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Researchers may have found an easy way to detect lung cancer in its early or even pre-cancerous stages, as well as a way to reverse the start of the deadly disease with a readily available, over-the-counter drug.

“It’s incredibly, incredibly exciting,” said Dr. Patrick Nana-Sinkam, a lung cancer expert with the Ohio State University Comprehensive Cancer Center, who was not involved with the new study. “This definitely has potential.”

The minimally invasive procedure involves using a small brush to collect a smattering of cells from the windpipe (a bronchoscopy), explained study co-author Andrea Bild, an assistant professor of pharmacology and toxicology at the University of Utah in Salt Lake City.

Maybe one day, screening could be done using an even simpler nasal or sputum test, the researchers said.

Currently, there is no good way to detect lung cancer — the number one cancer killer — in its early stages when it’s most treatable. By the time most lung cancers are diagnosed — which usually involves an invasive examination of the lungs — patients already have advanced malignancies. Only 15 percent of patients are still alive at five years, said Nana-Sinkam.

Cigarette smoking is responsible for 90 percent of all lung cancer cases in the United States.

Still, only 10 to 20 percent of smokers actually develop lung cancer, begging the question: Why do some smokers succumb to the disease and others don’t.

Now genomics may have provided an answer.

Working on the theory that cigarettes harm not only the lungs but a “field of injury” extending to other areas of the respiratory tract, the study authors surmised that evidence of existing or soon-to-develop lung cancer might be available further up in the airway.

The researchers used so-called microarray genetic analysis to measure gene expression levels in the epithelial cells — those cells lining the respiratory tract — that they had captured with the bronchoscopy.

“We were looking at the activity of genes in the cells that we obtained from the windpipe or airways of smokers at risk for lung cancer,” said study senior author Dr. Avrum Spira, a critical care physician at Boston Medical Center and associate professor of medicine, pathology and bioinformatics at Boston University School of Medicine.

It turned out that gene activity in the PI3K pathway was “off the chart” in smokers with lung cancer versus those without the disease.

“Obviously that’s very exciting,” Spira said. “We have identified a marker for an early risk of developing lung cancer.”

And when treated with the compound myo-inositol, the gene pathway activity declined along with improvement in the troublesome lesions, the researcher noted.

“This drug inhibits the pathway that’s activated in smokers. The drug is a natural compound. You can get it in health-food stores,” Spira said.

“We’re now in the midst of a large study to look at whether or not activity of this pathway can be used to pick those who could benefit from this as a treatment as opposed to just prevention,” said Spira, who is a co-founder of Allegro Diagnostics Inc., a company that plans to market this biomarker.

The researchers also need to explore whether or not the PI3K pathway is active in non-smokers, as well as what other pathways might also trigger lung cancer.

The study findings were published in issue of the journal Science Translational Medicine.

MRI scans are more likely to turn up undiagnosed tumors in the breasts of postmenopausal women who already had cancer in their other breast, researchers report.

However, the scans are less likely to detect tumors in premenopausal women, they added.

“Our findings are not really surprising because we know that the risk of breast cancer increases as age increases,” lead investigator Dr. Johnny Ray Bernard Jr., a radiation oncologist at the Mayo Clinic in Jacksonville, Fla., said in a news release from the clinic. “Elderly women in good health potentially benefit from earlier detection, and we believe that screening of the undiagnosed breast with MRI should be considered in all postmenopausal women diagnosed with a breast cancer.”

The study authors looked at the records of 425 women with breast cancer who underwent MRI scans of both breasts from 2003 to 2007. The goal was to discover how often the scans turned up cancer in breasts that were thought to be cancer-free.

The researchers found that women 70 and older were especially likely to have cancer turn up in the MRI scans: It was detected in the second breast in 5.4 percent of 129 women 70 and older.

“The combination of older age and a personal breast cancer history possibly makes women aged 70 years or older with newly diagnosed breast cancer at even higher risk” for developing breast cancer in both breasts, he said.

The findings appear in the March/April issue of The Breast Journal.

