks, and calcium supplements. But there's a dissenting point of view that 600 mg to 1,000 mg a day is sufficient, perhaps more healthful. Dr. Walter C. Willett, chairman of the Harvard School of Public Health and a member of the Health Letter's editorial board, is a leading voice among the dissidents.

QHow much calcium am I getting if I don't take a supplement?

AA reasonably good diet that includes some fruit and vegetables provides about 200 mg to 300 mg daily -- and that's without any dairy products. A cup of milk adds another 300 mg, and the typical serving of many dairy products provides 150 mg or more (cheese lovers should go for the hard stuff -- it has more calcium). So a well-rounded diet with some servings of milk and dairy products puts you well into the neighborhood of 600 mg to 800 mg a day.

QAnd what about the supplements -- which type should I take?

AThis presupposes you should be taking a calcium supplement, but we'll deal with that question below.

Most calcium supplements are made with either calcium carbonate or calcium citrate. Calcium carbonate needs stomach acid to be absorbed, so if it is the source of calcium in your supplement (you may need to read the fine print), it's best to take it just after a meal. Calcium citrate isn't as dependent on stomach acid, so it can be taken any time. People taking medications that reduce stomach acid -- such as the proton-pump inhibitors (Prevacid, Prilosec) or the H2 blockers (Tagamet, Zantac) -- should take a calcium citrate supplement because lower amounts of stomach acid mean they won't absorb calcium carbonate properly.

QCan calcium help prevent dangerous fractures?

AWell, this is the question, isn't it, because fracture prevention is the main reason we fret over calcium intake. Take a dash of evidence, mix in some impeccable logic, and you can come up with a cogent argument that calcium prevents fractures.

High calcium intake does result in high levels of calcium in the blood. High blood levels prevent the release of parathyroid hormone, a hormone that promotes bone resorption, a breaking down of bone tissue that releases calcium into the blood. If calcium levels in the blood are low, bone resorption can help nudge them back to normal. But in the process, bones get weaker and are more likely to fracture. In theory, keeping calcium levels in the blood high prevents that chain of events from happening.

But in several epidemiological studies, including some based at Harvard, people with high calcium intake haven't, as a group, broken fewer bones than people with skimpy intake. Randomized trials, which have made head-to-head comparisons between calcium and a placebo, have shown some improvement in bone density but not so much in the prevention of fractures.

So why the inconsistency between the expected benefits and the way this has played out in studies? One possible explanation is that in the long run, there are other factors -- muscle strength, balance, physical activity, Vitamin D intake -- that outweigh calcium intake in determining fracture risk.

Studies have repeatedly found that we're far better off getting most of our nutrients from food rather than from pills. With calcium, it's more complicated. In many ways, dairy products, and milk in particular, are ideal for supplying the mineral. The calcium content is high and easily absorbed. But when dairy comes into the diet, saturated fat comes with it, and high saturated fat intake increases cardiovascular risk. Furthermore, a few studies suggest that dairy food itself increases the risk of certain cancers.

These reservations notwithstanding, food is the preferred way to get calcium. The best food choices for calcium include non-fat dairy products (in limited amounts), as well as certain types of fish (canned salmon and sardines) and vegetables (collard greens are a winner). Whether you need to "top it off" with a supplement depends on your diet and whether you're trying to adhere to the official recommendations.

More questions? E-mail health_letter@hms .harvard.edu and put "calcium" in the subject line. We'll post the questions and answers on our Web site, health.harvard.edu. Address: Harvard Health Letter, 10 Shattuck St., Floor 2, Boston, Mass., 02115.

Copyright © 2009, Chicago Tribune
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How to keep your eyes safe in the sun

Good-quality sunglasses are the best way to protect your eyes from damaging rays that can lead to vision problems and cancer. Here are some tips:

Read the label. Sunglasses should block 99 to 100 percent of both types of ultraviolet rays -- UVA and UVB -- and most high-energy visible radiation, or HEV, rays.

Don't go too cheap (even for kids). Sun damage is cumulative from infancy. Shades are especially important for light-colored eyes; dark eyes provide limited protection.

Try wraparounds. The design limits stray light coming from above and to the side of glasses. If that model doesn't appeal, try large frames that sit close to your face, or look for glasses with an added anti-reflective coating.

Cover contacts. Because contact lenses only shield part of the eye, you still need shades.

Go dark enough. Glasses should let roughly 20 percent of light penetrate (lightly tinted lenses may let in 75 percent). Some designs darken depending on how bright it is.

Think comfort. Pay attention to earpieces and the bridge of the nose, and try on different types of frames to compare weight.

Ask about colors. Certain tints are better at blocking certain kinds of rays. Some eye doctors say gray is best for absorbing a wide variety, for example.

Keep them on. Be vigilant in higher-risk situations: between 10 a.m. and 2 p.m., when the sun is hottest, and in wide open places with reflective surfaces -- including the beach. Be aware that some medications heighten sun sensitivity.

Copyright © 2009, Chicago Tribune
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Colon cancer survival improved with Aspirin

Some people diagnosed with colon cancer who take Aspirin may reduce their risk of dying from the disease by nearly 30 per cent compared with those who don't take the pills, a new study suggests.

Acetylsalicylic acid (ASA) was developed as a painkiller and marketed as a headache medication or to treat aches and pains. Research has also suggested its regular use may help to prevent colorectal cancer in people at high risk of the disease.

In Wednesday's issue of the Journal of the American Medical Association, Dr. Andrew Chan of Harvard Medical School in Boston and his colleagues reported patients who already have colon cancer may benefit from taking Aspirin along with surgery and chemotherapy.

"It's exciting that an inexpensive, commonly used medication may be of benefit among this group of patients who are worried about having their cancer recur," Chan said.
Tumour typing

But ASA didn't work for everyone, he noted. It was most effective in patients with the most common type of tumour which overproduces the COX-2 enzyme.

The finding makes sense, the researchers said, since Aspirin blocks the effects of the enzyme, which is thought to contribute to the progression and spread of tumours.

In the observational study, Chan and his colleagues analyzed data from two large, ongoing studies of health professionals. Researchers tracked 1, 279 men and women with nonmetastatic colorectal cancer who were followed for an average of 12 years.

Among the 549 participants who used Aspirin regularly after their cancer diagnosis, 81 died from colorectal cancer, or about 15 per cent. In comparison, among the 730 people who didn't use Aspirin, 141 died of the disease, or about 19 per cent.

The 29 per cent relative reduction in risk of cancer death was found after taking other cancer risk factors into account, such as family history. The team also found a 21 per cent lower risk for overall mortality among those taking the drug.

ASA seemed to help those stage I, II and III of the disease.

"These results suggest that Aspirin may influence the biology of established colorectal tumors in addition to preventing their occurrence," the study's authors wrote.

"Our data also highlight the potential for using COX-2 or related markers to tailor Aspirin use among patients with newly diagnosed colorectal cancer. Nonetheless, because our data are observational, routine use of Aspirin or related agents as cancer therapy cannot be recommended, especially in light of concerns over their related toxicities, such as gastrointestinal bleeding."

Some tumours will continue to grow despite taking the drug, the study's authors warned.
'Wonderful and easy tool'

The findings are good news, but more research is needed, agreed Barry Stein, a colorectal cancer survivor and president of the Colorectal Cancer Association of Canada.

"Having in the toolbox so to speak, a simple Aspirin to assist in the treatment of the disease, following, for example, the removal of a tumour to prevent its recurrence, is a wonderful and easy tool to have."

