Swimmer's ear medical costs total $500M a year (AP)

ATLANTA � The first national estimates of swimmer's ear say it causes about 2.4 million trips to doctors and hospitals in a year.

The Centers for Disease Control and Prevention also said swimmer's ear cases amounted to about $500 million in annual medical costs � or roughly $200 per visit.

Some people get the problem repeatedly, and the CDC didn't estimate how many Americans suffer swimmer's ear each year. But according to calculations by The Associated Press based on CDC statistics, more than 2 million get it.

Swimmer's ear is an itchy, painful, outer-ear infection that can occur when bacteria in swimming water get through breaks in the skin. It's commonly treated with antibiotic ear drops.

More than half the cases were in adults. The CDC released the statistics Thursday.

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HPV test beats Pap for cervical cancer screening (AP)

Two big studies suggest possible new ways to screen healthy people for cervical or prostate cancers, but a third disappointed those hoping for a way to detect early signs of deadly ovarian tumors.

Researchers found:

_For women 30 and over, a test for the virus, HPV, is better than a Pap smear for predicting cervical cancer risk, and those who test negative on both can safely wait three years to be screened again.

_A single PSA blood test at ages 44 to 50 might help predict a man's risk of developing advanced prostate cancer or dying of it up to 30 years later. The PSA test is notoriously unreliable, but using it this way separates men who need a close watch from those who are so low-risk that they can skip testing for five years or more.

_Screening women with no symptoms for ovarian cancer with a blood test and an ultrasound exam is harmful. It didn't prevent deaths and led to thousands of false alarms, unneeded surgeries and serious complications.

The last study is a warning to people who get screening tests that aren't recommended, or who question whether screening can ever hurt.

"The answer is, it could hurt a lot," said Dr. Allen Lichter, chief executive of the American Society of Clinical Oncology. The group published these and 4,000 other studies Wednesday, ahead of its annual meeting next month.

Cervical cancer is easy to prevent. It's very slow-growing and screening finds precancerous cells and allows early treatment. The new study was the first big one to examine a newer screening tool, HPV tests, with or without Pap smears in routine practice.

For a Pap test, cells scraped from the cervix, the gateway to the uterus, are checked under a microscope. But this can miss problems or raise false alarms.

HPV tests detect the human papillomavirus, which causes most cases of cervical cancer. But HPV is "the common cold" of the nether regions � most sexually active young people have been exposed to it, said Debbie Saslow, the American Cancer Society's director of breast and gynecologic cancer. Most infections go away on their own; they're only a cancer risk when they last a year or more.

Younger women tend to have short-term infections, so Pap tests are a better way to screen them. HPV tests are approved as an option along with Paps for women 30 and older, and the cancer society says that if a woman tests negative on both, she can wait three years to be screened again. Few take this advice, though.

"Women still want their annual Pap and doctors still want to give them," and think it's rationing care to test less often, Saslow said.

The new study gives "very, very solid support" for screening less often, Lichter said.

Hormuzd Katki of the National Cancer Institute studied more than 330,000 women getting HPV and Pap tests through Kaiser Permanente Northern California for five years.

Only about three out of 100,000 women each year developed cervical cancer after negative HPV and Pap tests. HPV tests were twice as good as Paps for predicting risk. Adding a Pap after a negative HPV test did little to improve risk prediction.

However, if an HPV test was positive, a Pap test helped confirm or rule out the need for follow-up.

The study didn't look at the downside of HPV testing � how many false alarms and needless procedures it triggered. HPV tests cost $80 to $100 compared to $20 to $40 for Paps.

The prostate study sought a better way to use PSA tests, which are troublesome because PSA can be high for many reasons besides cancer, and doctors don't know which cancers need treatment or whether screening saves lives. Most groups don't recommend PSA tests, but most men over 50 get them anyway.

The new study "is not going to end the controversy, but it suggests a very interesting middle ground," Lichter said.

Researchers at Memorial Sloan-Kettering Cancer Center in New York used stored blood samples that 12,000 Swedish men gave for a heart study decades ago, when most were 44 to 50 years old. They also had second samples from some of them six years later, and samples from other 60-year-old men.

Looking 27 years later, researchers saw that 44 percent of cancer deaths occurred in men whose initial PSAs had been in the top 10 percent when they were 44 to 50 years old.

Conversely, scoring below the median meant very little cancer risk years later.

"They're identifying a group of guys who don't need to be screened, or need to be screened less often," said Dr. Otis Brawley, the cancer society's chief medical officer.

The results are "provocative," but this type of study can't prove that screening prevents deaths, said Dr. Matthew R. Smith of the Massachusetts General Hospital Cancer Center. Few of the Swedish men were treated for prostate cancer as most men are today, which can affect survival.

The National Cancer Institute, the Swedish Cancer Society and several foundations paid for the work, and one researcher holds patents for two PSA-related tests.

Baseline PSA tests for men in their 40s can't be recommended yet, Brawley said. The cancer society says men should be informed of the risks and benefits of PSA tests starting at age 50, and sooner for blacks and those with family history of prostate cancer.

