August 2014


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Two Cancer Codes Cracked

'We will think about cancers in a very different way's. Researchers have mapped the DNA mutations in skin and lung cancer — findings that one researcher says will change how cancer is viewed.


To read the full article Two Cancer Codes Cracked, click here.

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Why Women Wrinkle Around Mouth
Women More Likely Than Men to Get Wrinkles Around the Lips; Is Biology to Blame?


Biology may be the reason why women are more prone than men to developing wrinkles around the lips -- called perioral wrinkles-- and deeper ones, too, a new study says.

To read the full article Why Women Wrinkle Around Mouth, click here.

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A Device to De-Stress Your Workout

AFTER a night that included several beers and not enough sleep, Keith Gillis, a 31-year-old cyclist in Truro, Nova Scotia, set out on a 74-mile road ride with the caveat that he was feeling fatigued.

To read the full article A Device to De-Stress Your Workouts, click here.

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Study: Women Get More Wrinkles Than Men
Aesthetic Surgery Journal Finds Anatomical Differences in Male and Female Faces Make Women More Prone to Wrinkling


Mirror, mirror on the wall -- who has the most wrinkles of them all? According to a new study, men win the wrinkle war. Women wrinkle more easily.

To read the full article Women Get More Wrinkles Than Men , click here.


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From Genome to Hormones, Doctors Pick the Top Medical Advances of The Decade


The first decade of the 21st century brought a number of discoveries, mistakes and medical advances that influenced medicine from the patient's bedside to the medicine cabinet.

To read the full article The Top 10 Medical Advances of the Decade, click here.

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Antidepressants Change Personality

People who take anti-depressants may experience personality changes separate from the alleviation of their depressive symptoms.

To read the full article Antidepressants Change Personality , click here.

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Red wine or white? Which makes teeth a fright?
Health conscious (and vain) vino drinkers face cocktail conundrum


Monika Jones, 28, loves red wine. What she doesn’t love is the “monster mouth” it gives her. “I’ve found that red wine not only stains my teeth — it turns the inner part of my lips a dark magenta after just two glasses,” says Jones, a Seattle writer. “My friends call it ‘monster mouth.’”

To read the full article Red wine or white? Which makes teeth a fright?, click here.

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Does Dad Need A Nursing Home?
Dr. Jon LaPook Talks About The Tough Choice Of When To Send A Parent To A Nursing Home

One of the great blessings of my life is that my 91-year-old father, who I dearly love, lives in the apartment building next door. After 66 years of marriage, he's been living alone since my mother's death last March. He is still sharp as a tack, as he might say.

To read the full article Does Dad Need A Nursing Home?, click here.

Active ImageCDC Finds Uptick of salmonella Cases From Frogs, But Other Pets Can Infect, Too

Salmonella's back. Government officials announced this week that salmonella carried by your cute little green friends -- this time frogs -- have caused yet another outbreak in children. Aquatic pet frogs are under fire this week after 48 people in 25 states came down with salmonella serotype typhimurium, according to the U.S Centers for Disease Control and Prevention.

To read the full article Kiss a Frog and Get Salmonella?, click here.

Active ImageGeneral Mills' Pledge to Cut Sugar in Kids' Cereals Has Nutrition Experts Buzzing

The cereal giant General Mills has announced it will cut back the amount of sugar in 10 popular kids' cereals to single-digit grams of sugar per serving. As this move piqued the interest of nutritionists and other diet experts, the ABC News medical unit sent out a request for comment to some of the nation's top experts in the field.

To read the full article Experts Sound Off on Cereal, click here.

Active ImageTo PSA or Not to PSA, that is the Question

By Allen Lawrence, M.D.

In 2007, it is estimated that 218,890 men were diagnosed as having prostate cancer in the U.S. It is further estimated that 1out of every 6 men living in the U.S. will be diagnosed with prostate cancer during in his lifetime. In 2006, an estimated 27,350 men died from prostate cancer within the United States. The median age of death from prostate cancer from 2000 through 2004 was 80 years, and 71% of deaths occurred in men older than 75 years. African-American men have a substantially higher prostate cancer incidence rate than white men (217.5 vs. 134.5 cases per 100,000 men) and more than twice the prostate cancer mortality rate of white men (56.1 vs. 23.4 deaths per 100 000 men).

normalprostate-2.jpgStudies tell us that a substantial number of prostate cancer cases detected using current screening methods including PSA will never cause any symptoms during most of these patients’ lifetime. Modeling studies based on U.S. incidence data suggest that degree of prostate cancer is overdiagnosed in the ranging of between 29% and 44% of all prostate cancer cases detected by PSA screening. Because patients with this "pseudo-disease" receive no benefit from, and may be harmed by, prostate cancer screening and treatment, prostate cancer detection in this population constitutes an important potential burden.


