Dermatologists Best for Melanoma Diagnosis

Getting melanoma diagnosed by a dermatologist rather than a non-specialist could boost a patient's odds for long-term survival, a new study finds.

Researchers at Emory University School of Medicine in Atlanta studied 1,467 patients with melanoma diagnosed by a dermatologist and 553 melanoma patients diagnosed by a non-dermatologist.

On average, tumors diagnosed by dermatologists were thinner than those diagnosed by non-dermatologists -- 0.86 millimeters vs. 1 millimeter thick. When a melanoma tumor is still relatively thin (less than 1 millimeter), patients have a 90 percent cure rate.

Patients diagnosed by a dermatologist also had better survival rates.

"The two-year and five-year survival rates were 86.5 percent and 73.9 percent for the dermatologist group compared with 78.8 percent and 68.7 percent for the non-dermatologist group," the study authors wrote.

"These results suggest that increasing access to dermatologists, particularly for older patients who have higher rates of melanoma, may represent one approach to improving melanoma-related health outcomes from a health policy perspective," they concluded.

The study appears in the April issue of the journal Archives of Dermatology.

Melanoma is the most serious type of skin cancer, and can be fatal. Each year in the United States, more than 53,600 people learn they have the disease. In some parts of the world, especially Western countries, melanoma is becoming more common every year. In the United States, for example, the percentage of people who develop melanoma has more than doubled in the past 30 years, according to the National Cancer Institute.

Decline of HRT Use Linked to Drop in Breast Cancer Cases

When millions of U.S. women tossed out their prescriptions for hormone replacement therapy in 2002, the rates of breast cancer started dropping almost immediately, U.S. researchers reported Wednesday.

Their findings coincided with an early-release report from the U.K. that showed women who took hormone replacement therapy (HRT) after menopause were 20 percent more likely to develop ovarian cancer or die from it than postmenopausal women who never took HRT.

The breast cancer report, published in the April 19 issue of the New England Journal of Medicine, looked at the incidence of breast cancer both before and after the news broke from the long-term Women's Health Initiative (WHI) study that HRT might be more damaging than helpful to a woman's health. Between 2001 and 2004, it shows, the overall incidence of breast cancer went down by 8.6 percent in postmenopausal women.

The U.K. study, published online Wednesday by The Lancet, looked at the long-running Million Women Study and determined that 1,000 additional women died from ovarian cancer between 1991 and 2005 because they were using HRT, and that 1,300 extra cases of ovarian cancer were diagnosed in the same period.

The researchers, from the Cancer Research UK Epidemiology Unit in Oxford, also found that after women stopped taking HRT, their risk of ovarian cancer returned to the same level as those who never used HRT.

For the U.S. study, experts suspect that HRT may have been fueling some breast cancers because that decline began soon after many women stopped using HRT.

"From 1975 to 2000, breast cancer incidence increased rather dramatically. While part of that increase was clearly due to the introduction of screening mammography, once you take out that effect, there is still a rather astounding increase of 30 percent," said Donald Berry, chairman of the department of biostatistics at the University of Texas M.D. Anderson Cancer Center in Houston.

"While there have been a number of theories put forward to explain the increase, it now looks like some of that increase is due to the use of HRT," Berry said. "When women stopped using HRT, it looked kind of like a market correction and the numbers went back down."

Initially, it appeared as if combination estrogen-progestin hormone replacement therapy was the answer to many ills. Researchers hoped that HRT would lower the risk of such serious illnesses as heart disease and dementia.

However, the WHI study, which included more than 16,000 postmenopausal women, was stopped early in May 2002 because HRT was increasing the risk of coronary disease, stroke and blood clots.

After the WHI trial was halted, many women stopped taking hormones. In fact, the use of HRT had dropped by 38 percent in the United States by the end of 2002. In 2001, 61 million prescriptions were written for hormone replacement therapy. In 2002, there were about 47 million prescriptions. By 2003, that number had fallen to 27 million, and by 2004 just 21 million, the study authors noted.

The rate of breast cancer started dropping soon after the WHI results in 2002, according to the new study.

Between 2001 -- the last full year of combination HRT use -- and 2004, rates of breast cancer in the United States dropped by 8.6 percent in postmenopausal women. The rates of estrogen receptor-positive breast cancer -- those cancers known to be fueled by the hormone estrogen -- dropped by 14.7 percent in women between the ages of 50 and 69. Yet, rates of estrogen receptor-negative cancers dropped only 1.7 percent in the same time period, which further suggests that stopping HRT played a role in the decline.

