MaryO

http://www.reuters.com/newsArt....1889596

Estrogen, UV Added to US Govt. List of Carcinogens

Wed December 11, 2002 11:05 AM ET

By Todd Zwillich

WASHINGTON (Reuters Health) - A new US government report has for the first time identified estrogen-containing drugs and ultraviolet light as cancer-causing agents, federal agencies announced Wednesday.

The report also lists wood dust, common in carpentry shops and saw mills, as a known cause of lung cancer. Fifteen other compounds, including industrial chemicals, dyes and one compound found in foods cooked at high temperatures, were also added to the list as probable human carcinogens.

The report, published every 2 years by the National Toxicology Program, contains little new information about the agents it lists. Instead, it is a collection of known experimental data that the government uses to keep a running catalog of cancer-causing agents.

Federal agencies and Congress use the list to guide regulations and legislation governing industrial and environmental health hazards.

Wednesday's additions expanded the list to 228 compounds either "known" or "reasonably anticipated" to cause cancer in humans. It does not make conclusions about the magnitude of cancer risk posed by any of the compounds or what types of people may be most vulnerable.

Steroidal estrogens were added to the list for the first time because of research data linking the compounds to an increased risk of cancer of the endometrium, or lining of the uterus. They have also been associated with a rise in breast cancer risk.

Steroidal estrogens are used in hormone replacement therapy for menopausal women, and physicians are supposed to weigh the risk of cancer against the benefits of the drugs.

Estrogen replacement therapy is also known to reduce the chances of ovarian cancer in women who take it.

Broad-spectrum ultraviolet light, found in natural sunlight and in light used in tanning beds, was also classified as a known carcinogen because of a strong connection with cancers of the skin, lips and eyes, according to the report.

The report also upgraded beryllium compounds, which are commonly used in ceramics shops, nuclear reactors and jewelry making, from a probable to a known carcinogen.

Been shopping again! ?This morning before I left for work I visited Expedia at iGive and purchased our package for Vegas. ?I'd checked several sites for flights and hotels and the ones at iGive offered the same exact deals. ?

 

Last night when I was talking to Jerr he told me he'd purchased new computers for his business and bought them through iGive also.

 

Thanks to all who shop at iGive and help to support these boards!

 

 

Sue

Thanks, Sue!

iGive has extended its offer of a FREE $5 bonus donation for each new shopper until January 31, 2003! ?

That's on top of the up to 26% your group receives from each purchase a supporter makes via iGive.com.

412 different stores, the holidays, and great deals for your supporters make this prime time.

Make sure your supporters know they can use iGive to help your organization - at no cost to you or to them!

Unless you spread the word Cushing's Help and Support will miss out.

Plus, now through November 30th, get some PR, and get an Amazon.com Gift Certificate for FREE!

=========================================

FREE $5 + Up to 26% of Each Purchase!

-----------------------------------------

Each new person who registers at iGive.com between now and January 31, 2003 can raise an additional $5 for your cause, on top of earning up to 26% of each purchase for you!

All they have to do is shop via iGive.com within 45 days of joining. ?We make it easy, with over 400 familiar stores (like Amazon, Lands' End, PETsMART, Apple, Office Depot, and Best Buy) to choose from!

See the list:

http://www.iGive.com/html/merchantlisttour.cfm

Join iGive here.

Thanks, Cherri!  Very interesting

Thanks for thie info, Paula - I knew that President Kennedy had Addison's from somewhere deep in my brain LOL but maybe publishing this information will get more people aware of this - and Cushing's!

FDA Issues Warning About Painkiller

.c The Associated Press

WASHINGTON (AP) - People who develop a rash upon taking a new painkiller called Bextra should immediately stop the drug because it has been linked to some rare but life-threatening skin diseases, federal health officials warned Friday.

The Food and Drug Administration has about 20 reports of serious reactions - including the skin diseases Stevens-Johnson syndrome, toxic epidermal necrolysis and exfoliative dermatitis, as well as allergic reactions - among Bextra users since sales began in March.

The FDA estimates about 800,000 to 1 million people had recently begun taking Bextra when the reactions were reported. The immune system-linked skin disorders are thought to be more likely during the first few weeks of a drug's use than after the body becomes accustomed to the medicine.

Still, because those skin conditions are so rare, the FDA was surprised to see even that small cluster reported during Bextra's first year of sales. The conditions can be lifethreatening, and a few of the patients required hospitalization.

Stopping Bextra at the first sign of a rash lowers the chance of suffering a severe reaction, said Dr. Lawrence Goldkind, FDA's deputy director for painkillers.

In addition, the FDA warned that Bextra should not be used by anyone allergic to sulfa-containing drugs.

Bextra maker Pharmacia Corp. wrote thousands of doctors this week alerting them to the warning.

Bextra, known chemically as valdecoxib, treats arthritis and menstrual pain by reducing inflammation. It is a type of painkiller known as a cox-2 inhibitor.

11/15/02 13:46 EST

Copyright 2002 The Associated Press.

Anyone interested in any of this stuff as Cushing's merchandise?

Ski Cap

Ceramic Ornament

8x10 Frame with an 4x6 photo insert

Plush Bear wearing a t-shirt

Holiday Stocking

Woman's Thong :wow:

Greeting Cards with envelopes

1 Page Wall Calendar

Multi-page 12 month calendar

Postcards

What is Cushing's I or II?  Like pituitary and adrenal?  I've never heard of Cushing's described that way.

http://story.news.yahoo.com/news?tm....hing_dc

Health - Reuters

Diabetes Drugs May Help Cushing's Syndrome

By Keith Mulvihill

NEW YORK (Reuters Health) - A new study in mice is helping researchers zero in on a potential treatment for Cushing's syndrome, a hormone disorder that can be caused by a tumor in the brain's pituitary gland.

While such tumors can be removed surgically, this may not always cure the disease and there are no drugs suitable to treat the condition. The new study suggests that commonly used diabetes drugs may help such patients, according to a report in the November issue of the journal Nature Medicine.

Cushing's syndrome results from high levels of the hormone cortisol, and can cause fat accumulation in the upper body and face, and thinning of the arms and legs. Patients can experience high blood pressure and high blood sugar, along with depression, fatigue, irritability and weakened bones.

Cortisol levels rise when another hormone, called adrenocorticotropic hormone (ACTH), is overproduced by the brain's pituitary gland. ACTH stimulates the adrenal glands, which sit on top of the kidneys, to produce the cortisol, explained lead author Dr. Anthony P. Heaney of the Cedars-Sinai Medical Center in Los Angeles, California during an interview with Reuters Health.

Cushing's syndrome can be caused by a tumor of the pituitary gland, a tumor of the adrenal gland or by long-term use of drugs, called corticosteroids, commonly used to treat illnesses, such as rheumatoid arthritis and asthma.

In the current study, Heaney and colleagues found that a protein called PPAR-gamma, which is found on pituitary gland tumor cells, appears to be linked to overproduction of ACTH.

