Research Can Help Close Cancer 'Race Gap'

(HealthDay News) -- Collaborations between researchers and community groups can help ease cancer disparities among minority populations, researchers report.

They based their conclusions on the results of U.S. initiatives launched in Nashville, Tenn. and among the Navajo Nation.

Such partnerships between researchers and community groups can improve the quality of data collection, provide new insight into social factors/help, and result in sustained health improvements in disadvantaged populations, the scientists said.

The initiatives were to be outlined Thursday in Atlanta at an American Association for Cancer Research conference.

Like many communities across the United States, Nashville has experienced a large growth in its Hispanic population, a group whose health care needs are under-studied and not well documented in the academic literature. In response, a group of Nashville-area researchers partnered with community groups to survey the cancer care and prevention needs of more than 500 Hispanics, whose average age was 35. The information will be used in the development of future community programs and may help improve cancer prevention/care programs for local Hispanics.

Of the respondents, 98 percent were not born in the United States; more than half had emigrated from Mexico. The survey found that 80 percent of respondents didn't have health insurance, two-thirds hadn't completed high school, and 55 percent spoke little or no English.

Out of a list of 25 health topics, cancer was rated the top health concern. Almost 75 percent of respondents said they wanted to learn more about cancer prevention and just over half said they wanted more information on cancer screening. A large majority of respondents said they'd take part in a clinical trial to receive treatment if they had cancer. More than 90 percent of respondents with daughters under age 18 said they'd probably or definitely approve of their daughters receiving the new human papillomovirus virus (HPV) vaccine if it were free. HPV infection is linked with cervical cancer.

"Our local Hispanic community has grown nearly seven-fold over the last decade, yet we do not know much, if anything, about their cancer-related needs," lead investigator Pamela Hull, associate director of the Center for Health Research at Tennessee State University, said in a prepared statement. "Our survey has found that members of the Nashville Hispanic community are overwhelmingly interested in cancer prevention and health care efforts -- including cancer clinical trials and cervical cancer vaccination -- yet the community generally lacks access to care and information."

"Over the last 15 years of so, many smaller cities and rural communities across the interior of the United States have seen a similar growth of Hispanic immigrants moving from the states with traditionally larger Hispanic populations," Hull said. "Our survey, and the participatory methods we use, could help inform these new growth communities about their blossoming Hispanic populations."

In general, Hispanics have lower cancer rates than whites, but have higher rates for certain types of cancers, such as cervical, stomach, liver and leukemia, according to the American Cancer Society. Hispanics also have lower survival rates for most cancers. The Nashville survey found that cancer rates among Hispanics may vary according to their country of origin, Hull said.

The other researcher/community group partnerships outlined at the conference included one to help black Americans stop smoking and another to educate members of the Navajo Nation about colorectal cancer.

More information
The U.S. Centers for Disease Control and Prevention has more about Hispanic health issues.

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Cranberry Sauce May Be Healthy Treat

(HealthDay News) -- The cranberry on your Thanksgiving dinner plate may be more than a pleasant condiment, it may be good medicine, too, scientists say.

Compounds in cranberries may be able to protect against E. coli bacteria, -- which cause a number of human health problems, including gastroenteritis, kidney infections and tooth decay -- say researchers at Worcester Polytechnic Institute in Massachusetts.

A team led by Terri Camesano, an associate professor of chemical engineering at the institute, has uncovered a number of biochemical and biophysical mechanisms that may explain some of the health benefits attributed to cranberries, including cranberry juice's ability to prevent urinary tract infections (UTIs).

For example, they've found that a group of tannins (called proanthocyanidins or PACs) found primarily in cranberries interact with bacteria at the molecular level and prevent E. coli from attaching to cells in the body (a first step in infections) in a number of ways.

Among their findings:

• Chemical changes caused by cranberry juice create an energy barrier that prevents bacteria from getting close to the urinary tract lining.


• Cranberry juice causes compression of tiny tendrils on the surface of the type of E. coli that causes the most serious types of UTIs. Compression of these tendrils reduces the bacteria's ability to attach to the urinary tract lining.


• E. coli grown in cranberry juice or in PACs can't form biofilms, which contain high concentrations of bacteria and are required for infections to develop.

The research has been reported in a number of publications and presentations.

More information
The U.S. National Center for Complementary and Alternative Medicine has more about cranberry.

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Fetal Exposure to Arsenic Affects Genes

(HealthDay News) -- Children of women exposed to arsenic-contaminated water during pregnancy have gene expression changes that may result in cancer and other diseases later in life, a Massachusetts Institute of Technology study suggests.

The researchers, who said their work is the first documentation of widespread genetic changes caused by prenatal exposure to an environmental contaminant, analyzed umbilical cord blood from the children of 32 mothers in an area of Thailand with heavy mining-related arsenic contamination. Similar levels of arsenic are found in many other parts of the world, including the U.S. Southwest.

