About Cancer Treatment Methods

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Immune Systems In Breast Cancer Survivors Who Suffer From Fatigue Fail To Shut Off After Therapy

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04 May 2006

Note: This is in relation to breast cancer, not a cancer which can lead to ostomies. However, it's included here as many members report being fatigued after treatment .

Breast cancer survivors who suffer from persistent, debilitating fatigue years after their diagnosis have something in common: their immune systems don't shut down following treatment, according to researchers at UCLA's Jonsson Cancer Center.

This constant immune system activation, which researchers discovered by measuring specific proteins in blood samples from survivors, may be causing the fatigue, UCLA researchers theorize. Their discovery may lead to behavioral interventions such as tai chi and yoga that will help alleviate persistent fatigue, which affects about a third of breast cancer survivors for years after they complete treatment.

The study is the first to look at the cellular basis for immune activation in fatigued breast cancer survivors, said Dr. Michael Irwin, a researcher at UCLA's Jonsson Cancer Center and the study's lead author. The research appears in the May issue of Clinical Cancer Research, the peer-reviewed journal of the American Association of Cancer Research.

"Without knowing why this fatigue happens at the cellular level, we can't develop efficient therapies to treat it," said Irwin, who also serves as director of the Cousins Center for Psychoneuroimmunology at the Semel Institute for Neuroscience and Human Behavior at UCLA.

"Breast cancer survivors can be severely disabled by fatigue and that can dramatically impact their quality of life. That's the tragedy of our treatments for cancer," Irwin said. "We have focused on treating the disease, but we should also focus on the patient's well being later. Right now, we have no treatment for cancer-related fatigue and we need something that will allow patients to return to their prior level of functioning."

Dr. Patricia Ganz, a nationally renowned expert who has studied quality of life in breast cancer survivors for two decades, agrees that fatigue is a serious problem for survivors, a fact that their primary care physicians don't always understand.

"When breast cancer survivors talk to their physicians about being tired and how it affects their lives, they're often told that they survived cancer, so they should be grateful to be alive," said Ganz, one of the co-authors of the study. "But their fatigue is a very real problem that needs to taken seriously and addressed."

A small study at UCLA had previously demonstrated abnormalities in immune activation in breast cancer survivors. If researchers could determine the biological factors underlying this activation, and therefore fatigue, they could uncover a biomarker for the condition that could help them predict which patients would suffer from fatigue and which would not, Irwin said.

Irwin and his colleagues took blood samples from breast cancer survivors one to five years out from diagnosis and placed them into two groups, those who suffered from persistent fatigue and those who did not. The researchers measured the levels of a pro-inflammatory cytokine protein in their blood - levels that indicated the immune system was turned on. Irwin said the pro-inflammatory protein levels were significantly different between the two groups. Those with persistent fatigue had 30 percent more of the proteins circulating in their blood. Additionally, their immune cells produced more cytokines in laboratory analyses than the cells from survivors without fatigue, and those cytokines were more efficient at producing the pro-inflammatory proteins driving the immune response.

"This study proved that there is an aberrant immune response in breast cancer survivors with persistent fatigue," Irwin said. "With this information, we may now be able to identify those patients at greatest risk for persistent fatigue and implement interventions early on that will lessen the severity and duration of the fatigue."

The immune systems of women undergoing treatment for breast cancer are activated at high levels to help them fight disease and help the body recover from the side effects of chemotherapy and radiation. Some data suggest that survivors who develop fatigue might have immune system changes before the cancer and the treatments may be exacerbating that. Further studies are needed to understand how this immune activation occurs and what clinical factors predispose to it, Irwin said

"We know from studies that animals with immune activation and cytokines circulating in their blood don't move around a lot, they don't eat, they don't engage in sexual activity," Irwin said. "From our study, we believe that the severity of fatigue in breast cancer survivors is not related to the type of treatment they received or its duration, but rather that the fatigue is driven by constant immune activation. Their immune systems simply don't shut down after treatment."

Irwin and his team studied 32 breast cancer survivors with persistent fatigue and compared their blood samples to 18 survivors who did not suffer from fatigue. The pro-inflammatory proteins in the blood of fatigued cancer survivors could be used as a biomarker to classify those women who may suffer from fatigue after treatment. In those who appear to be predisposed to fatigue - the women whose immune systems have not shut off as they should - it may be possible in the future to provide interventions can right away that might eliminate or, at the least, alleviate the severity and duration of the fatigue.