The researchers injected mice with ACTH-secreting pituitary tumor cells and then treated them with commonly used diabetes drugs, rosiglitazone (Avandia) and troglitazone, or an inactive placebo. Such drugs are known to inhibit PPAR-gamma, which also plays a role in sugar metabolism. Troglitazone (Rezulin) was withdrawn from the US market in 2000 after it was linked to liver damage and deaths in some patients.

The investigators found that production of ACTH, as well as the chemical equivalent of human cortisol in mice, dropped substantially.

"We saw pretty dramatic reduction in ACTH and cortisol-like hormone in the mice that got either of the drugs," Heaney told Reuters Health. "There was an 85% reduction in ACTH and a corresponding 96% reduction in their cortisol-like hormone."

In addition, the drugs caused the tumor cells to die and the overall size of the tumors to shrink, Heaney explained.

"Since we know that PPAR-gamma plays a role in the pituitary tumors that cause Cushing's syndrome, we may be able to treat the illness effectively with (the diabetes drugs)," he added.

The study was funded by the Doris Factor Molecular Endocrinology Laboratory, the Annenberg Foundation, and a National Institutes of Health grant.

SOURCE: Nature Medicine 2002;8:1281-1287

http://story.news.yahoo.com/news?tm....hing_dc

Health - Reuters

Diabetes Drugs May Help Cushing's Syndrome

By Keith Mulvihill

NEW YORK (Reuters Health) - A new study in mice is helping researchers zero in on a potential treatment for Cushing's syndrome, a hormone disorder that can be caused by a tumor in the brain's pituitary gland.

While such tumors can be removed surgically, this may not always cure the disease and there are no drugs suitable to treat the condition. The new study suggests that commonly used diabetes drugs may help such patients, according to a report in the November issue of the journal Nature Medicine.

Cushing's syndrome results from high levels of the hormone cortisol, and can cause fat accumulation in the upper body and face, and thinning of the arms and legs. Patients can experience high blood pressure and high blood sugar, along with depression, fatigue, irritability and weakened bones.

Cortisol levels rise when another hormone, called adrenocorticotropic hormone (ACTH), is overproduced by the brain's pituitary gland. ACTH stimulates the adrenal glands, which sit on top of the kidneys, to produce the cortisol, explained lead author Dr. Anthony P. Heaney of the Cedars-Sinai Medical Center in Los Angeles, California during an interview with Reuters Health.

Cushing's syndrome can be caused by a tumor of the pituitary gland, a tumor of the adrenal gland or by long-term use of drugs, called corticosteroids, commonly used to treat illnesses, such as rheumatoid arthritis and asthma.

In the current study, Heaney and colleagues found that a protein called PPAR-gamma, which is found on pituitary gland tumor cells, appears to be linked to overproduction of ACTH.

The researchers injected mice with ACTH-secreting pituitary tumor cells and then treated them with commonly used diabetes drugs, rosiglitazone (Avandia) and troglitazone, or an inactive placebo. Such drugs are known to inhibit PPAR-gamma, which also plays a role in sugar metabolism. Troglitazone (Rezulin) was withdrawn from the US market in 2000 after it was linked to liver damage and deaths in some patients.

The investigators found that production of ACTH, as well as the chemical equivalent of human cortisol in mice, dropped substantially.

"We saw pretty dramatic reduction in ACTH and cortisol-like hormone in the mice that got either of the drugs," Heaney told Reuters Health. "There was an 85% reduction in ACTH and a corresponding 96% reduction in their cortisol-like hormone."

In addition, the drugs caused the tumor cells to die and the overall size of the tumors to shrink, Heaney explained.

"Since we know that PPAR-gamma plays a role in the pituitary tumors that cause Cushing's syndrome, we may be able to treat the illness effectively with (the diabetes drugs)," he added.

The study was funded by the Doris Factor Molecular Endocrinology Laboratory, the Annenberg Foundation, and a National Institutes of Health grant.

SOURCE: Nature Medicine 2002;8:1281-1287

Flu: Give It a Shot

By Jennifer Huget

Special to The Washington Post

Tuesday, November 5, 2002; Page HE01

The word "flu" has been misapplied to illnesses ranging from the common cold to upset stomach for so long that it has lost some of its well-deserved menace. The real thing -- officially known as influenza -- is a highly contagious disease of the upper respiratory system that delivers five or more days of some combination of high fever, headache, fatigue, sore throat, dry cough, congestion and achiness. You don't want to get it.

And in most cases (more on this qualification later), you don't have to. This year's flu vaccine, unlike those of the past few years, is in ample supply: Between 92 million and 97 million doses will be available this fall and winter at community clinics, hospitals and doctor's offices. All you need is one shot. And for about $20, you can ward off the disease that kills an estimated 20,000 Americans each year -- lots more than anthrax, West Nile virus and malaria put together. You still have questions? We knew that.

HOW DOES THE VACCINE WORK?

The vaccine is formulated anew each year as epidemiologists track strains of flu virus circulating worldwide and identify those most likely to cause widespread illness during our flu season, which starts in earnest in November and runs through March or April. The vaccine consists of dead or inactivated viruses -- two "A" strains and one "B" strain -- which, when injected, prompt your immune system to produce antibodies to fight those viruses. This year's mix is calculated to combat a variant of Hong Kong B virus similar to a strain that was epidemic in the United States in 1988 and is expected to return this winter. The vaccine takes about two weeks to be fully effective; that's why vaccination efforts started in October.

WILL THE SHOT MAKE ME SICK?

Because the biological agents in the vaccine are dead, they can't give you the flu. Still, some people experience mild fever and achiness within a few days after their shot. People with egg allergies shouldn't be vaccinated, because the viruses used to make the vaccine are grown in hen's eggs. Though no link has been clearly established, some believe the vaccine may cause Guillain-Barr? syndrome. The Centers for Disease Control and Prevention (CDC) speculates that even if such a link were established, only one person in 1 million receiving the flu vaccine might develop the nerve-damaging syndrome, which is fatal in about 6 percent of all cases.

Sadly, a small percentage (the number varies from year to year, according to how well the vaccine matches the circulating flu strains) of those who get the shot will still come down with the flu, albeit generally a milder-than-usual case.

WILL THE SHOT HURT?

Of course it will. Get the shot anyway. MaryONote:  It doesn't hurt much, just a tiny prick. ?We've been through MUCH worse!color>

WHO'S AT GREATEST RISK OF SERIOUS FLU COMPLICATIONS?

While anyone can get the flu, those with weakened or compromised immune systems are more likely to get it and also to experience complications that may put them in the hospital. People over 65 have long been known to be at high risk because the immune system naturally grows weaker -- less able to produce antibodies to fight the virus -- as we age.

But the CDC this year has expanded its high-risk list to include children between 6 months and 23 months. Research has shown that children in this age group face about the same risk of being hospitalized for flu-related complications as seniors. While the CDC has not yet made its recommendation official, it now suggests that parents consider having children of this age vaccinated.

Children younger than 6 months face the same risk as older babies and toddlers, but the vaccine is not licensed for use in babies this young. To offer them some protection, the CDC has further expanded its priority-vaccination group to include those who live with or are caregivers for infants and toddlers.

