A $500 Billion Hole in Global Economy

According to The Tobacco Atlas, tobacco’s estimated $500 billion drain on the world economy exceeds the total combined annual expenditure on health in all low-and middle-income countries. The economic costs come as a result of lost productivity, misused resources, ineffective taxation and premature death:

* Because 25 percent of smokers die and many more become ill during their most productive years, income loss devastates families and communities.

* Cigarettes are the world’s most widely smuggled legal consumer product. In 2006, about 600 billion smuggled cigarettes made it to the market, representing an enormous missed tax opportunity for governments, as well as a missed opportunity to prevent many people from starting to smoke and encourage others to quit. A ten percent increase in cigarette prices reduces demand by up to five percent among adults, with even better results among young smokers.

* Tobacco replaces potential food production on almost 4 million hectares of the world’s agricultural land, equal to all of the world’s orange groves or banana plantations.

* In developing countries, smokers spend great sums of money in proportion to their incomes that could otherwise be spent on food, healthcare and other necessities.

Burden Shift to the World’s Poorest Countries

The Tobacco Atlas crystallizes an undeniable trend: the tobacco industry has shifted its marketing and sales efforts to countries that have less effective public health policies and fewer resources in place:

* In 2010, tobacco will kill six million people worldwide annually, 72 percent of whom will be in low and middle-income countries.

* Since 1960 global tobacco production has increased 300 percent in low- and middle-resource countries while dropping more than 50 percent in high-resource countries.

* In India and China together, over half a billion men are consuming tobacco.

* In Bangladesh alone, if the average household bought food with the money normally spent on tobacco, more than 10 million people would no longer suffer from malnutrition and 350 children under age five could be saved each day.

“The Tobacco Atlas is crucial to understanding the nature of the most preventable global health epidemic,” said John R. Seffrin, Ph.D. chief executive officer, American Cancer Society. “This single resource can help advocates in every nation get the knowledge they need to combat the scourge of tobacco in their communities and on the worldwide stage. By utilizing the information in The Tobacco Atlas to develop public health strategies to reduce tobacco use and help people stay well, we will save millions of lives. ”

“Common throughout The Tobacco Atlas is vivid evidence that the health burden is shifting from high-income countries to their low and middle-income counterparts,” said Peter Baldini, chief executive officer, World Lung Foundation.” The evidence presented herein and online, however, must do more than clearly articulate the scope and dimensions of the problem. It should be applied actively to strengthen the case for policy change.”

The four authors of the publication bring together an impressive array of credentials and unique experience. Omar Shafey, Ph.D., M.P.H., is a medical anthropologist and epidemiologist, and an adjunct professor of Global Health at Emory University. Among many publications and studies, he was a coauthor of the second edition of The Tobacco Atlas. Michael Eriksen, Sc.D., is a professor and founding director of the Institute of Public Health at Georgia State University. He has been a Senior Advisor to the World Health Organisation (WHO), and was director of the Centers for Disease Control and Prevention’s Office on Smoking and Health. Hana Ross, Ph.D. is an economist and strategic director of international tobacco control research at the American Cancer Society. She is also deputy director of the International Tobacco Network (ITEN), a network promoting collaboration among economists interested in tobacco control issues. Judith Mackay. M.D., is a Fellow of the Royal Colleges of Physicians of Edinburgh and London, and a special advisor at World Lung Foundation. She is also a senior policy advisor to the World Health Organization (WHO) and a director of the Asian Consultancy on Tobacco Control.

The new online version of the publication, TobaccoAtlas.org, enables policy makers, public health practitioners, advocates and journalists interact with the data and create customizable charts, graphs and maps.

Notes:

The Tobacco Atlas and TobaccoAtlas.org were launched at a press conference at the World Conference On Tobacco OR Health in Mumbai, India.

About The American Cancer Society

The American Cancer Society is dedicated to eliminating cancer as a major health problem by saving lives, diminishing suffering, and preventing cancer through research, education, advocacy, and service. Founded in 1913, the Society has local offices in 3,400 communities, involving nearly three million volunteers across the United States and internationally. The Society’s international work focuses on capacity building of civil society and on collaborating with other cancer-related organizations to carry out its mission across the globe. For more information about the American Cancer Society, visit http://www.cancer.org/international.

