Breast Cancer Screening: New Study Suggests Benefit of Early Mammograms

Breast Cancer Screening: New Study Suggests Benefit of Early Mammograms

Credit: Dreamstime

Whether women in their 40s benefit from getting mammograms to detect breast cancer is controversial, but a new study argues in favor of more frequent screening in this age group.

The researchers analyzed information from 7,301 women who were diagnosed with breast cancer at one Boston hospital between 1990 and 1999, and were followed until 2007.

Of the 609 women who died from breast cancer, 71 percent were women who had not undergone regular breast cancer screening, or were never screened, while 29 percent of those who died did undergo regular screening. [6 Foods That May Affect Breast Cancer Risk]

About half of those who died of breast cancer deaths were younger than 50, while only 13 percent of those who died were 70 or older (most deaths among older women were not related to their breast cancer).

The findings "suggest less, or less frequent screening at ages older than 69 years, but more, or more frequent screening for women younger than 50 years," the researchers wrote in their study published today (Sept. 9) in the journal Cancer. Breast cancer tends to be more aggressive in younger women, but less aggressive in older women, said Dr. Blake Cady, a professor emeritus of surgery at Harvard Medical School in Boston.

The study is the latest to weigh in on the debate over what age breast cancer screening should begin. In 2009, the U.S. Preventive Services Task Force changed its breast cancer screening guidelines, and recommended that women ages 50 to 74 receive a mammogram every two years. However, the American Cancer Society still recommends yearly mammograms beginning at age 40.

Some experts criticized the new study, pointing out that the researchers did not look at screening rates among women who survived.

The results show "only half the story," said Dr. H. Gilbert Welch, a professor of medicine at Dartmouth Institute for Health Policy Clinical Practice. "If, among women who live, 30 percent were screened and 70 percent were not, everyone would agree that screening had no effect," Welch said.

The study also did not take into account which cancer treatments patients received, which could have affected the risk of death from breast cancer. It was assumed that the best, standard of care treatments were used.

There have been concerns that screening women for breast cancer increases their risk of "overdiagnosis," that is, diagnosis of cancers that would not cause noticeable disease during women's lifetimes. A 2012 study found that up to 25 percent of women diagnosed with breast cancer through a mammogram were actually overdiagnosed.

Another study, conducted by Welch and colleagues, found that, while mammograms have increased detection of early-stage breast cancers, they have done little to reduce the risk of death from advanced stage breast cancer.

The Centers for Disease Control and Prevention recommends mammograms every two years for women ages 50 to 74. Women ages 40 to 49 should speak to their doctor about when and how often to undergo mammogram screening, the CDC says.

Follow Rachael Rettner @RachaelRettner. FollowLiveScience @livescience, Facebook  Google+. Original article on LiveScience.

E-Cigarettes As Safe and Effective As Nicotine Patches: Study

E-Cigarettes As Safe and Effective As Nicotine Patches: Study

E-Cigarettes As Safe and Effective As Nicotine Patches: Study

By Julie S | Sep 08, 2013 12:31 PM EDT

A new study compared e-cigarettes to nicotine patches to see if it is as safe and effective in helping smokers quit the habit.

Arguments of whether e-cigarettes could really help people quit smoking have been ongoing with some people being skeptic of its ability to make people drop real cigarettes and tobacco.

Chris Bullen, lead author of the study from New Zealand's University of Auckland, and his colleagues recruited 657 smokers who wanted to quit for the trial. These participants were divided into three groups: 292 were given e-cigarettes with 16mg of nicotine, 292 were handed nicotine patches, while the rest were provided e-cigarettes under placebo.

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The trial ran for 13 weeks wherein 5.7 percent of the participants eventually quitted smoking before the monitoring ended.

At the end of the trial, 7.3 percent of the e-cigarettes users stopped smoking while it was 5.8 percent for the nicotine patch users. Those under placebo had 4.1 percent.

The researchers admitted that there was no significant difference between the e-cigarette users and nicotine patch users in terms of helping people quit smoking. However, their study was able to prove that e-cigarettes are not that far from the effect that nicotine patches provide.

