Breast Cancer

A new drug prevents breast cancer in older, high-risk women just as well as today's standby tamoxifen -- but with fewer side effects, the National Cancer Institute announced on 17th April.

Called raloxifene, the newer drug already is sold to treat bone-thinning osteoporosis.
But the striking new results, from a government study of nearly 20,000 women, suggest that raloxifene may supplant its older cousin as the first choice for breast cancer prevention in postmenopausal women at high risk of developing the disease.

"Now women have a choice," Dr. Leslie Ford, NCI's cancer prevention chief, said in an interview Monday. "It's good news, because we're giving you a choice with fewer side effects."
Manufacturer Eli Lilly & Co., which sells raloxifene under the brand name Evista, plans to seek Food and Drug Administration approval for the new use.

Until now, tamoxifen has been the only drug approved to reduce the chances of breast cancer striking high-risk women.

Both drugs are "selective estrogen response modulators" -- they act like the estrogen hormone in some tissues but like an anti-estrogen in others.

Estrogen can fuel certain breast cancers, making tamoxifen a longtime top choice both to prevent the disease's return in women with estrogen-sensitive tumors and to reduce the odds of it striking high-risk women in the first place.

However, tamoxifen causes some rare but serious side effects: It acts like an estrogen in the uterus and bloodstream, thus increasing users' risk of getting uterine cancer or a life-threatening blood clot.

Raloxifene is a close chemical relative, and earlier research suggested that it might help breast cancer, too. So the NCI launched the $88 million study to compare the two.

Taking either tamoxifen or raloxifene daily for up to five years cut in half women's chances of developing invasive breast cancer, NCI announced Monday.

Raloxifene caused the same side effects, but not as many. Raloxifene users had 36 percent fewer uterine cancers and 29 percent fewer blood clots, according to initial results of the "Study of Tamoxifen and Raloxifene," or STAR project. Raloxifene users also suffered fewer vision-blocking cataracts.

Some 2 million U.S. women every year are thought to be candidates for tamoxifen risk-reduction therapy, but many have avoided it for fear of those side effects, said STAR researcher Dr. Kathy Albain of Loyola University.

While the reduction in those side effects was significant, the study also showed how uncommon the effects are. Thirty-six tamoxifen users developed uterine cancers, compared with 23 raloxifene users. The risk of blood clots was similarly low: 54 tamoxifen users had one in the lung, compared with 35 raloxifene users.

Still, "here we have something that's a little less scary," Albain said of the raloxifene findings. "It might tip the scales for a lot of women."

The new study means no change for premenopausal women -- there's no data showing whether raloxifene is safe for them, Albain stressed.

Nor does it mean that tamoxifen users should necessarily switch, she said. Women currently are prescribed tamoxifen for five years, and its breast cancer prevention benefit continues even after they stop taking the drug -- as raloxifene's seems to. So a woman already in, say, year four of her tamoxifen course with no sign of side effects probably has little to gain by switching, she explained.

But that's a question researchers were girding for as they spent Monday notifying study participants of the results.

One puzzle: While raloxifene was equally effective in blocking invasive breast cancer, it didn't protect quite as well as tamoxifen against noninvasive types of breast cancer such as ductal carcinoma in situ, noted Dr. Len Lichtenfeld of the American Cancer Society.

That type of tumor isn't life-threatening and shouldn't water down the overall message of raloxifene's benefit, said Dr. Victor Vogel of the University of Pittsburgh, who oversaw the study's design.

Among postmenopausal women, who's at high risk? Most of the study participants had a 4 percent chance of getting breast cancer within five years -- because of advanced age, a close relative with the disease, never having a child or having one late in life, or other well-known risk factors that women can calculate on a government Web site: http://cancer.gov/bcrisktool.

In simpler terms, for every 1,000 of those women, doctors expected 40 to develop breast cancer within five years if they did nothing, but taking one of the drugs cut that number to 20, Ford explained.