About World Lung Foundation

World Lung Foundation was established in response to the global epidemic of lung disease, which kills 10 million people each year. The organization improves global lung health by improving local capacity to conduct research, develop public policy and deliver public health education. The organization’s areas of emphasis are tobacco control, tuberculosis, HIV/AIDS, asthma, and child lung health. For more information, please visit worldlungfoundation.org

Washington’s new law is based on a similar one introduced in Oregon ten years ago, where last year 60 patients made use of it. That is the highest number in a year since the law came into force in 1997, reports the NWPR news service of Washington State University.

Since then around 400 Oregon residents have used it to end their lives reports the Seattle Times who also said that Washington’s new law was approved in last November’s election and carried a nearly 60 per cent “yes” vote.

Like the Oregon act, Washington’s new law requires that any patient asking for a lethal prescription must be a resident of the state, be at least 18 years old, declared mentally competent to make the request, and two doctors have to certify that he or she has six months or less to live, reported the Seattle Times.

The patient’s request must be put into writing and witnessed by two people, and they must also make two oral requests 15 days apart, the so-called “15 day waiting period”.

A representative of Compassion & Choices, the largest aid-in-dying advocacy group in Washington State told NWPR that the names of patients asking for assistance with dying will not be made public, but there will be a need to report such requests. Terry Barnett said:

“The initiative strikes a balance between patient’s rights to privacy and the public’s interest in information about how the process works.”

Groups who support the initiative say that the new law gives people another option and helps them to feel in control of the dying process and thereby preserves their dignity.

Groups who are against the initiative say that the reporting requirements aren’t strong enough and there should be stricter safeguards to make sure patients are offered enough end of life options, including pain management, reported NWPR.

Eileen Geller, a spokesperson for True Compassion Advocates, a group that is against the new law, told the Seattle Times that it:

“Puts at risk far too many people for the far too few who would actually have choice.”

“One person’s autonomy is another person’s coercion,” said Geller, adding that the message the patient actually receives once the idea of assisted suicide is raised is that they should do it because they are a burden.

Geller, who is a hospice nurse, said that last year as her father in law was dying, a healthcare professional raised the idea of assisted suicide and this led him to feel like he should take up the option in order to stop being a burden to his family.

This was not the view of Barbara McKay of Kirkland, who said she will use the new law. McKay is terminally ill with advanced ovarian cancer and has already made a written request to her doctors declaring her wish to have lethal medication. She told a news conference on Thursday that she will be talking to her doctors about her other end of life options, reported the Seattle Times.

60-year old McKay said she watched both her parents suffer with few choices at the end of their lives. At the news conference sponsored by Compassion & Choices she told reporters that when her time comes she wants to be able to choose her own time and way to die:

“I don’t want my family to have to watch me wither away as can happen with cancer.”

Dozens of people stood outside University of Washington School of Medicine yesterday to protest against the new law. Some health systems have chosen not to take part while others have. Those against the new law are concerned that many terminally ill people who are depressed may not get the help they really need and the law will facilitate unnecessary deaths.

Not to be overlooked in all this is the need for health professionals to have fine tuned people skills to balance their medical expertise.

Helping patients to review options about how to spend their dying weeks and whether to terminate their lives deliberately or naturally places a considerable load on the health professional’s emotional wellbeing and they may need as much psychological support in this process as their patients.

Dr Alexis Willett, Policy Manager at Breakthrough Breast Cancer, says:

“This will be disappointing for some women with advanced breast cancer. Breakthrough hopes that if further results from clinical trials are positive this decision will be reviewed in future.

“It’s important to remember that not every new treatment will be suitable for all patients. It’s vital patients receive clear information about treatment options including possible risks and benefits. Anyone concerned should talk to their doctor.”

A new type of asthma therapy might be especially helpful for people with severe asthma who often have to take oral steroids to control their symptoms.

The drug is called mepolizumab, and two small studies in the March 5 issue of the New England Journal of Medicine have found that, when taken regularly, it can reduce asthma exacerbations. Additionally, people taking the drug had lower levels of eosinophils, a type of white blood cell that has been implicated as a potential cause of asthma.

“This is a new treatment which substantially reduces the risk of asthma attacks in a severe asthma population,” said the senior author of one of the studies, Dr. Ian Pavord, a consultant physician and an honorary professor of medicine at Glenfield Hospital, University Hospitals of Leicester, England.

Dr. Paul O’Byrne, the senior author of the other study, added that “we now have a likely new treatment modality that will improve outcomes and reduce exacerbations in severe prednisone-dependent asthma, and this is not a small population — it’s probably 2 to 4 percent of the asthmatic population.” O’Byrne is chairman of the Department of Medicine at McMaster University and executive director of the Firestone Institute for Respiratory Health at St. Joseph’s Hospital in Hamilton, Ontario, Canada.