"While our results don't show any clear-cut differences... in terms of quit success after six months, it certainly seems that e-cigarettes were more effective in helping smokers who didn't quit to cut down," Bullen said in an interview with Reuters.

About 92 percent of the participants also commented that they prefer using e-cigarettes than the nicotine patches and will recommend it to their family and friends.

The researchers also looked at the cigarette consumption of the two groups and found that there was a better improvement on the e-cigarette users. About 57 percent of the e-cigarette users have reduced their cigarette consumption by 50 percent after six months while it was only 40 percent for the nicotine patch users.

“It’s not like this is a magic bullet,” Bullen told Bloomberg. “If you continue to smoke, obviously that’s not ideal, but it’s something that’s a stepping-stone toward quitting. We just have to be a little patient. They’ve been doing it for most of their lives, and it’s not surprising they find it incredibly hard.”

The study was published in the Lancet.

CDC: E-cigarette use doubles among children

CDC: E-cigarette use doubles among children

The percentage of middle and high school students who smoke electronic cigarettes more than doubled between 2011 and 2012, bringing to light questions about whether an item that is not currently regulated by the FDA and is touted as less harmful than conventional cigarettes may actually spur people to smoke the old-fashioned way.

In the first large-scale look at the use of electronic cigarettes â€" otherwise known as e-cigarettes â€" among children, the U.S. Centers for Disease Control polled 19,000 sixth through tweflth grade students in 2011, and another 25,000 students in the same age range in 2012.

Electronic cigarettes are battery-powered and deliver nicotine in aerosol form, and are touted by the companies who make them as a safer alternative to regular cigarettes. They began to appear on store shelves in 2006, but marketing of e-cigarettes has exploded in the last few years, according to the Associated Press.

The study, which was released by the CDC on Thursday, found that 10 percent of high school students said they'd smoked an e-cigarette in 2012, up from 4.7 percent in 2011. During the same time period, high school kids who reported smoking e-cigarettes within the last month rose to 2.8 percent from 1.5 percent in the previous year. E-cigarette use also doubled among middle school students between 2011 and 2012.

What's more, the researchers found that more than 76 percent of the middle and high school students surveyed who had used e-cigarettes within the last month had also smoked conventional cigarettes. When paired with the fact that 90 percent of adult smokers pick up the habit as teenagers, according to the CDC, officials worry that kids may be picking up an affinity for nicotine through e-cigarettes and then getting hooked on conventional cigarettes.

"The increased use of e-cigarettes by teens is deeply troubling," said Dr. Tom Frieden, director of the CDC, in a statement. "Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."

While e-cigarettes are not regulated by the FDA, the agency in 2011 announced its intent to regulate them as tobacco products rather than drug delivery devices, putting them in the same category as traditional cigarettes. More than 20 states have banned store sales of e-cigarettes to minors so far.

Further compounding the issue is the fact that e-cigarettes, unlike traditional cigarettes, can be advertised on television. The Public Health Cigarette Smoking Act of 1970 instilled stronger health warnings on cigarette packaging and banned TV ads for cigarettes, but e-cigarettes do not yet face that kind of regulation.

The World Health Organization has warned that the safety of e-cigarettes has not been scientifically demonstrated, and that "the testing of some of these products also suggests the presence of other toxic chemicals" and "there is no way for consumers to find out what is actually delivered by the product they have purchased."

A study released last month by France's National Consumer Institute found that, in testing the ingredients of 10 different models of e-cigarettes, they were "potentially carcinogenic" and could be as harmful as regular cigarettes because they contain about the same amount of formaldehyde. The country's health minister has said she intends to ban the use of e-cigarettes in public places and will restrict them among children under the age of 18.

With The Associated Press

E-cigarette use doubles among US teens

E-cigarette use doubles among US teens

Jenny McCarthy, former Playboy model and upcoming co-host of 'The View,' began doing ads in August 2013 for blu eCigs, an electronic cigarette in which users inhale a nicotine solution that's been heated into a vapor.(Photo: Courtesy of blu eCigs)

Story Highlights

• Nicotine-containing electronic cigarettes are gaining favor with U.S. teens
• This rising popularity raises concerns that kids could become addicted to tobacco
• The FDA is expected soon to announce plans to regulat e e-cigarettes

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Now chic among celebrities, electronic cigarettes are gaining favor among U.S. teenagers as new data show a recent doubling in usage.