While there are drugs such as statins that can be used to dampen immune response, future studies by Irwin and his team will focus on behavioral interventions such as tai chi and yoga. Exercise and meditation, Irwin said, have been shown to decrease levels of pro-inflammatory cytokine expression in the blood.

"If we can identify survivors at greatest risk of persistent fatigue, we can implement interventions early on to help them," Irwin said. "That would be good news for the increasing numbers of women who are surviving breast cancer every year."

The number of breast cancer survivors is steadily increasing due to advances in screening and treatment strategies. More patients are being diagnosed with early stage breast cancer and are surviving longer. In fact, breast cancer survivors are the largest group of patients to overcome any type of cancer in the United States. It is estimated that there are more than 2 million breast cancer survivors in the U.S. today.
http://www.medilexicon.com/medicalnews.php?newsid=42632∞

Cancer Patient Receives First Proton Therapy Treatment At University Of Florida Proton Therapy Institute

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Article Date: 15 Aug 2006 - 0:00am (PDT)

A Cocoa Beach man with prostate cancer today (Aug. 14) became the first patient to undergo treatment at the new University of Florida Proton Therapy Institute, the first time the most advanced form of radiation therapy available has been offered in the Southeast.

"The first day a patient begins cancer treatment carries a great deal of significance for the patient, his or her family and the physicians, physicists, nurses, technicians and others members of the teams who deliver care," said Dr. Nancy Mendenhall, the UF Proton Therapy Institute's medical director. "In this case, it also happens to mark a significant milestone for the University of Florida, Jacksonville and cancer patients throughout the Southeast. Cancer patients now have access to a type of radiation therapy we believe will increase both the chance of cure and the chance of avoiding treatment-related side effects for many malignancies."

The 54-year-old patient will receive daily proton therapy for the next four to six weeks. Each treatment lasts less than three minutes, though each visit may take up to 40 minutes to accurately position and prepare him.

"After thorough evaluation of other treatment options, proton therapy was felt to be the best choice in this patient. While proton therapy is not right for every patient, it has a high rate of success in curing prostate cancer with minimal side effects. Thus far, the results reported for cancers in children and in cancers of the brain, lung, head and neck, eye, cervix, gastrointestinal tract, bones and soft tissues look extremely promising," said Mendenhall.

Only one of four treatment rooms in the 98,000-square-foot, $125 million facility is now in use, so a limited number of patients will be treated during the first few months of operation. Patient volume will increase gradually as each treatment room is brought online; the second is projected to come online within six months. All four treatment rooms are expected to be in operation, treating up to 200 patients per day, by 2008.

Protons differ from X-rays commonly used in conventional radiation. X-rays enter the body at a high energy level, travel through the body to the tumor, and then exit the body on the other side, exposing all tissue in their path to damaging radiation. In contrast, protons enter the body at a low energy level and release most of their energy upon impact with the tumor, so there is no "exit" dosage of radiation to healthy tissue. This results in a low incidence of side effects and, especially in children, fewer long-term effects.

Florida Proton, http://www.floridaproton.org∞, is one of only five proton therapy centers in the country and is affiliated with the UF College of Medicine and UF Shands Cancer Center, a national leader in cancer treatment and research.

"We are determined to offer patients in Florida and the Southeast the best possible treatment options, whether it be proton therapy, conventional radiation therapy, surgery or chemotherapy. We do believe that protons will occupy a very important place among the armamentarium of cancer weapons. We are also poised to become a center for both clinical and basic research that will increase our understanding of basic disease processes and improve cancer treatments," said Mendenhall. "Our mission is to deliver the best treatment possible to our patients today and to create the knowledge that will make the treatments of tomorrow even better."

Proton therapy has been used to treat cancer for decades in a limited number of treatment centers worldwide; an estimated 40,000 people worldwide have received proton therapy. Recent advances in imaging technology that enable radiation oncologists to see exactly the size, shape and depth of a tumor make proton therapy a suitable treatment option for a greater number of cancer patients.

"The successful treatment of our first patient today is a result of many years of planning, development and training by some of the brightest minds in the field of radiation oncology," said Stuart Klein, Florida Proton's executive director. "This tremendous team includes UF faculty and IBA, the world's leading proton therapy system designer and manufacturer. We are proud to bring this level of expertise to our patients and their families."