Those between 50 and 65 years old are more likely to have chronic medical conditions, so they're in the high-risk category, too, as are those who are household contacts or caregivers for high-risk people of any age.

Women who are in the second or third trimester of pregnancy during flu season are considered at increased risk of complications from the illness and should talk with their doctors about whether to get a shot.

WHAT ABOUT OLDER CHILDREN?

Healthy schoolchildren have long been known to be at low risk of flu-related complications, and therefore have not been included in priority groups. But those with asthma, cystic fibrosis and other chronic conditions are at high risk of complications and should be considered priority recipients.

A University of Washington School of Medicine survey of illness among school-age children during one flu season estimated that for every 100 children followed, there were 28 illnesses and 63 missed school days attributable to influenza. Also, for every 100 children followed, their parents missed 20 days of work due to their children's illness. Kids younger than 9 who are getting vaccinated for the first time should get their shots right away (October would have been ideal) because they will need a booster a month later to ensure full protection.

I GOT A SHOT LAST YEAR. AM I STILL COVERED?

Still trying to weasel out of it, aren't you? No, last year's shot doesn't carry over. The vaccine confers its fullest protection for only a few months, and then only for the specific strains it's designed to fight. Of the three viruses targeted each year, one or two will be different from those targeted the previous year.

I'M WORRIED ABOUT THE PRESERVATIVES USED IN VACCINES; I'VE HEARD BAD THINGS ABOUT THIMEROSAL.

Though there's no hard evidence linking thimerosal, which contains a form of mercury, to any adverse health effects, some parents are fearful enough that they'd rather skip the vaccine than expose their kids to the preservative. In response to this, one manufacturer, Evans Vaccines, offers a reduced-thimerosal pediatric vaccine, and Aventis Pasteur has just introduced a limited supply of a preservative-free vaccine for kids between 6 months and 35 months old. It is available through your pediatrician. The CDC notes that the health risks posed by the flu outweigh any risk posed by the preservative.

I'M HEALTHY AS A HORSE. WHY SHOULD I BOTHER?

If the prospect of feeling deathly ill doesn't motivate you, maybe the thought of using up a week of sick leave actually being sick will. Numerous studies cited by the CDC show the cost-effectiveness of vaccinating healthy adults, the major factor being lost productivity related to workers' taking sick days. A new Stanford University study based on computer models weighing the costs and benefits of vaccinating healthy people ages 18 to 50 showed an average $30 savings per vaccination.

French researchers reporting in the American Stroke Association journal early this year found that the flu vaccine may lower stroke risk by as much as 40 percent, particularly in people 75 and younger, by reducing the chance of subsequent infections that might lead to blood clots. But while some studies have suggested that, by a similar mechanism, the flu virus can trigger heart attack in certain high-risk people, a study in the American Journal of Epidemiology found the vaccine offered no discernible benefit in preventing a second heart attack.

The CDC has recently compiled a new vaccine schedule (including shots for tetanus and other diseases in addition to the flu) for adults. It is available on the Internet at www.cdc.gov/nip/recs/adult-schedule.htm.

WHAT I CAN DO TO GET THE MOST FROM MY FLU SHOT?

Become younger. Seriously, though, because they're aware that flu shots confer varying levels of protection in different groups of people, scientists are exploring what people can do to boost the immune response produced.

There's anecdotal evidence that a healthy diet can help boost the immune response -- but you were already eating this way, weren't you? More substantial evidence offered in the Sept. 25 issue of the Journal of the American Medical Association suggests that being sleep-deprived when you receive your vaccine lessens your immune response, at least temporarily.

Among older people, regular physical activity vigorous enough to produce sweat may increase your immunity. Researchers at Iowa State University found that a group of people 65 and older who exercised three times a week for 20 minutes at high intensity developed stronger immune responses after receiving the influenza vaccine than those who performed less rigorous exercise. The same study showed that participants with low perceived stress levels produced more antibodies to help fight the flu virus.

SO I NEED TO EAT RIGHT, GET ENOUGH EXERCISE AND SLEEP AND LIMIT STRESS IN ORDER TO IMPROVE MY CHANCES OF STAYING HEALTHY?

Does the word "duh" ring a bell?

WHERE DO I GO TO GET A SHOT?

Large companies often offer flu-shot clinics for their employees; watch for news of them at work. Flu-shot suppliers run clinics at grocery stores, pharmacies and other retail sites. You can find one by checking www.findaflushot.com, a Web site maintained by Maxim Health Systems, or call the company toll-free at 877-962-9358. (Of course, this service lists only those clinics sponsored by Maxim.) Or you can just ask your own physician for a shot.

DID OLYMPIC PHYSICIANS LEARN INTERESTING THINGS ABOUT THE FLU THAT YOU'D LIKE TO TELL ME ABOUT?

Why, yes. Researchers at the University of Utah School of Medicine working at the 2002 Winter Olympics in Salt Lake City found they could slow the disease's spread in a community (in their case, the athletes living in close quarters in the Olympic village) through a combination of early detection (using recently available diagnostic tests) and rapid administration of oseltamivir (Tamiflu), one of four prescription-only antiviral drugs licensed for use in the United States. (The others are amantadine, rimantadine and zanamivir, each with different indications for use.) When administered within two days of the onset of illness, oseltamivir can shorten the flu's duration by about a day; administered prophylactically to those in close contact with influenza-stricken people, the drug can slow the spread of the illness through the community. (As a bonus, researchers found they could dramatically decrease the inappropriate administration of antibiotics, which, though they fight bacteria and have no power over any virus, are all too often prescribed for flu symptoms.)

I JUST CAN'T GET ENOUGH INFORMATION ABOUT THE FLU. WHERE ELSE CAN I LOOK?

You're in luck: Check out the CDC's National Immunization Program Web site at www.cdc.gov/nip/flu

? 2002 The Washington Post Company

http://www.washingtonpost.com/wp-dyn/artic...3-2002Nov2.html

Joint Dilemma

New Data Suggest One-Third of U.S. Adults Have Arthritis. Unfortunately, Treatments Aren't Keeping Pace

By Brian Reid

Special to The Washington Post

Tuesday, November 5, 2002; Page HE01

With last week's announcement that almost 70 million American adults -- one out of three -- are affected by arthritis, it's a good time to face the unpleasant realities about the chronic joint inflammation disease. For most people, there's no preventing it, no curing it and no treating it effectively except by managing pain. Seeking pain relief carries risks of its own, and the best strategy for keeping the disease contained -- a healthy diet and regular exercise -- is not generally heeded by the afflicted.

"We are dealing with conditions that are very common, and that will be more common and more of a burden as the years go on," said Eric Matteson, a professor of rheumatology and internal medicine at the Mayo Clinic in Rochester, Minn. "We baby boomers are getting old."

The U.S. Centers for Disease Control and Prevention (CDC) reported late last month that 69.9 million adults have arthritis or chronic joint pain symptoms. That figure is more than 60 percent higher than past estimates, and experts said the number will grow as Americans get older and heavier, two of the most powerful risk factors for the disease.