Understanding the Germs and Viruses that cause infection

Bacteria, viruses and other infectious organisms live everywhere. You can find them in the air; on food, plants and animals; in the soil and in the water; and on just about every other surface — including your own body. They range in size from microscopic single-cell organisms to parasitic worms that can grow to several feet in length.

Most of these organisms (microbes) won't harm you. But others can cause infection. Your immune system protects you against an abundance of these infectious agents, and at times, it's a tough task. Viruses and bacteria are cunning adversaries, constantly seeking new ways to breach your immune system's defenses.

But you can give your immune system a fighting chance by understanding a little bit about the various kinds of microbes, what you can do to avoid infection and under what circumstances you should seek medical care.

Infectious agents: A multitude of microscopic invaders

Bacteria

Bacteria are one-celled organisms visible only with a microscope. They're so small that if you lined up a thousand of them end to end, they could fit across the end of a pencil eraser. They're shaped like short rods, spheres or spirals. They're usually self-sufficient and multiply by subdivision.

Among the earliest forms of life on earth, bacteria have evolved to thrive in a variety of environments. Some can withstand searing heat or frigid cold, and others can survive radiation levels that would be lethal to a human being. Many bacteria, however, prefer the mild environment of a healthy body.

Not all bacteria are harmful. In fact, less than 1 percent cause disease, and some bacteria that live in your body are actually good for you. For instance, Lactobacillus acidophilus — a harmless bacterium that resides in your intestines — helps you digest food, destroys some disease-causing organisms and provides nutrients to your body.

But when infectious bacteria enter your body, they can cause illness. They rapidly reproduce, and many produce toxins — powerful chemicals that damage specific cells in the tissue they've invaded. That's what makes you ill. The organism that causes gonorrhea (gonococcus) is an example of a bacterial invader. Others include some strains of the bacterium Escherichia coli — better known as E. coli — which cause severe gastrointestinal illness and are most often contracted via contaminated food. Other conditions caused by bacteria include strep throat and staph infection.

E. coli O157:H7 is a bacterium responsible for food-borne infections linked to eating undercooked ground beef.

Viruses

In its simplest form, a virus is a capsule that contains genetic material — DNA or RNA. Viruses are even tinier than bacteria. To see them, scientists must use an electron microscope, a high-powered instrument that produces enlarged images of minute objects. To put their size into perspective, consider that, according to the American Society for Microbiology, if you were to enlarge an average virus to the size of a baseball, the average bacterium would be about the size of the pitcher's mound. And just one of your body's millions of cells would be the size of the entire ballpark.

The main mission of a virus is to reproduce. However, unlike bacteria, viruses aren't self-sufficient — they need a suitable host to reproduce. When a virus invades your body, it enters some of your cells and takes over, instructing these host cells to manufacture what it needs for reproduction. Host cells are eventually destroyed during this process. Polio, AIDS and the common cold are all viral illnesses.

The influenza virus takes over healthy cells, spreads through your body and causes illness. Signs and symptoms include fever, chills, muscle aches and malaise.

Fungi

Molds, yeasts and mushrooms are types of fungi. For the most part, these single-celled organisms are slightly larger than bacteria, although some mushrooms are multicelled and plainly visible to the eye — for instance, the mushrooms you may see growing in a wooded area or even in your backyard. Mushrooms aren't infectious, but certain yeasts and molds can be.

Fungi live in the air, water, soil and on plants. They can live in your body, usually without causing illness. Some fungi have beneficial uses. For example, penicillin — an antibiotic that kills harmful bacteria in your body — is derived from fungi. Fungi are also essential in making certain foods, such as bread, cheese and yogurt.

Other fungi aren't as beneficial and can cause illness. One example is candida — a yeast that can cause infection. Candida can cause thrush — an infection of the mouth and throat — in infants, in people taking antibiotics and in people with impaired immune systems. It's responsible for most types of infection-induced diaper rash.

Infection with candida fungus can lead to problems such as diaper rash, vaginal yeast infections and oral thrush.

