Prostate testing's dark side: Men who were harmed (AP)

Terry Dyroff's PSA blood test led to a prostate biopsy that didn't find cancer but gave him a life-threatening infection.

In the emergency room, "I didn't sit, I just laid on the floor, I felt so bad," said Dyroff, 65, a retired professor from Silver Spring, Md. "I honestly thought I might be dying."

Donald Weaver was a healthy 74-year-old Kansas farmer until doctors went looking for prostate cancer. A PSA test led to a biopsy and surgery, then a heart attack, organ failure and a coma. His grief-stricken wife took him off life support.

"He died of unnecessary preventive medicine," said his nephew, Dr. Jay Siwek, vice chairman of family medicine at Georgetown University. "Blood tests can kill you."

Since Friday, when a task force of independent scientists said routine PSA testing does more harm than good, urologists who make a living treating prostate cancer have rushed to defend the test, as have patients who believe it saved their lives.

Less visible are men who have been harmed by testing, as Dyroff and Weaver were. The harm is not so much from the test itself but from everything it triggers � biopsies that usually are false alarms, and treatments that leave many men incontinent or impotent for cancers that in most cases were not a threat.

Once a PSA test suggests a problem, many men can't live with the worry that they might have cancer. And once cancer is found, most men feel they have to treat it, usually at the urging of their urologist.

"There are many men who have had serious consequences from treatment. Those stories don't get told and they are not uncommon," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, which thinks the task force reached "an appropriate conclusion" about the PSA test.

"I'm not going to criticize men who believe that their lives have been saved by this test," because that's what doctors have told them, Lichtenfeld said. "If you're sitting there and you wet your pants three times a day, you've got to believe it's worth it, that it saved your life."

Many men who agree to a PSA test do not understand what it is. Some common misconceptions:

� It shows cancer. In fact, PSA is just a measure of inflammation, and it can be elevated for many reasons besides cancer: normal enlargement of the prostate with age, an infection, even recent sex, a strenuous bike ride or horseback riding.

� It's been proven to save lives. Only two large, well-done studies have looked at this, the task force says. The American study found annual screening did not lower the chances of dying of prostate cancer. However, cancer fear is so great, and belief in the value of screening so ingrained, that half the men assigned to the group not offered PSA tests got one anyway. That made comparisons to the group given annual screening difficult. For that reason, some doctors don't believe the study's conclusion.

The other study, conducted in Europe, found a small benefit for certain age groups screened every two to seven years � not annually. However, one Swedish center had such rosy results that scientists think it may have biased the whole study. If that center is excluded, no benefit from the PSA test is seen.

� The task force's stance goes against past advice. Routine PSA testing has been supported by some advocacy groups and by urologists, the doctors who do the tests and treatments. But it has not been pushed by major scientific groups, the American Cancer Society or the government.

� It finds cancer early so you're more likely to survive. About 90 percent of prostate cancers found through screening are early-stage. Most will grow so slowly they will never threaten a man's life, but there's no good way to tell which ones will. Research suggests that tumors causing symptoms are more likely to warrant treatment than those that are not. Also, finding aggressive prostate tumors early may not affect how lethal they prove to be; the PSA test may just let men learn of them sooner than they otherwise would.

The task force said that in the European study, the rate of overdiagnosis from PSA screening � finding cancers that do not need to be treated � was estimated to be as high as 50 percent. Based on that study, 1,410 men would have to be screened, and 48 patients would have to be treated, just to save one life from prostate cancer.

Yet the public perception is that if PSA testing finds a cancer early, it must be good.

"Most people tend to think `if it may help, I'm all for it.' But we don't know if it will help," said Siwek, the Georgetown doctor whose uncle died.

Once a PSA test suggests a problem, "it's hard to stop the conveyor belt or the cascade effect" that leads to more testing and treatment, said Siwek, who also is editor of the journal American Family Physician. "The inclination is, `I've got to do something about it.'"

Dyroff, the retired professor, agreed to a biopsy after a blip in his PSA. Several days later, he ran a high fever, felt weak and faint, and spent three days in the hospital fighting a bloodstream infection. A week later he relapsed and required a combination of intravenous antibiotics to finally recover.

A recent Johns Hopkins University study found surprisingly high rates of hospitalization after prostate biopsies and a 12-fold greater risk of death in those who develop infections.

Tony Masraff, a Houston restaurant owner, reluctantly agreed to a biopsy and then was diagnosed with prostate cancer in 1999. His urologist pushed surgery and balked when Masraff asked about other options such as radiation. After some research, Masraff decided just to monitor his tumor, and has seen his PSA rise very slowly over more than a decade.

Now 74, he hasn't had treatment "and I never will," he said. "I'm not concerned because I don't want the debilitative effects � I don't want to wear a diaper, and I like women."

"There's a huge number of people that are being operated on that don't need treatment," said Masraff, who formed a foundation for research into less invasive options.