But even as the numbers affected by arthritis mount, doctors have few tools to stop or reverse the most common form of the disease, osteoarthritis, which is generally linked to wear on the joints and the breakdown of cartilage that cushions those joints from years of use, or trauma. Rheumatoid arthritis, which can affect people at any age and is caused by an autoimmune reaction, is estimated to affect more than 2 million people.

Physicians have evidence that lifestyle changes may slow osteoarthritis and reduce pain. But doctors say wonder drugs to prevent the condition or retard its progression are still years away.

"The largest group, the group that has the osteoarthritis or degenerative arthritis that's part of aging, that's the group that we still don't have perfect solutions for," said Lenore Buckley, a rheumatologist at Virginia Commonwealth University in Richmond. "We can't currently prevent most of the cases. We need new therapies."

That limits drug treatment largely to pain relief.

Last week a study out of Harvard flagged shortcomings with that approach, too, showing that regular, frequent use of acetaminophen (the active ingredient in Tylenol) and nonsteroidal anti-inflammatory drugs, or NSAIDS (such as ibuprofen, found in Advil and Motrin) appeared to dramatically increase women's risk of high blood pressure. Women who used either type of painkiller more than 22 days a month had about twice the risk of nonusers. Less-regular users also saw their risk elevated, though not by as much. And while that study showed no association between hypertension risk and aspirin, it carries other drawbacks. Regular use of the analgesic can put some patients at risk of bleeding ulcers, a shortcoming shared by NSAIDs.

New, more expensive pain relievers -- such as Vioxx and Celebrex -- have been designed to reduce the problem with bleeding, but doctors are still unsure whether they actually do. Concerns about higher-than-expected rates of heart attack in users of Vioxx and Celebrex also continue to dog the drugs.

About Those Numbers

The new government survey, conducted last year, asked more than 200,000 people two basic questions: Had they ever been diagnosed with arthritis? And had they experienced joint pain in the last year that lasted more than a month? Those who answered yes to the second question were included in the updated arthritis count, even though the CDC conceded that some of those individuals may have had joint pain that was unrelated to arthritis.

Chad Helmick, a CDC researcher who helped compile the survey results, said that about one-third of the respondents answered yes to at least one of the questions, with about 10 percent reporting both a diagnosis and recent episodes of joint pain.

The survey findings reaffirmed the basic tenets about arthritis risk. Those 65 and older are most affected, with nearly 60 percent reporting arthritis or chronic joint pain.

Individuals who are overweight, obese or inactive were also more likely to report joint problems than their normal-weight or active peers. Women were more likely to suffer symptoms than men, with roughly 37 percent of women affected compared with about 28 percent of men. Whites and blacks had higher rates of arthritis -- with both groups above 30 percent -- than Hispanics -- 23 percent.

The lack of good medical options for osteoarthritis stands in contrast to the treatment of rheumatoid arthritis. Though rheumatoid arthritis doesn't look different than osteoarthritis, it develops in a different way and can affect a broader spectrum of joints. Advances over the past two decades in our understanding of how the immune system goes awry have led to a few new drugs, notably Enbrel and Remicade, that can delay the disease and restore quality of life in both its early and late stages. The drugs have revolutionized treatment of the disease, experts said.

"No one should really have the kinds of deformities and disabilities that they had 10 years ago or 20 years ago, because the medication [for rheumatoid arthritis] is there," said Tino Mantella, president of the Arthritis Foundation, a nonprofit group that funds arthritis research and advocacy.

Looking Ahead

Now researchers are turning their attention to how osteoarthritis may begin, a first step in understanding that disease and fashioning treatments that may curb its impact on the millions with the disease -- and the millions more likely to develop it as they age.

"There's just beginning to be research about the causes and genetics and treatments for osteoarthritis," said Buckley. "We're really getting for the first time some insights into the mechanism. What's yet to be seen is if that understanding will parlay into better treatments."

Scientists are also taking a harder look at whether dietary supplements can make a difference. Glucosamine and chondroitin, substances naturally found around cartilage cells, are widely used as a self-care treatment, although reports of their effectiveness have been largely anecdotal. Makers claim the supplements can slow the effects of arthritis and may even repair battered joints.

The National Institutes of Health has funded a study of glucosamine and chondroitin that is designed to follow more than 1,000 patients. A smaller study, recently in The Lancet, a British medical journal, suggested the supplements may alleviate symptoms and slow the progression of the disease.

"There does appear to be an increasing science base" to claims of the substances' effectiveness, said John Klippel, the Arthritis Foundation's medical director. "You're seeing more patients use and more doctor recommending glucosamine."

But even future breakthroughs may not address one of the obstacles to arthritis care: patients who don't see their pain as arthritis or as treatable. Mantella says that he often deals with people who endure old sports injuries or a bad back, not realizing that those pains could signal arthritis.

"People tend to minimize these symptoms too often, and this loses valuable time in terms of treating and preventing worse outcomes," said Helmick.

And those with osteoarthritis are not completely without options. In addition to drugs for pain management, research has suggested that diet and exercise choices, while not able to rebuild deteriorating joints, can help reduce pain and improve mobility and daily life.

At the top of the list is exercise. Mantella says there was a time when treatment called for patients' immobilization within a body cast to give the joints time to heal. Those days are over. "Now," he says, "they would all say that's the worst thing in the world to do."

Ravaged joints benefit from strong muscle support, making muscle-building activities important. The evidence is strongest in arthritis of the knee. "Even in late knee osteoarthritis, if you can get people strengthening their quadriceps, you'll improve pain and improve function," Buckley said.

Regular exercise also helps shed pounds, one of the biggest contributors to osteoarthritis. That underscores the importance of proper diet, too, doctors said. Research has suggested that losing 11 pounds cuts osteoarthritis risk in half, and doctors said losing weight should help even patients who have already begun to show symptoms of arthritis.

That means public health efforts to stem arthritis dovetail with efforts to stem obesity. The bad news is that this effort is failing. Nationwide, a majority of people in every state but Colorado is either overweight or obese, and the CDC survey confirmed that more than 62 percent of adults contacted were above their ideal weight.

"Once you have the disease, if you lose weight, that should help," said Helmick.

Still, those interventions can't reverse the disease, and those with severe arthritis may never be able to regain even reasonable function if the condition is left unaddressed for too long, Buckley said. In a graying America, that group -- and the larger group of arthritis sufferers -- is growing, making new medical breakthroughs vital.

"We're all going to be joining that group. It's just a matter of time. The question is, when we get there, will there be better solutions?" Buckley paused. "I think there will, but it will take a significant investment by society."?

Brian Reid is a regular contributor to the Health section

? 2002 The Washington Post Company

This came in my email, if it applies to anyone:

ATTENTION RADIOLOGISTS!!!

If you or a radiologist that you know is interested in locating an excellent private practice opportunity in a beautiful area, please read on!!  We are currently working with a radiology group in Maryland, approximately 45 minutes from DC, who is looking to bring on an addition to their team.  This is an excellent opportunity for a board certified, motivated radiologist who is interested in relocating to an absolutely beautiful and charming community that offers a slow-paced lifestyle, suitable for family life, but with quick access to a major metropolitan area.  The group is offering a stable work environment in a well-equipped community hospital, a competitive starting salary, a partnership track, excellent benefits, and absolutely no call (covered by a nighthawk service).  The group is also offering a very nice home for the radiologist and his or her family to reside in for at least one year, and possibly more if necessary.  

If you know any radiologist who would be interested in hearing more about this opportunity, please contact Sally Seals with Hayman Daugherty & Associates at 1-800-765-0432 x21 or via email at sally@haymandaugherty.com

Please also feel free to visit our website at www.haymandaugherty.com

The occasional update...

From NIH Clinical Trials listings

Search term: CUSHING'S

Hi, ScienceTeacher!  Most of the Cushies who take Growth Hormone take it after pituitary surgery because their pit was removed or otherwise impaired.  Maybe you have a very astute endo who picked up that your pituitary is malfunctioning before surgery>

To read about other's experiences with this treatment, check out the Growth hormone Board.

Trial Information

Summary: Hypopituitary Control and Complications Study

Dr. Stanley Korenman of UCLA's Division of Endocrinology is conducting a study to look at the effects of the long-term use of Growth Hormone Therapy (Humatrope, an FDA approved medication). The study involves measurements of blood levels of hormones, bone density and body fat every 6 months for 5 years (a total of 11 visits).

Study Criteria:

• Be over 18 years of age
  
• Have known pituitary disease, either as a child or as a result of pituitary tumors
  
• Be taking hormone replacement
  
• Have health insurance
  
• Be interested in Growth Hormone Therapy
  

West Los Angeles:  Women With Pituitary Problems Wanted For A Testosterone Study

Purpose: Testosterone is the principal male sex hormone but is also present in smaller amounts and may be important in women. Among its likely actions in women are the building of bone and muscle mass, increase in interest in sex (libido) and effects on the mood. The role of testosterone replacement in women with low testosterone levels is currently being studied. In this study, you will be given an experimental preparation of a testosterone gel which will be applied on the skin of your outer thigh for seven days. It is anticipated that this experimental gel application will produce levels of the drug in the normal range for women. A further aim of this study is to assess whether female patients with dysfunction of the pituitary gland have abnormalities in body composition, muscle strength, thinking and sexual function.

Criteria for subjects:

• Women ages 18 to 50.
  
• Hypopituitarism with documented central adrenal and gonadal deficiencies, on conjugated equine estrogen replacement
  
• Serum testosterone level of
• Written informed consent
  
• No other significant medical condition
  
• Patients must discontinue their current testosterone replacement
  

Number of patients-10

Location: King/Drew Medical Center in Willowbrook and UCLA in West Los Angeles

Enrollment Period: Fall 2002

Patient Compensation: $200

For more information or subject referrals contact:

Ted F., M.D., Ph.D. Clinical Director

Telephone (323) 563-9353

Email: mail@goodhormonehealth.com

Fax: (323) 563-9352

Charles R. Drew University of Medicine and Sciences

1731 E. 120th St.

Los Angeles, California 90059

http://health.yahoo.com/search/healthnews?lb=s&p=id%3A30751

Promising New Treatment Preserves Bone Mass in Mice; May Help Women and Men With Osteoporosis

November 01, 2002, Acurian

Source: NIH/National Institute on Aging  

A completely new type of therapy, using a unique class of synthetic compounds, may someday protect both men and women from the bone-weakening disease osteoporosis. Researchers reported in the October 25, 2002, issue of Science that early studies of one of these compounds called estren successfully preserved and even restored bone mass in an animal model without the side effects associated with sex hormone therapies.

The group found that estren protected bone mass in both female and male mice as well as estrogen or testosterone did, but without the changes in reproductive organs associated with sex hormone therapy. They call this new class of compounds, ANGELS (Activators of Non-Genomic Estrogen-Like Signalling).

"The sex hormones estrogen and testosterone play a role in building bone throughout life as well as protecting the reproductive health of both sexes. To safeguard the bone mass often lost as women age, doctors may give estrogen. This is quite effective at preserving bone, but can have serious side effects," explained Jill Carrington, Ph.D., from the Biology of Aging Program at the National Institute on Aging (NIA). "This study suggests a new direction in research toward treating the disabling disease osteoporosis in both men and women." The NIA and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) supported the study by Stavros Manolagas, M.D., Ph.D., and colleagues at the University of Arkansas for Medical Sciences (UAMS) and the Central Arkansas Veterans Health Care System (CAVHCS), Little Rock, AR.

This new therapy evolved out of our knowledge of the role that sex hormones play in bone remodeling. Based on earlier work by Dr. Manolagas, he and his associates hypothesized that thebone building actions of sex hormones could be separated from their effects on the reproductive system; a different process seemed to be involved. If so, they proposed that it should be possible to trigger the bone building activities of cells without creating side effects in reproductive tissue.

For example, estrogen influences many organs in the body besides the breasts, ovaries, and uterus. These include the brain, cardiovascular system, and the skeleton. All of these organs contain estrogen receptors that link up with estrogen molecules and then turn on genes in the cells to perform various cellular functions. The investigators set out to identify whether it would be possible to use a substance that would attach to the estrogen receptors but only initiate the bone building activity and possibly beneficial activities in other non-reproductive tissues that use this process.

Estren appears to do that. The scientists looked at four groups of female mice and four of male mice: a group with ovaries or testes removed but no treatment, one with ovaries or testes removed that received estren, one with ovaries or testes removed that received a sex hormone, and a control group that kept their ovaries or testes, the natural source of sex hormones. In female mice the estren and estradiol (the type of estrogen used) were equally effective at preserving overall and spinal bone mineral density (BMD). In the hind limb of the estren-treated female mice the BMD appeared to be greater than that in either the estradiol-treated or control group, suggesting that estren treatment actually led to the addition of new bone. In male mice the estren was as effective as the sex hormone testosterone, and BMD in the spine was greater in the estren-treated group than in the control group. Lastly, estren did not cause any abnormal growth of cells in the uteri in the femal! e mice or the seminal vesicles in the male mice, and in the laboratory estren did not stimulate breast cancer cells to grow.

As people age, the delicate balance between the ongoing breaking down of old bone and its replacement by new bone, bone remodeling, begins to change. More bone is broken down than is replaced, and bone mass is lost. Bones weaken and eventually break easily, a condition known as osteoporosis.

Sex hormones help with bone remodeling by maintaining the balance to prevent the loss of bone mass. Menopause, when the estrogen supply becomes depleted, is the time that many women begin to experience a dramatic decrease in bone mass. In men the decline is more gradual, but the risk of fracture is serious by age 65.

One treatment for osteoporosis involves replacing sex hormones. Although very effective at maintaining bone mass, the sex hormones have side effects felt elsewhere in the body. For example, giving estrogen to a woman may lead to reproductive tissue changes such as endometrial cancer (cancer of the lining of the uterus), ovarian cancer, or breast cancer, and, likewise, giving testosterone to men might encourage prostate disease.