IBA is the international leader in particle therapy, acknowledged to be the most precise and effective clinical radiotherapy method in the selective destruction of cancer cells. "We are very excited to be part of the success of this first proton therapy treatment at the University of Florida Proton Therapy Institute. Never in the history of medicine has such a complex and advanced therapy system been put in operation so swiftly. This new record is important for proton therapy, as it will contribute to make the technology shift from research to clinical reality. The passion, rigor and care that the whole UFPTI staff has shown to make this happen is admirable," said Pierre Mottet, IBA's managing director and chief executive officer. "And this is just the beginning of a long term partnership for the advance of proton therapy and better patient care in the Southeast."

University of Florida Proton Therapy Institute is a nonprofit 501(c)3 organization affiliated with the UF College of Medicine. It is located at 2015 N. Jefferson St. in Jacksonville, near Shands Jacksonville. Information about Florida Proton is available at http://www.floridaproton.org∞ or by calling toll-free 877-686-6009.
http://www.medicalnewstoday.com/medicalnews.php?newsid=49596&nfid=30587∞

Side Effects of Colon and Rectal Cancer Treatments

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The National Comprehensive Cancer Network http://www.nccn.org/∞ has an informative page about:

Side Effects of Surgery
Side Effects of Radiation
Side Effects of Chemotherapy
Side Effects of Immunotherapy
Body Image and Sexuality Issues
Other Things to Consider During and after Treatment

http://www.nccn.org/patients/patient_gls/_english/_colon/5_side-effects.asp∞

Majority Of Cancer-Related Anemia Patients Treated With PROCRIT(R) (Epoetin Alfa) Once Every Three Weeks Achieved Target Hemoglobin

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09 Dec 2006

New investigational study results report that 80,000 units of PROCRIT(R) (Epoetin alfa) administered once every three weeks may increase hemoglobin (Hb) levels and improve quality of life in patients with non-myeloid malignancies who are not receiving chemotherapy or radiation therapy.(1) The study is published in the November supplement of the medical journal Blood as part of the American Society of Hematology (ASH) 48th Annual Meeting and Exposition.

PROCRIT is approved by the FDA for reducing transfusion requirements in non-myeloid cancer patients with anemia due to chemotherapy. The recommended starting dose for patients with chemotherapy-related anemia is 40,000 units once weekly.

In this study, 75.5% of patients (37/49) treated with PROCRIT achieved a hematopoietic response (HR), defined as an increase in Hb of 2 grams per deciliter (g/dL) of blood and/or achieving a target Hb 12 g/dL during the study, independent of blood transfusion within 28 days. PROCRIT-treated patients also demonstrated significant improvements from baseline in quality of life based on measures of energy level, improvements in daily activities, and overall quality of life.

"Once-weekly PROCRIT is a proven and widely accepted therapy for the management of chemotherapy-related anemia. But, as many as 40 percent of cancer patients who are not receiving chemotherapy or radiation treatment also experience anemia as it is not diagnosed or treated," said Daniel Shasha, MD, Assistant Professor, Department of Radiation Oncology at Beth Israel Medical Center, New York. "These investigational findings suggest dosing PROCRIT every three weeks may increase hemoglobin in many of these patients."

Study Methodology

The trial evaluated HR rates to PROCRIT 80,000 units dosed once every three weeks in 49 patients with non-myeloid malignancies. The most common tumor types were breast (n=12, 24.5%) and prostate (n=12, 24.5%). Inclusion criteria included a baseline Hb <11 g/dL, no chemotherapy administration within eight weeks or radiation therapy within four weeks of entering the study, and no plans to receive these therapies during the study period. The average age was 71 and average baseline Hb was 10.3 g/dL.

Treatment was administered at Weeks 1, 4, 7, and 10 with follow-up continuing to week 13. PROCRIT treatment was reduced for a Hb greater than 12 g/dL or a Hb increase greater than 1.5 g/dL in any three-week period. Dose was withheld for a Hb greater than 13 g/dL, then reduced when Hb was less than or equal to 12 g/dL.

Study Results

Overall, 75.5% of patients achieved HR. The mean time to the first HR was 5.76 weeks. In addition, 79.6% (39/49) of patients achieved a 1 g/dL increase in Hb from baseline in an average of 3.77 weeks. From Day 29 to end of study, 2/49 (4.1%) patients received a red blood cell transfusion. In 24 of 51 patients (47.1%), at least one dose was reduced or withheld.

PROCRIT was generally well tolerated among patients. Adverse events that were reported in over 5 percent of the population included arthralgia (joint pain), back pain and vomiting. One non-clinically relevant thrombotic vascular event of chest pain was reported.