The government-funded ovarian cancer study involved nearly 80,000 women. Half were screened annually with an ultrasound for four years and a blood test for six years. The blood test looked for CA-125, a substance often elevated in ovarian cancer.

After 13 years, there were no major differences in ovarian cancers found or deaths from the disease. Screening found only 212 cancers while giving 3,285 false alarms that led to 1,080 unneeded biopsy surgeries and 163 serious complications.

"So many people say `how can cancer screening be harmful?' This thing documents it," Brawley said.

The results don't apply to using these tests on women with symptoms of ovarian cancer or abnormal physical exams. That's still the best way to check for ovarian cancer in those cases.

___

Online:

CDC on HPV tests: http://www.cdc.gov/hpv/Screening.html

Cancer Society on HPV: http://tinyurl.com/44gnadx

Cervical cancer science review: http://tinyurl.com/6lc2rzg

Oncology society: www.cancer.net

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Giffords to have surgery while husband is in space (AP)

HOUSTON � Rep. Gabrielle Giffords' recovery isn't slowing down while her astronaut husband speeds around the Earth.

Giffords will undergo surgery Wednesday so doctors can replace a piece of her skull with a plastic implant, another encouraging step since the Arizona congresswoman was shot in the head more than four months ago.

The surgery � coming just days after Giffords traveled to Florida to watch her husband, Mark Kelly, launch into space � was confirmed to The Associated Press by two people familiar with the congresswoman's care. They spoke on condition of anonymity because the information has not officially been released.

Doctors removed a piece of Giffords' skull to allow room for brain swelling shortly after a would-be assassin shot her in the head Jan. 8, critically wounding her, killing six people and injuring 12 others at a political event in her hometown of Tucson, Ariz.

The three-term Democratic congresswoman has been wearing a helmet adorned with an Arizona state flag. Doctors said when she arrived in Houston in late January they hoped to do the cranial surgery in May.

Dr. Richard Riggs, chair of physical medicine and rehabilitation at Cedars-Sinai Medical Center in Los Angeles, said the surgery to place the plastic implant is relatively simple. Recovery is short � a day or two at the most � and is mostly from the effects of anesthesia, he said.

"This gives her quality of life because she won't have to worry about the helmet and protection when moving around," said Riggs, who is not involved in Giffords' care.

The implant is placed under the scalp, allowing hair to grow on top so it is not visible. Riggs said the piece of skull that doctors removed likely was contaminated or shattered by the bullet that pierced the left side of Giffords' brain. That would make the skull unfit to be reattached, which is why doctors would use an implant, Riggs said.

Giffords' chief of staff, Pia Carusone, declined to comment on whether Giffords would undergo the surgery on Wednesday. Giffords' doctors do not comment on her condition without approval from her family.

Giffords returned to Houston and rehab late Monday after watching her husband's shuttle launch in Florida. When Endeavour's five Americans and one Italian got off the ground Monday, Giffords watched in private from a wheelchair on the roof of the launch control center and remarked, "good stuff, good stuff," according to her staff.

That Giffords would watch the shuttle launch seemed improbable a little more than four months ago. And some patients don't have this type of surgery until after they are released from the hospital.

Her doctors have said she has made remarkable progress in what will be a long recovery.

The next step will be to release her from the hospital. Then she will continue speech, occupational and physical therapy at an outpatient clinic.

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APNewsBreak: Giffords set to undergo skull surgery (AP)

HOUSTON � Arizona Congresswoman Gabrielle Giffords will undergo surgery on Wednesday to place an implant where a piece of her skull was removed by doctors after she was shot in January.

The surgery was confirmed to The Associated Press by a person familiar with Giffords' care. The person spoke on condition of anonymity because the information has not officially been released.

Giffords had a piece of her skull removed shortly after the shooting to allow room for brain swelling, and has been wearing a helmet adorned with an Arizona state flag. Doctors had said when the three-term Democratic congresswoman arrived in Houston in late January they hoped to do the cranial surgery in May.

Dr. Richard Riggs, chair of physical medicine and rehabilitation at Cedars-Sinai Medical Center in Los Angeles, said the surgery to place the plastic implant is relatively simple. Recovery is short � a day or two at the most � and is mostly from the effects of anesthesia, he said.

"This gives her quality of life because she won't have to worry about the helmet and protection when moving around," said Riggs, who is not involved in Giffords' care.

The implant is placed under the scalp, allowing hair to grow on top so it is not visible.

The surgery, the latest sign Giffords' recovery is progressing as planned, comes just days after she returned from Florida where she watched her astronaut husband, Mark Kelly, rocket into space. When Endeavour's five Americans and one Italian got off the ground on Monday, Giffords watched in private from a wheelchair on the roof of the launch control center and remarked, "good stuff, good stuff," according to her staff.

Giffords returned to Houston and rehab late Monday, hours after the launch.

While some patients don't have this surgery until after they are released from the hospital, Giffords' operation indicates she is recovering according to schedule.

That Giffords would watch the shuttle launch seemed improbable a little more than four months ago. The would-be assassin shot her in the head, critically wounding her, killing six people and injuring 12 others at a political event in her hometown of Tucson, Ariz.

