Thursday, December 8, 2011
Some men can delay prostate cancer treatment: panel
Some men can delay prostate cancer treatment: panel
By Julie Steenhuysen
Dec 7, 2011
(Reuters) - Men with low-risk prostate cancer may wait to see if their disease progresses before treating it, an independent panel of experts convened by the U.S. National Institutes of Health (NIH) said on Wednesday.
The panel backed the so-called active monitoring approach to prostate cancer treatment as a way to help men avoid the potential health consequences of treatment, which include impotence and incontinence.
The NIH is considering dropping the name "cancer" from this very early stage of the disease because it may make it easier for men to accept that carefully monitoring for changes is a better approach for them than immediate treatment.
Prostate cancer is the most common non-skin cancer in men in the United States. Some 240,000 U.S. men will be diagnosed with prostate cancer this year, and about 33,000 will die of the disease. More than half of these cancers are confined to the prostate and unlikely to become life-threatening.
Even so, about 90 percent of men who are diagnosed with prostate cancer get immediate treatment, such as surgery or radiation therapy.
"It's clear that many men would benefit from delaying treatment," said Dr. Patricia Ganz, a cancer prevention expert at the University of California Los Angeles, who chaired the NIH's state-of-the-science panel on prostate cancer.
The problem, said Ganz, is there is no consensus on the best strategies for monitoring the progress of prostate cancer and what benchmarks should be used to determine when treatment is needed. The panel urged NIH for more research to clarify this matter.
Many doctors already use a variety of monitoring strategies for men whose low-grade prostate cancer was detected through PSA screening, a blood test that detects levels of a protein made in the prostate gland known as prostate-specific antigen.
Elevated levels of this protein can indicate prostate cancer, but it can be caused by other things as well..
Several studies have suggested many men are over-screened for prostate cancer, and this over-screening has in many cases caused more harm than good, leading men to chose a biopsy and treatment for a slow-growing cancer that may have never caused them harm during their lifetimes.
Alternative strategies for men with low-risk prostate cancer typically fall into two camps: observation with and without the intent to cure.
In the observation without intent to cure approach, sometimes called watchful waiting, doctors treat symptoms if they develop.
In observation with intent to cure, often called active surveillance, patients undergo frequent testing and are offered curative treatment if the cancer progresses.
Ganz said it is not yet clear which approach is best.
"Prostate cancer affects some 30-40 percent of men over the age of 50. Some of these men will benefit from immediate treatment, others will benefit from observation. We need to standardize definitions, group patients by their risks and conduct additional research to determine the best protocols for managing low-risk disease," she said in a statement.
(Editing by Todd Eastham)
Wednesday, December 7, 2011
Why Working the Night Shift May Boost Your Risk of Diabetes
Why Working the Night Shift May Boost Your Risk of Diabetes
By Alice Park
Time
December 7, 2011
The night shift isn't usually anyone's first choice, but in some professions — and in this economy — it can't be avoided. About 26% percent of the American workforce, including health-care workers and sanitation staff, clocks in after dark, and the schedule may be taking a toll on their health.
Past research has shown that working when you're supposed to be in bed disrupts your circadian rhythm, raising the risk of heart disease, obesity, ulcers and even depression. Now, reporting in the journal PLoS Medicine, scientists also find that rotating night-shift work can increase the risk of developing Type 2 diabetes. The backward schedule can mess with the body's ability to use insulin properly to break down sugars in the blood, according to Dr. Frank Hu, a professor of nutrition and epidemiology at Harvard School of Public Health.
In a study involving nearly 177,000 middle-aged women enrolled in two Nurses' Health Studies, women who worked rotating night shifts for 1 to 2 years increased their risk of developing diabetes by 5% over a 20-year follow-up period, compared with women who didn't get assigned these shifts. Women who kept up night work for 10 to 19 years increased their risk by 40%. Working on and off at night for more than 20 years boosted the risk of diabetes by 60%.
Certainly, body weight is part of the problem, since excess weight is a risk factor for diabetes. People who work at night may snack more when they should be sleeping — and our bodies are metabolically trained to slow down as the sun sets. So the calories we take in during the evening and night hours are less likely to get burned off efficiently, and more likely to be stored as fat.