Both studies were funded by GlaxcoSmithKline, the pharmaceutical company that is developing the drug.

He said that mepolizumab works by blocking a protein called interleukin-5, which is essential for the development of eosinophils. Eosinophils have long been implicated in asthma, though their exact role remains unclear. However, scientists do know that when an asthma exacerbation occurs, eosinophil levels usually rise.

In the first study, Pavord and his colleagues randomly placed 61 people with severe asthma on either 750 milligrams of mepolizumab or a placebo for a year. The drug and placebo were administered intravenously once a month for a year.

Over the study period, those on mepolizumab had fewer asthma exacerbations than those on placebo — 2 versus 3.4. People taking the drug also reported a greater improvement in their quality of life than did people taking the placebo.

The second study was smaller, including just 20 patients. Nine received 750 mg of mepolizumab, and 11 were given a placebo. Again, the drug and placebo were administered in intravenous doses once a month.

Everyone in this study had severe, prednisone-dependent asthma. Prednisone is an oral steroid that is generally quite effective in treating asthma but has numerous and serious side effects.

In the six-month trial, there were 12 asthma exacerbations in 10 people on placebo. Nine had evidence of eosinophils during their exacerbations. During the study, just one person in the treatment group had an exacerbation, but no eosinophils were present. Additionally, those taking the drug were able to reduce their dosage of prednisone more than people on placebo could.

Mepolizumab was not associated with a serious side effect in either study, though both authors pointed out that the studies were small and no more than six months to a year long.

“If you are one of those people [who has eosinophils] and your asthma is pretty severe, this may be a relatively promising treatment to prevent exacerbations, though it’s still experimental,” said the author of an accompanying editorial in the same issue of the journal, Dr. Sally Wenzel, director of the Asthma and Allergy Center at the University of Pittsburgh Medical Center.

But, she pointed out that not everyone who has asthma also has eosinophils.

All three experts said they were not sure if mepolizumab would have a place in treating less severe asthma, at least for awhile. O’Byrne said that the drug needs to be studied in larger populations and it’s currently very expensive, which would limit its use by people who have other treatment options.

In a long-awaited legal decision, the U.S. Supreme Court ruled Wednesday that patients who are injured by a drug can sue the drug’s manufacturer for damages, even if the drug has been granted FDA approval.

The decision, in the lawsuit Wyeth v. Levine, upheld $6.7 million in damages to a Vermont musician named Diana Levine who had to have her arm amputated after Wyeth’s Phenergan anti-nausea drug hit an artery and caused gangrene.

The complication is a rare one but is acknowledged on the drug’s labeling. Wyeth had argued that the U.S. Food and Drug Administration warning carried on the drug was sufficient.

At a press conference after the decision was announced, Levine, who was injured in April 2000, said: “I’m on the ceiling, I’m just so high about this, I’m so glad, it’s such a good decision and, next to getting my hand, it’s the best they could do, and it’s the least they could do. I’m in a state of almost shock and almost unrestrained joy.”

The court decision was hailed as a triumph by Public Citizen, a consumer watchdog group.

“It’s a terrific decision, because it understands both the importance of compensation for people who are harmed by defective or mislabeled drugs and also understands that the tort system is a complement to the federal regulatory system, that it is not an obstacle to that system,” said Brian Wolfman, director of the litigation group at Public Citizen in Washington, D.C.

Wolfman served as one of Levine’s attorneys.

Bert Rein, an attorney for Wyeth, said the company “fully complied with federal law” in its labeling, and that the FDA “is in the best position to weigh the risks and benefits of a medicine,” The New York Times reported.

In a news release, the Pharmaceutical Research and Manufacturers of America (PhRMA), said the group “is still reviewing the various opinions in the Wyeth v. Levine case. We continue to believe that the expert scientists and medical professionals at the Food and Drug Administration are in the best position to evaluate voluminous information about a medicine’s benefits and risks and to determine which safety information to include in the drug label.”

The high court’s decision is likely to unleash a torrent of similar lawsuits around the country.

“The court opinion not only declined to tell pharmaceutical companies that they could have this kind of immunity, it, in fact, pushed somewhat in the other direction,” said Benjamin C. Zipursky, professor of law at Fordham Law School in New York City and visiting professor at Harvard Law School in Boston.