The need to find a better screening tool is the real message from the task force, said Dr. Christopher Logothetis, prostate cancer research chief at the University of Texas M.D. Anderson Cancer Center in Houston. It may even be that there are better ways to use the PSA � employing it as a baseline test and tracking its rise over time � that might prove better than annual testing.

"If the debate gets reduced to `there's a right and a wrong,' we will lose what we are being told here, which is to search for the path forward," he said.

The cancer society's Lichtenfeld agreed. "Maybe it's time to listen to evidence instead of hope," he wrote in his blog.

___

Online:

Task force recommendations: http://www.uspreventiveservicestaskforce.org/tfcomment.htm

Task force evidence report: http://bit.ly/ovhKUW

PSA decision guide: http://bit.ly/cXq1QE

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement

80 percent of US boys use condoms the first time (AP)

CHICAGO � A surprising 80 percent of teenage boys say they are using condoms the first time they have sex, a government survey found in a powerful sign that decades of efforts to change young people's sexual behavior are taking hold.

But another promising trend � a drop since the 1980s in the number of teenagers having sex � has leveled off.

Boys' condom use may mean they are taking more responsibility for contraception or they are protecting themselves from sexually transmitted diseases, experts say. Or, as one young man said, girls may be drawing the line.

"I'm not sure how much of this is guys thinking they need to use a condom or girls insisting they use a condom," said 17-year-old Olivier Vanasse of Princeton, N.J. "I'd be hesitant to give guys credit for coming up with this on their own."

The study, released Wednesday, is based on interviews with about 4,700 teenagers, ages 15 to 19, conducted from 2006 through 2010. It shows the percentage of boys who said they used condoms the first time they had sex climbed from 71 percent in 2002 to 80 percent in the new survey. In 1988, 55 percent of boys said they used a condom during their first sexual intercourse.

"It comes as a general surprise to people that teenagers in general and teen boys in particular can behave responsibly when it comes to making decisions about sex," said Bill Albert, spokesman for the National Campaign to Prevent Teen and Unplanned Pregnancy. "I think it is surprising."

The survey suggests that condom use continues. Asked if they used a condom the last time they had sex in the previous three months, 75 percent said they did, an increase from 71 percent in 2002.

"We don't think it's a stupid thing to do anymore," said Vanasse, a high school senior and staff writer for http://www.sexetc.org, a project of Rutgers University's Answer, a national sex education organization. "It's just accepted as common sense that you should be using a condom if you're going to be having sex."

Overall, about 43 percent of girls and 42 percent of boys report ever having vaginal intercourse, a rate that is statistically unchanged since 2002. The rates had been declining steadily since 1988, when 51 percent of girls and 60 percent of boys reported that they had had sex.

Albert said those findings also explode myths about teen sex.

"There's the notion that all teenagers are doing it, and that's not the case. In fact, less than half said they've had sex," he said. "And there's no gender gap between the teen boys and the teen girls. There's a myth that guys are out on the prowl, and that's not supported by this data."

Less sex and more contraception are driving down teen births, he said. The U.S. teen birth rate in 2009 � 39 births per 1,000 females � was nearly 40 percent lower than the peak in 1991. It's still a dramatically higher birth rate than in Western Europe, where birth control is less expensive and more accessible to teens.

The new study contains more encouraging news. For the first time, there was no racial difference in the percentage of girls reporting they had had sex. In the past, black females were more likely than whites to be sexually experienced.

"That's due to a drop in black females who are sexually experienced," said the study's lead author, Gladys Martinez, a demographer for the government's National Center for Health Statistics.

Other findings:

� Teens were less likely to have had sex if they lived with both parents, if their mothers hadn't been teen moms themselves, or if their mothers were college graduates.

� Most teens � 70 percent of girls and 56 percent of boys � had their first sex with someone with whom they were "going steady."

� A minority � 16 percent of girls and 28 percent of boys � had their first sex with someone they just met or with whom they were "just friends."

Some teenage girls are trying newer contraceptive methods, even the first time they have sex. A small but growing proportion of girls � 6 percent in the new survey, compared with 2 percent in 2002 � reported using long-acting hormonal methods such as injectable birth control, contraceptive patches or the new contraceptive ring.

The finding on teenage boys' condom use heartened proponents of sex education.

"Boys have really stepped up to the plate in the last 20 years. We've included them in the conversation about teen sex and have seen them as able to be responsible actors, and they've done it for us," said Linda Lindberg, a senior research associate for the Guttmacher Institute. "There's been some shift from the double standard of teaching boys not to ask for sex and teaching girls to say no."

She said it was too soon to see any effect from the Obama administration's move away from abstinence-only sex education to programs that teach pregnancy prevention.

___

Online:

Report: http://www.cdc.gov/NCHS/

___

AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement

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.

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement

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.

___

Online:

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

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

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

__

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

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement

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."

___

Online:

http://www.who.int

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement

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.

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement