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duminică, 5 august 2012

Allergy Sufferers Have Lower Risk Of Brain Tumors

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Editor's Choice
Main Category: Neurology / Neuroscience
Also Included In: Allergy
Article Date: 05 Aug 2012 - 1:00 PDT Current ratings for:
Allergy Sufferers Have Lower Risk Of Brain Tumors
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A new study has added to the growing body of evidence implying that there's a link between allergies and reduced risk of a serious type of cancer that starts in the brain.

According to this particular study, published in the Journal of the National Cancer Institute, the reduced risk seems to be stronger among women than men, however men have a lower tumor risk with certain allergies.

Scientists have believed having allergies or similar factors reduces the risk for this cancer, and this study has strengthened that theory. Experts have never known whether allergies lower the risk of cancer or if, before diagnosis, these tumors (glioma) interfere with the hypersensitive immune response to allergens, because they have the potential to suppress the immune system in order to grow.

Stored blood samples that were taken from patients decades before they were diagnosed with glioma were analyzed by the researchers. The researchers found that there was a 50% reduced risk of developing glioma 20 years later for men and women who had blood samples containing allergy-related antibodies, compared to people without signs of allergies.

Judith Schwartzbaum, associate professor of epidemiology at Ohio State University, investigator in the University's Comprehensive Cancer Center, and leading author of the study, said:

"This is our most important finding. The longer before glioma diagnosis that the effect of allergies is present, the less likely it is that the tumor is suppressing allergies. Seeing this association so long before tumor diagnosis suggests that antibodies or some aspect of allergy is reducing tumor risk.

It could be that in allergic people, higher levels of circulating antibodies may stimulate the immune system, and that could lower the risk of glioma. Absence of allergy is the strongest risk factor identified so far for this brain tumor, and there is still more to understand about how this association works."

Studies, until now, have not been able to analyze blood samples collected longer than 20 years before tumor diagnosis. Previous studies examining the relationship between allergies and brain tumor risk have used self-report questionnaires on patients' histories with glioma.

The study also showed that women had at least a 50% lower risk for the most severe and common type of these tumors, known as glioblastoma, if their blood samples tested positive for specific allergy antibodies. These results were not seen in men. On the other hand, men had a 20% reduced risk of this tumor if they tested positive for both specific antibodies and antibodies of unknown function than men who tested negative.

In the United States, glioblastomas constitute about 60% of adult tumors that start in the brain, which affects 3 in 100,000 people. Patients may seek treatments such as radiation, surgery, and chemotherapy. On average, these patients survive for about one year, with fewer than 25% surviving up to 2 years and just 10% surviving up to 5 years.

The Janus Serum Bank in Norway granted the research team access to specimens. This bank contains samples collected over the last 40 years from people during their annual medical checkups or from volunteer blood donors. Since 1953, Norway has registered all recent cancer cases in the country, and personal identification numbers allows cross-referencing those cases with blood samples that have been previously collected.

The experts were able to analyze stored samples from 594 citizens who were diagnosed with glioma, including 374 that were diagnosed with glioblastoma, between 1974 and 2007. These samples were matched for age, sex, and date of blood collection with 1,777 samples from people who did not have glioma in order to compare.

The team was looking for levels of two types of proteins, IgE, or immunoglobulin E, while they were measuring the blood samples. This is a class of antibodies that are made from white blood cells that mediate immune responses to allergens. Two classes of IgE take part in the allergic response: allergen-specific IgE- identifies specific components of an allergentotal IgE- identifies these components but also includes antibodies with unknown functionsThe researchers observed each sample and determined whether the serum had elevated levels of IgE specific to the most common allergens in Norway as well as IgE. Specific Respiratory allergens were: tree pollen and plantsdog and horse danderdust mitesmoldA statistical analysis was then conducted in order to approximate the association between the risk of developing glioma and elevated concentrations of allergen-specific IgE and total IgE.

A 54% reduced risk of glioblastoma was associated with the women who tested positive for elevated levels of allergen-specific IgE compared to the women who tested negative. This association was not seen in men.

The relation between total IgE levels and risk of glioma was the same for both sexes. For men and women combined, a 25% reduced risk of glioma was associated with testing positive for elevated total IgE.

The analysis for effects on glioblastoma risk alone showed a similar decreased risk for both men and women combined whose blood samples tested positive for elevated levels of IgE. However, this finding was considered borderline in terms of statistical significance because it was not a significant enough number, meaning there is still the possibility that the association could be caused by chance.

"There is definitely a difference in the effect of allergen-specific IgE between men and women. And even results for total IgE suggest there still may be a difference between the sexes. The reason for this difference is unknown," explained Schwartzbaum.

This research has shown evidence for the likelihood that the immune system of people with respiratory allergies could help fight against this type of cancer. The author explained that being able to examine this association over 4 decades between blood sampling and tumor diagnosis gave him and his team better insight.

For example, a 46% reduced risk for developing glioma 20 years later was associated with a positive test for elevated concentrations of total IgE compared to samples that tested negative. That reduced risk was only about 25% in samples that tested positive for high levels of total IgE taken between 2 and 15 years before diagnosis.

Schwartzbaum explained:

"There may be a trend- the closer the samples get to the time of diagnosis, the less help the IgE is in decreasing the risk of glioma. However, if the tumor were suppressing allergy, we would expect to see a bigger difference in risk near the time of diagnosis."

He hopes to further his research and analyze the serum samples for concentration of cytokines (chemical passengers that promote or suppress inflammation as part of the immune response) in order to see if these proteins play a part in the relationship between elevated IgE levels and reduced tumor risk.

Written by Sarah Glynn
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our neurology / neuroscience section for the latest news on this subject. Association Between Prediagnostic IgE Levels and Risk of Glioma
Judith Schwartzbaum, Bo Ding, Tom Borge Johannesen, Liv T. N. Osnes, Linda Karavodin, Anders Ahlbom, Maria Feychting and Tom K. Grimsrud
Journal of the National Cancer Institute 2012 doi: doi: 10.1093/jnci/djs315 Please use one of the following formats to cite this article in your essay, paper or report:

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'Allergy Sufferers Have Lower Risk Of Brain Tumors'

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marți, 13 decembrie 2011

Lower Back Pain - MRI Does Not Improve Outcomes For Epidural Steroid Injection Candidates

Editor's Choice
Academic Journal
Main Category: Back Pain
Also Included In: Pain / Anesthetics;  MRI / PET / Ultrasound
Article Date: 13 Dec 2011 - 9:00 PST

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According to an investigation published Online First by the Archives of Internal Medicine, one of the JAMA/Archives journals, magnetic resonance imaging (MRI) prior to administration of epidural steroid injections (ESI), does not seem to improve outcomes for individuals with chronic lower back pain or for those with conditions like sciatica, and only has a small effect on the physician's decision making.

In the report the researchers explain:

"Lower back pain is the number one cause of disability in the world, and one of the top three reasons people seek medical attention.

Despite several studies demonstrating that advanced radiologic testing does not improve outcomes in patients with lower back pain, with or without radicular symptoms [nerve irritation, characterized, for example, by pain radiating down the back of the leg], the use of MRI in this context continues to soar.

The lack of unequivocal guidelines on the use of MRI before ESI is somewhat unexpected, considering that ESI is the most frequently performed procedure in pain clinics throughout the United States."

A multi-center randomized study was conducted by Steven P. Cohen, M.D., from Johns Hopkins School of Medicine, Baltimore and his team. A total of 132 patients, primarily women (57%) with an average age of 52, were enrolled to participate in the study.

The researchers randomly assigned participants to two groups. In one group the treating physician was blinded to the MRI results, while for group two the physician decided on treatment after reviewing the MRI findings.

For participants in group one, an independent doctor reviewed the MRI findings and recommended a treatment plan, the plan was then compared to the treatment the participant actually received. All participants in group one received ESIs. In group two not all participants received ESIs, if the MRI finding did not support the treatment, at which point the participant discontinued with the investigation. 34% of all participants were taking opioids. Pre-procedure leg pain scores and function showed moderate to severe dysfunction.

The researchers state:

"Slightly lower leg pain scores were noted in group two at one month compared with MRI-blinded patients in group 1. No differences were observed in pain scores or function at three months.

Overall, the proportion of patients who experienced a positive outcome was similar at all time points (35.4 percent at three months in group one vs. 40.7 percent in group two.

For the patients in group one who received a different injection that was proposed by the independent physician, scores for both leg pain (4.8 vs. 2.4) and function (38.7 vs. 28.2) were inferior to patients whose injection correlated with imaging.

Collectively, 6.8 percent of patients did not (group two) or would not have (group one) received an ESI after the MRI was reviewed."

The team conclude:

"In conclusion, our results suggest that although MRI may have a minor effect on decision making, it is unlikely to avert a procedure, diminish complications, or improve outcomes. Considering how frequently ESIs are performed, not routinely ordering an MRI before a lumbosacral ESI may save significant time and resources."

In a commentary associated with the report, Janna Friedly, M.D., from the University of Washington, Seattle, and Richard A. Deyo, M.D., M.P.H., from Oregon Health and Science University, Portland, Ore., explain:

"Given the modest benefits of epidural injections themselves, it may not be surprising that the benefit of imaging prior to injection is hard to demonstrate.

Although the overall results of this study were largely negative, they suggest a small benefit to using MRI to guide epidural steroid injection planning in patients with lumbar radiculopathy. Use of MRI may have reduced the total number of injections required and may have improved outcomes in a subset of patients.

Given these potential benefits as well as concerns related to missing important rare contraindications to epidural steroid injection, it seems premature to counsel against guideline recommendations for obtaining MRI prior to consideration of epidural steroid injections.

In the meantime, cost savings and clinical benefit might result from discouraging epidural injections in conditions for which efficacy is unclear, such as spinal stenosis and low back pain without radiculopathy. More prudent patient selection may help offset the costs of obtaining advanced imaging prior to injection for those in whom a treatment benefit is more likely."

Written by Grace Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our back pain section for the latest news on this subject. Arch Intern Med. Published Online December 12, 2011. doi:10.1001/archinternmed.2011.593. & doi:10.1001/archinternmed.2011.581. Please use one of the following formats to cite this article in your essay, paper or report:

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Grace Rattue. "Lower Back Pain - MRI Does Not Improve Outcomes For Epidural Steroid Injection Candidates." Medical News Today. MediLexicon, Intl., 13 Dec. 2011. Web.
13 Dec. 2011. APA

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luni, 12 decembrie 2011

First Ever All-Ireland Cancer Atlas Shows Cancer Risk In Northern Ireland Lower Than The Republic Of Ireland

Main Category: Cancer / Oncology
Also Included In: Melanoma / Skin Cancer;  Lymphoma / Leukemia / Myeloma
Article Date: 12 Dec 2011 - 1:00 PST

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People in Northern Ireland have a lower risk of developing some cancers than those living in the Republic of Ireland, according to the All-Ireland Cancer Atlas - a collaborative publication by the Northern Ireland Cancer Registry at Queen's University Belfast and the National Cancer Registry in Cork.

The first ever All-Ireland Cancer Atlas analysed 18 types of cancer by electoral division over a 12-year period. Those cancers which were significantly higher for both sexes in the Republic of Ireland were:

For men, the risk of prostate cancer was higher in the Republic of Ireland and, for women, cancer of the oesophagus and cervix were higher.

Lung cancer, however, was higher in Northern Ireland compared with the Republic.

The following cancers were higher for women in Northern Ireland: Uterus Non-Hodgkin's lymphoma Head and neck cancers The Atlas also found that the following cancers were more common in areas of higher unemployment and/or lower levels of degree attainment across the island: Lung Stomach Head and neck Cervical cancers The following cancers were lower in areas of higher unemployment and/or lower levels of degree attainment: Non melanoma skin cancer Female breast cancer Prostate cancer Melanoma Other findings include: Stomach cancer rates were higher in a band running from Dublin to Donegal, excluding the north-east, but including Belfast. There was no statistically significant difference in female breast cancer risk between the Republic of Ireland and Northern Ireland. The risk of diagnosis of prostate cancer was 29 per cent lower in Northern Ireland. Men in areas with the highest educational attainment had the highest risk. The risk of head and neck cancer was greater, by 21 per cent, for women in Northern Ireland compared to the Republic of Ireland but there was no statistically significant difference for men. Commenting on the findings in the Atlas, Dr Anna Gavin, Director of the Northern Ireland Cancer Registry, said: "Mapping the incidence of cancer geographically in Ireland is hugely important in our quest to understand factors that increase cancer rates and also to provide appropriate treatment and cancer services.

"While it is generally accepted that geographic variations in cancer risk are predominantly the result of factors such as tobacco smoking, alcohol drinking, obesity, diet and sexual behaviour there are also a number of findings which we cannot explain yet including the band of increased stomach cancer incidence from Donegal to Dublin. The launch of the first All-Ireland Cancer Atlas will enable us to further identify different contributing factors to cancer in Ireland."

Dr Harry Comber, Director of the National Cancer Registry, said: "The Atlas shows major variations, sometimes more than two-fold, in the risk of several cancers, across the island. Understanding the reasons for this geographical variation, and taking appropriate action, would reduce the cancer burden significantly in Ireland. Areas with unexplained higher than average risk should now be studied in detail and a comprehensive programme of research into already known determinants of cancer risk in Ireland is needed to inform cancer control."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Queen's University Belfast. "First Ever All-Ireland Cancer Atlas Shows Cancer Risk In Northern Ireland Lower Than The Republic Of Ireland." Medical News Today. MediLexicon, Intl., 12 Dec. 2011. Web.
12 Dec. 2011. APA

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duminică, 11 decembrie 2011

Potential Breast Cancer Prevention Agent Found To Lower Levels Of 'Good' Cholesterol Over Time

Main Category: Breast Cancer
Also Included In: Cholesterol
Article Date: 10 Dec 2011 - 0:00 PST

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Exemestane steadily lowered levels of "good" cholesterol in women taking the agent as part of a breast cancer prevention study, say researchers at Georgetown Lombardi Comprehensive Cancer Center. Exemestane, an aromatase inhibitor used to treat estrogen receptor-positive breast cancer, is being tested to prevent breast cancer in women at an increased risk of developing the disease.

Georgetown researchers say their findings, presented at the 2011 CTRC-AACR San Antonio Breast Cancer Symposium (SABCS), suggest that the effect this agent has on blood lipids may prove to be significant for women at high risk for heart disease due to elevated blood cholesterol, although no such effects have been seen yet in patients studied over two years of treatment.

There are two types of cholesterol transported in our blood - HDL and LDL. HDL cholesterol is known as "good" cholesterol, because high levels of it protect against heart attack. LDL cholesterol is known as "bad" cholesterol because it can buildup in the inner walls of the arteries that feed the heart and brain, and lead to atherosclerosis.

"Lower levels of the HDL, the good cholesterol, have been shown to increase the risk of heart attack and stroke. While we found that exemestane lowers good cholesterol levels, the clinical significance of this decrease is unknown," says a study investigator, Margaret Gatti-Mays, M.D. an intern in internal medicine at Georgetown.

The results come from a phase II multi-institutional study of women at increased risk for breast cancer that evaluated the safety and efficacy of exemestane over two years of therapy. The findings, from 31 patients, showed that the absolute change from the baseline HDL level at 3, 12, and 24 months were -8.0 mg/dL, -8.5 mg/dL, and -9.9 mg/dL, respectively. The rest of the lipid panel, including LDL (the bad cholesterol) was relatively unchanged.

"It is notable that both women taking and not taking lipid-lowering medication had decreases in HDL," Gatti-Mays says.

"Lower HDL levels are associated with an increased risk of heart disease, so if a patient has a low HDL level, exemestane may not be the best choice as a breast cancer prevention agent," says the study's senior investigator, Jennifer Eng-Wong, M.D., senior medical director of the Capital Breast Care Center at Georgetown Lombardi Comprehensive Cancer Center.

She adds that other anti-estrogen therapies designed to prevent breast cancer don't appear to lower HDL. "Less data is available on anastrozole and letrozole, which are other aromatase inhibitors, but they do not appear to lower HDL. Conversely, tamoxifen has an overall favorable effect on cholesterol."

"Exemestane has been shown to be an effective therapy in the prevention of breast cancer in postmenopausal women who have an increased risk of developing it. This study adds information that will help individualize care for these women though larger studies are needed to more fully evaluate the impact of exemestane on cholesterol and cardiovascular health," says Gatti-Mays.

The research was conducted at Georgetown and the National Cancer Institute (NCI), and was supported by both institutions, as well as the National Institutes of Health, and Pfizer Inc. (which supplied exemestane). (OVER)

A recipient of the ACCR Scholar-in-Training Award, Gatti-Mays' travel to the SABCS conference was funded by this award which is supported by Susan G. Komen for the Cure. She reports no personal financial interests related to the study.

The 2011 CTRC-AACR San Antonio Breast Cancer Symposium is presented by the Cancer Therapy & Research Center at UT Health Science Center San Antonio, the American Association for Cancer Research, and Baylor College of Medicine.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our breast cancer section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

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Georgetown University Medical Center. "Potential Breast Cancer Prevention Agent Found To Lower Levels Of 'Good' Cholesterol Over Time." Medical News Today. MediLexicon, Intl., 10 Dec. 2011. Web.
11 Dec. 2011. APA

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