The bullet pierced the left side of Giffords' brain, affecting speech and movement on her right side.

Her doctors at a Houston rehabilitation center have said she has made remarkable progress in what will be a long recovery.

The next step will be to release her from the hospital. Then she will continue speech, occupational and physical therapy at an outpatient clinic.

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How to square budget cuts, need for aging research (AP)

WASHINGTON � A disease standoff may be brewing: How can Alzheimer's research receive more scarce dollars without cutting from areas like heart disease or cancer?

In one of the stark realities of the budget crisis, scientists' chances of winning research dollars from the National Institutes of Health for any condition have dipped to a new low.

"We are clearly not able to support a lot of great science that we would like to support," NIH Director Dr. Francis Collins told senators last week. This year, for every six grant applications that NIH receives, "five of them are going to go begging."

That's down from nearly 1 in 3 grants funded a decade ago, and 1 in 5 last year. And it comes before the looming fight over how much more to cut in overall government spending for next year, and where to make those cuts.

Already, a new report says one of the biggest losers is aging research, despite a rapidly graying population that promises a worsening epidemic of dementia, among other illnesses.

"Nobody wants to say Alzheimer's is worse than diabetes or heart disease or cancer," says Dr. Sam Gandy, a prominent neuroscientist at New York's Mount Sinai School of Medicine.

But "part of the problem now with all the pressure to cut the budget ... is that for Alzheimer's to get more, something else has to lose," adds Gandy. His own lab is scrambling for funds to study a potential dementia drug after losing out on an NIH aging grant.

The NIH pays for much of the nation's leading biomedical research. Republicans and Democrats alike have long been staunch supporters. But the agency's nearly $31 billion budget offers an example of the hard choices facing lawmakers, especially if they're to meet House calls for a drastic scale-back of overall government spending.

Consider aging issues.

The NIH spends about $469 million on Alzheimer's research, says a new report from the Alzheimer's Foundation of America that criticizes overall aging research as "a minuscule and declining investment."

About 5.4 million Americans now have Alzheimer's disease, and studies suggest health and nursing home expenditures for it cost more than $170 billion a year, much of it paid by Medicare and Medicaid.

NIH's Collins told a Senate appropriations subcommittee that there's a "very frightening cost curve." In 2050, when more than 13 million Americans are projected to have Alzheimer's, the bill is expected to reach a staggering $1 trillion. But he said that cost could be halved merely by finding a way to delay people getting Alzheimer's by five years.

Monday, Republican presidential contender Newt Gingrich jumped into the debate, saying that over the next four decades Alzheimer's could cost the government a total of $20 trillion. He suggested selling U.S. bonds to raise money for research rather than have the disease compete each year for a share of the federal budget.

"We are grotesquely underfunded," Gingrich said of health research dollars.

The Alzheimer's Foundation report goes beyond dementia, finding that the National Institute on Aging receives 3.6 cents for every dollar Congress sends to the NIH. Cancer and heart disease get nearly three to four times as much. Despite the tough economic times, the foundation has joined with other groups lobbying for an extra $300 million for the aging institute's overall work next year, to boost its budget to $1.4 billion.

Competition for today's dollars is fierce, with applications up 60 percent at the aging division alone since 2003. Aging chief Dr. Richard Hodes says last year, his institute couldn't pay for about half of what were ranked as the most outstanding applications for research projects. Still, he hopes to fund more scientists this year by limiting the number who get especially large grants.

What's the squeeze? Congress doubled the NIH's budget in the early 2000s, an investment that helped speed the genetic revolution and thus a host of new projects that scientists are clamoring to try. But in more recent years, economists say NIH's budget hasn't kept pace with medical inflation, and this year Congress cut overall NIH funding by 1 percent, less than expected after a protracted battle.

The Obama administration has sought nearly $32 billion for next year, and prospects for avoiding a cut instead are far from clear. Sen. Tom Harkin, D-Iowa, who chairs the subcommittee that oversees the issue, warns that under some early-circulating House plans to curb health spending, "severe reductions to NIH research would be unavoidable. That doesn't make sense."

Sen. Jerry Moran, R-Kan., pushed Collins to make the case that investments in medical research really can pay off.

Collins' response: Four decades of NIH-led research revealed how arteries get clogged and spurred development of cholesterol-fighting statin drugs, helping lead to a 60 percent drop in heart-disease deaths. Averaged out, that research cost about $3.70 per person per year, "the cost of a latte, and not even a grande latte," Collins told lawmakers.

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EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington. Associated Press writer Philip Elliott contributed to this report.

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CDC: TB treatment can now be done in 3 months (AP)

ATLANTA � Health officials say there's a faster treatment for people who have tuberculosis but aren't infectious. A combination of pills knocks it out in just three months instead of nine.

That means more people are likely to finish their treatment. Some are calling it one of the biggest developments in tuberculosis treatment in decades.

The Centers for Disease Control and Prevention presented the study Monday at a medical conference in Denver.

The CDC estimates that more than 11 million Americans have latent TB, meaning they're infected with the TB bacteria but haven't had symptoms and are not infectious.

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