[Oradlist] July 16, 2008: Past X-Rays May Increase Risk Of Prostate Cancer (fwd)
Gibbs, S Julian
s.julian.gibbs at vanderbilt.edu
Wed Jul 16 10:08:12 PDT 2008
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Date: Wednesday, July 16, 2008 7:23 AM -0400
From: Radiological Society of North America
<DailyScan at rsna.custombriefings.com>
To: j.gibbs at vanderbilt.edu
Subject: July 16, 2008: Past X-Rays May Increase Risk Of Prostate
Cancer
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The Daily Scan
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Customized Briefing for Samuel GibbsJuly 16, 2008
Leading the News Clinical Practice Medical-Legal Issues Research
Practice Management Quality and Safety Newsmakers
Leading the News
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Past diagnostic radiation procedures could increase risk of
young-onset prostate cancer, study suggests.
The UPI (7/16) reports that research published in the British
Journal of Cancer suggests that "there's an association between
some past diagnostic radiation procedures and an increased risk of
young-onset prostate cancer." The study "showed that men who had a
hip or pelvic X-ray or barium enema 10 years previously were 2 1/2
times more likely to develop prostate cancer than the general
population." This correlation "appeared to be stronger in men who
had a family history of prostate cancer." The study included 431
men who had been diagnosed with young onset prostate cancer.
Procedures considered "included hip and leg X-rays and barium meals
and enemas used to diagnose problems with the digestive system
[that] were performed five, 10, or 20 years before the prostate
diagnosis."
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Clinical Practice
Imaging technique may allow physicians to see prostate cancer
metastases via PET scan.
In continuing coverage from Monday's edition of the Daily Scan,
HealthDay (7/15) reported that a study published in the July 11
edition of Nature Medicine describes a "new imaging technique,
based on an engineered version of the common cold virus, [which]
may help doctors detect the spread of prostate cancer to the lymph
nodes earlier." Researchers at UCLA's Jonsson Cancer Center
"engineered a common cold virus armed with a specific 'genetic
payload' to travel directly to lymph nodes in mice and to express
its payload only in prostate cells." The payload is "a protein that
can be picked up on PET scans," which could allow physicians to
find prostate cancer metastases in the pelvic lymph nodes early.
HealthDay noted that this is currently "supremely difficult to do
with conventional imaging techniques." The researchers "next want
to combine the imaging technique with treatment, so that a drug
contained in the genetic payload could kill the traveling tumor
cells."
"Halo signs" common in patients following RFA of kidney tumors,
research suggests.
Renal and Urology News (7/15, Schieszer) reported that researchers
at the University of Toronto (UT) have noticed a "halo sign" in
patients following radiofrequency ablation (RFA) of kidney tumors.
The phenomenon is "a common delayed finding" following RFA,
according to researchers. Principal investigator John Kachura,
M.D., assistant professor in the department of medical imaging at
UT, said, "By halo sign, we mean a ring-like area of soft tissue
that does not enhance, which is surrounded by fat on either side."
The 33 patients with kidney tumors treated with RFA chosen for the
study "had imaging follow-up with triphasic CT. Typical CT
follow-up was performed four weeks after ablation and then every
four to six months thereafter." The researchers found "halo signs,
consisting of curvilinear soft tissue attenuation in perinephric
fat,...around 16 ablation zones (43 percent). They were first
identified at a mean of 11 months post ablation." Dr. Kachura noted
that "he believes the halo sign is benign," but that the study is
significant "because we need to know what to expect when we follow
these patients."
Medical-Legal Issues
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Congress overrides veto of Medicare bill.
In continuing coverage from previous editions of the Daily Scan,
the Los Angeles Times (7/16, Gaouette) reports that "Congress
delivered a stern rebuke to President Bush on Tuesday, overriding
his veto of a Medicare bill and preventing pay cuts to doctors who
treat seniors, the disabled, and military personnel." The measure
"halts a scheduled 10.6 percent cut in payments to physicians, and
institutes a 1.1 percent payment increase in 2009." Still, even
though he had "little chance of prevailing, Bush issued the veto
[Tuesday] morning, declaring the bill 'objectionable,'" and
"fiscally irresponsible."