Last year, 10% of high school students say they tried e-cigarettes, up from 4.7% in 2011, according to the National Youth Tobacco Survey released Thursday by the U.S. Centers for Disease Control and Prevention. A doubling also occurred among U.S. middle school students saying they've experimented with e-cigarettes â€" from 1.4% to 2.7% â€" a nd similar spikes in teen usage were found in the 2013 Florida Youth Tobacco Survey.

"The increased use of e-cigarettes by teens is deeply troubling," CDC Director Tom Frieden said in announcing the findings. "Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."

The CDC survey comes as the federal government is expected to announce, as early as October, its plan to regulate these battery-powered devices as tobacco products. E-cigarettes heat a solution containing nicotine, which is derived from tobacco leaves, into a vapor that users inhale. While they don't have the myriad chemicals of regular cigarettes, they still provide a nicotine kick.

"We don't yet understand the long-term effects of these novel tobacco products," Mitch Zeller, director of FDA's Center for Tobacco Products, said in a statement. He said the survey's findings reinforce why FDA plans to regulate the booming market of e-cigarettes, which each of the nation's top three tobacco companies have joined in the last 16 months.

The annual survey found that while most teens who say they've used e-cigarettes also report using regular cigarettes, one in five middle school students who've tried the former say they've never tried the latter.

"This indicates that e-cigarettes could be a gateway to nicotine addiction and use of other tobacco products," says Matt Myers, president of the Campaign for Tobacco-Free Kids. He blames this upswing on slick new marketing, which enlists celebrities including Jenny McCarthy, Stephen Dorff and Courtney Love for the pitches.

"These ads portray e-cigarette use as an act of rebellion, much like cigarette ads have done," Myers says, adding they undercut efforts to de-glamorize smoking to kids. He also says the sweet flavors of some e-cigarettes, such as chocolate an d "cherry crush," lure youth.

The survey finds more teens aren't just trying e-cigarettes once. Last year, 2.8% of high school students said they used them within the past 30 days, up from 1.5% in 2011. For middle school students, such usage rose from 0.6% to 1.1% during the same period.

The Florida survey, done by the state's health department, provides similar but more recent data. This year, it found that 5.4% of the state's high school students say they used e-cigarettes within the past month, up from 3.1% in 2011. It found that 12.1% of these students now say they've tried e-cigarettes at least once, up from 6.0% in 2011.

The e-cigarette industry says its product helps adult smokers kick the habit and is not aimed at kids. Altria, the parent company of Philip Morris, the nation's largest tobacco company, says it won't sell its new e-cigarette â€" the Mark-Ten, which debuted last month â€" to minors. R.J. Reynold s, the second-largest tobacco company, says its newly revamped VUSE product is also targeted only at adults.

"We're for responsible regulation," including a ban on sales to kids, says Thomas Kiklas of the Tobacco Vapor Electronic Cigarette Association, an industry group.

More states, including Indiana and Mississippi, have banned the sale of e-cigarettes to minors, and others are seeking to tax the devices or extend indoor smoking restrictions to them.

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FDA tests find very low levels of arsenic in rice

FDA tests find very low levels of arsenic in rice

Low levels of arsenic were found in FDA testing of rice and rice products.(Photo: Jupiterimages, Brand X)

Story Highlights

• FDA tests more than 1,300 samples of rice and rice products
• Arsenic occurs naturally in soil, but most crops don't absorb it
• Brown rice has highest average levels

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In tests for arsenic in more than 1,300 samples of rice and rice products, the Food and Drug Administration has found levels vary but overall are far too low to cause any immediate or short-term adverse health effects.