In an editorial accompanying the study, Dr. Alfred Neugut of Columbia University Medical Center in New York said the study "comes as close as it can to offering patients a way to help themselves."

Neugut, who was not involved in the study but has done similar research, said if ASA becomes the standard of care in colon care, Cox-2 testing may become routine. It shouldn't add much to the cost of standard tumour tissue testing, he said.

Chan, Stein and Neugut all said colorectal patients should talk to their oncologist before starting to take ASA.

The best defense against colorectal cancer is still early detection of polyps, Stein said.

Approximately 20,000 new cases of colorectal cancer are diagnosed in Canada every year, and roughly 8,500 Canadians will die from the disease every year. One in 14 men and one in 16 women can expect to develop colorectal cancer during their lifetimes.

The study was funded by the National Cancer Institute and the National Institutes of Health.
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Aspirin shows promise for colon cancer patients

Score another win for the humble aspirin. A study suggests colon cancer patients who took the dirt-cheap wonder drug reduced their risk of death from the disease by nearly 30 percent.

Aspirin already is recommended for preventing heart attacks and strokes, along with its traditional use for relief of minor aches and pains. Its merit in colon cancer prevention has been tempered by its side effects, bleeding from irritation of the stomach or intestines.

The new study suggests patients who already have colon cancer may benefit from taking aspirin along with surgery and chemotherapy. In a separate analysis of a subgroup of patients, only those with the most common type of tumor, those that overproduce the Cox-2 enzyme, saw a benefit.

"The paper is absolutely incredible, and I don't gush normally," said Dr. Alfred Neugut of Columbia University Medical Center in New York who has done similar research but was not involved in the new study. In an accompanying editorial, Neugut wrote that the study "comes as close as it can to offering patients a way to help themselves."

"This is certainly something patients would want to discuss with their doctors," said Dr. Andrew Chan of Harvard Medical School in Boston, who led the study, which appears in Wednesday's Journal of the American Medical Association.

It's too early for an across-the-board recommendation however, both Chan and Neugut said. The results should be confirmed in an experiment where patients would be randomly assigned to take aspirin or a dummy pill. A study based in Singapore that's now recruiting patients may verify aspirin's benefit.

Chan's study was observational, meaning researchers merely observed what patients were already doing, such as taking aspirin regularly for headaches. It's possible that factors other than aspirin accounted for the difference in cancer deaths.

Colorectal cancer is the second leading cause of cancer death in the United States after lung cancer. The National Cancer Institute estimates that nearly 50,000 Americans will die from it this year.

The researchers analyzed data from two large ongoing studies, the Nurses' Health Study and the Health Professionals Follow-up Study.

They looked at nearly 1,300 people with colorectal cancer who'd been followed for an average of 12 years. All the patients in the study had surgery for colon cancer and many also had chemotherapy.

Among the 549 participants who used aspirin regularly after their diagnosis, 81 died from colorectal cancer (about 15 percent). In contrast, among the 730 people who didn't use aspirin, 141 died of the disease (about 19 percent).

Taking into account other cancer risk factors, such as family history, the researchers calculated aspirin's overall benefit: a 29 percent reduction in risk of cancer death.

"It's exciting that an inexpensive, commonly used medication may be of benefit among this group of patients who are worried about having their cancer recur," Chan said.

About one-third of the tumors could be tested for Cox-2. Aspirin helped only those patients whose tumors tested positive for the enzyme. That makes sense, Chan said, because aspirin blocks the enzyme, which is thought to play a role in cancer's spread.

If aspirin becomes the standard of care in colon cancer, testing for Cox-2 may become routine, Neugut said. That wouldn't add much to costs, he said, because tumor tissue already is tested and a Cox-2 test could be easily added.

By CARLA K. JOHNSON, AP Medical Writer Carla K. Johnson, Ap Medical Writer
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50 mln women in Asia at risk of HIV infection - UNAIDS

By Tan Ee Lyn

BALI, Indonesia, Aug 11 (Reuters) - Fifty million women in Asia are at risk of being infected with HIV because of the risky sexual behaviour of their husbands or boyfriends, leading health experts said in a report on Tuesday.

More than 90 percent of the 1.7 million women now living with HIV in Asia became infected while being in monogamous, long-term relationships with men who engaged in risky sex behaviour, the report launched by UNAIDS said.

These include men who had other sexual partners or who were drug users.

"We need to target men who engage in paid sex, injecting drug users, men who have sex with men, who can transmit the virus to their partners," Jean D'Cunha, regional director of the United Nations Development Fund for Women in South Asia, told a news conference held on the margins of an HIV/AIDS conference in Bali.

"We need to question the attitudes, values and behaviour and transform these so that women would be less vulnerable to HIV/AIDS."

While the issue of gender inequality is often ignored or laughed off, experts say it cannot be taken lightly in the context of HIV/AIDS, a disease that can be transmitted through sexual contact and which is incurable.

Sex workers, who have very little bargaining power to begin with, are usually forced to comply when their clients refuse to use condoms. Back home, the wives of these men too have no power to demand that condoms be used even if they know about the risky sexual behaviour of their husbands.

While the fight against the AIDS epidemic has seen progress on some fronts, women continue to bear the brunt of it. Women make up 35 percent of all adult HIV infections in Asia now, up from 17 percent in 1990.

REVERSING A CULTURE

Maire Bopp-Allport, head of the Pacific Islands Aids Foundation, contracted the AIDS virus from her boyfriend around 1996. Today, she is a familiar figure in the global fight against the disease.

"At the heart of the issue is thousands of years of education to our males that it's okay to think that women are there to simply serve them and do everything they want. We need to bring a new culture where it's not okay," she told Reuters.

"They need to be able to think that the abuse of a woman is the abuse of their daughters when their daughters become women," she added.

(Reporting by Tan Ee Lyn, Editing by Don Durfee and Sanjeev Miglani)
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Costa Rican president has swine flu

By John McPhaul

SAN JOSE (Reuters) - Costa Rican President Oscar Arias is suffering from the H1N1 virus, making him the first head of state known to have contracted swine flu.

Nobel Peace Prize winner Arias, 68, has a mild case of the virus which he tested positive for on on Tuesday after feeling unwell at the weekend, the government said.

Arias is at home and plans to do some work from there.

"Apart from the fever and a soar throat, I feel well and in good shape to carry out my work by telecommuting. I expect to return to all my duties on Monday," he said in a statement.


The H1N1 flu outbreak, declared a pandemic on June 11, has spread around the world since emerging in April and could eventually affect 2 billion people, according to estimates by the U.N. World Health Organization. More than 20 people have died of swine flu in Costa Rica.

Arias suffers from asthma. While the vast majority of swine flu cases have not been serious, infected people who have other medical conditions are most susceptible to complications.

"The tests ... show that there is no other complication," Information Minister Mayi Antillon said.

Some of the president's duties have been given to Cabinet ministers for the moment.

Last month, Arias brokered talks to try to end a political crisis in Honduras after President Manuel Zelaya was ousted in a coup on June 28.

Negotiations broke down two weeks ago over whether Zelaya can return to power and Arias' illness is unlikely to affect the situation in Honduras.

Arias won the Nobel prize in 1987 for a peace plan to end Central American civil wars and guerrilla conflicts.

He first served as president from 1986-90 and was re-elected in 2006 on a promise to end corruption and take the small country into a Central American free trade pact with the United States.