Ortho Biotech Products, L.P., markets PROCRIT and supported the study. Dr. Shasha, principal investigator of the study, is a consultant to Ortho Biotech Clinical Affairs, L.L.C.

About Anemia

Anemia, a potentially life-threatening condition, occurs when the body does not have enough red blood cells, which carry oxygen. Oxygen acts like fuel for the body, providing energy for muscles and organs to work. Common symptoms include tiredness, shortness of breath, dizziness, decreased ability to concentrate and sleeplessness.

About PROCRIT(R) (Epoetin alfa)

PROCRIT is for the treatment of chemotherapy-related anemia in patients with most types of cancer and for the treatment of anemia in chronic kidney disease patients who are not on dialysis. PROCRIT is available by prescription only and is injected by a doctor or nurse. PROCRIT has been prescribed for more than 10 years to treat anemia in patients with chronic kidney disease not on dialysis.

Important Safety Information

PROCRIT is not for patients with uncontrolled high blood pressure. High blood pressure has been noted in patients treated with PROCRIT and blood pressure should be monitored carefully. Drugs like PROCRIT may increase the risk of blood clots and seizures. Loss of response to PROCRIT could be a sign of a very rare but serious condition. In studies, the most common side effects were high blood pressure, headache, joint pain, and nausea. Please visit http://www.procrit.com∞ for important product information.
http://www.medicalnewstoday.com/medicalnews.php?newsid=58566&nfid=30587∞

Researchers Identify New Drug Targets For Cancer

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02 Jan 2007

Solving a 100-year-old genetic puzzle, researchers at the University of California, San Diego (UCSD) School of Medicine have determined that the same genetic mechanism that drives tumor growth can also act as a tumor suppressor. Their findings could lead to new drug targets for cancer therapies.

In a study published in the January 1 issue of Cancer Cell, Don Cleveland, Ph.D., UCSD Professor of Medicine, Neurosciences and Cellular and Molecular Medicine and member of the Ludwig Institute for Cancer Research, looked at a common characteristic of cancer cells called aneuploidy. Aneuploidy the occurrence of one or more extra or missing chromosomes ?" was first proposed as the cause of cancerous tumors nearly a century ago by German biologist Theodor Boveri, but his hypothesis had remained unproven.

We questioned whether the wrong number of chromosomes contributed to tumor growth, or was a consequences of the accrued damage in cancerous cells, said Cleveland.

To find out, researchers in the Cleveland lab created and analyzed mouse models with cells having a highly variable number of chromosomes to discover if such aneuploidy made the mice more tumor-prone.

We found that, with age, having cells which inherited the wrong composition of chromosomes resulted in a larger number of spontaneous tumors, said Cleveland. But the more unexpected feature of their findings was discovered when the research team added other genetic errors to mice with a high rate of aneuploidy tumor development was slowed.

The UCSD researchers also studied mice that were missing a tumor suppressor gene, which is a gene that acts to prevent cell growth. If a mutation occurs in this gene, it makes the individual or in this case, the mouse more susceptible to the development of cancer in the tissue in which the mutation occurs.

When we created mice missing a tumor suppressor gene that also had a high rate of aneuploidy, tumor development was actually sharply delayed, said Cleveland, adding that in tumors, there is always a balance between uncontrolled growth and death.

The researchers hope that, in the future, they can develop what they are calling aneuploidy therapy. Drugs that inhibit accurate delivery of the right number of chromosomes to each new cell, resulting in aneuploidy, would be used to destroy tumors caused by mutations in the tumor suppressors.

This study opens up a whole series of potential therapeutic targets for cancer, said Beth A.A. Weaver, of the Ludwig Institute for Cancer Research and UCSD Department of Cellular and Molecular Medicine, the study's first author. By increasing the level of genetic damage, we can kill those tumor cells.
http://www.medilexicon.com/medicalnews.php?newsid=59863∞

Holographic Images Use Shimmer To Show Cellular Response To Anticancer Drug

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11 Mar 2007

The response of tumors to anticancer drugs has been observed in real-time 3-D images using technology developed at Purdue University.

The new digital holographic imaging system uses a laser and a charged couple device, or CCD, the same microchip used in household digital cameras, to see inside tumor cells. The device also may have applications in drug development and medical imaging.

"This is the first time holography has been used to study the effects of a drug on living tissue," said David D. Nolte, the Purdue professor of physics who leads the team. "We have moved beyond achieving a 3-D image to using that image for a direct physiological measure of what the drug is doing inside cancer cells. This provides valuable information about the effects of various doses of the drug and the time it takes each dose to become significantly effective."