The results, out Friday, represent the first time FDA has released broad numbers on arsenic's presence in rice products. The findings show the highest average levels in brown rice, the lowest in rice wine. The brown rice had 160 parts per billion inorganic ar senic per serving, infant rice cereal 120 and rice wine 11.

Arsenic comes in two chemical forms, organic and inorganic. Inorganic arsenic is more common. It occurs in rocks and is a known human carcinogen. Organic arsenic is considered harmless.

The Environmental Protection Agency has set arsenic limits for drinking water at 10 parts per billion, by comparison. Officials note that Americans drink much more water than they eat rice. Except for apple juice, federal agencies have not yet detailed safe limits in other foods.

LIST: Inorganic arsenic levels in rice and rice products

"All of the data suggest levels that are not high enough to give us cause for concern for immediate or near-term effects," said FDA commissioner Margaret Hamburg.

The arsenic accumulates in the hull, the outer portion of the rice, "so the more highly you refine and polish rice, the more arsenic is reduced," said Donald Zink, an FDA senior science adviser.

Last year the magazine Consumer Reports called for the FDA to set limits for acceptable arsenic content in rice after it found levels potentially above what some consider safe.The magazine editors are very pleased that the FDA has released the new numbers, said Urvashi Rangan, director of consumer safety for Consumers Union, the policy division of Consumer Reports, based in Yonkers, N.Y. "It's an important step that needed to be taken to deal with a food product that's particularly prone to taking up arsenic," she said.

The most important point for consumers is that they should diversify the grains they eat, she said. That's especially the case with young children, who are often given rice-based cereals as their first solid food. "Infants do not need to eat rice cereal every single day, there are many different grains to chose from," Rangan said.

If the extremely low levels of arsenic found in rice were a problem, health effects might be seen worldwide, said Deborah Willenborg, spokeswoman for the USA Rice Federation, a rice trade group based in Washington, D.C. Americans eat on average 25 pounds of rice per person per year, compared with 210 pounds in China and 365 pounds in Vietnam.

"FDA has provided American consumers with renewed assurances that there is no need to change a well-balanced diet that includes rice, which it notes is a life-long dietary staple for many people," Willenborg said.

"Arsenic levels found in rice represent no immediate health concern. FDA has said in their most recent statement that arsenic levels in rice are too low to cause any immediate or short-term adverse health effects. There are no reported instances of illness nor are there any scientific studies that directly connect inorgani c arsenic in food in general, nor rice specifically, to adverse human health effects," Willenborg said.

Arsenic occurs naturally in soil worldwide. Most crops don't take it up. However, rice is grown in flooded fields. That changes the soil chemistry, releasing arsenic locked up in soil minerals so it can be taken up by the rice's roots. The amount of arsenic in rice varies by local conditions. In the USA, California rice has lower arsenic levels than rice from Texas and Arkansas.

"Nobody wants arsenic, period," Hamburg said. "But it's a fact of life, it's in soil."

The agency is currently conducting a risk assessment that will consider how much rice and rice products Americans eat and whether there is any possible danger due to long-term exposure at the very low levels of arsenic found in these food items, said Michael Taylor, the agency's deputy commissioner for foods.

The United States is at the forefront of the issue. The results published Friday are the largest data set yet compiled on arsenic in rice products, Hamburg said.

Hamburg and Taylor met with rice growers and researchers in California's Sacramento delta earlier this week to better understand the issues faced by growers. "There's no magic wand to reducing these levels but there's a lot of collaboration looking at ways to possibly reduce arsenic levels through growing and processing practices," Taylor said.

Arsenic levels don't appear to be rising in rice. Zink said his team analyzed rice samples that were decades old "and they were identical to what we were seeing in modern samples."

However, Rangan said humans may be compounding the problem in areas where chicken manure is used as a fertilizer. "The chickens are fed the organic version of arsenic, for growth promotion and disease protection. It passes out as manure which is used as a fertilizer." Whether this increases levels in rice isn't known.

Chicken producers disputed the clai m. Some chickens raised for meat used to be given feed that contained a product called Roxarsone, which included safe levels of organic arsenic, said Thomas Super, vice president for communications with the National Chicken Council in Washington D.C.