Protozoa

Protozoa are single-celled organisms that behave like tiny animals — hunting and gathering other microbes for food. Protozoa can live within your body as a parasite. Many protozoa inhabit your intestinal tract and are harmless. Others cause disease, such as the 1993 Cryptosporidium parvum invasion of the Milwaukee water supply, sickening more than 400,000 people. Often, these organisms spend part of their life cycle outside of humans or other hosts, living in food, soil, water or insects.

Most protozoa are microscopic, but there are some exceptions. One type of ocean-dwelling protozoa (foraminifer) can grow to more than 2 inches in diameter.

Some protozoa invade your body through the food you eat or the water you drink. Others can be transmitted through sexual contact. Still others are vector-borne, meaning they rely on another organism to transmit them from person to person. Malaria is an example of a disease caused by a vector-borne protozoan parasite. Mosquitoes are the vector transmitting the deadly parasite plasmodium, which causes the disease.

Cryptosporidium is a protozoan protected by a strong outer shell that allows it to survive outside the body for long periods of time.

Helminths

Helminths are among the larger parasites. The word "helminth" comes from the Greek for "worm." If this parasite or its eggs enter your body, they take up residence in your intestinal tract, lungs, liver, skin or brain, where they live off the nutrients in your body. The most common helminths are tapeworms and roundworms.

The largest of the roundworms range in length from 6 to 14 inches. But imagine the largest of the tapeworms — they can grow to be 25 feet or longer. Tapeworms are made up of hundreds of segments, each of which is capable of breaking off and developing into a new tapeworm.

Infection by one type of roundworm, known as a hookworm, can cause problems in your small intestine or lungs. The average hookworm is about half an inch long.

Understanding infection vs. disease

There's a distinct difference between infection and disease. Infection, often the first step, occurs when bacteria, viruses or other microbes enter your body and begin to multiply. Disease occurs when the cells in your body are damaged — as a result of the infection — and signs and symptoms of an illness appear.

In response to infection, your immune system springs into action. An army of white blood cells, antibodies and other mechanisms goes to work to rid your body of whatever's causing the infection. For instance, in fighting off the common cold, your body might react with fever, coughing and sneezing.

When to seek medical care
If you think you've contracted an infectious disease, contact your doctor. Although some infectious diseases, such as the common cold, might not require a visit to the doctor, others might call for the expertise of a trained professional.

Seek medical care if you suspect that you have an infection and you have experienced any of the following:

An animal bite
Difficulty breathing
A cough lasting longer than a week
A fever of 100.4 F (38.0 C) or more
Periods of rapid heartbeat
A rash, especially if it's accompanied by a fever
Swelling
Blurred vision or other difficulty seeing
Vomiting
An unusual or severe headache

Your doctor can perform diagnostic tests to find out if you're infected, the seriousness of the infection, and how best to treat that infection.

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Bacteria and Foodborne Illness

Foodborne illness results from eating food contaminated with bacteria (or their toxins) or other pathogens such as parasites or viruses. The illnesses range from upset stomach to more serious symptoms, including diarrhea, fever, vomiting, abdominal cramps, and dehydration. Although most foodborne infections are undiagnosed and unreported, the Centers for Disease Control and Prevention estimates that every year about 76 million people in the United States become ill from pathogens in food. Of these, about 5,000 die.


Causes
Harmful bacteria are the most common causes of foodborne illnesses. Some bacteria may be present on foods when you purchase them. Raw foods are not sterile. Raw meat and poultry may become contaminated during slaughter.

Seafood may become contaminated during harvest or through processing. One in 20,000 eggs may be contaminated with Salmonella inside the egg shell. Produce such as lettuce, tomatoes, sprouts, and melons can become contaminated with Salmonella, Shigella, or Escherichia coli (E. coli) O157:H7.

Contamination can occur during growing, harvesting, processing, storing, shipping, or final preparation. Sources of contamination are varied; however, these items are grown in the soil and therefore may become contaminated during growth or through processing and distribution. Contamination may also occur during food preparation in the restaurant or in the person's kitchen.