Doctors and patients often have different expectations for knee and hip replacement surgery, and steps should be taken to close that gap, a new study shows.

Hospital for Special Surgery (HSS) researchers compared the expectations of 42 patients and their doctors and found clinically meaningful disagreement in 68 percent of patients, with 53 percent of the patients’ expectations exceeding those of the surgeons.

“The take-home message for the surgeon is that inexpensive, educational interventions like a preoperative class can be used to better align the patient’s and the surgeon’s expectations prior to surgery,” Dr. Alejandro Gonzalez Della Valle, associate attending orthopedic surgeon at HSS, said in a hospital news release. “This may ultimately result in higher perceived outcome.”

“If a patient has unrealistic expectations that are not properly trimmed preoperatively or achieved after surgery, the patient will most likely be dissatisfied with some aspects of the final result. Conversely, if the patient has low expectations for function after surgery, it is likely that he or she will not enthusiastically engage in the different phases of the postoperative recovery including physically therapy. That patient will probably have a lower than expected functional result,” Gonzalez Della Valle said.

“For the patient, the take-home message is that it is paramount to discuss the expectations for pain relief and function with the surgeon and in the class before undergoing a total joint replacement to make sure that the expectations of the physician and the patient are similar.”

The study was presented this week at the annual meeting of the American Academy of Orthopaedic Surgeons.

Survivors of childhood cancer have a significantly increased risk for developing heart disease as young adults, a new study finds.

The finding came from an analysis of data on 14,358 five-year cancer survivors who were diagnosed before age 21 and 3,899 siblings of cancer survivors. The cancers were leukemia, brain cancer, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, kidney cancer, neuroblastoma, soft tissue carcinoma or bone cancer.

The study found that young adult survivors of these childhood cancers are much more likely than others in their age group to have cardiovascular problems, including heart failure, heart attack, heart inflammation and heart valve abnormalities, for up to 30 years after being treated for cancer.

They also found that the risk was associated with lower exposure to chemotherapy and radiation treatment than previously thought.

“Young adults who survive childhood or adolescent cancer are clearly at risk for early cardiac morbidity and mortality not typically recognized within this age group,” wrote the study’s lead author, Dr. Daniel Mulrooney, a pediatric hematology oncologist at the University of Minnesota, and his research colleagues. “Such individuals require ongoing clinical monitoring, particularly as they approach ages in which cardiovascular disease becomes more prevalent.”

Health-care providers need to be aware of this increased risk for heart disease when caring for patients who survived childhood cancer, the researchers said.

The incidence of breast cancer in the United States declined 7 percent between 2002 and 2003, but only part of that decrease can be attributed to reduced use of hormone replacement therapy (HRT) by menopausal women, researchers say.

HRT use declined after the 2002 release of The Women’s Health Initiative study, which concluded that hormone therapy increases the risk of breast cancer. Other studies have confirmed the link.

“We found that the change in hormone therapy use only accounted for a decline (in breast cancer) of about 3 percent, so there’s another 4 percent that is being caused by something we do not yet know,” study leader Brian Sprague said in a news release.

He and his colleagues reviewed studies that looked at the decline of HRT use and the decline in breast cancer incidence. Based on the available literature, Sprague and colleagues estimated that reduced use of HRT accounted for 42 percent of the decline in breast cancer incidence.

Further research is needed to identify the other reasons for the decrease in breast cancer cases, Sprague said.

“This does not mean that women should start taking hormones again, but there appear to be additional factors that have contributed to the decline in breast cancer,” he noted.

People who have asthma and who also smoke could reverse some of the damage to their lungs by saying no to cigarettes, new Dutch research suggests.

“We found that exposure to cigarette smoke appears to increase the thickness of the epithelium, or lining, of the airways in the lung,” Martine Broekema, lead author of the study and a researcher at the University of Groningen in the Netherlands, said in a news release from the American Thoracic Society. “This may be the underlying cause of the fact that smoking asthma patients experience more asthma symptoms, such as shortness of breath and phlegm production, compared to nonsmoking asthma patients.”