Children who were exposed to arsenic in the womb had about 450 genes that were either significantly more active (in most cases) or less active than the same genes in unexposed children.

Most of the gene expression changes detected in the exposed children are associated with inflammation, which can lead to increased cancer risk. It's not clear how long these gene expression changes may last, and the researchers plan to continue testing the children.

The researchers also found that a subset of 11 of these genes could be used as a highly reliable test for determining whether a child had been exposed to arsenic while in the womb.

The study was published in the Nov. 23 issue of the journal PLoS Genetics.

More information
The U.S. Agency for Toxic Substance and Disease Registry has more about arsenic.

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Why Obese Men Post Lower PSA Levels

(HealthDay News) -- In recent years, doctors have learned that they need to adjust the results of blood tests to properly diagnose prostate cancer in obese men, but now researchers think they know why.

It turns out that larger men have more blood, which dilutes the levels of the protein called PSA -- a key indicator of prostate trouble.

The new study doesn't definitively prove why overweight and obese men with prostate cancer tend to score lower on the PSA (prostate specific antigen) test, but it does give doctors an idea about what may be going on, said study co-author Dr. Stephen Freedland, an assistant professor of urology and pathology at Duke University.

"PSA is not a bad test for obese men. We just need to know how to use it," he said. "If we use it correctly, it will be just as good as in normal-weight men."

Prostate cancer strikes one in six men, mostly those over the age of 65, according to the Prostate Cancer Foundation.

Older men often routinely undergo a PSA blood test that looks for an antigen made by the prostate that helps it function. The antigen leaks into the bloodstream at a steady rate, and the amount is higher in men with prostate cancer, Freedland explained.

Recent research has revealed that PSA levels are 20 percent to 25 percent lower in overweight and obese men than in men of normal weight. This can translate into diagnostic problems with bigger men, Freedland said.

"You may call him normal and not worry about him and wait another year or two or longer, and that gives time for the cancer to grow," he noted.

According to Freedland, it's not clear if there's any impact on PSA levels from being underweight.

In the new study, researchers tested a theory that the reason PSA levels are lower in larger men is because the antigen gets diluted in larger volumes of blood. "It's like taking a little bit of a drug and putting it in a cup of water versus a bowl of water," Freedland said.

The study authors looked at the records of about 14,000 men with prostate cancer who underwent removal of their prostates between 1988 and 2006. The findings are published in the Nov. 21 issue of the Journal of the American Medical Association.

The researchers found that men who were fatter had larger blood volumes, which the study authors said supports their theory that dilution caused their PSA levels to lower.

The same thing could hold true for blood markers of other cancers, Freedland said. "As we develop blood tests for other cancers, we should be keeping this in mind," he added.

However, Dr. Nelson Stone, a clinical professor of urology and radiation oncology at Mount Sinai School of Medicine, is skeptical of the results, because the research just focused on men with advanced prostate cancer. That and other factors may have skewed the results, he said.

"I don't think they've proved their point," he said. But he added, "We need to be a little bit more careful when we evaluate a patient who is larger, and we look at his PSA and compare to a patient who is thinner. The PSAs are not the same."

More information
For advice on losing weight, visit the U.S. Food and Drug Administration.

Major U.S. Autism Study Gets Under Way

(HealthDay News) -- A large, five-year study looking at the genetic and environmental factors that may cause autism, as well as other developmental delays, has started enrolling 2,700 children and their families from six areas in the United States.

The Study to Explore Early Development -- which researchers called the largest of its kind -- will include children with autism and other developmental delays, as well as children with normal development.

Family medical history, genetics, and sociodemographic, lifestyle and environmental factors will be among the areas of focus in the study. Information will be gathered through interviews, physical examinations, medical records and cheek swab, blood and hair samples.

"We hope this will help us learn more about the factors that may lead to autism and other developmental disabilities, and how genes and the environment may affect child development," Lisa A. Croen, principal investigator at a site in California, said in a prepared statement.

"The results may also contribute to better services and treatments for affected children and to prevention strategies," said Croen, an epidemiologist with Kaiser Permanente's Division of Research in Oakland, Calif.

It's not understood why, but the incidence of autism is increasing and now affects about one in 150 children born in the U.S. The chronic disorder affects the normal functioning of the brain and affects development of communication and social skills.

More information
The U.S. National Institute of Child Health and Human Development has more about autism.

Nitrite, Nitrate-Rich Foods Boost Heart Attack Outcomes

(HealthDay News) -- Eating nitrite/nitrate-rich foods such as vegetables and cured meats may help improve the chances of surviving a heart attack and of recovering more quickly.