"Even though the science shows that such low levels of arsenic do not harm chickens or the people eating them, this product was removed from the market in 2011 and it is no longer used in raising broilers in the United States. No other products containing arsenic are currently used in broiler meat production in the U.S." he said.

If FDA decides that arsenic levels in rice are of concern, it may consider proposing limits, such as an action level, which is a level that it considers to be protective of public health. FDA would consider such an action level, in addition to other factors, when considering whether to bring enforcement action in a particular case. This summer the agency set an action level for arsenic in a pple juice of 10 parts per billion.

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Electronic cigarettes growing in popularity with teens

Electronic cigarettes growing in popularity with teens

The sharp increase has public health experts worried. Electronic cigarettes contain the addictive chemical nicotine and traces of cancer-causing compounds called nitrosamines. The safety profile of the devices has not been fully studied, according to warnings from the Food and Drug Administration.

In addition, e-cigarettes are sold with cartridges that give them enticing flavors such as mint or chocolate, and health advocates fear they have the potential to turn teens on to regular cigarettes.

"The increased use of e-cigarettes by teens is deeply troubling," Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, said in a statement. "Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."

The new study, published in Friday's edition of the CDC's Morbidity and Mortality Weekly Report, is based on data from the National Youth Tobacco Survey. It found that 1.1% of students in grades 6 through 8 were using e-cigarettes at least once a month, as were 2.8% of students in grades 9 to 12.

Among these regular e-cigarette users, 76.3% also smoked traditional cigarettes. But the report's authors â€" from the FDA's Center for Tobacco Products and the CDC's Office on Smoking and Health â€" expressed particular concern about students who had used e-cigarettes but had not yet tried conventional cigarettes. The researchers estimated that 160,000 students across the country fell into that category.

"The risk for nicotine addiction and initiation of the use of conventional cigarettes or other tobacco products" among these students is a "serious concern," they wrote.

Cigarette smoking is responsible for more than 440,000 deaths each year, including 49,400 due to secondhand smoke, according to the CDC. Tobacco use is the No. 1 cause of preventable death in the U.S., and it contributes to cancers of the lung and other organs, cardiovascular disease and respiratory ailments.

Electronic cigarettes are not regulated by the FDA, though the agency has said it plans to bring them under its jurisdiction.

The American Lung Assn. has been a consistent advocate for FDA regulation of e-cigarettes.

"When you see cotton candy, bubble gum and atomic fireball flavors, there's no question these products are being marketed directly at kids," said Erika Sward, the group's vice president for national advocacy. "I think this data really shows our concerns are real."

E-cigarette manufacturers insist that they are not marketing the devices to minors.

Tom Kiklas, the chief financial officer of the Tobacco Vapor Electronic Cigarette Assn., said a federal appeals court ruled in 2010 that e-cigarettes were not medical devices and should instead be considered tobacco products. As such, their sale to minors is prohibited by law, and it's the responsibility of retailers to ensure that buyers are of legal age, he said.

"Kids aren't supposed to be buying any tobacco product," Kiklas said.

The American Thoracic Society, like the American Lung Assn., has criticized e-cigarette manufacturers for marketing their products as a means to help people quit smoking.

"These products are not approved by the FDA as smoking cessation devices," said society spokesman Gary Ewart.

If the FDA intends to restrict access to e-cigarettes before they take off with consumers, it's probably too late. One tobacco industry analyst from Wells Fargo Securities predicts Americans will spend $1.7 billion on e-cigarettes this year.

That means public health authorities should get busy, according to the authors of the new study.

"Given the rapid increase in use and youths' susceptibility to social and environmental influences to use tobacco, developing strategies to prevent marketing, sales, and use of e-cigarettes among youths is critical," they wrote.

karen.kaplan@latimes.com

monte.morin@latimes.com

Number of US students who've tried e-cigarettes has doubled, CDC says

Number of US students who've tried e-cigarettes has doubled, CDC says

3 hours ago

The percentage of U.S. high school students who say they have tried e-cigarettes has doubled in the past year to 10 percent, government researchers reported Thursday.