It's not just night work that causes a problem. Simply not sleeping when you're supposed to, or not getting enough sleep, can also wreak havoc with your metabolism, by pushing up levels of the appetite-stimulating hormone ghrelin and suppressing the appetite-curbing hormone leptin. Our circadian clocks also regulate body weight indirectly, by controlling body temperature and blood glucose levels. "The bottom line is there are probably multiple mechanisms through which disrupted sleep patterns or long term rotating night shift work can influence the risk of Type 2 diabetes," says Hu.
The study focused on people who rotated night shift work, so they weren't working nights routinely, but perhaps once every few days or weeks. Hu says it's not clear whether those who regularly work at night (and therefore sleep during the day) can adjust their body clocks to avoid this increased risk of diabetes.
What intrigued Hu and his team the most was the cumulative effect that night work had on diabetes risk. The longer people worked irregular hours at night, the higher their risk of developing the disease. "It's something people should keep in mind," he says. "If they minimize or reduce the time they work on night shifts, they may be able to attenuate their risk."
That's an important lesson for those who have to work at night. They might not be able to avoid the late hours, but they should remember that sticking with a night shift schedule for too long can be harmful for their health. And because these individuals may be at higher risk of developing diabetes, they should pay more attention to things that can lower their risk, such as watching their diet, exercising and getting screened for the disease more regularly.
By Alice Park
Time
December 7, 2011
The night shift isn't usually anyone's first choice, but in some professions — and in this economy — it can't be avoided. About 26% percent of the American workforce, including health-care workers and sanitation staff, clocks in after dark, and the schedule may be taking a toll on their health.
Past research has shown that working when you're supposed to be in bed disrupts your circadian rhythm, raising the risk of heart disease, obesity, ulcers and even depression. Now, reporting in the journal PLoS Medicine, scientists also find that rotating night-shift work can increase the risk of developing Type 2 diabetes. The backward schedule can mess with the body's ability to use insulin properly to break down sugars in the blood, according to Dr. Frank Hu, a professor of nutrition and epidemiology at Harvard School of Public Health.
In a study involving nearly 177,000 middle-aged women enrolled in two Nurses' Health Studies, women who worked rotating night shifts for 1 to 2 years increased their risk of developing diabetes by 5% over a 20-year follow-up period, compared with women who didn't get assigned these shifts. Women who kept up night work for 10 to 19 years increased their risk by 40%. Working on and off at night for more than 20 years boosted the risk of diabetes by 60%.
Certainly, body weight is part of the problem, since excess weight is a risk factor for diabetes. People who work at night may snack more when they should be sleeping — and our bodies are metabolically trained to slow down as the sun sets. So the calories we take in during the evening and night hours are less likely to get burned off efficiently, and more likely to be stored as fat.
It's not just night work that causes a problem. Simply not sleeping when you're supposed to, or not getting enough sleep, can also wreak havoc with your metabolism, by pushing up levels of the appetite-stimulating hormone ghrelin and suppressing the appetite-curbing hormone leptin. Our circadian clocks also regulate body weight indirectly, by controlling body temperature and blood glucose levels. "The bottom line is there are probably multiple mechanisms through which disrupted sleep patterns or long term rotating night shift work can influence the risk of Type 2 diabetes," says Hu.
The study focused on people who rotated night shift work, so they weren't working nights routinely, but perhaps once every few days or weeks. Hu says it's not clear whether those who regularly work at night (and therefore sleep during the day) can adjust their body clocks to avoid this increased risk of diabetes.
What intrigued Hu and his team the most was the cumulative effect that night work had on diabetes risk. The longer people worked irregular hours at night, the higher their risk of developing the disease. "It's something people should keep in mind," he says. "If they minimize or reduce the time they work on night shifts, they may be able to attenuate their risk."
That's an important lesson for those who have to work at night. They might not be able to avoid the late hours, but they should remember that sticking with a night shift schedule for too long can be harmful for their health. And because these individuals may be at higher risk of developing diabetes, they should pay more attention to things that can lower their risk, such as watching their diet, exercising and getting screened for the disease more regularly.
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