The laser is gentle and does not harm living tissue, Nolte said. The cancer cells used for the research were grown independently in a bioreactor in the laboratory.

Holography uses the full spectrum of information available from light, more than what the human eye can detect, to create a 3-D image called a hologram. By shining a laser on both the object and directly on the CCD chip of the digital camera, the system screens the pattern of light reflected back from the object and allows the camera to record very detailed information, including depth and motion on a scale of microns, or 0.0001 centimeter.

The scattered light waves reflected back from the object come together at the camera's detector and form what is called "laser speckle." To the eye, this speckle appears as a random pattern of blotches of bright and dark, but the pattern changes if there is motion within the object.

"All living matter is in constant motion, and the laser speckle from a living object is constantly changing with that motion," Nolte said. "This was the key to the diagnostic ability of the technique. The image appears to shimmer with the motion inside the cell. As the anticancer drug works, there is less motion inside the cell and the shimmer effect is reduced. This can be seen right on the screen."

The findings of this National Science Foundation funded research were detailed in an oral presentation at the American Physical Society Meeting in Denver, Colo. The team was selected from more than 7,000 submissions as one of 25 to present results at a meeting press conference. John Turek, a professor of basic medical sciences at Purdue, and Kwan Jeong, a graduate assistant, collaborated with Nolte on this work.

The team detects the motion of organelles inside cancer cells. Organelles are tiny specialized structures that perform internal cell functions and are a common target of anticancer drugs because they play a key role in the uncontrolled cell division that makes cancer lethal.

Colchicine, the anticancer drug studied by the group, limits the ability of organelles to travel throughout the cell and perform their functions. The drug disrupts the growth of microtubules, the highways of the internal cellular structure, and leaves organelles stuck at dead ends unable to move.

This reduction in motion translates to less shimmer in the image on the screen and can be quantitatively analyzed by a computer program, Nolte said.

"Let's say there are 1,000 organelles reflecting light; the exact pattern of the laser speckle is sensitive to each organelle's location," he said. "If one moves even one-half micron, then the pattern changes. It is highly dynamic and sensitive to changes."

In addition to the technology's sensitivity to motion, the field of view is unique because of its "dynamic range," the difference between the largest and smallest scale accessed.

"We can look at a fairly large section of the object, about a 30-micron-thick section of a 700-micron-thick tumor," Nolte said. "At the same time, we can retrieve information within the micron scale.

"Biologists currently have to look at things on the cellular level through microscopes. With this technology, we now can detect things on the cellular level and the tissue scale at the same time. In this case, the whole is greater than the sum of its parts. Tissue is more than just an accumulation of cells. It is a communication network in 3-D that behaves differently than 2-D cell cultures."

In addition to realizing the diagnostic applications of the shimmer, the group has simplified and reduced the cost of the system.

In 2002 Nolte's group was the first to use holography to produce images inside of tissue. The original technique used special semiconductor holographic film developed by the team as opposed to a CCD chip.

"At the time, the only way to capture the image was on this very expensive, very difficult to make film," Nolte said. "But the CCD cameras kept getting better and better and reached the point where we could make the transition from holographic film to the CCD."

Light waves have peaks and valleys that offer information about depth undetected by the human eye. By shining a second laser directly on the CCD chip, bright and dark fringes occur corresponding to the relationship of these peaks and valleys. These fringes, or interference patterns, can be recorded directly onto the camera.

"This extra laser light wave, called the reference wave, acts like a yardstick," Nolte said. "It provides depth information and measurement. It gives us the original image layered with the fringes and the specific locations of these fringes tell us about the 3-D structure of the object."

The team combines this holography technique with "laser ranging," a method similar to radar that measures the time it takes for a laser pulse to travel to an object and be reflected back.

"The holography gives us the peaks and valleys and detailed depth information, while the laser ranging allows us to control how deep we are looking," he said.

The team plans to make measurements of the cytoskeleton, the support structure of cells, and to further examine what types of motion influence the shimmer effect.

"What we have seen is just the tip of the iceberg," Nolte said.
http://www.medilexicon.com/medicalnews.php?newsid=64714∞

Preventive Health Exams May Provide Opportunities For Cancer Screening

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30 Mar 2007

Health plan members who receive preventive health examinations, as opposed to going to a physician only when they are sick, appear more likely to undergo testing for colorectal, breast and prostate cancers, according to a report in the March 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Preventive or periodic health examinations-also called well visits, health maintenance visits or general medical examinations-have been part of medical practice since at least the middle of the 19th century, according to background information in the article. These examinations generally include a medical history and a physical examination and may also include screening, counseling or immunizations. "The preventive health examination may be an auspicious time to promote cancer screening," the authors write. "The preventive health examination may afford primary care physicians the opportunity to discuss and recommend cancer screening when indicated, and physicians' recommendations have been consistently associated with timely cancer screening."

