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Weekly Links: July 28, 2011

Posted on August 2, 2011, 3:00 PM

Women with early-stage breast cancer have plenty of procedures and treatments to deal with. So it may come as welcome news that a large clinical trial has found no reason for doctors to perform two tests that were thought to help predict patient survival. The tests in question involve looking for micrometastasis - microscopic evidence of a breast tumor’s spread - in sentinel lymph nodes and in bone marrow. To test their theory, researchers from the American College of Surgeons Oncology Group recruited 5,119 women from around the country with early-stage breast cancer whose sentinel lymph nodes were examined. In addition, 3,413 of the women had bone marrow biopsies. The researchers, led by Dr. Armando Guiliano of Cedars-Sinai Medical Center in Los Angeles, found evidence of micrometastasis in 10.5% of the women whose lymph nodes were tested and in 3% of the women whose bone marrow was analyzed. But in both cases, women with microscopic spread of their tumors fared just as well as women without such spread. When researchers took into consideration the age of the patients and the size of their primary tumors, the presence of micrometastases in bone marrow had no correlation with the odds that their cancer would return or that it would kill them. Therefore, making these tests unnecessary for patients with early-stage breast cancer.,0,408168.story

Doctors are now seeing more and more men with prostate cancer in their 40s, partly because more men are being tested at an earlier age. Treatment of younger men with cancer is also becoming more aggressive. In the past, doctors told some patients it was okay to simply watch and wait, putting off surgery or radiation. However, a new study in the New England Journal of Medicine is changing that thinking. Researchers found surgery reduced the risk of death by 39 percent in men of all ages, but in younger men, it was even more dramatic. Surgery cut the risk of death by 51 percent in men under age 65. Doctors say men should have a baseline prostate cancer screening at age 40, then follow-up screenings based on the results and family history.

Screening tumors from all colon cancer patients could be a cost-effective way of spotting families at high genetic risk of the disease, a new study suggests. Of the roughly 160,000 Americans diagnosed with colon cancer each year, about 3 percent have an inherited condition called Lynch syndrome, which involves abnormalities in particular genes that help repair damage to body cells’ DNA. Over time, that unchecked damage is likely to result in cancer: A person with Lynch syndrome has an 80 percent chance of developing colon cancer at some point—often before the age of 50. Lynch syndrome also carries higher-than-normal risks of developing tumors in the uterus (endometrial cancer) and several other organs, including the ovaries, stomach, liver and kidney. Right now, families affected by Lynch syndrome are most often identified based on “clinical suspicion,” said Dr. Uri Ladabaum, the lead researcher in this new study. To gather their data, Dr. Ladabaum’s team used a computer model to estimate the cost-effectiveness of different approaches to spotting families with Lynch syndrome. It turned out that tumor testing first, followed by genetic tests if needed, was the most cost-effective. Doing the tumor tests first helped doctors know which particular gene mutation to test for, helping to keep the ultimate cost down. “There’s reasonably strong evidence that it would be worthwhile to institute some systematic way of trying to identify these families,” Ladabaum said. But ultimately, he added, the effectiveness of any tactic for catching Lynch rests on cancer-free family members’ willingness to have the genetic testing.

As summer heats up, we’ve learned to slather sunscreen with a SPF 15 or higher all over our bodies in an effort to prevent sun damage or skin cancer. What about our scalp? Skin cancer of the scalp is not a common as on other areas of the body but it poses its own set of challenges. “The problem is that the hair can obscure a skin cancer so that the diagnosis is delayed,” says Dr. Ronald Moy, president of the American Academy of Dermatology. Lighter skin and the total accumulation of sun exposure to the scalp pose the biggest risk factors. Using a zinc oxide or titanium oxide sunblock, such as Blue Lizard Australian Suncream or a sunscreen that absorbs both UV-A and UV-B rays—and reapplying every few hours—can reduce sun exposure and reduce risk. Balding individuals can easily apply sunscreen to their scalps, but those with hair find it trickier to protect the scalp without resorting to a greasy style. However, many hair-care manufacturers offer SPF products specially formulated to help protect scalps from the sun. Another good tip: change your part often so one area of the scalp is not consistently exposed to the sun. Of course, a hat offers the best protection against skin cancer of the scalp. Pay attention to the weave—the tighter the weave, the less exposure to damaging UV-A and UV-B rays.,0,4865693.story

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