Because estren appears to be specific for the pathway of cellular activity that it turns on, but not for an individual organ or tissue, Dr. Manolagas is hopeful that it might also prove useful in other areas. These could include treating the vasomotor symptoms associated with menopause (hot flashes and night sweats) and preserving blood vessels and nerve cells against age-related changes.

A lot remains to be learned about estren. Future studies may focus on questions such as: Will estren prove useful in those areas? Will it improve lipid levels or cause blood clots as estrogen does? How does it compare to SERMs (selective estrogen receptor modulators), such as raloxifene, which target specific tissues? Is it as effective in preserving bone as bisphosphonates? Does estren have side effects? Continued research in animal models will help answer such concerns before studies in humans can be considered.

Reference:

S. Kousteni, J-R. Chen, T. Bellido, L. Han, A.A. Ali, C.A. O'Brien, L. Plotkin, Q. Fu, A.T. Mancino, Y.Wen, A.M. Vertino, C.C. Powers, S.A. Stewart, R. Ebert, A.M. Parfitt, R.S. Weinstein, R.L. Jilka, and S.C. Manolagas, "Reversal of Bone Loss in Mice by Nongenotropic Signaling of Sex Steroids," Science, Vol. 298, pp. 843-846, 2002.

Copyright © 2002 Acurian Inc. All Rights Reserved.

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Cushing's Syndrome Pituitary Tumor Cells Found to Express Large Amounts of PPAR-Gamma Source: Cedars-Sinai Medical Center

10/29/2002    

While most cases of a hormonal disorder called Cushing's Syndrome are caused by non-cancerous pituitary tumors that secrete too much of a particular hormone resulting in high cortisol levels, the disorder can ultimately lead to an early death for many patients whose tumors cannot be removed surgically.

Now, researchers at Cedars-Sinai Medical Center have found that pituitary tumors express an abundance of a specific protein receptor and report that treatment with a common diabetes drug was effective in shrinking tumor size and reducing hormone production in Cushing's pituitary tumors in mice. The findings, reported in the November 2002 issue of the journal, Nature Medicine, may lead to a new way to treat patients who have Cushing's Syndrome.

"Now that we know that this protein receptor plays a role in the pituitary tumors that cause Cushing's syndrome, we may have found a drug that can effectively treat this disease," said Dr. Anthony Heaney, lead author of the study and Assistant Professor and Medical Director of the Neuroendocrine Tumor Center at Cedars-Sinai Medical Center. "We will soon begin a clinical trial to test the effectiveness of this antidiabetic drug in patients with Cushing's syndrome who have pituitary tumors."

The most common type of Cushing's syndrome is caused by prolonged high-level exposure of a hormone called ACTH (adrenocorticotropin), which is secreted in excess by tumors of the pituitary gland, situated at the base of the brain and, which controls growth, metabolism and reproduction. Although the disorder is rare, it affects more women than men by a ratio of 5:1. Symptoms include weight gain with rounding of the face; increased fat in the neck; thinning skin; excess hair growth on the face neck, chest abdomen and thighs; muscle weakness and bone loss (osteoporosis); high blood sugar; diabetes; and high blood pressure. These effects are caused by high levels of adrenal steroids, or cortisol. The disorder is commonly treated with surgery to remove the tumor, but tumors are not always completely removed, either because they are too small to detect or have spread to parts of the brain that cannot be accessed via surgical procedures. Further, even if the tumor is successfully removed initially, about 50 percent of patients' experience a recurrence sometime after surgery.

The protein receptor, called PPAR-gamma (peroxisome proliferator-activated receptor), is a member of the steroid family and functions to regulate other genes involved in growth and metabolism. For example, the protein plays a role in the body's ability to respond to insulin, which lowers blood sugar. In fat cells, PPAR-gamma regulates sugar metabolism.

In view of the relationship between excess steroid hormones and obesity, the investigators first examined normal human pituitary tissue to determine which pituitary cells expressed PPAR-gamma. Their analysis revealed that PPAR-gamma was present selectively on normal ACTH-secreting pituitary cells, leading them to examine tumor specimens that secreted too much ACTH. In this analysis, they evaluated six ACTH-secreting pituitary tumors that had been surgically removed. They found that PPAR-gamma was abundantly expressed in all six tumors, as compared to modest expression in the normal pituitary tissue samples.

"The over-expression of this receptor on pituitary tumor cells indicates that PPAR-gamma may play a major role in the causation of Cushing's syndrome," said Dr. Shlomo Melmed, senior author of the study and Sr. Vice President of Academic Affairs and Professor and Director of the Burns and Allen Research Institute at Cedars-Sinai Medical Center.

Based on these findings, the investigators tested whether pituitary tumor cells would respond to drugs called thiazolidinediones (TZDs), which are commonly used in the treatment of diabetes and work by activating gamma. To do this, they first treated pituitary tumor cells with two different types of TZD drugs called troglitazone or rosiglitazone. They found that both drugs caused pituitary tumor cells to die, and inhibited secretion of ACTH hormone from the tumor cells.

Given that the TZD's were effective to induce tumor-cell death and slow the secretion of ACTH in cell cultures, the investigators subsequently tested the drugs in mice with ACTH-secreting pituitary tumor cells, which were then randomly selected to receive food containing rosiglitazone or normal food. After four weeks, the investigators found that four of the five untreated mice developed large, visible pituitary tumors, and the typical Cushing's features of a "moon shaped" face and large neck. In comparison, only one of the five rosiglitazone treated mice developed a small pituitary tumor. The investigators also found that ACTH and other steroid hormones were considerably lower in the treated mice as compared to those not receiving treatment.

"These results indicate that TZDs may be effective in slowing tumor growth in humans," said Dr. Heaney.

Cedars-Sinai Medical Center is one of the largest non-profit academic medical centers in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthrough in biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.

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Doubts Grow About Post-Menopausal Hormone Use

At NIH Conference, Emerging Skepticism That Combination Therapy Should Be Used to Prevent Disease

By David Brown

Washington Post Staff Writer

Sunday, October 27, 2002; Page A12

Three months after the unexpected end of a huge study of postmenopausal hormone use, a consensus is emerging that there is essentially no use for the drugs in the prevention of chronic ailments that come with age.

Although the hormones have both good and bad effects -- raising the risk for heart attack, breast cancer and blood clots while lowering it for osteoporosis and colon cancer -- their net effect is harmful in terms of disease prevention. They still have a role in the treatment of symptoms of menopause. But how large a role is a matter of dispute.

Those were among the conclusions that emerged from a two-day meeting held this week at the National Institutes of Health. The gathering was called to assess the immediate consequences of the hormone study results and talk about what new research may be needed.

"For the community of practitioners, the clear message is: If you're using hormones, try to limit it to short-term treatment for symptoms. It's not a prescription for life -- and that's a big, big change," said Florence Comite, a physician and founder of the women's clinic at Yale University, and one of about 500 medical researchers, clinicians and regulatory officials who attended.

