Estudio: Colonoscopia reduce riesgo de muerte por cáncer de colon

LOS ANGELES (AP) — Millones de personas se han sometido a una colonoscopia, pues creen que el temido examen puede ayudar a evitar que mueran de cáncer de colon. Por primera vez, un importante estudio ofrece evidencia clara de que lo hace.

Eliminar tumores precancerosos detectados durante la prueba puede reducir a la mitad el riesgo de morir de cáncer de colon, sugiere el estudio. Los médicos lo daban por sentado desde hacía mucho tiempo, pero la investigación no había demostrado antes que la extirpación de pólipos mejore la supervivencia, la medida clave de que vale la pena cualquier detección de cáncer.

Algunas personas evitan la prueba debido a los desagradables pasos necesarios para prepararse para ella.

"Claro, es un fastidio. La gente se me queja todo el tiempo: 'Es horrible. Es terrible''', dijo el doctor Sidney Winawer, un gastroenterólogo en el Centro de Cáncer Memorial Sloan-Kettering en Nueva York, quien ayudó a dirigir el estudio. "Pero mira la alternativa".

Un segundo estudio en Europa encontró que las colonoscopias fueron mejores detectoras de pólipos que otras herramientas comunes de evaluación, como los análisis de materia fecal. Ambos estudios fueron publicados en el New England Journal of Medicine.

El cáncer colorrectal es la segunda causa de muerte por cáncer en Estados Unidos y la cuarta en el mundo.

Las muertes por cáncer colorrectal han ido disminuyendo desde hace más de dos décadas, sobre todo debido a la detección, incluyendo colonoscopias y otras pruebas, asegura la organización. Las personas de riesgo promedio de cáncer de colon en edades de 50 a 75 años deben ser examinados, pero apenas cerca de la mitad se someten a estudios en Estados Unidos.

Un panel de expertos designado por el gobierno recomienda usar uno de tres métodos: pruebas anuales de sangre en materia fecal; una sigmoidoscopia (examen de la parte inferior del intestino) cada cinco años, además de análisis de materia fecal cada tres años; o una colonoscopia cada 10 años.

En una colonoscopia, un tubo delgado y flexible con una cámara diminuta es guiado a través del intestino grueso. Los tumores pueden ser cortados y revisados en busca de cáncer. Los pacientes están sedados, pero a muchos les aterra la prueba, ya que requiere que los pacientes se alimenten con una dieta especial y beban soluciones la víspera para limpiar el intestino. Por lo general, cuesta más de 1.000 dólares, en comparación con un análisis de materia fecal que cuesta 20 dólares.

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Governor of Virginia Shifts Position on Abortion Bill

The bill had drawn intense national attention in recent days, with a large protest by women’s health groups over the weekend and spoofs on left-leaning television shows.

In a political year that was suppposed to be all about the economy, this was the second instance in a month in which a public outcry  organized in part by women’s health advocates through social media caused a reversal on the issue of abortion. 

The governor’s decision not to support the bill capped several days of brinkmanship in which opponents of the measure lobbied furiously against it, galvanizing opposition by drawing on the image of male lawmakers mandating a procedure that requires inserting a probe into the vagina. One Democrat was prompted to denounce it as a “rape” bill.

Opponents presented what they said were 33,000 signatures protesting the measure. At the same time, the mostly Republican supporters in the legislature kept putting off debate on the measure, raising suspicions that the governor might be balking.

Finally, on Wednesday afternoon, Mr. McDonnell, a rising star in the Republican Party who is often talked about as a candidate for vice president, told Republican delegates to make changes that softened the requirements in the legislation. Some political analysts speculated that the decision was made with an eye to a broader national audience that might not look favorably on the passage of such a conservative bill.

This month the Susan G. Komen for the Cure foundation yielded to pressure by affiliates and women’s rights advocates and reversed its decision to largely end decades of partnership with Planned Parenthood.

In Virginia, in a written statement issued minutes before the House of Delegates was to debate the bill on Wednesday afternoon, Mr. McDonnell said that after discussion with doctors, lawyers and legislators, he had concluded that amendments were needed. He called for changes stipulating that the ultrasound be abdominal rather than vaginal. A doctor would be required to offer the next level of ultrasound, most often vaginal, but a woman would be free to reject it.