Arias broke Costa Rica's decades-old diplomatic relations with Taiwan in 2007 to establish ties with rival Beijing, saying his country could no longer ignore China's growing power in the world.

Doctors ordered Arias last year to stop talking for a month due to a vocal chord ailment. He communicated by writing and typing.

(Writing by Alistair Bell, editing by Anthony Boadle)
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International development minister urges firms to pool HIV patents

Drug companies should give up their patent rights to HIV medicines to help prevent the deaths of millions of people in poor countries, a British government minister will say this week.

The international development minister, Mike Foster, will call on pharmaceutical companies to put lives before profits, as the all-party parliamentary group on Aids publishes a report this week detailing the scale of the "treatment timebomb". By 2030, they estimate, 50 million people will need new drugs, which are currently prohibitively expensive, to keep them alive.

Three million people are on cheap, basic HIV drug combinations, but they are only a third of those in need and resistance is growing to these drugs both in the developing world and in the west.

New and improved drugs are urgently required, but they are expensive, and cheap generic copies of the newest drugs can no longer easily be made and sold because of tightened intellectual property rules in India and China.

The UK generally has a very close relationship with the drug companies, which regard patents as the means of recouping the substantial costs of researching and developing new drugs.

But Foster says they must change their stance on HIV. He wants companies to contribute to a "patent pool", which the international drug-purchasing facility, Unitaid – set up by a number of donor countries, including the UK – is trying to establish.

"While it is absolutely vital that we work to reduce the human cost of HIV by focusing our efforts on preventing new infections, we must also face up to the stark reality of the treatment challenge we face. The pharmaceutical industry has an opportunity to act now to help prevent future human catastrophe. It is time for them to state their clear commitment to make new HIV medicines affordable to those who need them most."

According to the all-party report, if HIV patents are put in a pool, generics companies – which make the cheap combinations now used in Africa – will be permitted to make low-cost copies of newer drugs and devise new combinations in a single pill, which is important for people living in poverty.

The report lays out in stark terms the coming crisis. "It took political activism almost a decade ago to make life-saving drugs available to the poor in developing countries," it says. "Only a third of those who need it are on treatment and this treatment will not work for them forever. Political activism is needed once more to ensure that the next generation of drugs is available to the world's poorest in future."

MP David Barrow, who chairs the group, said: "We are sitting on a treatment timebomb. We must reduce the price of second-line medicines and less toxic first-line medicines before millions need them. We cannot sleepwalk into a situation where we can only afford to treat a tiny proportion of those infected."

The only way to end the HIV/Aids epidemic is to prevent infection, the report says, but because the drugs suppress the virus, those receiving treatment are much less likely to pass it on.
Sarah Boseley, health editor

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Michael Jackson coroner's drug report

MICHAEL Jackson had lethal levels of powerful painkiller Demerol and heroin substitute methadone in his body when he died, The Sun can reveal.

Tests show the tragic star had taken a cocktail of drugs strong enough to have killed any normal person instantly.

This is it ... narcotic note written by doctor to tragic Jackson

But he had been on vast quantities so long his body became tolerant to huge doses - until his fatal collapse on Thursday of last week.

The shock findings are in preliminary toxicology reports submitted to the Los Angeles county coroner’s office.

The contents were revealed as sources predicted Jacko’s death could result in manslaughter or even MURDER charges.

A case insider told The Sun: “Michael Jackson was a walking drug store when he died — he never stood a chance.”

'Walking drug store' ... what Jacko was taking

As well as lethal levels of DEMEROL and METHADONE, blood tests found high levels of antianxiety drug XANAX.

Also present were lower levels of PROPOFOL — an anaesthetic for hospital use only, but which Jackson used as a sleeping draft.

A significant amount of narcotic DILAUDID, normally used to numb post-surgery pain, was discovered.

Found ... detox info at Jackson's house

In addition there were “therapeutic” levels of FENTANYL, another post-op painkiller 100 times more potent than morphine, plus prescription painkiller VICODIN, anti-anxiety pills VALIUM and the sleeping drug AMBIEN.

The insider said: “The body can build up extreme tolerances to huge doses of drugs but eventually it overloads and just shuts down. That is what happened to Michael.

Pressure

“Tests showed that as well as Demerol and methadone, he had taken four more painkillers and anaesthetics plus anti-anxiety pills.

“This is sure to increase pressure on police to establish exactly how one man obtained so many prescription medications — and which doctors were responsible.

“There is increasing talk of manslaughter charges if it can be shown he was given drugs without proper regard for his safety.”

Police Chief William Bratton said he was waiting for the final toxicology reports, currently weeks away.

He added: “Based on those, we will have an idea what we are dealing with. Are we dealing with a homicide or are we dealing with accidental overdose?”

The early findings support The Sun’s exclusive revelation that 50-year-old King of Pop was given an injection of Demerol about 40 minutes before his heart stopped.

Jackson’s dermatologist Dr Arnold Klein — the close pal rumoured to be the father of two of the star’s three children — has already admitted occasionally giving Jackson Demerol after surgery.

But he insisted he had warned him about Propofol, also known as Diprivan.

'Quit' ... Dr Arnold Klein

Pacific Coast News

Klein said: “I knew at one point he was using Diprivan was on tour in Germany. I told him he was absolutely insane. I said, ‘You have to quit it. This drug, you can’t repeatedly take’.”

Jackson last toured Germany in 1997 — indicating he may have been taking the potentially lethal medication for at least 12 years.

At least four doctors are at the core of the investigation. One, personal physician Dr Conrad Murray, was with Jacko when he collapsed.

Yesterday a letter from a Dr Alex Farshchian and dated July 21, 2002, emerged suggesting Jackson trade his dependence on Demerol for injectable painkiller Buprenex.

Said to have been found at Jackson’s rented house and published on a US website, it said: “Buprenex is the potent narcotic I told you about last week. It is just like the D but better.” The letter suggests a five to seven-day program “that offers you the solution”.

The doctor adds: “I have everything ready. This is it.”

Eerily, seven years later This Is It would be the title Jackson chose for his comeback shows.

A scribbled note found near his drug stash, possibly written by Jackson, said: “Buprenex does the same as Demerol, the only difference is you can’t become an addict on Buprenex.”

Evidence ... painkiller note, perhaps scrawled by Michael Jackson

Another letter — headed Outpatient Detoxification Sheet — names methadone as the most common way to treat drug dependency.

Meanwhile documents and snaps from the Santa Barbara County Sheriff’s department also emerged showing the depths of Jackson’s drug habit were uncovered in 2003.

Officers raided his Neverland home while probing child abuse claims — and found powerful narcotics, syringes, vials and IV bags.

Jackson had been so desperate to score prescription drugs that he even used his best friend’s identity.

Among the police snaps is one showing a bottle of anti-anxiety drug Alprazolum, also known as Xanax, in the name Frank Tyson — prescribed by Dr Klein.

Tyson’s real name is Frank Cascio. He is a pal’s son who Jackson befriended as a toddler and put on his payroll when he turned 18.

Prescription ... pills for 'Frank'

Frank hung out with him at Elizabeth Taylor’s Swiss chalet in Gstaad in September 1993. And Jackson often sought sanctuary in Frank’s New Jersey home — once spending three months there.

It is thought Frank, now 30, had no idea Jackson was using his name like this — though the star frequently begged aides to get him prescription drugs to top up his own legal supply.

