Pinkwashing for breast cancer awareness questioned (AP)

PITTSBURGH � The country is awash in pink for breast cancer awareness month � and some women are sick of it.

While no one is questioning the need to fight the deadly disease, some breast cancer advocates are starting to ask whether one of the most successful charity campaigns in recent history has lost its focus.

"The pink drives me nuts," said Cynthia Ryan, an 18-year survivor of breast cancer who also volunteers to help other women with the disease. "It's the cheeriness I can't stand."

Activists have even coined a new word: pinkwashing.

They say that's when a company or organization does a pink breast cancer promotion, but at the same time sells and profits from pink-theme products.

Some of the pink products have generated plenty of discussion among breast cancer advocates.

A Smith & Wesson 9mm handgun with pink pistol grip? The manufacturer says a "Portion of the Proceeds Will Be Donated to a Breast Cancer Awareness Charity."

You can get the "Pink Ribbon Combo" at Jersey Mike's Subs, or the Sephora Collection Pink Eyelash Curler. One year, there was a pink bucket of Kentucky Fried Chicken.

The San Francisco group Breast Cancer Action has led the campaign to question pink products, but executive director Karuna Jaggar said it isn't saying all such products are bad.

She said there's no doubt that when the pink ribbon campaigns started about 20 years ago there was still a great need to raise awareness.

"At one time, pink was the means," Jaggar said. "Now, it's almost become the end in itself. In its most simplistic forms, pink has become a distraction. You put a pink ribbon on it, people stop asking questions."

Breast cancer activists agree that the use of a ribbon to promote awareness evolved in stages. They note that in 1979 there were yellow ribbons for the American hostages in Iran; in 1990, AIDS activists used red ribbons to call attention to victims of that disease; and 1991 saw the first major use of the pink ribbon, when the Susan G. Komen Foundation gave them out at a New York City race for cancer survivors.

But the ribbon symbol may tie into a far older tradition, according to the American Folk Life Center at the Library of Congress. It notes that various versions of the song "Round Her Neck She Wore A Yellow Ribbon" have been popular for 400 years, all with the theme of displaying the ribbon for an absent loved one.

And it's clear that too many loved ones are still lost to the disease, despite many advances in diagnosis and treatment. The National Cancer Institute estimates that about 40,000 women will die of breast cancer this year, and 230,000 new cases will be diagnosed.

But Jaggar, of Breast Cancer Action, wonders whether more awareness is what's needed to reduce those numbers.

And Breast Cancer Action does take exception to products it considers potentially harmful � like a perfume the Komen Foundation introduced this year, "Promise Me." Jaggar said the perfume contains some possibly toxic or hazardous ingredients, and Breast Cancer Action asked that Komen discontinue its sale.

Federal regulatory agencies don't consider small amounts of those ingredients to be a threat, and Komen's scientific and medical advisers didn't believe there was any problem. But Komen said that to allay any concerns the next batch of "Promise Me" will be reformulated without the ingredients that were criticized.

Leslie Aun, a spokeswoman for Susan G. Komen for the Cure, based in Dallas, said the advocacy group isn't apologizing for all the pink.

"Research doesn't come cheap. We need to raise money and we're not apologetic about it," Aun said.

Komen, founded in 1982, has contributed $685 million to breast cancer research and $1.3 billion to community programs that help with mammograms, transportation and other needs, Aun said.

Komen would love not to have to do marketing, but that's simply not realistic, she said.

"We don't think there's enough pink. We're able to make those investments in research because of programs like that," Aun said.

Samantha King, a professor at Queens University in Ontario and author of the book Pink Ribbons Inc., said that at first people warned that she'd get hate mail for writing critically about the pink campaigns.

"And in fact the opposite was true," King said. "I had underestimated the level of alienation that many women felt."

King said she felt the Komen Foundation crossed the line a few years ago, when they partnered with Kentucky Fried Chicken on the pink bucket of fast food.

"What's next, pink cigarettes for the cure?" King asked. "I think this really speaks to the fact that they've lost sight of their mission. Their primary purpose appears to be to sell products."

But perhaps not, said Ryan.

Over the last two years she's worked with homeless women who have breast cancer, in her hometown of Birmingham, Ala. Some of the women have an advanced stage of the disease, no health insurance and no place to call home. Yet when Ryan recently asked two of them what they wanted to help promote awareness among other homeless women, the response came quickly.

Pink handbags.

That answer promoted Ryan to take a hard look at her aversion to pink.

Now, she's not sure whether it's her place � or anyone else's � to proclaim that a particular pink-themed product is acceptable, or not.

"I'm conflicted," Ryan said, adding that she still worries that many people buy the pink products without really knowing where the money is going.

Jaggar said that different women will make a variety of choices. The point is to have them consider what the best choice is, instead of buying a pink product blindly.

For example, the lingerie company Aerie, based in Pittsburgh, draped thousands of bras on one of the many steel bridges in the city, to heighten awareness. Aerie said $1 from every sale during October will be donated to a breast cancer charity, up to $50,000.