According to the New York Times (7/16, A13, Pear), "In his
veto message, Mr. Bush said he objected to the bill because it
would cut federal payments to Medicare Advantage plans and slow the
growth of such plans, offered by insurance companies as an
alternative to traditional Medicare." President Bush added, "I
support the primary objective of this legislation, to forestall
reductions in physician payments," although "taking choices away
from seniors to pay physicians is wrong."
Just hours after the veto, the "House voted 383 to 41 to
override" it, "while the Senate voted 70 to 26, in both cases far
more than the two-thirds necessary to block the President's
action," the Washington Post (7/16, A2, Abramowitz, Kane) adds.
During the votes, "Republicans broke heavily from the White House.
A total of 153 House Republicans voted to defy the White House, 24
more than in a June 24 vote that started the momentum toward
passage of the Medicare doctors' bill" on Tuesday. Furthermore, "21
Senate Republicans voted for the bill this time, including four
senators who had voted 'nay' in the two previous Medicare votes."
The Wall Street Journal (7/16, A6, Mathews) calls the law
"a win for doctors, among other lobbying interests, largely at the
expense of health insurers," which "will face cutbacks to the
Medicare" Advantage plans they offer. The AP (7/16, Freking),
Bloomberg (7/16, Marcus), Minnesota's Star Tribune (7/16),
Congressional Quarterly (7/16, Armstrong), The Hill (7/16, Young),
the Washington Times (7/16, Ward), MedPage Today (7/15, Walker),
Modern Healthcare (7/15, Lubell), and CNN (7/15) also covered the
story.
Research
Study suggests early onset breast cancer may differ from disease in
women aged 65 and older.
MedWire (7/15, Czyzewski) reported that "[y]oung women with breast
cancer have larger tumors with higher levels of estrogen receptor
(ER) β expression and more involved lymph nodes than older breast
cancer patients," according to a study published in the Journal of
Clinical Oncology. U.S. researchers "recruited 784 breast cancer
patients aged between 33 and 93 years, and looked for age-specific
differences in prognosis, clinicopathologic variables, and gene
expression patterns, 'thus combining traditional prognostic
variables with phenotypes.'" The researchers found that "[c]ompared
with women aged ≥65 years, those aged ≤45 years had, on
average, more tumors larger than two cm in diameter, more positive
lymph nodes, higher ER-β expression, and higher epidermal growth
factor receptor expression." In addition, "among women aged
≤45 years, all these factors were associated with worse
disease-free survival with HRs [hazard ratios] of 1.97, 1.60, 1.41,
and 1.24, respectively." The authors "also found 367 genes, which
were either up- or down-regulated in women aged ≤45 years
relative to their expression in women aged ≥65 years."
Breast self-exams may not increase survival, study suggests.
NBC Nightly News (7/15, story 7, 2:25, Williams) reported that a
new study has raised the possibility that "breast self-exams for
women don't work." As a result, some health groups may "recommend
against advising women to carry out regular breast
self-examinations to check for possible breast cancer."
The BBC (7/15) reported that "there is no evidence that
rigorous monthly 'self-examination' reduce[s] breast cancer deaths,
and it can lead to unnecessary biopsies," according to a study
published in The Cochrane Library. Researchers analyzed "all the
available evidence on the success of self-examination programs,
principally two large studies of a total of 388,535 women in Russia
and China, half of whom self-examined, while the other half did
not." The authors found that the "death rates from breast cancer
were the same in both groups, while there were almost twice the
number of biopsy operations...in the self-examination group."