In 2004 bodyguard Chris Carter told investigators he used several names to get prescriptions, including those of ranch manager Jesus Salas and employee Joe Marcus.

Carter also claimed Jacko was once so “spaced out” he fell flat on his face in a hotel — but still continued the drug binge which five years later would lead to his death.

The progress of the drug addictions is to be mapped by a battery of tests — to Jackson’s BRAIN.

Shock ... Sun front pages on Jackson

The Sun

It was removed before Tuesday’s memorial service and slices will show when he first suffered drug reactions.

Renowned pathologist Dr Michael Baden said: “Everything from whether he was beaten as a child to any small tumours, or previous overdoses that he may have suffered, will show up.

“The brain results will determine if he was given improper medication, and how authentic statements provided by his physicians were.”

THE human body can build up a startling tolerance to morphine-based and tranquilliser drugs, writes Health and Science Editor Emma Morton. The phenomenon, tachyphylaxis, means larger and larger doses are needed to have an effect. This puts massive pressure on the heart, triggering heart failure.

n.parker@the-sun.co.uk

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Non-Drug Therapies

When people talk about "alternative therapies" or "alternative medicine" they are talking about kinds of treatment that are different from the medicines or surgery usually prescribed by MDs and other mainstream health professionals. Some people even define alternative medicine as treatments that aren't taught in U.S. medical schools and aren't available at U.S. hospitals. Conventional American health professionals are becoming more interested in these treatments, however.

Some alternative therapies have long histories in other parts of the world and some are recent developments. What they have in common is that the safety and effectiveness of most of them have not been proven by well-designed scientific studies. Some of them may be very helpful, but they must be chosen and used with care.

The list of alternative therapies changes over time as new approaches emerge and others are proven safe and effective and become part of conventional health care. In epilepsy, for instance, the ketogenic diet began as an alternative therapy but has been scientifically tested and is rapidly being accepted as a conventional therapy for certain kinds of patients.

Precisely defined, alternative medicine is used in place of conventional medicine. In actual practice, however, most people who use so-called alternative therapies also receive conventional treatments from a physician. In this situation, better terms might be "complementary" or "integrative" medicine.

Are alternative therapies the same as complementary and alternative medicine (CAM)?
Another popular term for these therapies is "complementary and alternative medicine" (often shortened to CAM). When two things are complementary, they work together, with each one making up for the shortcomings of the other. Complementary therapies, therefore, are used in addition to conventional therapies to try to improve results or quality of life. For instance, people with epilepsy who are taking seizure medicines prescribed by their doctor may also use CAM to try to achieve better seizure control or to reduce side effects.

Therapies listed as CAM are generally the same ones indicated by the term "alternative therapies." The difference lies in whether the person also uses conventional therapies.

What is integrative medicine?
Some people who are interested in CAM, including many doctors, want to emphasize that complementary and alternative therapies can be a valuable addition to conventional medical care. They use the term "integrative medicine" to emphasize that both types of treatment are combined (integrated) in the patient's care. Practitioners of integrative medicine generally emphasize those CAM therapies that have been the most thoroughly tested.

Where can I find out more?
The United States government has had an agency working in the area of alternative therapies since 1993. The current name of this agency (which is part of the NIH, the National Institutes of Health) is the National Center for Complementary and Alternative Medicine (NCCAM). The NCCAM website is a reliable source of up-to-date information and links to other resources.

Topic Editor: Steven C. Schachter, M.D.

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Alzheimer's disease drug treats traumatic brain injury, report GUMC researchers

They say the findings cement relationship between the two brain disorders

Vienna, Austria – The destructive cellular pathways activated in Alzheimer's disease are also triggered following traumatic brain injury, say researchers from Georgetown University Medical Center (GUMC). They say this finding suggests that novel therapy might successfully target both conditions.

In an oral presentation at the Alzheimer's Association 2009 International Conference on Alzheimer's Disease, the scientists will show that deactivating these pathways in part by using a gamma secretase inhibitor - a class of Alzheimer's disease drugs currently being tested - reduced loss of neurons in animal models of traumatic brain injury and protected the animals against motor and cognitive deficits.

"The goal for both diseases is to prevent neuronal cell death, and this study suggests that one therapy could possibly work for both," says the study's lead author, neuroscientist Mark Burns, PhD, an assistant professor at GUMC.

Both disorders are associated with build-up of beta amyloid, a toxic brain peptide. This substance is commonly found in the brains of elderly patients who died from Alzheimer's disease, but has also been found in a third of traumatic brain injury victims, some of whom are children, Burns says. It is also known that people who experience such a brain injury have a 400 percent increased risk of developing Alzheimer's disease.

Burns says that buildup of beta amyloid occurs in a second wave of damage that follows immediate "necrotic" death of nerve cells after traumatic brain injury. This secondary injury can last months, if not years, resulting in large holes within brain tissue.

Amyloid peptides are produced when a long brain protein known as the amyloid precursor protein (APP) is cut in two by the enzyme beta secretase, and then cut once again by a second enzyme known as gamma secretase. Agents that inhibit the activity of gamma secretase are now being studied as treatment for Alzheimer's disease.

In this study, researchers used mice that were either treated with DAPT, an experimental gamma secretase inhibitor, or mice which were "BACE knock-outs" – so called because they were genetically altered in such a way that they could not produce beta secretase. In unaltered and untreated "normal" mice, brain injury resulted in a rapid accumulation of beta amyloid, along with cognitive and motor deficits. But DAPT and BACE knock-out mice had brain lesions that were as much as 70 percent smaller than control animals and they experienced minimal impairment.

The findings further cement the connection between Alzheimer's disease and traumatic brain injury, Burns says, and show that "modulation of beta and gamma secretase may provide novel therapeutic targets for the treatment of traumatic brain injury."

###

The study was funded by grants from the National Institutes of Health and by the Klingel Family Foundation. The scientists report no potential financial conflicts in this research. Georgetown University has filed a patent application for the technology involved in this research.

About Georgetown University Medical Center

Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through Georgetown's affiliation with MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, the world-renowned Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO), home to 60 percent of the university's sponsored research funding.

Contact: Karen Mallet
km463@georgetown.edu
215-514-9751
Georgetown University Medical Center

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WHO likely to give H1N1 jab guidance on Monday

Source: Reuters
* WHO expert set to give briefing on flu vaccine Monday
* H1N1-resistant cases have raised interest in jab
(updates with WHO spokeswoman saying briefing likely on Monday)

The World Health Organisation (WHO) will probably hold a media briefing on Monday to issue guidance about the need for a H1N1 influenza jab, a WHO spokeswoman said on Friday.
"The recommendations are still in the process of being developed," Fadela Chaib told a news briefing in Geneva, where the United Nations agency is based.
"The press conference will probably be on Monday," she later told Reuters.
Marie-Paule Kieny, WHO director of the Initiative for Vaccine Research, would give a news briefing once the recommendations emerging from the closed-door WHO meeting on Tuesday are approved by WHO Director-General Margaret Chan.

The WHO raised its influenza pandemic alert to the highest level on June 11 in response to the worldwide spread of H1N1, a newly discovered virus strain commonly known as swine flu.

Vaccine makers such as Sanofi-Aventis , Novartis , Baxter , GlaxoSmithKline and Solvay are seeking WHO guidance about whether to ramp up production of jabs for the strain, to keep making seasonal flu vaccines, or to produce a combination.

The discovery of three isolated cases of H1N1 flu in Denmark, Japan and Hong Kong that resisted treatment with the anti-viral drug Tamiflu, made by Roche and Gilead , has raised interest in a jab to prevent infection.