Jaggar said that's the type of detail shoppers should pay attention to, and decide whether $1 out of a $20 or $30 sale is enough.

Jani Strand, a spokeswoman for Aerie's parent company, American Eagle Outfitters, said company officials feel strongly that it's a good thing to get young women talking about breast cancer.

Aerie's target audience is 20-year-old women, and Strand said the things that get that age group excited about a cause are different from what attracts older women.

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Vitamin E pills linked with prostate cancer risk (AP)

CHICAGO � There is more evidence that taking vitamin E pills can be risky. A study that followed up on men who took high doses of the vitamin for about five years found they had a slightly increased risk of prostate cancer � even after they quit taking the pills.

Doctors say it's another sign that people should be careful about using vitamins and other supplements.

"People tend to think of vitamins as innocuous substances, almost like chicken soup � take a little and it can't hurt," said lead author Dr. Eric Klein of the Cleveland Clinic. The study shows that is not true.

"If you have normal levels, the vitamin is probably of no benefit, and if you take too much, you can be harmed," Klein said.

Men randomly assigned to take a 400-unit capsule of vitamin E every day for about five years were 17 percent more likely to get prostate cancer than those given dummy pills. That dose, commonly found in over-the-counter supplements, is almost 20 times higher than the recommended adult amount, which is about 23 units daily.

The results mean for every 1,000 men who took vitamin E, there were 11 additional cases of prostate cancer, compared with men taking dummy pills.

The study was actually launched to try to confirm less rigorous research suggesting vitamin E might protect against prostate cancer. Overall, about 160 of every 1,000 U.S. men will develop prostate cancer in their lifetime.

Risks increase as men age. Detection can be tricky since symptoms such as frequent urination can also be caused by harmless conditions, and doctors disagree about the benefits of screening tests. Treatment is also complex since some slow-growing prostate cancers are not deadly but some procedures, including surgery, can damage sexual function and cause incontinence.

Just last week, a government-convened panel of experts recommended against routine PSA screening for prostate cancer. That draft advice is open for public comment.

What should vitamin E users do, given the new study results? About 13 percent of American men take it, according to a supplement trade group.

Dr. Otis Brawley, chief medical officer for the American Cancer Society, says they should stop taking large doses and talk to their doctors about risks and benefits from prostate cancer screening. Smaller doses, typically found in multivitamins, are probably fine, said Brawley, who was not involved in the research.

Vitamin E is found in foods such as nuts, seeds and vegetable oils. The nutrient helps nerves, muscles, blood vessels and the immune system function.

Vitamin E supplements have long been promoted for disease prevention, but scientific research has disproven many claims and suggested they might increase risks for some conditions, including heart failure.

Brawley noted that the study echoes previous thinking on beta-carotene, which once was thought to protect against cancer but more recently has been linked with increased risks for lung cancer, especially in smokers.

"There should be a global warning that ... excessive use of vitamins has not been proven to be beneficial and may be the opposite," Brawley said.

Experts generally agree that foods are the best sources for vitamins.

The new research appears in Wednesday's Journal of the American Medical Association. The National Cancer Institute and National Center for Complementary and Alternative Medicine paid for the multimillion-dollar study.

Joe Latina, a cabinet shop owner in Aurora, Ohio, was among study participants. He said researchers gave him pills they said "might slow down prostate cancer." Now 71 and cancer-free, he says he doesn't know whether he was given vitamins or dummy pills.

Latina said he "was kind of surprised" by the study results, but is not stressing out over the possibility that he still might get cancer.

"I'm a positive thinker," he said. "I'm not walking around saying, `Oh my God, the other shoe is going to drop. I don't think I have any way to control it."

The study involved more than 35,000 healthy men aged 50 and older, from the United States, Canada and Puerto Rico. They were randomly assigned to take daily vitamin E or selenium supplements, both pills or dummy pills. The study was halted after about five years when there were signs of no benefit and a possible increased risk for prostate cancer in vitamin E users. The researchers continued tracking the men even after they stopped taking pills.

The follow-up found that a potential link between selenium and diabetes was a false alarm, but it confirmed signs of a vitamin E-prostate cancer link. Over a total of about seven years, there were 76 cases of prostate cancer diagnosed per 1,000 men, versus 65 cases in men given dummy pills.

"The implications of our observations are substantial," the study authors said.

The results suggest that extra risks associated with taking relatively high doses of vitamin E continue even after supplements are stopped. The researchers said it is unclear how vitamin E would harm the prostate.

There was no increased risk for men who took both vitamin E and selenium, suggesting that selenium might somehow counter the harmful effects of vitamin E, the study authors said.

Duffy MacKay of the Council for Responsible Nutrition, a supplement makers' trade group, said the study shouldn't be interpreted as questioning the benefits of vitamin E as an essential nutrient, and he said there is evidence that many Americans don't get enough.