When the results from the Women's Health Initiative hormone trial were released in early July, Comite had more than 100 patients taking combinations of estrogen and progestin, the two hormones that were studied. About one-third have stopped. "I think the dust has settled to some degree," she said.

Ronald K. Ross, a preventive medicine physician at the University of Southern California said he believes there is less confusion in the scientific community about the study results than the public might think. "Combination treatment [for disease prevention] is certainly out of the question," he said, summing it up.

Agreement on the study's implications, however, is far from universal.

Some people at the NIH workshop argued that hormone preparations different from those used in the study might have given different results. Some believe that the long-imagined cardiovascular benefit would have been seen if younger women had been enrolled, and if they'd started taking hormones as soon as they entered menopause. Some people think lower doses of the medicines won't cause harm. There was much talk about "individualizing" therapy for each woman -- a concept that appears to leave much room for the liberal prescription of hormones for long-term use.

"Is there a role for hormone therapy in prevention? Absolutely," said Frederick Naftolin, an obstetrician-gynecologist who is also affiliated with Yale. "Preventing bone loss, preserving skin, possibly in dementia. And I'm still not convinced there is no role in [preventing] cardiovascular disease."

This view appeared to be a distinct minority. A number of experts -- and authority figures -- went out of their way to say it was also an incorrect interpretation of study's results.

"It is clear that this combination hormone therapy should not be generally used for prevention purposes of chronic diseases," NIH's director, Elias A. Zerhouni, said in a statement published at the end of the workshop. Asked if this means that prescribing estrogen and progestin to a woman without symptoms is bad practice, he said: "Yes, it is bad practice."

Marcia L. Stefanick, a physiologist at Stanford University and one of the chief architects of the study, said she believes there is a real hazard in trying to find exceptions to the main findings.

"To say that the risks don't exceed the benefits -- unless you are focusing on menopausal symptoms -- is simply wrong," she said.

In what is probably the closest to an official position on the issue, the United States Preventive Services Task Force -- which provides advice to the Department of Health and Human Services -- next month will publish a guideline that "recommends against" combination hormone use for the prevention of disease in women.

In the mid-1980s, about 40 percent of postmenopausal women in America took hormone replacements at least for a while. The fraction who do today is unknown, although it is in the millions.

The main reason estrogen and progestin combinations are prescribed is to relieve hot flashes and other symptoms of menopause. The Women's Health Initiative study didn't examine that use -- or the benefit gained from the medicines' near-certain ability to relieve those symptoms. Instead, it looked at the claims that hormones, taken for years or decades, prevent disease, heart disease in particular.

The study randomly assigned nearly 17,000 women to take either a placebo or an estrogen-and-progestin combination. The participants' average age was 63, meaning that most were more than a decade beyond menopause, which occurs on average at age 51 in the United States.

Although designed to last eight years, the study was stopped after a little more than five because it was clear that the major anticipated benefit -- fewer heart attacks in hormone takers -- wasn't occurring. In fact, there were more heart attacks in women assigned to the drugs.

(A study of about 11,000 women who have had a hysterectomy -- the surgical removal of the uterus -- is continuing. They are assigned to take estrogen alone or a placebo. None is taking progestin.)

In the entire group, the number of bad events was small, and the absolute risk for any individual woman very low.

For example, at the rates seen over the course of the study, hormone use will cause an extra heart attack each year in about 1 in every 1,100 women taking the medicines; an extra stroke in 1 in 1,200; an extra blood clot of a serious nature in 1 in 600; and an extra case of breast cancer in 1 in 1,300. At the same time, hormone use will protect 1 in about every 2,000 women from a hip fracture she would otherwise have suffered; and 1 in 1,700 from a case of colon cancer.

A calculation presented at the meeting by Deborah Grady, a physician and epidemiologist at the University of California in San Francisco, suggested that given those numbers, essentially nobody is likely to benefit from preventive use of hormones.

For example, if women with family histories of colon cancer (which doubles their own risk) take hormones, the net effect still tips toward harm, with 1 in 700 users suffering an additional one of the bad events. For women with osteoporosis, it's 1 in 650. Only in women with osteoporosis who have already suffered a fracture do the risks and benefits balance out, according to Grady's calculation. But for them, she argued, there are many lower-risk interventions, such as exercise, smoking cessation, calcium and vitamin D supplements, and the anti-osteoporosis drugs called bisphosphonates.

Further analysis of the data is underway. But the investigators said the main trends were seen in all age groups and races, and that no subpopulations appear to benefit.

For example, for cardiovascular events (heart attack, stroke, clots) the risk was increased 67 percent in the youngest group of hormone users, those age 50 to 59 at the start of the study. For women 60 to 69, it was up 26 percent, and for the oldest women, those 70 to 79, it was up 18 percent. Breast cancer risk was up 23 percent, 22 percent and 42 percent, respectively, in those three age groups.

The potential wild card in hormone use is dementia.

Studies have shown that women with Alzheimer's disease are less likely to have taken hormones than women without Alzheimer's. That observation, however, doesn't mean hormones protected them. Only a randomized, controlled trial could determine that.

A subgroup of elderly women in the Women's Health Initiative study is being observed for the development of dementia. There is also a trial of two estrogenlike compounds (tamoxifen and raloxifene) underway.

A recent trial of estrogen in women who already have Alzheimer's found the hormone didn't help. However, if it turned out there was a preventive effect, that benefit might swamp the harms.

For example, out of 10,000 women who are older than 65 and have a close relative with Alzheimer's, 500 every year will develop dementia. That's far, far more than the 20 additional bad events per 10,000 women per year seen in the hormone users in the Women's Health Initiative study.

? 2002 The Washington Post Company

There seems to be yet another email virus going around, just before Halloween.  The title of the email is Happy Allhallowmas and there's no text to the email, just a file to download.  Please don't download that file, no matter who it came from.  We had quite a bit of discussion about email viruses earlier on the By the water cooler Board.

Please remember that these things send themselves, using address books.  One of these emails may look like it came from a friend, but it didn't really.

Stay safe, everyone!

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Smoking at an Early Age Increases Risk of Developing Breast Cancer

October 17, 2002, Acurian

Source: 411Cancer.com "Cancer Experts leading the way to optimal cancer care."

According to two recent articles published in The Lancet and the American Journal of Epidemiology, smoking at a young age appears to significantly increase the risk of developing breast cancer in women.

Breast cancer claims the lives of approximately 40,000 women each year in the United States alone. Since this disease occurs so frequently, researchers are evaluating both genetic and environmental factors in an attempt to determine if associations exist between specific variables and the development of breast cancer. One variable that is being studied is smoking.

One clinical study, as published in the American Journal of Epidemiology, involved nearly 470 women who had been diagnosed with premenopausal breast cancer. Data was collected regarding lifetime active and passive smoking among these women and was compared to over 1,000 women of approximately the same age who had not been diagnosed with breast cancer. Compared with women who had never actively smoked or been consistently exposed to passive smoke, former smokers had a 20% increased risk of developing premenopausal breast cancer and current smokers had a 50% increased risk of developing premenopausal breast cancer. The risk of developing breast cancer increased the longer a woman had smoked and decreased the longer it had been since she quit smoking. Women who had the highest exposure to active and passive smoking had an 80% increased risk of developing premenopausal breast cancer.