The WHO said earlier this week that Tamiflu-resistant H1N1 flu does not appear to be spreading in a sustained or worrisome way. All patients with the resistant variety have recovered fully, and their viruses were sensitive to treatment with the other anti-viral recommended by the WHO, the inhaled drug Relenza made by Glaxo under license from Biota .
(Reporting by Laura MacInnis and Stephanie Nebehay; Editing by Louise Ireland)

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U.S. Moves Forward With Preparations For H1N1 Vaccination Campaign

The Obama administration on Thursday said a nationwide vaccination program could begin as early as mid-October to protect Americans from the H1N1 (swine flu) virus and pledged $350 million to help prepare communities across the country for this effort, the Washington Times reports (Ward, 7/9).

"I think it's clear that although we were fortunate not to see a more serious situation in the spring when we first got news of this outbreak, the potential for a significant outbreak in the fall is looming," President Obama said, speaking by phone from the G8 summit in Italy to U.S. health officials who gathered in Maryland for a daylong flu summit organized by his Cabinet, AFP/Yahoo! News reports. "We want to make sure that we are not promoting panic, but we are promoting vigilance and preparation," he said.

"The White House has drawn up a battle plan for taking on the virus when influenza season returns to the northern hemisphere in several weeks' time," contingent on the development of a viable H1N1 vaccine. Clinical trials on the first H1N1 vaccine are scheduled to start next month, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "We know that a safe and effective vaccine is the best means of both preventing the disease in individuals and stopping the community spread of the virus," HHS Secretary Kathleen Sebelius said (Zeitvogel, 7/9).

"The federal government should get about 100 million doses of vaccine by mid-October, if the current production by five companies goes as planned," the Washington Post writes. "But enough vaccine for wide use by the 120 million people especially vulnerable to the newly emerged strain of H1N1 influenza virus will not be available until later in the fall" (Brown/Hsu, 7/10).

Sebelius told the group gathered at the summit that children, pregnant women, people with chronic illness, the elderly and health workers and will be the first to receive the vaccine, CNN reports.

Reuters reports: "The government is also considering buying even more antiviral drugs, including more of GlaxoSmithKline's inhaled drug Relenza and pediatric doses of Roche AG's Tamiflu" as well as a drug nearing the end of clinical trials, which "would help address the issue of resistance," the news service writes (Fox, 7/9).

The Washington Times writes: "HHS is making $350 million in grants available to state and local governments to get ready, with $260 million slotted to help communities prepare for a vaccination program, and $90 million to help hospitals plan for a surge of patients" (7/9). "The federal government has spent about $1 billion so far on pandemic flu vaccine, with about $7 billion available for further purchases and other pandemic countermeasures," according to the Washington Post (7/10).

H1N1's Impact On World GDP; Zimbabwe's Vulnerabilities

Dow Jones Newswires/NASDAQ examines the impact H1N1 is having on the world gross domestic product and the ongoing fear of the devastating effects the virus could have on developing countries (Quinton, 7/9). VOA News explores conflicting reports over whether or not the H1N1 virus has arrived in Zimbabwe, a country just beginning to rebound after a cholera epidemic has claimed the lives of more than 4,000 since August 2008 (Nyaira, 7/8).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

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Dramatic drop in deaths from most common cancers

The death toll from three of the UK's most common cancers has dropped to its lowest level for almost 40 years* - according to new figures released by Cancer Research UK.

Mortality rates for breast, bowel, and male lung cancer** are at their lowest since 1971 even though more than 100,000 people are now diagnosed with these kinds of cancers every year.

Breast cancer deaths peaked in 1989 with 15,625 women dying from the disease. The latest figures for 2007 show that figure has dropped to 11,990 which is equivalent to a drop in mortality rates of 36 per cent.

Bowel cancer deaths peaked in 1992 with 19,598 men and women dying from the disease. In 2007 16,007 died - equivalent to a drop in mortality rates of 31 per cent.

And the number of men dying from lung cancer peaked in 1979 at 30,391 but dropped to 19,637 in 2007 - a drop in mortality rates of 53 per cent.

Although more people are getting cancer because the population is living longer, Cancer Research UK believes that fewer are dying from the disease because new and better treatments and screening are making a real difference. And deaths from lung cancer have been falling as more people give up smoking.

While the new figures show that great progress is being made in the battle to beat cancer, there is still much more to be done. And that is the theme of the charity's new national TV advertising campaign launching on Sunday July 12th to improve awareness of the disease and to raise money for further research.

Appearing in the TV advertisement is Audrey Williams - a 50 year old artist and mother of two from Streatham in London who was diagnosed with breast cancer in 2002.

"I just feel so lucky to be here," she said. "I want everyone to know that more and more people are surviving cancer thanks to the work being done by Cancer Research UK. I found a lump in my breast when I was having a shower. After a mastectomy I had reconstruction but my body rejected the implants. It was a difficult time but I think it helps to stay cheerful and to try and keep your sense of humour to get through.

"The important thing about the TV advertisement is that we aren't actors; we are all real people who have gone through cancer and we can reach out to others and tell anyone who is worrying about symptoms to make that trip to the doctor because if they do have cancer the chances of surviving it are greater than ever."

Harpal Kumar, chief executive of Cancer Research UK, said: "Years of research are behind the dramatic progress being made in the fight against Britain's common cancers. Survival rates have doubled in the last thirty years and the work of Cancer Research UK has been at the heart of that progress.

"Our research is behind 19 of the top 20 drugs used to treat cancer patients worldwide today. Our work has underpinned the huge progress we are now seeing in preventing more deaths from lung cancer. And our progress over decades has helped to develop radiotherapy as a major form of treatment for half of all cancer patients.

"But research is expensive and - because we rely completely on donations from the public - we can only continue this vital work with people's support."

Scientists at Cancer Research UK have been responsible for vital discoveries in the quest to understand how cancer develops and how best to treat the disease.

Cancer Research UK funded large trials that proved the benefits of tamoxifen for breast cancer patients and other trials have shown how to prevent the disease in high risk post-menopausal women. In 1995, the charity showed that two X-rays were better than one in detecting more breast cancers and reducing recall rates. This contributed to a widespread change in clinical practice with two-view mammography now used by all the national screening centres.

The charity's laboratory work is behind many life-saving drugs, such as Herceptin, which has given hope to thousands of women with a particular type of breast cancer. Early work on aromatase inhibitors paved the way for anastrozole, a new gold standard of care for the most common type of breast cancer.

Cancer Research UK scientists contributed to key trials of the drug capecitabine, used to treat both bowel and breast cancer. And they showed that Taxol is an effective treatment for breast cancer; it is now also used for advanced lung cancer.

Cancer Research UK has also made a series of breakthroughs pinpointing new regions of the genome linked to breast, bowel, prostate, lung and brain cancer as well as funding more than 100 clinical trials in the UK at any time.

The charity's chief scientist, Professor Sir David Lane, discovered the p53 protein which is faulty in many cancers and this paved the way for many treatments being tested in clinical trials today.

Cancer Research UK scientists helped to develop the drug cisplatin and later discovered carboplatin which has fewer side effects than cisplatin and is widely used in treating ovarian, lung and head and neck cancers.

Temozolomide, now used worldwide to treat the most common form of brain cancer, is another drug discovered in the charity's laboratories and developed through early clinical trials.