They say it’s a troubling trend as no one knows yet how safe e-cigarettes are, although they are often marketed as a safer alternative to regular cigarettes.

“E-cigarette experimentation and recent use doubled among U.S. middle and high school students during 2011â€"2012, resulting in an estimated 1.78 million students having ever used e-cigarettes as of 2012,” researchers at the Centers for Disease Control and Prevention and the Food and Drug Administration wrote in a report.

“Moreover, in 2012, an estimated 160,000 students who reported ever using e-cigarettes had never used conventional cigarettes. This is a serious concern because the overall impact of e-cigarette use on public health remains uncertain.”

While the numbers of kids smoking e-cigarettes aren’t huge yet, the fact that they are doubling so quickly is a bad sign, said Dr. Tim McAfee, director of the CDC Office on Smoking and Health. 

“I think the thing of most concern is the trend,” McAfee told NBC News. “There aren’t many things where we see a doubling in one year. We are not talking about adults here. The absolute numbers in middle school are small but they are doubling. We think it is something we need to get ahead of.”

And, health experts say, tobacco companies are obviously marketing e-cigarettes to young people. “With flavors like bubble gum and cotton candy, e-cigarettes are very clearly being made and marketed in ways that appeal to children,” said Paul Billings of the American Lung Association.

“These data show the urgent need for oversight of these products,” Billings added the FDA doesn’t regulate e-cigarettes but wants to.

CRACKDOWN LOOMING ON E-CIGARETTES

Just 2.8 percent of high school students say they’ve used e-cigarettes in the past 30 days, which suggests many are experimenting but not smoking them steadily - yet. "Nicotine is a highly addictive drug,” says CDC director Dr. Tom Frieden.

E-cigarettes are pencil-shaped devices that use a cartridge to deliver an aerosol mist containing nicotine with flavorings. It’s propelled by propylene glycol or glycerol. “Potentially harmful constituents also have been documented in some e-cigarette cartridges, including irritants, genotoxins (which can damage DNA), and animal carcinogens,” FDA say s in a statement on its website. 

They are pricey - an e-cigarette product ranges from $10 to $120, depending on how many charges it provides. And there are dozens, if not hundreds, of brands. 

CDC and FDA researchers looked at answers from the 2011 and 2012 National Youth Tobacco Survey, a pencil-and-paper question­naire given to students in grades 6-12 at their schools.

The data show that 76.3 percent of middle and high school students who used e-cigarettes within the past 30 days also smoked conventional cigarettes in the same time. And about 20 percent of the middle school students who had tried e-cigarettes said they have never tried conventional cigarettes.

The researchers worry that e-cigarettes might act as a gateway to conventional tobacco products. “About 90 percent of all smokers begin smoking as teenagers,” said McAfee. “We now have young movie stars being paid to appear in ads on television for the first time in 40 years do ing something that looks to all intents and purposes like smoking.”

McAfee fears the promotion may undo years of work marginalizing smoking, banning it from workplaces and restaurants and making it an unpopular habit.

Nicotine itself may also be harmful, McAfee added. “We are particularly concerned about adolescents being exposed to nicotine in any form because it has the potential to impact their brain development,” he said.

About 20 percent of Americans smoke, down from 40 percent in the 1960s. About 18 percent of high school students have smoked one or more cigarettes in the past month. Earlier this year the CDC reported the number of adults who have tried e-cigarettes has also doubled, to 21 percent, in the past year.

SALES OF E-CIGARETTES ON THE RISE

CDC says cigaret te smoking is the leading preventable cause of dis­ease, dis­ability, and death in the United States, killing 443,000 people a year. 

Video: There are reports the FDA may be cracking down on the booming, but unregulated, e-cigarette market, including a ban on television ads. Dr. Robert Lahita, chief of medicine at Newark Beth Israel Medical Center discusses.

Video: Sales of electronic cigarettes, a smoking alternative, are expected to double this year. But are they really a healthier cigarette alternative? NBC’s Erica Hill reports and NBC’s Dr. Nancy Snyderman discusses the health claims.