“Some trial lawyers who had been hesitant to bring claims against pharmaceutical companies are now going to be more willing to do so,” Zipursky said. “A number of cases that were stayed in state and federal court pending this decision will now go forward and go forward with a more plaintiff-oriented posture. This is going to change the balance of incentives for lawyers who are thinking about suing pharmaceutical companies to make them more willing to sue and make trial judges and appellate courts less willing to throw out weak cases.”

Wolfman added: “In general, it’s going to mean that these claims are not pre-empted and that people with drug and injury claims are going to be able to sue for damages and get to a jury and, if the jury agrees, be compensated for that.”

The high court’s 6-3 decision essentially upended moves by the Bush administration to protect drug makers from lawsuits as long as the product was FDA-approved.

Many watchers had predicted that the court would decide the other way, Zipursky said.

“It was a surprise in two respects,” he said. People had believed “that whatever the court did, it would rule narrowly and, in fact, the decision is quite broad.”

Many middle-age and older Americans aren’t getting enough micronutrients such as calcium, magnesium, potassium and vitamin C, all of which play an important role in maintaining health, a new study finds.

Researchers analyzed data from more than 6,200 people in four ethnic groups — white, black, Hispanic and Chinese. More than half of the participants took supplements, and those most likely to use supplements were older, women, white and college-educated. The most common supplements were calcium and vitamin C.

Dietary intake of calcium, magnesium, potassium and vitamin C was similar between those who took supplements and those who didn’t, but there were differences in median dietary intake levels between the different ethnic groups. Chinese Americans tended to have the lowest dietary intakes of all micronutrients, particularly calcium. Blacks also had significantly lower dietary intakes of calcium than whites and Hispanics.

The researchers also evaluated differences between high-dose supplements and multivitamins. High-dose calcium was associated with users meeting recommended daily allowances (RDA) or adequate intake (AI) for all ethnic groups.

However, some high-dose supplements could cause users to exceed their Tolerable Upper Intake Levels (ULs). For calcium, 15 percent of high-dose users exceeded the UL compared with 1.9 percent of multivitamin users and 2.1 percent of non-users. For magnesium, 35.3 percent of high-dose supplement users exceeded the UL, compared with zero percent of both multivitamin users and non-users. For vitamin C, 6.6 percent of high-dose users exceeded the UL, compared with zero percent of both multivitamin users and non-users.

The researchers also found that potassium intake was well below the RDA in both supplement users and non-users. This suggests it may be necessary to reformulate supplements to deliver higher potassium doses, they said.

“The present study indicates a clear association between meeting RDA/AIs and supplement use for calcium, magnesium and vitamin C,” wrote Pamela J. Schreiner, professor and director of graduate studies in the division of epidemiology and community health at the University of Minnesota, and her colleagues.

“However, even with the assistance of dietary supplements, many middle-aged and older Americans are not getting adequate nutrition, and there was no association between supplement use and meeting the AI for potassium,” the researchers concluded. “In addition, those taking high-dose vitamin supplements were more likely to exceed the UL for that nutrient. Future studies should explore dietary supplementation along with other methods to improve nutrition in middle-aged and older Americans.”

The study was published in the March issue of the Journal of the American Dietetic Association.

Despite some improvements, U.S. school meal programs are still laden with unhealthy fat, salt and sugar, nutrition experts contend.

Students also have limited choices in foods available in vending machines, á la carte in cafeterias, at school stores and snack bars and for fund-raisers, they say in a series of articles in a supplement to the February issue of the Journal of the American Dietetic Association.

Echoing these sentiments, a Chicago chef brought to the White House to cook for the Obamas has said that too much of the food available at schools also is high in additives and preservatives.

Unhealthy eating at school, these food experts believe, is contributing to the surge in obesity rates among U.S. children. Obesity rates have more than doubled among infants and toddlers aged 2 to 5, quadrupled in children aged 6 to 11 and more than tripled among adolescents aged 12 to 19, according to an editorial in the journal.

The rising rates have health experts concerned about a nascent epidemic of obesity-related diseases, including cardiovascular disease and type 2 diabetes, in young people.

“Of course, school meals are only one part of the problem,” said Anne R. Gordon, a senior researcher at Mathematica Policy Research in Princeton, N.J., and co-author of a paper on school lunches in the supplement. “Kids don’t eat well throughout the day. But, we do find at least some evidence that in some of the schools that restrict the availability of sugar-sweetened beverages, you don’t see the kids going and drinking more sugar-sweetened at other times of day. It really does decrease intake, so that’s encouraging.”