That's the finding of a preliminary study in the Nov. 12 online edition of the Proceedings of the National Academy of Sciences.

Researchers found that mice fed extra nitrite and nitrate had 48 percent less cell death in the heart following a heart attack than mice fed a regular diet. Mice fed a low nitrite/nitrate diet had 59 percent greater cell death.

The study also found that 77 percent of mice fed extra nitrite survived a heart attack, compared with 58 percent of mice fed a low nitrite diet.

"This is a very significant finding, given the fact the simple components of our diet -- nitrite and nitrate -- that we have been taught to fear and restrict in food can now protect the heart from injury," lead author Nathan S. Bryan, a cardiovascular physiologist at the University of Texas Health Science Center at Houston, said in a prepared statement.

"Simple changes in our daily dietary habits such as eating nitrite and nitrate-rich foods such as fruits and vegetables and some meats in moderation can drastically improve outcome following a heart attack," said Bryan, who is also an assistant professor at the university's Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases.

He explained that nitrite forms nitric oxide gas during a heart attack, which reopens closed or clogged arteries and reduces the amount of permanent damage to the heart muscle.

"This paper provides the first demonstration of the consequences of changes in dietary nitrite and nitrate on nitric oxide biochemistry and the outcome of heart attack," Bryan said.

The next logical step in this line of research would be to determine if increasing nitrite/nitrate intake in patients with known cardiovascular risk factors would decrease the incidence and severity of heart attack and stroke, or enhance recovery, he said.

While some studies have linked nitrites/nitrates with cancer, Bryan said many of those study findings were based on weak epidemiological data.

More information
HeartHealthyWomen.org has explains the use of nitrate medicines.

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FDA Issues New Warnings for Anemia Drugs

(HealthDay News) -- The U.S. Food and Drug Administration on Thursday approved new "black box" warnings on labels of erythropoiesis-stimulating agents, which are drugs used to treat certain types of anemia.

The warnings cover the drugs Aranesp, Epogen and Procrit, and detail their dangers to patients with cancer and patients with chronic kidney failure. Those dangers include heart attack, stroke, heart failure and cancer tumor growth and shortened survival.

The drugs had been touted as a treatment to lessen fatigue and improve quality of life among cancer, HIV and other patients with anemia, but the new label says there's no evidence to back that claim.

"Today's labeling changes are being made to make clear recommendations about the safe and effective use of these products and to strengthen the information about the risks that these drugs pose to patients with cancer and to patients with chromic kidney failure," Dr. Richard Pazdur, the FDA's director of the Office of Oncology Drug Products at the Center for Drug Evaluation and Research, said at a Thursday teleconference.

This is the fifth time the FDA has called for label changes for these drugs -- also known as ESAs -- since Procrit was approved in 1989, Pazdur said.

"We are emphasizing that ESAs should be used at the lowest dose necessary to avoid blood transfusions, since that is the only identifiable benefit for ESAs," Dr. John Jenkins, director of the FDA's Office of New Drugs. "Doctors should have discussions with their patients about whether to use ESAs at all."

These drugs are synthetic versions of a protein made in the kidney that tells bone marrow to produce red blood cells. The drugs are manufactured by Amgen Inc., of Thousand Oaks, Calif. Procrit is marketed and distributed by Ortho Biotech LP of Bridgewater, N.J., a subsidiary of Johnson & Johnson.

Dr. Roger M. Perlmutter, Amgen's executive vice president of research and development, said in a prepared statement that his company "has been working closely with the FDA and J&JPRD [Pharmaceutical Research and Development] to ensure that the information contained in the approved labeling for ESAs accurately reflects the current state of knowledge of these important products and to develop a comprehensive and feasible clinical study program to complement our existing pharmacovigilance program.

"In the current label revisions, we have endeavored to include as much information as possible so physicians and their patients can make informed treatment decisions," he added.

For cancer patients, the new warnings emphasize that the drugs can cause tumor growth and reduce survival among patients with advanced breast, head and neck, lymphoid and non-small cell lung tumors. This is especially true when the dose is designed to produce a hemoglobin level of 12 grams per deciliter of blood or more.

For hemoglobin levels less than 12 grams per deciliter, the label will say there is no evidence to determine if the drugs cause any of these problems, the FDA said.

"We recommend that prescribers talk to their patients about the risks that ESAs might cause cancer to grow or shorten survival before they prescribe these drugs or continue ESA therapy, Pazdur said. "The risks should be weighed against blood transfusions and their associated risks."
The new label will also make it clear that ESAs should be used in cancer patients only when their anemia is caused by chemotherapy and not from other causes. Also, ESAs should be stopped when the patient's chemotherapy has ended, the FDA said.