A second clinical study, as published in The Lancet, involved over 700 women under the age of 75 years who had been diagnosed with breast cancer. The researchers assessed data regarding all known or suspected risk factors, smoking and alcohol consumption and compared these risk factors to a group of over 1,000 women who did not have breast cancer. Of the 318 premenopausal women with breast cancer, there was nearly a 70% increase in the incidence of breast cancer if women had been pregnant and started smoking within 5 years from the initiation of menstruation, or if women had not had children but smoked 20 or more cigarettes daily or had a 20-pack year history. Conversely, in the 700 postmenopausal women with breast cancer, their risk was significantly reduced if they had gained weight since the age of 18 and had started smoking after a first full-term pregnancy. Researchers speculate that this reduction in breast cancer is due to the interference of smoking with female h! ormones

Both of these studies indicate that smoking increases the risk of developing premenopausal breast cancer in women. This provides further reason to discourage teenagers from starting to smoke. Women who started smoking early may wish to discuss their risks of developing breast cancer and appropriate screening measures with their physician. Further studies will be conducted to verify these findings, particularly those in postmenopausal women.

References:

Kropp S, Chang-Claude J. Active and passive smoking and risk of breast cancer by age 50 years among German women. American Journal of Epidemiology. 2002;156:616-626.

Band P, Le N, Fang R, Deschamps M. Carcinogenic and endocrine disrupting effects of cigarette smoke and risk of breast cancer. The Lancet. 2002;360:1044-1049.

© CancerConsultants.com

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Government Offers Hormone Caution

.c The Associated Press

WASHINGTON (AP) - Women should not use estrogen and progestin supplements in hopes of preventing bone loss or other chronic ailments, the government said Tuesday.

Federal scientists broke the news in July that long-term use of the combination hormone therapy significantly increased women's risk of breast cancer, heart attacks and strokes.

The news caused dismay and confusion for millions of American women. Many used the combination not just in hopes of long-term health but to relieve short-term menopausal symptoms such as hot flashes and night sweats, and wondered how long they could safely use hormones for that purpose.

Now the independent panel charged by the U.S. government to set the nation's disease-prevention guidelines has weighed in, with recommendations not likely to settle the confusion.

The clear risks of routine estrogen-and-progestin use outweigh the few long-term benefits, such as bone strength, the U.S. Preventive Services Task Force said Tuesday. But when it comes to menopause symptom relief, the panel urged women to discuss their personal disease risks with their health provider in choosing whether to try hormones.

For example, most discussion of hormone therapy's risks has centered on long-term use, yet the risk of heart attack actually rises in the first year women swallow the pills, said task force co-chairwoman Dr. Janet Allan. A woman with high cholesterol or high blood pressure might make a different decision on using hormones for hot flashes than a healthier woman would.

"This is tough for women," Allan acknowledged.

The task force last examined hormone therapy in 1996, calling the evidence too paltry to decide if women should use it. But doctors' and patients' enthusiasm for hormones overrode that cautionary note, and an estimated 6 million women were taking the estrogen-progestin combination when the National Institutes of Health announced the bad news in July.

Millions more are thought to be taking estrogen alone, something reserved for women who have had their uterus removed. The task force said there's not enough evidence to know yet if estrogen-only therapy is any safer than combination therapy; a study of that question is continuing.

10/15/02 18:20 EDT

Copyright 2002 The Associated Press.

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3% donation at Amazon.com.  The following special rules apply:

No donation on: out-of-print, gift certificate, auction, 3rd party sold/shipped (like partners, zshops, used items). Max. $4 donation/order. Report all amazon.com orders: http://www.iGive.com/html/missingtrans.cfm

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'Bugbear' worms in, opens doors to hackers

By Jeordan Legon (CNN)

Friday, October 4, 2002 Posted: 5:40 PM EDT (2140 GMT)

(CNN) -- The stealthy "Bugbear" worm continued on a ravenous digital path this week, prompting anti-virus firms to escalate warnings from moderate to high and leaving thousands of computers worldwide at the mercy of hackers.

But initially, at least, the virus was not causing major problems for computer users, because its purpose appeared to be to open communication ports on infected systems and to replicate itself, not to destroy files.

"It appears to be designed by someone who intended to steal credit card info or other data, not necessarily destroy files," said George Stagonis, a researcher for anti-virus company Central Command.

While experts hoped the bug would be contained at its source in Malaysia on Monday, the virus rapidly made its way around the world as users in Asia, Europe, Canada and the United States fired up their computers to check e-mail. At least 120,000 people reported infections to British anti-virus firm MessageLabs by Friday. Thousands more logged attacks in Ireland, Australia, Canada and the United States.

The number of new cases reported daily is rivaling, and even exceeding, that of the better-known Klez virus, a similar bug that hit millions of computers this year.

Central Command received 5221 reports of new infections Thursday -- evenly split between the United States and Europe. The company booked an average of 4,000 daily Klez infections when that virus was at its height, Stagonis said.

"We don't think it's peaked yet because it's staying way ahead of people updating their anti-virus software," said George Stagonis, a researcher for anti-virus company Central Command.

What makes the virus dangerous?

Bugbear, also known as Tanatos, doesn't destroy files like its viral cousins "Melissa," "Michelangelo" and "Iloveyou." Instead, it disables popular firewall and anti-virus protections and prepares a port that can receive instructions from remote users.

That is what makes the virus so dangerous, experts say. Hackers aware of this vulnerability will search for open ports on infected computers. Once found, attackers can access passwords, view or destroy data and get reports of keystrokes being entered ? including credit card numbers and other sensitive information. All of this happens without the knowledge of the hacked computer owner or business.

Silent spread

When the virus first appeared, anti-virus gurus were unable to mirror the spread of the bug in their labs. Many thought Bugbear would remain a minor threat.

"We still haven't managed to replicate it in our labs, but obviously it's replicating," said Alex Shipp, a tech with MessageLabs. "One of the theories is that this requires an Internet connection in order to spread."

The virus spreads quickly by disguising infected messages as "replys" or "forwards" to an existing message. It targets known vulnerabilities in Windows systems and has no trouble moving through banks of networked office computers, said Vincent Weafer, of Symantec Security Response.

"Once it gets into a machine it will try to replicate itself from machine to machine," Weafer said.

Avoid infection

While the virus is difficult to spot, there are ways to avoid it.

The file can arrive in mails with varied subject headings, but almost always it has an attachment that is 50,668 bytes, Shipp said.

Also, computer owners should make certain that Internet Explorer's I-FRAME patch is installed, which prevents the bug from automatically downloading itself from an infected message. And they should update to new versions of Microsoft Outlook message program, which are less prone to infection.

The one bright spot in all of this, said Shipp, is that many people are updating their anti-virus software and making sure firewalls are up, which appears to be killing off the Klez virus.

The bad news is "this new one is just as bad, if not worse, than Klez," Shipp said.