PSA Testing, Yes or Now, The World is Waiting


Since the development of the PSA (Prostate Specific Antigen) test the medical community has stressed that PSA testing was an important virtually mandatory on a yearly basis for men 50 to 70 years of age. For men over 70 years of age however, the criteria has not been as clear. In recent months with the release of the U.S. Preventive Services Task Force (USPSTF) update report on PSA, we may now have better answers for men 70 years of age or older.

normalprostate.jpgAfter review of many studies performed in the U.S. and abroad the USPSTF has updated their criteria published in August 2008 to more firmly suggest that while evidence is still unclear and inconclusive, evidence now appears to show that PSA testing in men over 75 years of age may lead to more harm than good. The issue is not so much the dangers of the test procedure itself, but rather the fact as one spokes person put it: “The PSA test is not a good test. We are not able to find quality evidence to find for or against the use of PSA testing for men 75 years of age or older.”

The issue is whether or not the PSA test is a good test and whether it can help the physician differentiate men who have prostate cancer and need treatment from those who have prostate cancer and do not need to be treated.

In the end, the question regarding PSA testing becomes, “Does PSA screening test lead to more benefit or more harm?” The USPSTF update report suggests that this is still unclear. An abnormal PSA inevitably leads to biopsy, biopsy, if positive for Prostate cancer, will inevitably lead to surgery or some other form of treatment. In most men over 75 years of age, the treatment of prostate cancer (whether actually is necessary or not) is associated with significant harm and for many of  men these harms and injuries will endure and cause problems for them for many years. All this may happen while treating a condition that most likely would never have caused them any significant ill effects during the remaining life time.

Abnormalprostate.jpgProstate cancer is the most common nonskin cancer and the second leading cause of cancer death among men in the United States. However, in men 75 years of age or older USPSTF suggests that “the absolute risk reduction associated with PSA screening was 0.71 deaths per 1000 men.”  This means that “1410 men would need to be screened and 48 cases of prostate cancer would need to be treated to prevent 1 death.” Stated differently, 47 of the 48 men treated because of an abnormal PAS would ultimately have to live with potential side effects and consequences from the treatment whether it us hormonal therapy, surgery, or radiation therapy. Complications from prostate treatment can and often do include impotency, erectile dysfunction, urinary incontinence, bowel dysfunction, chronic pain, and even death for a condition which if not treated most likely would have caused no problem to these men at all.

This does not also include the small harms such as pain and discomfort associated with prostate biopsy nor the psychological effects of false-positive test results which may affect hundreds of other men where cancer of the process is ultimately ruled out.

In men younger than age 75 years, the USPSTF claims that it still has found no significant evidence to determine whether treatment for prostate cancer after abnormal PSA screening improves health outcomes compared with treatment after clinical detection.

While the USPSTF concludes that for men younger than age 75 years, the benefits of screening for prostate cancer are uncertain and the balance of benefits and harms cannot be determined, for men 75 years or older, there is moderate certainty that the harms of PSA screening for prostate cancer outweigh the benefits.


Conclusion

In men younger than age 75 years, the USPSTF could not determine the degree of benefit from PSA screening for prostate cancer because of low certainty about the magnitude of benefits of screening and treatment.

Given the uncertainties and controversy surrounding prostate cancer screening in men younger than age 75 years, a clinician should not order the PSA test without first discussing with the patient the potential but uncertain benefits and the known harms of prostate cancer screening and treatment. Men should be informed of the gaps in the evidence and should be assisted in considering their personal preferences before deciding whether to be tested or not.

The USPSTF is now considering suggesting that men 75 years of age or older no longer be routinely screened with PSA testing. The risks, benefits and options should be routinely discussed with the patient and the decision left to the patient after understanding all of the facts involved in making this decision.

In each situation the patient should be instructed that current management strategies for localized prostate cancer can and do include watchful waiting (observation with palliative treatment for symptoms only), active surveillance (periodic monitoring with conversion to curative treatment for signs of disease progression), radical prostatectomy, external-beam radiation therapy, and brachytherapy (or radioactive seed implantation therapy) and rarely, hormonal suppression therapy.

Unless otherwise indicated in specific situations the USPSTF appears to be suggesting that “PSA screening as infrequently as every 4 years could yield as much of a benefit as annual screening.”