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Online:

JAMA: http://www.jama.ama-assn.org

National Cancer Institute: http://www.cancer.gov

PSA recommendations: http://www.ahrq.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner.

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WHO: Number of people with TB falls for 1st time (AP)

LONDON � The World Health Organization says the number of people with tuberculosis has fallen for the first time.

In a report issued Tuesday, WHO estimated 8.8 million people fell ill last year, dropping from a peak of about 9 million in 2005. Officials said fewer people are now dying from the disease, but that a third of cases worldwide are probably not reported.

The small decline in reported cases is partly due to increased availability of medical treatment for TB, WHO said. The U.N. health agency also said estimates are now more accurate because countries have better surveillance of tuberculosis patients.

The TB death rate is expected to be reduced by half by 2015 everywhere except Africa, where the AIDS epidemic has also fueled a spike in tuberculosis. India and China account for about 40 percent of the world's tuberculosis cases.

In recent years, health experts have also warned of the increasing threat of drug-resistant tuberculosis, a signal that many people with TB aren't being treated properly.

Last month, officials warned that drug-resistant tuberculosis is spreading fast in Europe and that there are few drugs left to treat it. WHO estimated countries need another $1 billion to fund tuberculosis programs in 2012.

In the report, officials said they didn't have enough data to know whether the global outbreak of drug-resistant tuberculosis is increasing, decreasing or stable.

Last year, a new rapid test for drug-resistant TB was unveiled in more than two dozen countries, allowing patients to be treated sooner and stopping the disease's spread.

"But the promise of testing more people must be matched with the commitment to treat all detected," Mario Raviglione, the director of WHO's TB department, said in a statement. "It would be a scandal to leave diagnosed patients without treatment."

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Online:

http://www.who.int

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Study: Gates project spared 100K Indians from HIV (AP)

An estimated 100,000 people in India may have escaped HIV infection over five years thanks to one of the world's biggest prevention programs, an encouraging sign that targeting high-risk groups remains vital even as more donors focus on treatment, a new study suggests.

While the initial findings regarding the $258 million Avahan project, funded by the Bill & Melinda Gates Foundation, come with large uncertainty due to data limitations and methodology, the study's authors say the overall message is clear: that investing in prevention can make a dent in one of the world's largest epidemics, with an estimated 2.4 million Indians infected.

The program was assessed from 2003 to 2008 in six Indian states, home to 300 million people and the country's highest HIV rates when it started. It involved needle exchanges, safe-sex counseling, condom distribution and other interventions to reach vulnerable groups, including truck drivers, injecting drug users, men who have sex with other men, and prostitutes, along with their clients and partners. The project's aim was to reduce the number of infections infiltrating the general population by targeting those who posed the highest risk.

The assessment published Tuesday in The Lancet medical journal suggests that higher Avahan grants per infected person correlated with fewer HIV cases in the general population in the southern states of Andhra Pradesh, Karnataka and Maharashtra. However, that was not the case in southern Tamil Nadu and the small northeastern states of Manipur and Nagaland.

Part of the difference may be linked to the epidemics, with sex the main mode of transmission in the crowded south and injecting drug use the top driver in the remote northeast, said co-author Dr. Lalit Dandona, a professor at the Public Health Foundation of India. In Tamil Nadu, the authors, who are also from the University of Washington, note that HIV levels were already lower there because other prevention programs were already running when Avahan began.

In Karnataka, the program was linked to a 13 percent drop in overall HIV rates, the largest observed. Maharashtra saw the smallest decline, just over 2 percent.

In all six states, an estimated 100,178 HIV infections were averted due to the program, which is the best possible outcome with the available data, Dandona said.

The study, also funded by the Gates Foundation, explains that the conclusions do come with a degree of uncertainty, mainly because pregnant women from antenatal clinics were used as the data source even though corrections for this were factored into the calculations.

Dr. Prabhat Jha, director of the Centre for Global Health Research in Canada, who has conducted large-scale HIV studies in India, said those data are typically used to monitor trends or changes in the epidemic, not to estimate infections averted in the general population.

"Right from the start, it just doesn't work," he said. "I'm not going to judge how high my plane is flying by how many times my ears pop. It doesn't tell you where you're at."

Jha also noted that other prevention programs were in place before Avahan began and that HIV infections were already in decline. Instead of focusing on infections averted, he said it makes more sense to assess the program more broadly.

"There is substantial evidence that most new HIV infections in India arise from sex work, so taking sex work seriously means it will generate benefits," he said. "Even if these are hard to quantify."

Avahan, which translates from Sanskrit as "call to action," has been criticized by some for throwing large sums of money at the problem and creating more waste than results. As the Gates Foundation's largest HIV prevention program in a single country, the organization donated an additional $80 million to the project in 2009. The Indian government is expected to take it over.

In an accompanying commentary, World Health Organization experts Ties Boerma and Isabelle de Zoysa said that despite many remaining questions about the project's overall success, the findings are an encouraging first step. "However, seven years into the project, many questions remain unanswered," they wrote.

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