"HRT is probably not something that causes cancer; it probably just fuels existing cancers," explained Berry. "If you feed it, it grows, and if you stop feeding it, it stops growing."

Berry said the Emory researchers looked at other potential causes for the decline in breast cancer rates, including whether fewer women were getting screening mammograms to detect tumors. The researchers also checked for environmental factors and the use of breast cancer drugs such as tamoxifen and raloxifene. But none of these factors had changed significantly enough to cause such a drop in breast cancer rates, the study authors said.

The breast cancer rates leveled off by 2004, to rates not seen since 1987, the study authors said.

"Overall, this is very encouraging news," said Dr. Julia Smith, director of the New York University Cancer Institute Breast Cancer Screening and Prevention Program in New York City.

However, Smith said she'd like to know if this drop will affect survival rates in the future. "Have these cancers been eliminated, or are they just below our level of detection now, but will rise up again?" she asked.

Both Berry and Smith pointed out that if a woman is suffering through menopausal symptoms, such as hot flashes, short-term use of hormone replacement therapy is likely safe.

"You can give low-dose HRT for short periods of time for women who really have a quality-of-life issue," Smith said. She added that individual risk needs to be assessed on a case-by-case basis, but even some women at high risk of breast cancer may be able to use HRT for short-term relief.

"It doesn't make sense to do something in the name of prevention and protection -- (withholding HRT) -- that ends up hurting the person," Smith said.

Berry said: "If you're taking HRT for long-term health effects, it's not worth it. But, if you're taking HRT for menopausal symptoms and it works for you, it's probably a reasonable thing to continue. I'd stop it occasionally to see if the hot flashes are still there, but short-term use for a year or two probably won't affect your risk in the long run."

By Serena Gordon, HealthDay News, April 18, 2007

Athletic Trainers See Rise in MRSA Skin Infection

A new U.S. survey found that more than half of athletic trainers said they've treated an athlete for a skin infection caused by the antibiotic-resistant "superbug" called methicillin-resistant Staphylococcus aureus (MRSA) bacteria.

MRSA infections were once seen almost exclusively in ill and immunocompromised hospital patients, but they have become increasingly common in otherwise healthy people over the past decade, according to background information in a news release about the survey.

While MRSA infections typically aren't fatal, they can cause skin abscesses that require surgical draining, and the infections are likely to be resistant to first-line antibiotics. In some cases, MRSA can cause serious and potentially fatal problems such as pneumonia, bloodstream infections and flesh-eating disease.

This Web-based survey of 364 certified athletic trainers found that 53 percent said they'd treated MRSA skin infections in athletes. Of the infections treated: 86 percent were in males and 35 percent were in females; 65 percent were in football players; 21 percent in basketball players; and 20 percent were in wrestlers.

The infections typically occurred in: the lower leg (38 percent); forearm (31 percent); and the knee (29 percent).

Athletes may be at increased risk for MRSA infection because it can be spread into cuts and scrapes during contact sports, as well as from shared items such as towels.

"Given that these infections could potentially become serious, it's important for athletic trainers to be aware of the signs and symptoms of MRSA infections and to treat them appropriately, as well as educate athletes about them," Kristin Brinsley-Rainisch, a health scientist at the U.S. Centers for Disease Control and Prevention, said in a prepared statement.

The survey was presented Saturday at the annual scientific session of the Society for Healthcare Epidemiology of America in Baltimore.

HealthDay News, April 14, 2007

Antigen-cloning Technique May Bolster Skin Cancer Vaccine

A new antigen-cloning technique may help advance efforts to develop a vaccine against melanoma and other kinds of cancer, a U.S. study suggests.

To date, scientists have had difficulty isolating and cloning antigens needed to develop cancer vaccines that directly stimulate immune system helper T-cells, which have receptors on their cell surfaces that can recognize and bind to tumor-related antigens, according to background information in a news release.

A team at the Wistar Institute in Philadelphia says it has developed a novel method to clone an antigen recognized by helper T-cells. In this study, the scientists identified and cloned a new tumor antigen called ribosomal protein L8 (RPL8) from melanoma.

They then found that a peptide of RPL8 stimulated a response in helper T-cell clones and lymphocytes in four out of nine melanoma patients but stimulated no response in cells taken from healthy people.

RPL8, which is involved in protein synthesis and is present in normal cells, is overexpressed in melanoma, breast cancer and gliomas, the most common type of brain tumor.

This new antigen-cloning technique may lead to the development of vaccines that can directly stimulate helper T-cells to fight not only these cancers, but also infectious diseases, the researchers said.

The study was published in the April 15 issue of Cancer Research.