When food is cooked and left out for more than 2 hours at room temperature, bacteria can multiply quickly. Most bacteria grow undetected because they do not produce an "off" odor or change the color or texture of the food. Freezing food slows or stops bacteria's growth but does not destroy the bacteria. The microbes can become reactivated when the food is thawed. Refrigeration may slow the growth of some bacteria, but thorough cooking is needed to destroy the bacteria.

Symptoms
In most cases of foodborne illness, symptoms resemble intestinal flu and may last a few hours or even several days. Symptoms can range from mild to serious and include:

abdominal cramps
nausea
vomiting
diarrhea
fever
dehydration

Risk Factors
Some people are at greater risk for bacterial infections because of their age or immune status. Young children, pregnant women and their fetuses, the elderly, and people with lowered immunity are at greatest risk


Complications
Some micro-organisms, such as Listeria monocytogenes and Clostridium botulinum, cause far more serious illness than vomiting or diarrhea. They can cause spontaneous abortion or death.

In some people, especially children, hemolytic uremic syndrome (HUS) can result from infection by a particular strain of bacteria, E. coli O157:H7, and can lead to kidney failure and death.

HUS is a rare disorder that affects primarily young children between the ages of 1 and 10 years and is the leading cause of acute renal failure in previously healthy children. The child may become infected after consuming a contaminated food, such as meat (especially undercooked ground beef), unpasteurized apple cider or apple juice, or raw sprouts.

The most common symptoms of infection are vomiting, abdominal pain, and diarrhea, which may be bloody. In 5 to 10 percent of cases, HUS develops about 2 to 6 days after the onset of illness. This disease may last from 1 to 15 days and is fatal in 3 to 5 percent of cases.

Symptoms of HUS include fever, lethargy, irritability, and pallor. In about half the cases, the disease progresses until the kidneys are unable to remove waste products from the blood and excrete them into the urine (acute renal failure). A decrease in circulating red blood cells and blood platelets and reduced blood flow to organs may lead to multiple organ failure. Seizures, heart failure, inflammation of the pancreas, and diabetes can also result. However, most children recover completely. You need to see a doctor right away if you have any of the following symptoms, with or without gastrointestinal symptoms:

Signs of shock, such as weak or rapid pulse; shallow breathing; cold, clammy, pale skin; shaking or chills; or chest pain.
Signs of severe dehydration, such as dry mouth, sticky saliva, decreased urine output, dizziness, fatigue, sunken eyes, low blood pressure, or increased heart rate and breathing.
Confusion or difficulty reasoning.


Treatment
Most cases of foodborne illness are mild and can be treated by increasing fluid intake, either orally or intravenously, to replace lost fluids and electrolytes. In cases with gastrointestinal or neurologic symptoms, people should seek medical attention.

In the most severe situations, such as HUS, the patient may need hospitalization in order to receive supportive nutritional and medical therapy. Maintaining adequate fluid and electrolyte balance and controlling blood pressure are important. Doctors will try to minimize the impact of reduced kidney function. Early dialysis is crucial until the kidneys can function normally again, and blood transfusions may be needed.

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Mercury content in fish: A concern for pregnant women

I've heard that pregnant women should avoid eating fish. Is this true?

The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) recommend that pregnant women limit the amount of commercial and sport fish they eat to no more than 12 ounces (cooked) a week. This is because some fish contain high levels of mercury, which can harm the nervous system of the developing fetus. If you're pregnant, the FDA advises that you eat a variety of fish and avoid fish that contain higher levels of mercury.

Fish most likely to contain mercury	Fish known to be low in mercury
Shark	Salmon
Swordfish	Pollock
King mackerel	Farm-raised catfish
Tilefish	Canned light tuna*

*Note: Tuna steaks and canned albacore tuna have higher levels of mercury than canned light tuna.

Mercury occurs naturally in trace amounts in the environment. But it can also accumulate in streams, lakes and oceans as a result of industrial pollution. Nearly all fish contain trace amounts of a form of mercury called methylmercury. Large fish tend to have higher levels of mercury than small fish.

Check local advisories about the safety of fish caught in your local rivers and streams. If no advice is available, limit the amount of fish you eat from local waters to 6 ounces (cooked) a week.