Study: Docs overtesting for cervical cancer virus (AP)

WASHINGTON � Too many doctors are testing the wrong women, or using the wrong test, for a virus that causes cervical cancer.

The days of one-size-fits-all screening for cervical cancer are long gone. How often to get a Pap smear � and whether to be tested for the cancer-causing HPV virus at the same time � now depend on your age and other circumstances.

But a government study reports Monday that a surprising number of doctors and clinics aren't following guidelines from major medical groups on how to perform HPV checks, suggesting a lot of women are getting unnecessary tests.

That wastes money and could harm women who wind up getting extra medical care they didn't need, says Dr. Mona Saraiya of the Centers for Disease Control and Prevention, who led the research.

Even she wasn't protected from the confusion. Saraiya was stunned to get a bill showing that her own doctor had ordered testing for HPV strains not connected to cervical cancer.

The findings, reported in the journal Obstetrics & Gynecology, show women have to be savvy to ensure they're getting the right checkups � enough, but not too much.

"It's extremely discouraging," says Debbie Saslow, gynecologic cancer director at the American Cancer Society, who's had to argue with her doctor against testing too often. "We have not been able to get that message across."

Cervical cancer grows so slowly that Pap smears � which examine cells scraped from the cervix � usually find it in time to treat, or even to prevent when precancerous cells are spotted and removed.

For decades, Paps were the only way to screen for cervical cancer. Now doctors know that certain strains of HPV, the human papillomavirus, cause most cervical cancer. HPV testing isn't a replacement for the Pap. But it can provide extra information to help determine if a woman is at higher or lower risk and thus guide her ongoing care � if it's used correctly.

The new CDC study, part of a national survey of medical practices that included 600 providers of cervical cancer screening, examined how doctors are using it.

The study found 60 percent of doctors and clinics say they give a routine Pap-plus-HPV test to women who are too young for that combination. Guidelines stress that so-called co-testing is only for women 30 and older. If both tests are negative, they can wait three years before their next screening.

Why the age limit? Saslow says HPV is nearly as common as the common cold, especially in younger women � but their bodies usually clear the infection on their own and only a years-long infection is risky. Learning that a 20-something has HPV increases the odds of more invasive testing that in turn can leave her cervix less able to handle pregnancy later in life. Younger women are supposed to get HPV testing only if a Pap signals a possible problem and doctors really need the extra information.

Then there's the question of which test to use. Only a few so-called high-risk strains of HPV cause cervical cancer, the strains doctors are supposed to test for. Before scientists understood the different HPV types, a test already was on the market that detects strains that can cause genital warts, not cervical cancer. The CDC's Saraiya says there's no reason to use that old test because learning you have a probably transient warts-causing strain doesn't alter your care.

Yet her study found 28 percent of doctors and clinics say they order tests for both the cancer-causing and warts-causing strains, regardless of patient age. The study couldn't tell why, although Saraiya says some doctors don't know there's a difference and some order forms for the lab tests don't differentiate.

An HPV test costs $80 to $100, on top of a $40 Pap. Saraiya says labs can bill for two HPV tests when doctors order testing for both kinds of strains.

So what does a woman need to know before her next checkup? The CDC has developed a consumer-friendly brochure to help women understand their options for cervical cancer screening: http://tinyurl.com/6g8de6v

And guidelines from the American College of Obstetricians and Gynecologists recommend that:

_Routine Paps start at age 21.

_Most women in their 20s get a Pap every two years.

_Women 30 and older wait three years between screenings if they've had a negative Pap and negative HPV test, or three consecutive clear Paps.

_If a Pap is inconclusive at any age, HPV testing may help rule out who needs further examination and who can just repeat a Pap in a year.

_Anyone who's been vaccinated against HPV, a relatively new vaccine, still must follow Pap screening guidelines for their age group.

_Higher-risk women, such as those with HIV or previous cervical abnormalities, need more frequent screening.

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EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Study says 1 in 13 US children have food allergy (AP)

CHICAGO � Food allergies affect about one in 13 U.S. children, double the latest government estimate, a new study suggests.

The researchers say about 40 percent of them have severe reactions � a finding they hope will erase misconceptions that food allergies are just like hay fever and other seasonal allergies that are troublesome but not dangerous.

Overall, 8 percent of the children studied had food allergies; peanuts and milk were the most common sources. That translates to nearly 6 million U.S. children.

The most recent government estimate, from the Centers for Disease Control and Prevention, was based on in-home interviews and found that about 3 million children were affected, or about 4 percent. Other estimates based on different methods have ranged from 2 percent to 8 percent.

The new study, funded by an advocacy group, is based on online interviews with parents of kids younger than age 18 and involved 40,104 children. Research firm Knowledge Networks conducted the survey. Families were recruited through random telephone dialing.

Results were released online Monday in Pediatrics.

The findings suggest that food allergies affect two kids per classroom, said lead author Dr. Ruchi Gupta, a pediatrician and researcher with Chicago's Children's Memorial Hospital.

Dr. Calman Prussin, an investigator with the National Institute of Allergy and Infectious Diseases, said the study "confirms that food allergy is a substantial public health problem."

Prussin said differences in estimates are due to different survey methods and definitions of what constitutes a food allergy. He said the only way to know for sure how many kids are affected would be lab tests on scores of children, which isn't practical.

Because the new figure is within the range of previous estimates, he said the study doesn't mean prevalence has increased, although experts generally believe allergies including those to food are on the rise, Prussin noted.

He said some people mistake food intolerances for food allergies. For instance, many people are lactose intolerant, meaning they can't properly digest milk. That can cause bloating and digestive problems, but not an allergic reaction.

Typical signs of a true food allergy include skin rashes, wheezing, tightness in the throat or difficulty breathing.

The new survey asked parents whether their children had those symptoms � a big strength of the study, Prussin said.

Many children outgrow allergies to some foods, including eggs and wheat, but they're less likely to outgrow allergies to peanuts and other nuts.

The study was funded by the Food Allergy Initiative, a nonprofit advocacy group founded by parents of children with allergies.

Mary Jane Marchisotto, the group's executive director, said the study "paints a more comprehensive picture" of food allergies, and should help raise awareness.

The group, funded privately but without industry money, is working with the CDC on national guidelines on how to manage food allergies in schools, she said.

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Online:

Pediatrics: http://www.pediatrics.org

Food Allergy Initiative: http://www.faiusa.org

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

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Obama admin to end health care waivers (AP)

WASHINGTON � Removing a potential political distraction ahead of next year's elections, the Obama administration Friday announced an early end to a health care waiver program that has come under fire from congressional Republicans.

Political considerations were "absolutely not" part of the decision, said Steve Larsen, head of a section of the Health and Human Services department that oversees President Barack Obama's health care law.

Larsen said no new applications for waivers will be considered after Sept. 22. Approvals or renewals received by the deadline will be good through 2013. Starting in 2014, the main coverage provisions of the health care law will take effect, and such waivers will no longer be needed.

The waivers address a provision of the law that phases out annual dollar limits on coverage by health insurance plans. Starting this year, plans could not impose a limit below $750,000. But some plans, offered mainly to low-income workers, currently provide $50,000 a year in coverage, and in certain cases much less.

Those plans would have been forced to close down or jack up premiums significantly, leaving more people uninsured.

The waivers were established to avoid disrupting existing coverage. In 2014, taxpayer-subsidized insurance will be available to most of the people now covered by the affected plans.

Some Republicans charged favoritism in the granting of the waivers, alleging that they were being granted to unions. But a review this week by the Government Accountability Office found that HHS had approved over 95 percent of the 1,400 waiver applications it received, most of them involving employer plans. The nonpartisan investigative agency also found that the administration used objective standards to make its decisions.

Larsen said Friday that insurance experts have advised his office that most plans that needed waivers probably already applied for them this year. For that reason, the effects of ending the program early would be negligible.

A conservative policy expert who has been critical of the program wasn't buying the technical explanation.

"It looks like they finally figured out they were in a public relations hole and decided to stop digging," said Ed Haislmaier of the Heritage Foundation think tank.

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Cancer death rate gap widens based on education (AP)

ATLANTA � The gap in cancer death rates between college graduates and those who only went to high school is widening, the American Cancer Society reported Friday.

Among men, the least educated died of cancer at rates more than 2 1/2 times that of men with college degrees, the latest data show. In the early 1990s, they died at two times the rate of most-educated men.

For women, the numbers aren't as complete but suggest a widening gap also. The data, from 2007, compared people between the ages of 25 and 64.

People with college degrees are seeing a significant drop in cancer death rates, while people who have spent less time in school are seeing more modest improvements or sometimes none at all, explained Elizabeth Ward, who oversees research done by the cancer society.

The cancer society estimates there will be nearly 1.6 million new cancer cases in the United States this year, and 571,950 deaths. It also notes that overall cancer death rates have been dropping since the early 1990s, but the decline has been greater for some groups more than others.

Experts believe that the differences have to do with education, how much people earn and where they live, among other factors. Researchers like to use education as a measuring stick because death certificates include that information.

"Just because we're measuring education doesn't mean we think education is the direct reason" for the differences among population groups, Ward said.

That said, the cancer death rate connection to education is striking.

For all types of cancer among men, there were about 56 deaths per 100,000 for those with at least 16 years of education compared to 148 deaths per 100,000 for those with no more than 12 years of school.

For women, the rate was 59 per 100,000 for the most educated, and 119 per 100,000 for the least educated.

The gap was most striking when it comes to lung cancer.

People with a high school education or less died at a rate four to five times higher than those with at least four years of college education, the new report said.

More than a third of premature cancer deaths could have been avoided if everyone had a college degree, cancer society officials estimated.

Studies have suggested that less educated people are more likely to do risky things with their health.

They are more likely to smoke, drink and overeat, leading to obesity. All those things raise the risk for various cancers.

As for survival after diagnosis, the least-educated are often poor people without good health insurance. Studies have found that people with no health insurance are more likely to be diagnosed when their cancer is advanced stage, and they are also less likely to receive standard treatment.

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CDC: 1 in 4 high schoolers drink soda every day (AP)

ATLANTA � A new study shows one in four high school students drink soda every day.

The national survey found that teens drink water, milk and fruit juices most often. But a quarter say they have at least one soda each day.

For all sweetened beverages, the figure is closer to two-thirds when other sugary drinks like Gatorade are counted along with soda. That seems to be less than in the past when more than three-quarters reported drinking a sugary drink each day.

The survey of more than 11,000 teens was conducted last year. The results were reported Thursday by the Centers for Disease Control and Prevention.

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Weighing cancer risks, from cellphones to coffee (AP)

You're sitting in a freshly drywalled house, drinking coffee from a Styrofoam cup and talking on a cellphone. Which of these is most likely to be a cancer risk?

It might be the sitting, especially if you do that a lot.

Despite all the recent news about possible cancer risks from cellphones, coffee, styrene and formaldehyde in building materials, most of us probably face little if any danger from these things with ordinary use, health experts say. Inactivity and obesity may pose a greater cancer risk than chemicals for some people.

"We are being bombarded" with messages about the dangers posed by common things in our lives, yet most exposures "are not at a level that are going to cause cancer," said Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer.

Linda Birnbaum agrees. She is a toxicologist who heads the government agency that just declared styrene, an ingredient in fiberglass boats and Styrofoam, a likely cancer risk.

"Let me put your mind at ease right away about Styrofoam," she said. Levels of styrene that leach from food containers "are hundreds if not thousands of times lower than have occurred in the occupational setting," where the chemical in vapor form poses a possible risk to workers. "In finished products, certainly styrene is not an issue," and exposure to it from riding in a boat "is infinitesimal," she said.

Carcinogens are things that can cause cancer, but that label doesn't mean that they will or that they pose a risk to anyone exposed to them in any amount at any time.

They have been in the news because two groups that periodically convene scientists to decide whether something is a carcinogen issued new reports.