Notes:

* *UK figures routinely collated by Cancer Research UK since 1971
* Breast cancer deaths in women were 12,472 (rate = 37.5 per 100,000 women) in 1971; 15,625 (rate = 41.6) at the peak in 1989; and 11,990 (rate = 26.7) in 2007.
* Bowel cancer deaths were 18,110 (rate = 28.9 per 100,000 persons) in 1971; 19,598 (rate = 25.5) at the peak in 1992; and 16,007 (rate = 17.7) in 2007.
* Male lung cancer deaths were 28,395 (rate = 106.9 per 100,000 men) in 1971; 30,391 (rate = 108.5) at the peak in 1979; and 19,637 (rate = 51.5) in 2007.
* **Lung cancer mortality rates in women under 75 increased by seven per cent over the last 30 years but have fallen by four per cent in the last 10 years.
* The difference in lung cancer trends between men and women reflect variations in past smoking behaviour.

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An Experimental Drug Eases Poisonous Scorpion Stings in Children, a Study Finds

By RONI CARYN RABIN
Published: May 13, 2009

Scorpion stings rarely leave a trace, so when 10-year-old Michael Moerdler-Green woke up at 3 a.m. during a recent family trip to Phoenix, all he knew was that his leg hurt. But as the scorpion’s poison began to spread, his body started to tingle, his eyes rolled around in his head and his legs and arms began to flail.

At the emergency room of Phoenix Children’s Hospital, doctors offered Michael’s parents a choice of treatments: heavy sedation to quell the boy’s symptoms, or an experimental scorpion antivenom made in Mexico but not approved by the Food and Drug Administration for use in the United States.

The boy’s father, Dr. David Moerdler-Green, chose the antivenom. A new study suggests he made the right decision.


No other antivenom specifically for scorpion stings is available in the United States, and a small clinical trial of young children stung by bark scorpions has found that most of those given the investigational drug recovered within two hours, while children given a placebo had symptoms that lasted four hours or more and required heavy sedation and hospitalization.

The study is to be published on Thursday in The New England Journal of Medicine.

“It was like a miracle,” said Dr. Moerdler-Green, who is head of radiology at St. Barnabas Hospital in the Bronx. His son was able to leave the hospital just an hour after receiving the medication. “How many people go into the emergency room around the world and are able to get medication and be cured in the course of one hour?”

Dr. Leslie V. Boyer, principal investigator of the new study, said the trial, though small, demonstrated that the effects of bark scorpion venom could be quickly reversed.

“Using this antivenom in the emergency room will make intensive care treatment unnecessary for most patients,” said Dr. Boyer, who is director of a venom research institute at the University of Arizona College of Medicine in Tucson.

Although 8,000 Arizona residents are stung by poisonous scorpions each year, most adults recover without needing medical treatment. Each year about 200 young children, however, suffer severe neurotoxic symptoms, including trouble breathing, after being stung.

Wider use of the scorpion antivenom, called Anascorp, could make treatment much easier in rural areas and small towns in the state that do not have pediatric intensive care units and usually have to helicopter children to hospitals for care, Dr. Boyer said.

A professor at Arizona State University used to make her own scorpion antivenom. She retired in 1999, leaving behind her recipe and enough of the drug to last about five years. Ever since, the state has been using up its inventory.

In the new study, children from ages 6 months to 18 years who were admitted to a pediatric intensive care unit in Tucson after being stung by scorpions were randomly assigned to receive either Anascorp or a placebo. Eight received the antivenom, and seven received a placebo.

Within two hours, children who had received Anascorp recovered from most of their symptoms; within four hours, the children recovered completely, the researchers found. None of the children who received the drug had detectable levels of scorpion venom in their blood an hour after infusion.

By contrast, children who received the placebo treatment required sedation at levels 65 times higher than did the children who received antivenom. Symptoms persisted for more than four hours in all but one of the children receiving the placebo, the researchers found, and some were hospitalized for up to 48 hours.

--NYTimes--

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Hope of new prostate cancer test

Scientists have found a potential new way to assess whether prostate cancer is aggressive.
They have found tiny bubbles of fat in the urine may hold the key information needed to decide what type of treatment the patient needs.
If prostate cancer is aggressive it requires urgent treatment, but this is not appropriate for patients with slow-growing forms of the disease.
The study appears in Cancer Research UK's British Journal of Cancer.

"This approach holds promise as a non-invasive test of malignancy that could help men and their doctors in the future"

John Neate
Prostate Cancer Charity

Prostate cancer is the most common cancer in men in the UK.
Each year around 34,000 men are diagnosed with the disease, and around 10,000 die from it.

But while the disease can be a killer, in its more benign form it often requires nothing other than close monitoring and the patient often eventually dies from another, unrelated condition.
Until now, researchers have used levels of proteins, like prostate specific antigen (PSA), produced by cancer cells to try to spot the aggressive tumours.
But this can throw up inaccurate results, and lead to people unnecessarily undergoing treatment which can have long-term side effects, such as incontinence and impotence.

Direct from tumour

The latest work focused on fatty capsules called exosomes that are flushed out of the body in the urine.
Scientists found that in patients with prostate cancer exosomes contain molecules that come directly from the tumour itself.
These molecules, which contain a type of genetic material called RNA, can be used to figure out which genes are turned on and off in the cancer - and thus whether it is aggressive or not.
The researchers, led by Dr Jonas Nilsson, from the VU University Medical Centre in Amsterdam, hope the discovery will enable them eventually to develop a more effective test for aggressive tumours.
John Neate, of the Prostate Cancer Charity, said the study was a step towards finding a reliable way to identify aggressive forms of the disease.
But he warned it was a small study, and scientists would need to examine exosomes from a larger number of men before they could assess the reliability of the technique.

Acceptability?

He also said the need to massage the prostate to increase the likelihood that the relevant molecules were released into the urine might reduce its acceptability as a mass screening tool.
Mr Neate added: "Nevertheless, this approach holds promise as a non-invasive test of malignancy that could help men and their doctors in the future.
"Possibly the most significant research question in prostate cancer is how to distinguish early, and with confidence, the potentially life-threatening prostate tumours from the slow growing form of the disease.
"Then treatments could be refined and concentrated on the aggressive cancers where the benefits of treatment far outweigh the risk of side-effects, which can seriously affect a man's quality of life.

---BBC---

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WHO Avoids Assigning Severity Scale to H1N1 Flu

The World Health Organization (WHO) said today it is unable to assign a severity scale to the influenza A (H1N1) epidemic for the reason that disease characteristics and responses of countries vary.

Dr. Sylvie Briand, with the WHO Global Influenza Programme, spoke today at a media briefing in Geneva. As of 1:00 am EDT, 33 countries had reported 5728 confirmed cases of influenza A (H1N1) infection.

According to Dr. Briand, the WHO pandemic alert level phases are mainly based on the transmission of the virus and its geographical spread, while "the severity itself is assessed by other means." Currently, the pandemic alert level has remained at level 5 out of 6, indicating community-based outbreaks in a single WHO region.


The severity of a potential pandemic is based on 3 factors: "the [characteristics of the] virus, the vulnerability of the population, and the intervention we can put in place to reduce the impact of severe disease," Dr. Briand said.

Assessing severity is important for helping countries determine their response to an outbreak, but at a global level, a severity index is "not very helpful" because "severity will vary from place to place," she said.