The researchers looked at 147 people with asthma symptoms, including 35 smokers, 46 ex-smokers and 66 people who had never smoked.

People who currently smoked had more cells that produce mucous than did those who never smoked, the researchers found. “These pathological findings were associated with the severity of phlegm production reported by the asthma patients, suggesting a causal relationship between the two,” Broekema said. “Smoking asthmatics also showed a distinct inflammatory profile in their lungs compared to never-smoking asthmatics.”

“Furthermore, our data suggest that smoking cessation can reverse the thickening of the lining of the airways,” she said.
In the big picture, “this study shows again how important smoking cessation is for pulmonary health, and this appears to be especially true for asthmatic patients,” Broekema said. “The good news is that quitting appears to have a measurable benefit in these individuals.”

Improved home ventilation that dehumidifies the air may make it easier for people with asthma to breathe at night, hint findings of a small study from the United Kingdom.

In theory, lowering indoor humidity should lower concentrations of moisture-loving dust mites - a major trigger for asthma-related breathing problems.

To test this, Dr. Neil C. Thomson, at the University of Glasgow, and colleagues measured breathing patterns over 12 months in 119 men and women who were about 42 years old on average and had asthma for 9 to 30 years.

Specialists retrofitted each home with a humidity-lowering ventilation system. They also steam-cleaned carpets, and replaced mattress covers and bedding, to clear dust mites.

In half the homes the ventilation systems actively exchanged indoor and outdoor air. In the other “control group” half, the systems had operational motors but non-operational fans to help ensure the groups remained “blinded” to what was actually happening, the researchers report in the journal Allergy.

Thomson’s team found no overall difference in dust mite concentrations between the homes with and without a working ventilation system.

Also, their comparison of morning breathing tests done at the start of the study and again at 3, 6, 9, and 12 months, showed no difference between those living with or without operational ventilation.

However, participants living in homes with working ventilation systems showed an overall significant improvement in evening breathing tests, while those with non-working systems worsened in these tests.

This may be partially due to the slightly reduced humidity, and dust mite levels found in the bedrooms and bedding of participants with active ventilation systems. But ventilation may also have improved overall air quality, Thomson speculated in an email to Reuters Health.

Two genes containing mutations known to cause rare familial forms of parkinsonism are also associated with the more common, sporadic form of the disease where there is no family history, researchers have found.

The finding came in the largest genome-wide association study (GWAS) reported to date involving Parkinson’s disease. GWAS studies look in the DNA on all of the chromosomes in a specific population of individuals for common genetic associations with a disease. To date, such studies have been done on relatively small numbers of samples and have not been able to identify genetic variations of smaller effect in Parkinson’s disease. But now, GWAS studies in very large sample sets are able to identify these elusive genetic variations.

Collaborating scientists in the United States and Europe pooled nearly 14,000 DNA samples and data to confirm that mutations in the alpha-synuclein (SNCA) gene and microtubule associated protein tau (MAPT), both present in the general population, are risk factors for sporadic Parkinson’s disease.

In an independent study from Japan, researchers also identified a different combination of genetic variants as risk factors in people of Japanese descent, a finding that highlights the power of GWAS in comparing risk factors among different populations.

The findings presented in the Nov. 15, 2009, online issue of Nature Genetics were supported in part by the National Institute on Aging (NIA), National Institute of Neurological Disorders and Stroke, National Cancer Institute, and the National Institute of Environmental Health Sciences, all components of the National Institutes of Health.

Parkinson’s disease, which affects about 1.5 million Americans, is a progressive neurologic disorder caused by the degeneration of nerve cells in the portion of the brain that controls movement. The likelihood of developing the disorder increases with age and involves a combination of environmental risk factors and genetic susceptibility. GWAS studies require large numbers of DNA samples — a hurdle the international team of researchers overcame through collaboration.