Gordon’s paper described and assessed data from the third School Nutrition Dietary Assessment, sponsored by the U.S. Department of Agriculture and conducted by Mathematica, as well as findings from other studies that used the same data. The USDA-backed analysis covered both the National School Lunch Program, which provides subsidized meals to about 30 million children daily, and the School Breakfast Program, which provides meals to about 10 million children a day.

The lunch program began in 1946 to help ensure that U.S. children were receiving enough nutritious food. The breakfast program was institutionalized in 1975. Both offer free or low-cost meals to eligible students.

“It’s very clear that USDA needs to update the standards of schools” related to nutrition, Gordon said. “They know what they’re aiming for, but … having standards is not enough.”

“We need to explore other ways of making change, which could include items such as providing more training and technical assistance to schools, providing more funding for nutrition education,” she said. “It also may be worth considering more laws or regulations to limit the availability of certain types of food, such as whole or 2 percent milk.”

Mary Ford, a registered dietitian and professor in the School of Public Health at the University of Minnesota, and author of the journal editorial, urged such action.

“Schools need to do even more to reduce the availability of high-calorie, low-nutrient foods and make school meals more nutritious,” she wrote. Foods available by choice to students — in vending machines, á la carte and the like — “should include only fruits, vegetables, whole grains and non-fat and low-fat dairy products,” she wrote.

The editorial also suggested that the federal government withhold funding for meal programs from school systems that don’t comply with stepped-up nutrition expectations.

Sam Kass, the chef who followed the Obamas to the White House, also has put the school lunch program under fire. According to a report in The New York Times in January, Cass attributes the nutritional shortcomings in school lunches, at least in part, to the use of donated surplus agricultural commodities that result from government subsidies.

“As a result, he says, meals served to students are low in vegetables and disproportionately high in fat, additives, preservatives and high-fructose corn syrup,” the Times report said.

The School Nutrition Dietary Assessment included information from 398 public schools in 130 districts across the United States, including 2,314 students in first through 12th grade during the 2004-05 school year.

It found that more than 70 percent of the schools served meals that met the standards for critical nutrients such as protein, vitamins A and C, calcium and iron.

But a mere 6 to 7 percent of subsidized meals met all nutritional standards, the study found. Most had too much saturated fat or fat overall, and not enough calories.

About 42 percent of the schools surveyed offered no fresh fruits or raw vegetables in their lunch programs.

Fat tended to come from salad dressings, condiments and spreads, pizza products, peanut butter sandwiches and french fries. Saturated fat tended to come from pizza products, condiments and spreads, 2-percent milk, salad plates or salad bars and hamburgers or cheeseburgers.

Foods in vending machines and offered á la carte and in snack bars were most often high in calories and low in nutrients: candy, french fries, donuts, sweetened drinks and salty snacks.

The study found that low-income children fared worse, nutritionally, than those from higher-income homes, although school-lunch-program participants generally got more nutrients in their meals than kids responsible for their own lunches.

As for remedies, Gordon and the other researchers offered some. “Innovative preparation methods or improvements in the presentation of fruits and vegetables could make these items more appealing to children,” they wrote. The study suggested that school cooks use whole-grain flours to prepare pizza crusts and mix whole-grain and regular pasta in pasta-based entrees and that school lunchrooms control the available portions of condiments such as ketchup, mustard and barbeque sauce to control sodium intake.

Gordon noted that schools have made progress in improving meal offerings, but more needs to be done.

“Part of it is getting kids to eat healthier foods, part of it is providing schools with more support,” she said.

Cancer harms the body when damaged cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with the digestive, nervous, and circulatory systems, and they can release hormones that alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign.

More dangerous, or malignant, tumors form when two things occur:

1. a cancerous cell manages to move throughout the body using the blood or lymph systems, destroying healthy tissue in a process called invasion
2. that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis.

When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.

In 2007, cancer claimed the lives of about 7.6 million people in the world. Physicians and researchers who specialize in the study, diagnosis, treatment, and prevention of cancer are called oncologists.

What causes cancer?

Cancer is ultimately the result of cells that uncontrollably grow and do not die. Normal cells in the body follow an orderly path of growth, division, and death. Programmed cell death is called apoptosis, and when this process breaks down, cancer begins to form. Unlike regular cells, cancer cells do not experience programmatic death and instead continue to grow and divide. This leads to a mass of abnormal cells that grows out of control.

What is cancer? – Video

A short, 3D, animated introduction to cancer. This was originally created by BioDigital Systems and used in the Stand Up 2 Cancer telethon.

3D Medical Animation – What is Cancer?