“Mandating an invasive procedure in order to give informed consent is not a proper role for the state,” the governor said in the statement.

The Family Foundation, a strong backer of the ultrasound bill, made reference to the Komen decision in a note to supporters blasting Mr. McDonnell’s reversal, saying that it was “extremely disappointed in this outcome,” particularly, it said, “given the strong pro-life credentials of this governor.”

The change — which passed the House in a vote of 65 to 32 — softens the bill considerably, but did not abolish the requirement that women have an ultrasound. If it is signed into law, Virginia would become the 10th state to require such procedures, though the requirement has been stayed by court rulings in two states, Oklahoma and North Carolina.

Specifically, the bill’s new wording would require a doctor to offer the woman a different type of ultrasound if the fetus is not viewable through an abdominal screening, but not require her to have one.

That opponents of the bill were successful in getting the language softened was a major success for them, particularly considering that vaginal ultrasounds are often administered before abortions anyway. A spokeswoman for Planned Parenthood said the group routinely includes ultrasounds “as part of the thorough medical practice of abortion care,” and gives the woman the option of viewing the image. But the group said a legal requirement that women undergo such a screening was politically motivated and “is the very definition of government intrusion.”

Erik Eckholm and Jennifer Preston contributed reporting.

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National Briefing | South: Virginia: Ex-Lacrosse Player Convicted in Killing of His Former Girlfriend

The beliefs of a Catholic media network have put it at odds with the Obama administration.

Room for Debate asks: What is missing from this sprawling legislation, and what should be cut?

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Hispanic Americans Born Outside Country Have Fewer Strokes

TUESDAY, Feb. 21 (HealthDay News) -- Hispanic Americans who were born in another country are less likely to have a stroke than white Americans, a new study finds.

It included 1,424 Hispanics and 14,360 whites over age 50 (average age 66) who had no history of stroke when they were enrolled in 1998. They were followed until 2008.

During the follow-up period, 1,388 of the participants suffered a first stroke. After accounting for socioeconomic factors, the researchers concluded that foreign-born Hispanics -- those who immigrated to the United States after age 6 -- were 42 percent less likely than whites to have a first stroke.

There was no difference in risk between Hispanics born in the United States and whites.

The study appears in the journal Stroke and will be presented at the American Academy of Neurology (AAN) annual meeting, to be held in New Orleans from April 21-28.

"Hispanics are the fastest-growing ethnic group in the U.S. and more research is needed to understand why they might have lower stroke risk than non-Hispanic whites," study author J. Robin Moon, at the Harvard School of Public Health in Boston, said in an AAN news release.

"This protective effect does not extend to Hispanics born in the U.S., who have stroke risk similar to non-Hispanic whites with similar education and financial resources," Moon added. "Future research should address what could explain this pattern. We are interested in differences in childhood conditions that might shape adult risk factors, for example diet, social or family connections, physical activity and health behaviors."

Learning more might help researchers find ways to reduce stroke risk for everyone, Moon said.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about stroke risk and prevention.

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FDA Moves to Head Off Shortages of 2 Cancer Drugs

TUESDAY, Feb. 21 (HealthDay News) -- The U.S. Food and Drug Administration announced Tuesday what it called a series of steps to ensure the continued availability of vital cancer drugs that have been in dangerously short supply.

One of the drugs, methotrexate, is used in combination with other drugs to combat -- and in many cases cure -- acute lymphoblastic leukemia (ALL), the most common type of cancer in children. It typically strikes kids aged 2 to 5.

And another drug, Lipodox, will be temporarily imported from a pharmaceutical company in India to ease a shortage of the chemotherapy drug Doxil (doxorubicin), which is used to treat ovarian cancer, multiple myeloma and AIDS-related Kaposi's sarcoma. Lipodox is similar in chemical makeup to Doxil; there are no generic versions of Doxil.

"Through the collaborative work of [the] FDA, industry and other stakeholders, patients and families waiting for these products or anxious about their availability should now be able to get the medication they need," FDA Commissioner Dr. Margaret A. Hamburg said in a news release.

The FDA also said it was issuing guidelines to the drug industry that spell out detailed requirements for "both mandatory and voluntary notifications" to the agency of potential problems that could result in a drug shortage or supply disruption.