“Because previous Parkinson’s GWAS were too small and lacked power, we worked together to compile and analyze the large data sets needed to identify the elusive genetic variations that play a role in this complex disease,” said Andrew B. Singleton, Ph.D., chief of the NIA Laboratory of Neurogenetics, who co-led the study with Thomas Gasser, M.D., of the Hertie Institute for Clinical Brain Research, University of Tubingen, and the German Center for Neurodegenerative Disease, of Tubingen, Germany. “With this better understanding of the underlying genetic variants involved in the progress of this disorder, we have more insight into the causes and underlying biology of this disease. We hope this new understanding will one day provide us with strategies to delay, or even prevent, the development of Parkinson’s disease.”

The two-phase GWAS first analyzed DNA samples of 1,713 people with the disease and 3,978 free of the disorder, all of whom were Europeans. The findings were then replicated in a similar group of 3,361 people with Parkinson’s disease and 4,573 without the disorder. Following the initial findings implicating SNCA and MAPT variants as risk factors for typical Parkinson’s disease, the team then compared results with researchers performing a GWAS study in a group of Japanese people (2,816 with Parkinson’s disease and 3,401 free of the disorder). This second GWAS also revealed the strong association for SNCA but not for MAPT. Additionally, both GWAS studies found evidence for two additional risk variants; the first, which was strongest in the Japanese population, was named Park16; the second is close to a gene, LRRK2, which Dr. Singleton’s and Dr. Gasser’s groups previously found contains mutations that cause an inherited form of Parkinson’s disease.

“These findings support the notion that the sporadic and rare familial forms of the disease are related and that common genetic variability plays a role in developing the disorder,” said NIA Director Richard J. Hodes, M.D. “Future GWAS involving greater numbers of DNA samples will likely reveal additional common genetic risk factors. As we continue to use these and other novel approaches to understand complex diseases, we move closer to a complete understanding of the genetic basis of Parkinson’s disease.”

Teen girls aged 15 to 19 accounted for the largest number (409,531) of the 1.5 million reported chlamydia and gonorrhea cases in the United States in 2008, followed by women aged 20 to 24, according to an annual federal report released Monday.

The researchers also found that black females continue to have a higher rate of sexually transmitted diseases (STDs) than any other racial or ethnic group.

Last year, there were about 1.2 million reported cases of chlamydia and nearly 337,000 reported cases of gonorrhea in the United States, according to the Sexually Transmitted Disease Surveillance, 2008, report.

Among the other findings from the report:
Gonorrhea rates among blacks were higher than any other racial or ethnic group and 20 times higher than among whites. While blacks represent 12 percent of the U.S. population, they accounted for about 71 percent of reported gonorrhea cases, 48 percent of chlamydia cases, and 49 percent of syphilis cases.
Black females aged 15 to 19 had the highest rates of chlamydia and gonorrhea (10,513 per 100,000 and 2,934 per 100,000, respectively), followed by black women aged 20 to 24 (9,373 per 100,000 and 2,770 per 100,000, respectively).
There were 13,500 cases of syphilis in 2008, an increase of nearly 18 percent from 2007. About 63 percent of the cases were among men who have sex with men. However, syphilis rates among women increased 36 percent from 2007 to 2008 (1.1 cases per 100,000 versus 1.5 cases per 100,000), compared with a 15 percent increase among men (6.6 cases per 100,000 versus 7.6 cases per 100,000).

“We cannot ignore the glaring racial disparities in rates of STDs, particularly when we consider the hard truth that gonorrhea rates among African-Americans are 20 times those of whites,” Dr. John M. Douglas Jr., director of the U.S. Centers for Disease Control and Prevention’s Division of STD Prevention, said in a news release.

“Research has shown that socioeconomic barriers to quality health care and higher overall prevalence of STDs within minority communities contribute to this pervasive threat. It is imperative that we improve access to effective STD prevention and treatment services in local communities for those who need them most,” he said.

Early testing, diagnosis and treatment are essential to prevent long-term health consequences of sexually transmitted diseases. Each year in the United States, untreated STDs lead to complications that cause at least 24,000 women to become infertile, according to the CDC.

Of the almost 19 million new cases of sexually transmitted diseases that occur each year in the United States, almost half are among those aged 15 to 24 years. STDs cost the nation’s health-care system as much as $15.9 billion a year, the CDC said.