Dr. Briand pointed out that while wealthier countries may have the resources to mount a more effective response to an outbreak, some developing parts of the world such as West Africa are already used to coping with epidemics and may be at an advantage due to having healthcare systems in place. This is referred to as the "resilience" of a country, she said.

Dr. Briand also emphasized that oseltamivir and zanamivir are effective against this novel H1N1 strain, which is in contrast to the seasonal influenza strain, which is resistant to these antiviral drugs.

News reports are circulating regarding a claim by an eminent Australian influenza researcher that human error may have been involved in creating this strain. Adrian Gibbs, 75, said in an interview that he intends to publish a report suggesting the new strain may have accidentally evolved in eggs that scientists use to grow viruses and drugmakers use to make vaccines.

WHO spokesperson Gregory Hartl said the WHO is looking into evidence regarding these claims, but "it is way too soon to say anything." He added that the WHO's main task is to assess the current risk level and to "help member states to be prepared to respond."

The US Centers for Disease Control and Prevention (CDC) today is reporting 3009 laboratory-confirmed cases in 44 states and Washington, DC.

Yesterday the CDC issued a dispatch in the Morbidity and Mortality Weekly Report on novel influenza A (H1N1) virus infections in pregnant women. As of May 10, 20 probable or confirmed cases had been reported in pregnant women. Of the women, 3 have been hospitalized and 1 woman died.

The CDC is recommending that pregnant women with confirmed, probable, or suspected novel influenza A (H1N1) virus infection should receive antiviral treatment for 5 days.

---MedScape--

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Human error behind H1N1? WHO probes

The World Health Organization is investigating a claim by an Australian researcher that the swine flu virus circling the globe may have been
created as a result of human error.

Adrian Gibbs, 75, who collaborated on research that led to the development of Tamiflu drug, said that he intends to publish a report suggesting the new strain may have accidentally evolved in eggs scientists use to grow viruses and drugmakers use to make vaccines. Gibbs said he came to his conclusion as part of an effort to trace the virus’s origins by analyzing its genetic
blueprint.

“One of the simplest explanations is that it’s a laboratory escape,” Gibbs said on Wednesday. “But there are lots of others.”

The World health Organization received the study last weekend and is reviewing it, Keiji Fukuda, the agency’s assistant director-general of health security and environment, said in an interview on May 11.

Gibbs, who has studied germ evolution for four decades, is one of the first scientists to analyze the genetic makeup of the virus that was identified three weeks ago in Mexico and threatens to touch off the first flu pandemic since 1968.

---The Times of India---

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Influenza A(H1N1) - update 27

As of 06:00 GMT, 13 May 2009, 33 countries have officially reported 5728 cases of influenza A(H1N1) infection.

Mexico has reported 2059 laboratory confirmed human cases of infection, including 56 deaths. The United States has reported 3009 laboratory confirmed human cases, including three deaths. Canada has reported 358 laboratory confirmed human cases, including one death. Costa Rica has reported eight laboratory confirmed human cases, including one death.

The following countries have reported laboratory confirmed cases with no deaths - Argentina (1), Australia (1), Austria (1), Brazil (8), China (3, comprising 1 in China, Hong Kong Special Administrative Region, and 2 in mainland China), Colombia (6), Cuba (1), Denmark (1), El Salvador (4), Finland (2), France (13), Germany (12), Guatemala (3), Ireland (1), Israel (7), Italy (9), Japan (4), Netherlands (3), New Zealand (7), Norway (2), Panama (29), Poland (1), Portugal (1), Republic of Korea (3), Spain (98), Sweden (2), Switzerland (1), Thailand (2), and the United Kingdom (68). WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus.

Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care. These recommendations are prudent measures which can limit the spread of many communicable diseases, including influenza.
---WHO---

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Cisplatin

Cisplatin is a chemotherapy drug that was approved by the Federal Drug Administration (FDA) in 1978 and is used to treat patients suffering from malignant pleural mesothelioma. Cisplatin is administered when surgical procedures are not an option, and it is often used in combination with other chemotherapy drugs, including Alimta. Manufactured by Bristol Myers Squibb, Cisplatin is also used to treat ovarian and lung cancer and is a highly effective method of mesothelioma treatment that is often recommended by oncologists.

Cisplatin is administered intravenously and may be given along with other drugs, such as anti-nausea medication and antibiotics that prevent buildup of Cisplatin within the kidneys. Your doctor will determine how often you receive Cisplatin and for how long, but patients who receive Cisplatin in tandem with Alimta will follow a 21-day treatment cycle.

Because Cisplatin was developed three decades ago, the side effects associated with this drug are often much more severe. Side effects include damage to the kidneys, (which is often prevented by administering other drugs, such as a diuretic or sodium polystyrene sulfonate, during Cisplatin treatment) serious nausea, depleted levels of calcium, potassium and other nutrients, loss of appetite, tiredness, hair loss, and an increased risk of infection. Because cancer treatment in general has become so advanced since Cisplatin was first developed, doctors are generally able to control the unpleasant side effects associated with Cisplatin treatment in an effort to make the patient more comfortable.

Other drugs similar to Cisplatin include Carboplatin, generally used to treat cancer of the lung, head and neck, and Oxaliplatin, which is most often used to treat colorectal cancer.

As with any mesothelioma cancer drug, your doctor will decide whether or not Cisplatin is a beneficial option for treating your cancer.
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Cancer Centers

National

National Cancer Institute
National Institutes of Health
Bethesda, MD 20892
301-496-4000
800-4-CANCER
800-422-6237

Alabama

University of Alabama at Birmingham
Comprehensive Cancer Center
Basic Health Sciences Building
1824 Sixth Avenue South
237 T.I.
Birmingham, AL 35294-3300
205-934-5077

Arizona

University of Arizona Cancer Center
1501 North Campbell Avenue
Tucson, AZ 85724
520-626-7383

California

Jonsson Comprehensive Cancer Center at UCLA
Box 951781
Los Angeles, CA 90095-1781
800-825-2631
310-825-5268

USC/Norris Comprehensive Cancer Center
1441 Eastlake Avenue MS #83
Los Angeles, CA 90033-0800
323-865-0816

City of Hope National Medical Center
Beckman Research Institute
1500 East Duarte Road
East Duarte, CA 91010-3000
626-359-8111
Comprehensive Cancer Center

Salk Institute
Cancer Center
10010 North Torrey Pines Road
La Jolla, CA 92037
619-453-4100 x1386
Cancer Center

The Burnham Institute
10901 North Torrey Pines Road
La Jolla, CA 92037
619-455-6480 x3209
Cancer Center

University of California at Irvine
Cancer Center
Building #23 4th Floor
101 The City Drive
Orange, CA 92868
714-456-6310
Clinical Cancer Center

UCSF Stanford Health Care
300 Pasteur Drive
Stanford, CA 94305
650-723-4000

University of California at San
Diego Cancer Center
9500 Gilman Drive
La Jolla, CA 92093-0658
619-534-7600
Clinical Cancer Center

Colorado

University of Colorado Cancer Center
4200 East 9th Avenue
Denver, CO 80262
Clinical Cancer Center

Connecticut

Yale Comprehensive Cancer Center
Yale University School of Medicine
333 Cedar Street
New Haven, CT 06520-8028
203-785-4095

Florida

Sylvester Comprehensive Cancer Center
University of Miami Medical School
1475 Northwest 12th Avenue, Room 4023
Miami, FL 33136