Methotrexate is a cornerstone in the treatment of children with acute lymphoblastic leukemia. In high doses, the generic drug has been successful in curing patients and beneficial in preventing recurrence. Without the drug, a patient's chance for a cure is reduced while the risk of recurrence rises, oncologists said.

Some cancer doctors had warned last week that supplies of methotrexate could be exhausted within two weeks.

To offset the shortage of methotrexate, the FDA said Tuesday that it has worked with several drug manufacturers to help maintain supplies to meet all patient needs. Preservative-free methotrexate is needed for the intrathecal (injection into the fluid surrounding the brain and spinal cord) treatment of children with ALL, the agency said.

The FDA said the steps taken with methotrexate included approving a preservative-free version of the generic drug manufactured by APP Pharmaceuticals, of Schaumburg, Ill. Those supplies should become available in March and continue indefinitely, the agency said.

Second, Illinois-based Hospira Inc., which already manufactures methotrexate, has sped up additional supplies, producing 31,000 new vials of the drug -- enough for more than one month's supply. Those additional vials are being shipped Tuesday to hundreds of U.S. hospitals and treatment centers, the FDA said.

The FDA also noted that it continues to work with other manufacturers of methotrexate that have also stepped up production. Those manufacturers include Mylan Inc., of Canonsburg, Pa., and Sandoz US Inc., of Princeton, N.J.

At a midday news conference Tuesday, one of the speakers was Sara Stuckey, mother of 6-year-old Nate Stuckey, who has been on methotrexate since he was diagnosed with ALL in 2009.

"It is hard enough to hear your child has cancer, but to hear that the treatment that is successfully working is suddenly not available is devastating," she said. "My husband and I pray the recommended drugs to fight his cancer will be available when it's time for Nate's next treatment. And we hope that in the future no more families have to go through the stress of wondering whether proven, lifesaving treatments will be out of reach when they need it the most."

Speaking at the news conference, Hamburg said: "There are too many families like the Stuckeys who worry they won't have the medication they need for their next treatment and are understandably anxious about switching to a medication that may have more side effects or may be less effective. Clearly this is not acceptable."

"We are making progress," Hamburg added. "There were 195 drug shortages prevented in 2011 and 114 drug shortages prevented since October 2011 when we made the call for early notification" of potential shortages.

As for the ovarian cancer drug Lipodox, the FDA said it will allow the temporary importation of the drug made by Sun Pharma Global FZE. The agency said in its news release that "temporary importation of unapproved foreign drugs is considered only in rare cases when there is a shortage of an approved drug that is critical to patients and the shortage cannot be resolved in a timely fashion with FDA-approved drugs."

The shortages of methotrexate and Doxil are just the latest in a series of drug shortages that have existed for several years.

In 2011, prescription drug shortages in the United States hit an all-time high. Last fall, some 200 drug shortages had been reported, compared to 178 in all of 2010, the FDA reported.

Many of the scarce drugs are injectables, such as cytarabine and cisplatin, used to treat serious conditions such as cancer. Some are only given in hospitals and are "absolutely critical," Valerie Jensen, associate director of the FDA's drug shortage program, said during a news conference last September.

More than half (54 percent) of shortages in 2010 were due to quality issues, such as drug impurities. Some were caused by delays or manufacturing capacity problems, while 11 percent were caused by discontinuation of a drug and 5 percent resulted from raw material shortages, Jensen said.

Jensen also said the shortages tend to occur in drugs that aren't "economically attractive." This could mean that only one company produces the drug, making it harder to find alternatives if the supply dries up.

A lot of the problems are tied to generic drugs, health experts explained, because few manufacturers make them and profit margins aren't as high as for brand-name drugs still under patent protection.

On Oct. 31, 2011, President Barack Obama signed an executive order designed to help ease the drug shortages. The order directed the FDA to "take action" to prevent and reduce worsening prescription drug shortages.

In response to Tuesday's announcement, Dr. Armand Keating, president of the American Society of Hematology (ASH), said in a statement: "ASH is encouraged by the steps FDA is taking to alleviate drug shortages that have significantly affected so many patients with hematololgic malignancies under our members' care. The measures announced today are consistent with the Society's recommendations to FDA, Congress and the Obama Administration to expand the agency's authority to prevent drug shortages by requiring manufacturers to provide early notification of impending shortages and importing drugs in critical supply."