For patients with chronic kidney failure, the new black box warning says that ESAs should be used to keep hemoglobin levels between 10 grams per deciliter to 12 grams per deciliter. Higher hemoglobin levels in these patients can increase the risk for death, stroke, heart attack or heart failure, the FDA said.

The new labeling also gives instructions for dosage adjustments and hemoglobin monitoring for chronic kidney failure patients who do not respond to ESA treatment.

The new label also says there is no evidence that ESAs improve symptoms of anemia, quality of life, fatigue, or patient well-being in cancer patients or patients with HIV taking the drug AZT.

"There are no data from controlled trials demonstrating that ESAs improve symptoms of anemia, quality of life, fatigue or patient well-being," Pazdur said.

The FDA is working with Amgen on new clinical trails and is also reviewing a Medication Guide that will explain the use of these drugs to patients, Pazdur said.

Epogen, Procrit and Aranesp are used to treat anemia in patients with chronic kidney failure and anemia caused by chemotherapy in some cancer patients. Epogen and Procrit are also used in some anemic patients who are undergoing surgery to reduce the need for blood transfusions. These drugs are also used to treat anemia in HIV patients taking AZT.

More information
For more information on ESAs, visit the U.S. Food and Drug Administration.

Health Tip: When Air Quality is Bad

(HealthDay News) - Poor air quality can be especially troublesome for asthmatics, making it difficult for them to breathe.

Here are suggestions for asthmatics during bouts with poor air quality, courtesy of the U.S. Environmental Protection Agency:

• Gauge your sensitivity to air quality by being aware of your symptoms, and how often you have attacks.
• Reduce any physical activity outdoors.
• Try exercising early in the morning, when air quality tends to be best.
• If outdoors, go inside as soon as you start to feel symptoms.
• Keep your inhaler and other asthma medications on hand at all times.

Study Describes Molecules That Control Blood Pressure

(HealthDay News) -- Researchers are reporting a newly discovered molecular mechanism that makes blood pressure go up or down -- knowledge that could lead to new treatments for the hypertension that affects at least 50 million Americans.

A report published Nov. 1 in the Journal of Clinical Investigation is the latest in a series of studies on molecules called WNK kinases, which are proteins that help regulate blood pressure, said study co-author Dr. David H. Ellison, a professor of medicine at the Oregon Health & Science University.

"It has been known that these kinases are important for regulating blood pressure, because mutations of them cause hypertension," Ellison said. "This report adds two things that were not previously known."

One new finding was that one kinase, WNK3, plays a key role in regulating NCC, a protein that normally keeps salt in the body. Salt content helps govern blood pressure; more salt means higher pressure.

Another finding was that WNK3 does not act alone but in conjunction with two other kinases, WNK1 and WNK4. The interaction of WNK3 and WNK4 is important, Ellison said, because it helps explain why fruits and vegetables, which are rich in potassium, help keep blood pressure low.

Start with WNK4. If extra copies of a gene for the normal version of the kinase are put into a laboratory animal, its blood pressure goes down. If extra copies of a mutated version of WNK4, differing in only one of the amino acid units making up the protein, are added, its blood pressure goes up, Ellison said.

"It has been shown that the mutant of WNK4 causes disruption of the normal form of its metabolic pathway," he said. "There is continuing salt resorption caused by an interaction with the normal form, which turns off the normal form."

Potassium keeps blood pressure down by stimulating production of WNK4, Ellison said. The extra WNK4 reduces the activity of WNK3. The entire complex of three WNK kinases also acts as a unit, modifying the activity of the NCC protein.

"What happens is that WNK4 normally inhibits WNK3, reducing salt resorption," Ellison said. "Mutant WNK4 blocks this effect, thereby generating more active WNK3, increasing salt transport and causing hypertension."

The WNK kinases are members of one of the largest protein families in the human body. There are 518 of them, coordinating a wide variety of biological functions. The WNK kinases, which were discovered in 2000, have been objects of research since a group led by Dr. Richard P. Lifton, who heads his own laboratory at Yale University, found a link between them and a rare inherited form of high blood pressure, called familial hyperkalemic hypertension.

Lifton had no immediate comment on the new report.

The new research is still at a basic level, Ellison said. "If we develop a new pharmaceutical approach to hypertension, that could be helpful," he added.

"I think what this report highlights is the importance of understanding the protein level of expression in every kind of cell," said Melanie Cobb, a professor of medical sciences and pharmacology at the University of Texas Southwestern Medical Center at Dallas, where the first WNK kinase was cloned.

"It certainly makes clear that they interact more among themselves than might be expected," Cobb said. "It highlights the complexity of interactions among the proteins, and the importance of understanding those interactions."

More information
A guide to lowering high blood pressure is offered by the U.S. National Heart, Lung, and Blood Institute.