Genes – the DNA type

Cells can experience uncontrolled growth if there are damages or mutations to DNA, and therefore, damage to the genes involved in cell division. Four key types of gene are responsible for the cell division process: oncogenes tell cells when to divide, tumor suppressor genes tell cells when not to divide, suicide genes control apoptosis and tell the cell to kill itself if something goes wrong, and DNA-repair genes instruct a cell to repair damaged DNA.

Cancer occurs when a cell’s gene mutations make the cell unable to correct DNA damage and unable to commit suicide. Similarly, cancer is a result of mutations that inhibit oncogene and tumor suppressor gene function, leading to uncontrollable cell growth.

Carcinogens

Carcinogens are a class of substances that are directly responsible for damaging DNA, promoting or aiding cancer. Tobacco, asbestos, arsenic, radiation such as gamma and x-rays, the sun, and compounds in car exhaust fumes are all examples of carcinogens. When our bodies are exposed to carcinogens, free radicals are formed that try to steal electrons from other molecules in the body. Theses free radicals damage cells and affect their ability to function normally.

Genes – the family type

Cancer can be the result of a genetic predisposition that is inherited from family members. It is possible to be born with certain genetic mutations or a fault in a gene that makes one statistically more likely to develop cancer later in life.

Other medical factors
As we age, there is an increase in the number of possible cancer-causing mutations in our DNA. This makes age an important risk factor for cancer. Several viruses have also been linked to cancer such as: human papillomavirus (a cause of cervical cancer), hepatitis B and C (causes of liver cancer), and Epstein-Barr virus (a cause of some childhood cancers). Human immunodeficiency virus (HIV) – and anything else that suppresses or weakens the immune system – inhibits the body’s ability to fight infections and increases the chance of developing cancer.

What are the symptoms of cancer?

Cancer symptoms are quite varied and depend on where the cancer is located, where it has spread, and how big the tumor is. Some cancers can be felt or seen through the skin – a lump on the breast or testicle can be an indicator of cancer in those locations. Skin cancer (melanoma) is often noted by a change in a wart or mole on the skin. Some oral cancers present white patches inside the mouth or white spots on the tongue.

Other cancers have symptoms that are less physically apparent. Some brain tumors tend to present symptoms early in the disease as they affect important cognitive functions. Pancreas cancers are usually too small to cause symptoms until they cause pain by pushing against nearby nerves or interfere with liver function to cause a yellowing of the skin and eyes called jaundice. Symptoms also can be created as a tumor grows and pushes against organs and blood vessels. For example, colon cancers lead to symptoms such as constipation, diarrhea, and changes in stool size. Bladder or prostate cancers cause changes in bladder function such as more frequent or infrequent urination.

As cancer cells use the body’s energy and interfere with normal hormone function, it is possible to present symptoms such as fever, fatigue, excessive sweating, anemia, and unexplained weight loss. However, these symptoms are common in several other maladies as well. For example, coughing and hoarseness can point to lung or throat cancer as well as several other conditions.

When cancer spreads, or metastasizes, additional symptoms can present themselves in the newly affected area. Swollen or enlarged lymph nodes are common and likely to be present early. If cancer spreads to the brain, patients may experience vertigo, headaches, or seizures. Spreading to the lungs may cause coughing and shortness of breath. In addition, the liver may become enlarged and cause jaundice and bones can become painful, brittle, and break easily. Symptoms of metastasis ultimately depend on the location to which the cancer has spread.

How is cancer classified?

There are five broad groups that are used to classify cancer.

1. Carcinomas are characterized by cells that cover internal and external parts of the body such as lung, breast, and colon cancer.
2. Sarcomas are characterized by cells that are located in bone, cartilage, fat, connective tissue, muscle, and other supportive tissues.
3. Lymphomas are cancers that begin in the lymph nodes and immune system tissues.
4. Leukemias are cancers that begin in the bone marrow and often accumulate in the bloodstream.
5. Adenomas are cancers that arise in the thyroid, the pituitary gland, the adrenal gland, and other glandular tissues.

Cancers are often referred to by terms that contain a prefix related to the cell type in which the cancer originated and a suffix such as -sarcoma, -carcinoma, or just -oma. Common prefixes include:

* Adeno- = gland
* Chondro- = cartilage
* Erythro- = red blood cell
* Hemangio- = blood vessels
* Hepato- = liver
* Lipo- = fat
* Lympho- = white blood cell
* Melano- = pigment cell
* Myelo- = bone marrow
* Myo- = muscle
* Osteo- = bone
* Uro- = bladder
* Retino- = eye
* Neuro- = brain

How is cancer diagnosed and staged?