"While ASH applauds the specific actions announced today," Keating added, "we also realize that these measures represent only a portion of a solution to a much larger problem. In addition to these steps, additional measures -- such as developing a national drug registry and providing economic incentives to manufacturers to produce a steady supply of generics -- must be implemented to permanently prevent shortages. Until a complete solution is in place, treatment will be delayed and care will be rationed for critically ill patients."

More information

For more on drug shortages, visit the U.S. Food and Drug Administration.

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Study: Colonoscopy cuts colon cancer death risk

LOS ANGELES (AP) — Millions of people have endured a colonoscopy, believing the dreaded exam may help keep them from dying of colon cancer. For the first time, a major study offers clear evidence that it does.

Removing precancerous growths spotted during the test can cut the risk of dying from colon cancer in half, the study suggests. Doctors have long assumed a benefit, but research hasn't shown before that removing polyps would improve survival — the key measure of any cancer screening's worth.

Some people skip the test because of the unpleasant steps need to get ready for it.

"Sure, it's a pain in the neck. People complain to me all the time, 'It's horrible. It's terrible,'" said Dr. Sidney Winawer, a gastroenterologist at Memorial Sloan-Kettering Cancer Center in New York who helped lead the study. "But look at the alternative."

A second study in Europe found that colonoscopies did a better job of finding polyps than another common screening tool — tests that look for blood in stool. Both studies were published in Thursday's New England Journal of Medicine.

Colorectal cancer is the second leading cause of cancer death in the United States and the fourth worldwide. More than 143,000 new cases of cancers of the colon or rectum are expected in the U.S. this year and nearly 52,000 people will die from it, according to the American Cancer Society.

Deaths from colorectal cancer have been declining for more than two decades, mostly because of screening including colonoscopies and other tests, the organization says. People of average risk of colon cancer ages 50 to 75 should get screened, but only about half in the U.S. do.

A government-appointed panel of experts recommends one of three methods: annual stool blood tests; a sigmoidoscopy (scope exam of the lower bowel) every five years, plus stool tests every three years; or a colonoscopy once a decade.

In a colonoscopy, a thin, flexible tube with a tiny camera is guided through the large intestine. Growths can be snipped off and checked for cancer. Patients are sedated, but many dread the test because it requires patients to eat a modified diet and drink solutions the day before to clear out the bowel. It usually costs more than $1,000, compared with a $20 stool test.

Researchers at Sloan-Kettering previously showed that removing polyps during colonoscopy can prevent colon cancer from developing, but it was not clear whether it saved lives.

The new study followed 2,602 patients who had precancerous growths removed during colonoscopies for an average of 15 years. Their risk of dying from colon cancer was 53 percent lower than what would be expected among a similar group in the general population — 12 patients followed in the study died, versus 25 estimated deaths in the general population.

The study was not a randomized trial that's the gold standard in medical research. But Robert Smith, director of screening at the American Cancer Society, said it's the first direct evidence that removing polyps can reduce the risk of colon cancer death.

"There's no question that these are findings that we can take to the bank," said Smith, who had no role in the research.

The National Cancer Institute and several cancer organizations paid for the study.

Government and private cancer groups also funded the second study in the journal, led by researchers in Spain. About 53,000 participants were given a colonoscopy or a stool blood test. Both tests found similar numbers of colon cancer cases — about 30 in each group.

However, colonoscopies found advanced growths in twice as many people — 514 versus 231 of those given the stool test. Colonoscopy also found 10 times more people with less serious growths than the stool test did.

Neither test proved very appealing — only a quarter of patients offered a colonoscopy had one. Similarly, only a third agreed to the offered stool test.

The Spanish study is continuing and similar research in the U.S. and Norway that began recently is looking at the long-term impacts of colonoscopy.

Stephen Raquet, of Mount Kisco, N.Y., finds the test reassuring even if the preparation is unpleasant. He had his first colonoscopy 13 years ago at age 41, earlier than usual because of a family history of colon cancer.

The sudden death of his 45-year-old sister from the disease prompted Raquet to get checked out. He had a precancerous growth removed at Memorial Sloan-Kettering in 1999, and has had the test every three years since.

During his last appointment four months ago, doctors said he can come back in five years.

"It's given me peace of mind," said the 54-year-old business executive.