H. Lee Moffitt Cancer Center
12902 Magnolia Drive
Tampa, FL 33612-9497
813-979-3050

Hawaii

Cancer Research Center of Hawaii
University of Hawaii at Manoa
1236 Lauhala Street
Honolulu, HI 96813
808-586-3013
Clinical Cancer Center

Illinois

Robert H. Lurie Cancer Center
Northwestern University
303 East Chicago Avenue
Olson Pavilion, Room 8250
Chicago, IL 60611
312-908-5250
Clinical Cancer Center

University of Chicago Cancer
Research Center
5841 South Maryland Avenue
Chicago, IL 60637
Clinical Cancer Center

Indiana

Purdue University Cancer Center
Hansen Life Sciences Research Building
South University Street
West Lafayette, IN 47907-1524
765-494-9129 Cancer Center

Maine

The Jackson Laboratory
600 Main Street
Bar Harbor, ME 04609-0800
207-288-6041
Cancer Center

Maryland

The Johns Hopkins Oncology Center
600 North Wolfe Street
Baltimore, MD 21287-8943
410-955-8822

Massachusetts

Center for Cancer Research
Massachusetts Institute of Technology
77 Massachusetts Avenue, Room E17-110
Cambridge, MA 02139-4307
617-253-6422
Cancer Center

Dana-Farber Cancer Institute
44 Binney Street
Boston, MA 02115
617-632-3000

Michigan

University of Michigan
Comprehensive Cancer Center
102 Observatory
Ann Arbor, MI 48109-0724
313-936-1831

Barbara Ann Karmanos
Cancer Institute
110 East Warren Avenue
Detroit, MI 48201
1-800-KARMANOS

Minnesota

University of Minnesota
Cancer Center
Box 806, 420 Delaware Street, S.E.
Minneapolis, MN 55455
612-624-8484
Comprehensive Cancer Center

Mayo Cancer Center
Mayo Foundation
200 First Street SW
Rochester, MN 55905
507-284-3753
Clinical Cancer Center

Nebraska

University of Nebraska Medical Center
Eppley Cancer Center
600 South 42nd Street
Omaha, NE
402-559-7081
Cancer Center

New Hampshire

Norris Cotton Cancer Center
Dartmouth-Hitchock Medical Center
One Medical Center Drive
Lebanon, NH 03756-0001
603-650-6300

New Jersey

The Cancer Institute of New Jersey
Robert Wood Johnson Medical School
195 Little Albany Street, Room 2002B
New Brunswick, New Jersey 08901
732-235-8064
Clinical Cancer Center

New York

Albert Einstein College of Medicine
Cancer Research Center
Chanin Building
1300 Morris Park Avenue
Bronx, NY 10461
718-430-2302
Cancer Center

American Health Foundation
320 East 43rd Street
New York, NY 10017
212-953-1900
Cancer Center

Cold Spring Harbor Laboratory
P.O. Box 100
Cold Spring Harbor, NY 11724
516-367-8383
Cancer Center

Herbert Irving
Comprehensive Cancer Center
College of Physicians and Surgeons
701 West 168th Street, Room 1509
New York, NY 10032
212-305-6921

Kaplan Cancer Center
New York University Medical Center
550 First Avenue
New York, NY 10016
212-263-5349
Clinical Cancer Center

Memorial Sloan-Kettering
Cancer Center
1275 York Avenue
New York, NY 10021
800-525-2225
212-639-6561

Roswell Park Cancer Institute
Elm and Carlton Streets
Buffalo, NY 14263-0001
213-845-5770
800-767-9355

University of Rochester Cancer Center
601 Elmwood Avenue
Rochester, NY 14642
716-275-6292
Clinical Cancer Center

Albert Einstein College of Medicine
Cancer Research Center
Chanin Building
1300 Morris Park Avenue
Bronx, NY 10461
718-430-2302

North Carolina

UNC Lineberger Comprehensive
Cancer Center
University of North Carolina
School of Medicine Chapel Hill
CB#7295
Chapel Hill, NC 27599-7295
919-966-3036

Duke Comprehensive Cancer Center
Duke University Medical Center
Box 3843
Durham, NC 27710
919-684-5613

Comprehensive Cancer Center of
Wake Forest University at Bowman
Gray School of Medicine
Medical Center Boulevard
Winston-Salem, NC 27157
336-716-7971

Ohio

Ohio State University
Comprehensive Cancer Center
Arthur G. James Cancer Hospital
300 West 10th Avenue
Columbus, OH 43210
614-293-4878

Case Western Reserve University
Cancer Research Center
11100 Euclid Avenue
Cleveland, OH 44106
Comprehensive Cancer Center

Oregon

Oregon Cancer Center
Oregon Health Sciences University
3181 S.W. Sam Jackson Park Road, L609
Portland, OR 97201-3098
503-464-1617
Clinical Cancer Center

Pennsylvania

Fox Chase Cancer Center
7701 Burholme Avenue
Philadelphia, PA 19111
215-728-3600

Wistar Institute Cancer Center
3601 Spruce Street
Philadelphia, PA 19104-4268
215-898-3926
Cancer Center

University of Pennsylvania Cancer Center
16 Penn Tower
3400 Spruce Street
Philadelphia, PA 19104
215-662-6334

University of Pittsburgh Cancer Institute
3471 5th Avenue
Pittsburgh, PA 15213-2592
412-692-4670

Kimmel Cancer Center
233 South 10th Street
Philadelphia, PA 19107
215-503-4645
Clinical Cancer Center

Jefferson Cancer Center
Thomas Jefferson University
233 South 10th Street
Philadelphia, PA 19107
215-503-4645

Tennessee

Vanderbilt Cancer Center
Vanderbilt University
649 Medical Research Building II
Nashville, TN 37232
800-811-8480
615-936-5847
Clinical Cancer Center

St. Jude Children's Research Hospital
332 North Lauderdale Street
Memphis, TN 38105
901-495-3300
Clinical Cancer Center

Texas

The University of Texas
M.D. Anderson Cancer Center
1515 Holcolmbe Boulevard
Houston, TX 77030
713-792-7500

San Antonio Cancer Institute
8122 Datapoint Drive, Suite 600
San Antonio, TX 78229
210-616-5580

Utah

Huntsman Cancer Institute
University of Utah Health
Sciences Center
15 North 2030 East, Room 2100
Salt Lake City, UT 84112
801-581-4048
801-581-4330
Clinical Cancer Center

Vermont

Vermont Regional Cancer Center
University of Vermont
Medical Alumni Building
Burlington, VT 05405-0068
802-656-4414

Virginia

Cancer Center
University of Virginia Health
Sciences Center
Box 334
Charlottesville, VA 22908
804-924-2562
Clinical Cancer Center

Massey Cancer Center
Medical College of Virginia
401 College Street
Richmond, VA 23298
804-828-0450
Clinical Cancer Center

Washington

Fred Hutchinson Cancer Research Center
1100 Fairview Avenue
P.O. Box 19024
Seattle, WA 98109-1024
206-667-5000

University of Washington
Academic Medical Center
Seattle, WA

Washington, D.C.

Lombardi Cancer Research Center
Georgetown University Medical Center
3800 Reservoir Road NW
Washington, DC 20007
202-687-2110

Wisconsin

McArdle Laboratory for Cancer Research
University of Wisconsin
1400 University Avenue, Room 1009
Madison, WI 53706-1599
608-262-2177
Cancer Center

University of Wisconsin
Comprehensive Cancer Center
600 Highland Avenue
Madison, WI 53792-0001
608-263-8600

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