Joshua J. Fenton, M.D., M.P.H., University of California, Davis, Sacramento, and colleagues assessed the association between preventive health examinations and screening for colorectal, breast or prostate cancer in 64,288 enrollees of a Washington State health plan in 2002 to 2003. This included 39,475 patients eligible for colorectal cancer screening, 31,379 women eligible for breast cancer screening and 28,483 men eligible for prostate cancer screening. The patients were between the ages of 52 and 78, and all visited their primary care physician at least once during the study period.

More than half (52.4 percent) of the patients received a preventive health examination in 2002 or 2003. After the researchers controlled for other factors influencing cancer screening rates, including patient demographic characteristics and historical use of medical care, eligible patients who received preventive health examinations were significantly more likely than those who did not receive them to undergo testing for colorectal cancer (57.2 percent vs. 17.2 percent), breast cancer screening mammography (74.1 percent vs. 55.9 percent) and prostate cancer PSA testing (58.8 percent vs. 21.1 percent). "The associations were particularly strong for colorectal cancer and prostate cancer, for which the health plan provides no centralized screening program," as it does for mammography, the authors write.

"In similar populations, the preventive health examination may serve as a clinically important forum for the promotion of evidence-based colorectal cancer and breast cancer screening and of prostate cancer screening, which is not universally recommended," they conclude. "Experimental studies could confirm the efficacy of the preventive health examination in health promotion, elucidate the ideal content of preventive health examinations and guide the development of interventions to help physicians make the most of preventive health examinations."
http://www.medilexicon.com/medicalnews.php?newsid=66238∞

Severely Obese Women More Likely To Skip Cancer Screenings

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11 May 2007

While severe obesity can be accompanied by other health problems including cancer, severely obese women are likely to skip clinical breast exams, mammograms and Pap smears, according to a recent analysis.

The study, however, found that physicians are as likely to recommend mammograms and Pap smears to obese as to non-obese women.

While lead study author Jeanne Ferrante, M.D., found the latter finding "reassuring," she said it is important to figure out why severely obese women aren't getting screened, because "the obese person has an increased risk in developing and dying of cancer."

Ferrante practices in the family medicine department at the University of Medicine and Dentistry of New Jersey/New Jersey Medical School in Newark. Her study was presented at a meeting of the American Society of Preventive Oncology in March and appears in the June issue of the American Journal of Preventive Medicine.

The study was conducted in 2006 and analyzed data from the 2000 National Health Interview Survey, involving nearly 8,300 women ages 40 to 74.

Up-to-date status on clinical breast exams, mammograms and Pap smears was 9 percent to 10 percent less prevalent among severely obese women, compared to women of normal weight. Severely obese women had 51 percent lower odds of adhering to physician recommendations for mammography and 83 percent lower odds of adhering to Pap recommendations.

A woman is severely obese if she has a body mass index of at least 40. The calculation takes into account height and weight: a 5-foot-5-inch person who weighs 247 pounds has a BMI of 41

As a next step, Ferrante is sending surveys to doctors to determine if there are barriers that may keep severely obese women from getting examined. For example: Is there proper equipment to examine severely obese patients?

Ferrante is also using focus groups to get patients' perspectives. Women have reported they feel embarrassed because of their weight, she said. "They don't like to be examined. They don't like to wear two gowns or have a scale inadequate to weigh them."

Susan Curry, Ph.D., director of the Institute for Health Research and Policy at the University of Illinois at Chicago, suggested record-keeping methods that flag patients in at-risk groups.

"What might happen is a physicians' group would get a listing of all patients who have a [BMI] of 40 or greater," Curry said. "Along with it would be mammography and Pap status. If they haven't been in, they might get a postcard saying, 'You are due for a Pap smear. We'd love to see you. We can accommodate you.'"

Ferrante JM, et al. Cancer screening in women: BMI and adherence to physician recommendations. Am J Prev Med 32(6), 2007.

Health Behavior News Service
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Washington, DC 20009
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http://www.hbns.org∞
http://www.medilexicon.com/medicalnews.php?newsid=70570∞

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