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Online:

Guidelines: http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm

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Follow Alicia Chang's coverage at http://www.twitter.com/SciWriAlicia

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Officers Who Searched Home Can’t Be Sued, Court Says

The case, Messerschmidt v. Millender, No. 10-704, arose from an early-morning search in 2003 of the home of Augusta Millender. The police were looking for Ms. Millender’s foster son, Jerry Bowen, and for a shotgun he had used in a domestic assault.

They found neither. But they did take a gun owned by Ms. Millender, who was then 73 and has since died. The gun was legal, and she said she kept it for self-defense.

The police had obtained a warrant to search the home, but lower courts ruled that it violated the Fourth Amendment because parts of it were not supported by probable cause. In particular, they said, the warrant improperly allowed the police to search for “all handguns, shotguns and rifles” and “evidence showing street gang membership.”

Chief Justice John G. Roberts Jr., writing for the court, rejected Ms. Millender’s lawsuit. The case did not concern the validity of the warrant, he wrote, though he suggested that there was every reason to think it valid. Rather, he said, the question was whether a lawsuit against the officers was permitted.

A 1986 Supreme Court decision, Malley v. Briggs, said police officers should be denied immunity from such lawsuits “only where the warrant application is so lacking in indicia of probable cause as to render official belief in its existence unreasonable.”

Chief Justice Roberts, joined in full by five other members of the court, said Ms. Millender’s suit did not fit that exception.

Justice Elena Kagan agreed that the search for guns was proper but dissented from the part of the majority opinion concerning gang-related evidence, which she said was not connected to the domestic violence that prompted the search.

Justice Sonia Sotomayor, joined by Justice Ruth Bader Ginsburg, issued a heated dissent. In response to the chief justice’s conclusion that the officers’ conduct had been “objectively reasonable,” she wrote, “I could not disagree more.”

“It bears repeating that the founders adopted the Fourth Amendment to protect against searches for evidence of unspecified crimes,” Justice Sotomayor wrote. “And merely possessing other firearms is not a crime at all.” She cited District of Columbia v. Heller, the 2008 decision finding a Second Amendment right to keep a gun at home for self-defense.

Justice Sotomayor added that she was not persuaded by the fact that the officers’ superiors and a judge had approved the warrant. “Under the majority’s test,” she wrote, “four wrongs apparently make a right.”

In a second decision issued Wednesday, the court sidestepped a knotty question in a case over California’s attempt to cut Medicaid payment rates.

Speaking from the bench Wednesday morning, Justice Stephen G. Breyer began his summary of the majority opinion with an assessment of his task. “The difficult thing,” he said, “is to explain what this case is about.”

In response to the budget crisis in California, state officials there lowered payments to medical providers in the Medicaid program there. A federal law requires states that participate in the program, which provides health care to poor and disabled people, to pay rates “sufficient to enlist enough providers” to ensure that care available under Medicaid is similar to that available to other local residents.

There is no question that federal authorities can enforce the law and that states that fail to comply with their obligations face the loss of federal money. The question for the court was whether the providers and Medicaid recipients were themselves entitled to sue over the move.

After the court agreed to hear the case, federal authorities concluded that the state law passed muster. The majority returned the case to the lower courts to take account of that development.

Chief Justice Roberts, writing for himself and Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr., chastised the majority for failing to address the question of whether private lawsuits in such circumstances are ever proper. The correct answer, he said, was no.

The decision concerned three consolidated cases that had been argued on Oct. 3, the first day of the current term, including Douglas v. Independent Living Center of Southern California, No. 09-958. It was the first 5-to-4 ruling of the term, and the justices aligned in one of the two usual configurations in such cases, here with Justice Anthony M. Kennedy joining the court’s four more liberal members.

The third decision, PPL Montana v. Montana, No. 10-218, was unanimous. The court, in an opinion by Justice Kennedy, overturned a $41 million judgment by the Montana Supreme Court in favor of Montana and against a power company that owns hydroelectric plants on Montana rivers.

The question in the case was whether the portions of the rivers in dispute belonged to the state, and the answer turned on whether they were navigable when Montana joined the union in 1889. Drawing in part on journals kept by Meriwether Lewis during his expedition with William Clark, Justice Kennedy concluded that the state court had used the wrong standard in determining navigability and that at least substantial stretches of one river dotted by waterfalls were plainly not navigable.

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