HealthDay News, April 16, 2007

Tai Chi Boosts Immune System Against Shingles

Tai chi, an exercise that features slow martial arts-like movements and meditation, significantly improves the ability of older adults' immune systems to fight the virus -- varicella zoster -- that causes shingles, a new study says.

Shingles is a painful, blistery rash. About one-third of adults over age 60 develop shingles.

The 25-week study, conducted at the University of California, Los Angeles, involved 112 people, ages 59 to 86. The researchers found that Tai chi, by itself, increased immunity against varicella zoster to a level that was comparable to having received the standard vaccine against the virus.

When a person did Tai chi and received the vaccine, the immunity against the virus reached a level normally seen in middle age, said the study, which was published in the April issue of the Journal of the American Geriatrics Society.

The study results confirm that a behavioral intervention such as Tai chi can trigger a positive, virus-specific immune response, said lead author Michael Irwin, professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA.

"These are exciting findings, because the positive results of this study also have implications for other infectious diseases, like influenza and pneumonia. Since older adults often show blunted protective responses to vaccines, this study suggests that T'ai chi is an approach that might complement and augment the efficacy of other vaccines, such as influenza," Irwin, who is also director of the UCLA Cousins Center for Psychoneuroimmunology, said in a prepared statement.

HealthDay News, 4/6/2007

Humira Helps Psoriasis

The arthritis drug Humira eased symptoms of psoriasis of patients in two clinical trials and drug maker Abbott Laboratories says it will apply for U.S. and European approval to market the drug to treat the skin disease.

One study found that Humira cleared up all symptoms of psoriasis while the other study found the drug led to an 80 percent improvement in patients, Bloomberg News reported.

Symptoms of psoriasis include inflamed, scaly skin lesions that can crack and bleed. The disease affects about 125 million people worldwide.

Currently, Humira is approved to treat the immune system disorders rheumatoid arthritis, psoriatic arthritis, spinal arthritis, and Crohn's disease. The drug works by blocking the activity of a protein called TNF. Too much TNF can cause the immune system to attack healthy tissue, Bloomberg News reported.

Gender May Be Reason Why More Men Get Skin Cancer

Ohio State University researchers have found that a naturally occurring amount of antioxidants in females may be the reason that males are three times more likely to get skin cancer.

The university scientists, led by assistant professor Dr. Tatiana Oberyszyn, investigated the incidence of squamous cell cancer -- a common type of skin cancer in humans -- in a controlled experiment on laboratory mice.

According to an Ohio State University news release, the researchers exposed the animals to UVB, a type of ultraviolet light that causes the most damage to the skin. They found that the naturally occurring amount of antioxidants produced by the female mice not only protected them three times as much from squamous malignancy, but also may have caused tumors that developed in females to be smaller than those in the male mice.

"It's given us clear evidence of a biological basis for the gender bias in developing squamous cell carcinoma," Oberyszyn is quoted as saying in the news release.

The study appears in the April 1 issue of the journal Cancer Research.

HealthDay News, April 1, 2007

Suntan Gene Discovered

An anticancer gene that moonlights as a suntan gene may partly explain why people crave sunlight and even become addicted to tanning.

Scientists report that the p53 gene, which works to curb tumors, also triggers the chemical chain reaction that makes the skin tan when exposed to ultraviolet (UV) light.

The p53 gene spurs the tanning process to reduce UV damage, note the researchers, who included David Fisher, MD, PhD, of Boston's Dana-Farber Cancer Institute and Harvard Medical School.

Fisher's team found that mice without the p53 gene weren't able to tan when exposed to UV light.

And when the p53 gene triggers the tanning process, it also boosts the release of beta-endorphin, one of the body's "feel-good" chemicals.

"The induction of beta-endorphin appears to be hard-wired to the tanning pathway," Fisher says in a Cell Press news release. "This might explain addictive behaviors associated with sun-seeking or the use of tanning salons."

The study appears in Cell, along with an editorial by experts including Moshe Oren, PhD, of the molecular cell biology department at the Weizmann Institute in Rehovot, Israel.

One day, skin lotions may be able to activate p53 just enough to trigger tanning without allowing UV damage, the editorialists note.

In the Cell Press news release, Fisher says he is involved in a small biotechnology company working to develop such a product.

SOURCES: Cui, R. Cell, March 9, 2007; vol 128: pp 853-864. Oren, M. Cell, March 9, 2007; vol 128: pp 826-828. News release, Cell Press. News release, Dana-Farber Cancer Institute.

By Mirandi Hitti, WebMD, March 9, 2007