WebMD (7/15, Hitti) added that for the study, some
participants "were trained to do breast self-exams. They also got
regular reminders or refresher classes to make sure their technique
was correct." The subjects were followed for 10 years, during which
time "587 women died of breast cancer, with similar numbers of
deaths in the breast self-exam group (292 breast cancer deaths),
and in the group of women who weren't trained to do breast
self-exams (295 breast cancer deaths)." WebMD noted that while the
findings do not "support breast-self-exams," they "urge women to be
aware of -- and seek prompt medical assessment of -- any breast
changes."
Practice Management
CMS to pay some physicians PQRI bonuses.
Modern Healthcare (7/15, DoBias) reported that just over "half of
the healthcare professionals who participated in a Medicare
pay-for-reporting initiative will receive a bonus this year, with
average payments tallied at $600 per individual, and more than
$4,700 for group practices." The Centers for Medicare and Medicaid
(CMS) "said it would pay out more than $36 million to 56,700 health
professionals, or 52 percent, of the 109,000 who participated in
the Physician Quality Reporting Initiative (PQRI) in 2007." CMS
noted that the PQRI payments "are a first step toward improving how
Medicare pays for healthcare services."
Quality and Safety
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FDA says CT scans can cause some electronic medical devices to
malfunction.
In continuing coverage from Tuesday's edition of the Daily Scan,
Medscape (7/15, Waknine) reported that "Direct X-ray exposure from
computed tomography (CT) may cause some implanted and external
electronic medical devices to malfunction," according to a
preliminary public health notification from the Food and Drug
Administration (FDA). While "most patients undergo CT with no
adverse effects, a small number of patients have reported
interference with devices such as pacemakers, defibrillators,
neurostimulators, and implanted or externally worn drug infusion
pumps." The agency said that "[t]he reported malfunctions differ
from those caused by the strong electric and magnetic fields in
magnetic resonance imaging." The FDA's notification said, "For CT
procedures that require scanning over the medical device
continuously for more than a few seconds, as with CT perfusion or
interventional exams, attending staff should be ready to take
emergency measures to treat adverse reactions if they occur."
Newsmakers
Increase in HMO premiums expected to outpace inflation in 2009,
analysis indicates.
The Atlanta Business Chronicle (7/15) reported that national "HMO
premium rates are expected to increase 11.8 percent in 2009," which
is "on track to outpace inflation and underlying healthcare
trends," according to an analysis by Hewitt Associates, a global
human resources consulting and outsourcing company. "HMO premium
rates for the Southeast are expected to rise 15.4 percent in 2009
-- the highest rate increase of any region in the United States."
In response to the findings, Jeff Smith, a senior consultant and
co-leader of Hewitt's HMO rate analysis project, expects "more
companies [to] move away from traditional employer strategies, such
as employee costshifting, toward more aggressive and innovative
steps that not only help mitigate healthcare costs, but also keep
more money in employees' pockets."
Light Sciences raises $40 million to continue to develop its light
infusion therapy.
The Seattle Post-Intelligencer (7/16, Tartakoff) reports that Light
Sciences Oncology Inc. "raised $40 million, enough to fund the
company until it is able to ask the Food and Drug Administration to
approve its technology's use in patients with two types of cancer."
The funding will help the company continue to develop its light
infusion therapy, which "uses light-emitting diodes to activate a
drug that can kill cancer tissue with minimal side effects. The
technology is in late-stage trials in patients with hepatocellular
carcinoma and metastatic colorectal cancer."
Seattle's Puget Sound Business Journal (7/15) added that
the technology "is aimed at patients with hepatocellular carcinoma,
metastatic colorectal cancer, glioblastoma multiforme (brain
cancer), and benign prostatic hyperplasia." The Seattle Times
(7/16, González) also covers the story.
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S. Julian Gibbs, DDS, PhD Voice: 615-322-1477
Professor, Emeritus
Dept. of Radiology & Radiological Sciences
Vanderbilt University Medical Center Home: 615-356-3615
209 Oxford House Email:s.julian.gibbs at vanderbilt.edu
Nashville TN 37232-4245 or alias:j.gibbs at vanderbilt.edu
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