Early detection of cancer can greatly improve the odds of successful treatment and survival. Physicians use information from symptoms and several other procedures to diagnose cancer. Imaging techniques such as X-rays, CT scans, MRI scans, PET scans, and ultrasound scans are used regularly in order to detect where a tumor is located and what organs may be affected by it. Doctors may also conduct an endoscopy, which is a procedure that uses a thin tube with a camera and light at one end, to look for abnormalities inside the body.

Extracting cancer cells and looking at them under a microscope is the only absolute way to diagnose cancer. This procedure is called a biopsy. Other types of molecular diagnostic tests are frequently employed as well. Physicians will analyze your body’s sugars, fats, proteins, and DNA at the molecular level. For example, cancerous prostate cells release a higher level of a chemical called PSA (prostate-specific antigen) into the bloodstream that can be detected by a blood test. Molecular diagnostics, biopsies, and imaging techniques are all used together to diagnose cancer.

After a diagnosis is made, doctors find out how far the cancer has spread and determine the stage of the cancer. The stage determines which choices will be available for treatment and informs prognoses. The most common cancer staging method is called the TNM system. T (1-4) indicates the size and direct extent of the primary tumor, N (0-3) indicates the degree to which the cancer has spread to nearby lymph nodes, and M (0-1) indicates whether the cancer has metastasized to other organs in the body. A small tumor that has not spread to lymph nodes or distant organs may be staged as (T1, N0, M0), for example.

TNM descriptions then lead to a simpler categorization of stages, from 0 to 4, where lower numbers indicate that the cancer has spread less. While most Stage 1 tumors are curable, most Stage 4 tumors are inoperable or untreatable.

How is cancer treated?

Cancer treatment depends on the type of cancer, the stage of the cancer (how much it has spread), age, health status, and additional personal characteristics. There is no single treatment for cancer, and patients often receive a combination of therapies and palliative care. Treatments usually fall into one of the following categories: surgery, radiation, chemotherapy, immunotherapy, hormone therapy, or gene therapy.

Surgery

Surgery is the oldest known treatment for cancer. If a cancer has not metastasized, it is possible to completely cure a patient by surgically removing the cancer from the body. This is often seen in the removal of the prostate or a breast or testicle. After the disease has spread, however, it is nearly impossible to remove all of the cancer cells. Surgery may also be instrumental in helping to control symptoms such as bowel obstruction or spinal cord compression.

Radiation
Radiation treatment, also known as radiotherapy, destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide. Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal, healthy tissue, but technologies have improved so that beams can be more accurately targeted. Radiotherapy is used as a standalone treatment to shrink a tumor or destroy cancer cells (including those associated with leukemia and lymphoma), and it is also used in combination with other cancer treatments.

Chemotherapy

Chemotherapy utilizes chemicals that interfere with the cell division process – damaging proteins or DNA – so that cancer cells will commit suicide. These treatments target any rapidly dividing cells (not necessarily just cancer cells), but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. It is a necessary treatment for some forms of leukemia and lymphoma. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. However, there are still common side effects such as hair loss, nausea, fatigue, and vomiting. Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options.

Immunotherapy

Immunotherapy aims to get the body’s immune system to fight the tumor. Local immunotherapy injects a treatment into an affected area, for example, to cause inflammation that causes a tumor to shrink. Systemic immunotherapy treats the whole body by administering an agent such as the protein interferon alpha that can shrink tumors. Immunotherapy can also be considered non-specific if it improves cancer-fighting abilities by stimulating the entire immune system, and it can be considered targeted if the treatment specifically tells the immune system to destroy cancer cells. These therapies are relatively young, but researchers have had success with treatments that introduce antibodies to the body that inhibit the growth of breast cancer cells. Bone marrow transplantation (hematopoetic stem cell transplantation) can also be considered immunotherapy because the donor’s immune cells will often attack the tumor or cancer cells that are present in the host.

Hormone therapy

Several cancers have been linked to some types of hormones, most notably breast and prostate cancer. Hormone therapy is designed to alter hormone production in the body so that cancer cells stop growing or are killed completely. Breast cancer hormone therapies often focus on reducing estrogen levels (a common drug for this is tamoxifen) and prostate cancer hormone therapies often focus on reducing testosterone levels. In addition, some leukemia and lymphoma cases can be treated with the hormone cortisone.