Last month, the International Agency for Research on Cancer, part of the World Health Organization, said there is a possibility cellphones raise the risk of brain tumors.

"The operative word is `possibility,'" said Lichtenfeld, who among others has pointed out the thin evidence for this and the fact that cancer rates have not risen since cellphones came out.

Last week, the National Toxicology Program, part of the National Institute of Environmental Health Sciences � both of which Birnbaum heads � issued its report.

It adds to the list of known carcinogens formaldehyde, which is in building materials and some hair-straightening products, though Birnbaum said on-the-job exposure is the main concern. The list also adds a plant substance in some "natural" arthritis remedies, aristolochic acid. Six other things were dubbed "reasonably anticipated" to be carcinogens, including styrene and another herbal medicine ingredient, riddelliine (rih-DELL-een).

Since 1971, the international cancer agency has evaluated more than 900 substances. Just over 100 have been deemed carcinogens, 59 are called probable carcinogens, and 266 others are possible ones.

In this last category of possibles � besides the electromagnetic energy from cellphones � are coffee, engine exhaust and talc-based body powder. Talc in its natural form may contain asbestos, though products sold for home use since the 1970s have been asbestos-free. Again, most risk is thought to involve occupational or unusual exposure to natural talc.

The evidence on coffee has gone back and forth for years, with no clear sign of danger and some suggestions of benefit.

However, known carcinogens include alcoholic beverages, estrogen treatments for menopause symptoms, birth control pills, certain viruses and parasites, and even some drugs used to treat cancer, such as cyclophosphamide and tamoxifen.

"Most people would probably be shocked to see the number of things they interact with every day" on these lists, Lichtenfeld said.

Here's the problem: The agencies that pass judgment on a carcinogen don't regulate it or determine what levels or routes of exposure are a concern and for whom.

"People immediately assume it's going to cause cancer at any exposure level, and that's simply not true," said A. Wallace Hayes, editor of the scientific journal Food and Chemical Toxicology, and an industry consultant.

The rule is "RITE" � Risk Is equal to Toxicity times Exposure � and "they've left out half of the equation" by not saying how much exposure is a concern, Hayes said.

"The organizations that list these substances as possibly carcinogenic have to be conservative. That means if there's any reasonable evidence, way before it's a sure thing, they have to say, `Let's be cautious.' That's their job � to raise the flag," said David Ropeik, a consultant and author of "How Risky Is It Really? Why Our Fears Don't Always Match the Facts."

It's human nature to fear risks we didn't choose, such as hazardous chemicals, more than those we did, such as lack of exercise, poor diets or smoking, he said.

"A risk that is imposed on us scares us more than a risk we take voluntarily," especially if it comes from companies we don't trust, Ropeik said.

Styrene is an example: The government says it is a component of tobacco smoke and that is the biggest way most people are exposed to it. Smoking, of course, is the most easily preventable cancer risk.

To minimize risk, people can take reasonable measures to avoid exposure to possibly harmful things, experts say.

"If you walk into a room and you can smell formaldehyde, you probably want to vent the room before you spend a lot of time in it. That's just common sense," Birnbaum said.

If you're concerned about pesticides, you can peel fruit and vegetables or choose organics, though there is some evidence that organic products may be less safe in terms of germs like E. coli and salmonella.

People worried about cellphones can hold them farther from the head, text-message instead of talk, or use a headset or earpiece as Lichtenfeld does. He was returning from a major cancer conference in Chicago last week when a fellow traveler pointed at Lichtenfeld's Bluetooth earpiece and said, "Do you know that thing can cause cancer?"

"I said, `Yes, ma'am, I'm very familiar with the data and I choose to use Bluetooth,'" said Lichtenstein, who didn't tell her he was one of the biggest cancer experts she'd ever meet.

"You can't live life in fear," he said. "You have to live life."

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Online:

Carcinogens: http://bit.ly/aJI6ht

IARC: http://monographs.iarc.fr/index.php

NIH: http://ntp.niehs.nih.gov/go/roc12

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

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