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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