Gene therapy

The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA. For example, researchers are trying to replace the damaged gene that signals cells to stop dividing (the p53 gene) with a copy of a working gene. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell commits suicide. Gene therapy is a very young field and has not yet resulted in any successful treatments.

How can cancer be prevented?

Cancers that are closely linked to certain behaviors are the easiest to prevent. For example, choosing not to smoke tobacco or drink alcohol significantly lower the risk of several types of cancer – most notably lung, throat, mouth, and liver cancer. Even if you are a current tobacco user, quitting can still greatly reduce your chances of getting cancer.

Skin cancer can be prevented by staying in the shade, protecting yourself with a hat and shirt when in the sun, and using sunscreen. Diet is also an important part of cancer prevention since what we eat has been linked to the disease. Physicians recommend diets that are low in fat and rich in fresh fruits and vegetables and whole grains.

Certain vaccinations have been associated with the prevention of some cancers. For example, many women receive a vaccination for the human papillomavirus because of the virus’s relationship with cervical cancer. Hepatitis B vaccines prevent the hepatitis B virus, which can cause liver cancer.

Some cancer prevention is based on systematic screening in order to detect small irregularities or tumors as early as possible even if there are no clear symptoms present. Breast self-examination, mammograms, testicular self-examination, and Pap smears are common screening methods for various cancers.

How to eat to prevent cancer – Video

A guide to some everyday foods that contain nutrients that may help reduce your risk of getting cancer. Video by Howcast.

How To Eat To Prevent Cancer

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Women who do not have enough vitamin B12 in their blood before and after conception have a greater chance of having a baby with brain or spinal cord defects, a new study says.

Most at risk may be vegans and vegetarians, since B12 is far more common in meat and animal-based foods, noted an American and Irish research team whose findings were published in the March issue of Pediatrics..

According to the study, women with low levels of B12 had at least 2.5 times the risk of giving birth to a child with these neural tube defects, which can lead to partial paralysis or even death, than women with the highest B12 levels.

“Vitamin B12 is essential for the functioning of the nervous system and for the production of red blood cells,” Dr. Duane Alexander, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a news release issued by its parent organization, the U.S. National Institutes of Health. “The results of this study suggest that women with low levels of B12 not only may risk health problems of their own, but also may increase the chance that their children may be born with a serious birth defect.”

Researchers analyzed blood collected during the early pregnancy stages of hundreds of women from Ireland, a country with a high rate of neural tube defects. Either the women had previously given birth to a baby with a neural tube defect or were known to be carrying babies with the disorder.

Women with B12 concentrations below 250 ng/L before pregnancy had roughly three times the risk of having a child with a neural tube defect as those with higher B12 blood levels. Those women whose levels were less than 150 ng/L, which is considered B12 deficient, had five times the risk of women with higher levels.

The researchers used statistical techniques to focus solely on B12 levels and factor out the role of folic acid, a nutrient known to help prevent pregnant women from birthing babies with neural tube defects. The study authors noted that B12 and folate are jointly linked to several key biochemical reactions, but that a lack of either B12 or folate increased the risk of a neural tube defect.

While confirmation from other studies is needed, the authors suggested women should have vitamin B12 levels above 300 ng/L before becoming pregnant. Study co-author Dr. James L. Mills, a senior investigator in the NICHD division of epidemiology, statistics and prevention research, went further, recommending all women of childbearing age always consume the daily recommended amount of vitamin B12 and at least 400 micrograms of folic acid.

To address the disparity, the bill would:

* Increase Medicaid reimbursement rates for mammograms and screenings;

* Give Medicaid providers bonus payments for using best practices in screening and treatment;

* Require insurers to cover pain medication for women undergoing breast cancer treatment;

* Improve access to screening and eliminate copayments for mammograms;

* Establish two statewide patient navigator pilot programs that will train professionals to help patients coordinate care; and

* Increase breast cancer health education.

According to Harris, the cost of the bill has not been determined, as it will be merged with an already existing breast cancer screening program. Nancy Amicangelo, executive director of breast cancer outreach for the Illinois chapter of Network of Strength, said that if enacted, the law would improve trust in the community. “There’s a lot of mistrust out there. That’s a tough barrier,” she said. “The medical system and the state have let them down many times. It’s very hard to get that trust back,” she added.

Amicangelo said that it is important to inform women of the resources available to them, especially undocumented immigrants who face more complicated barriers. “A lot of these women, once they’re diagnosed, they have no idea what to do and what resources are available to them,” she said, adding, “If it’s really robust, the benefits could be invaluable” (Parker, Chi-Town Daily News, 2/23).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.