Risk Is Even Greater for Women, Study Shows

By Denise Mann
WebMD Health News

Reviewed by Laura J. Martin, MD

Dec. 14, 2011 -- Indoor tanning has been under heavy fire the last few years, and a new study will do nothing to tone down the assault.

Indoor tanners are close to 70% more likely to develop the most common type of skin cancer before their 40th birthday, a new study shows.

The skin cancer, basal cell carcinoma, looks like open sores, red patches, pink growths, or shiny bumps. This type of skin cancer is usually not lethal but can be disfiguring.

Many previous studies have linked indoor tanning to melanoma, a potentially fatal form of skin cancer. Growing numbers of people younger than 40 -- especially women -- have developed basal cell skin cancer in recent years. The findings, which appear in the Journal of the American Academy of Dermatology, suggest that indoor tanning may play a role in this increase. As many as 28 million people use indoor tanning beds each year, according to the Indoor Tanning Association.

Study: Risk Greatest Among Women

Researchers analyzed data from the Yale Study of Skin Health in Young People. It included more than 750 people under 40. Of these, slightly more than 69% were women.

Overall, people who had used indoor tanning beds were 69% more likely to develop basal cell skin cancer before age 40 when compared to people who did not.

The risk was greatest among women, the study showed. Women who tanned were more than twice as likely to develop basal cell skin cancer as those who never tanned.

Exactly why the effects of indoor tanning seem to be worse in women is not known. Women may start tanning earlier and tan more frequently than men, the study authors write. About 43% of basal cell skin cancers occurring at an early age in women could be prevented if there were a ban on indoor tanning beds, they point out.

Other factors that increased risk in the presence of indoor tanning were:

• History of more than one basal cell skin cancer
• History of a sunburn particularly at the site of the cancer
• Use of high-speed, high-intensity, or high-pressure tanning beds
• Genetic predisposition to skin cancer



High Proportion of Younger Adults Diagnosed With Colorectal Cancer Have Advanced Disease

By Brenda Goodman, MA
WebMD Health News

Reviewed by Laura J. Martin, MD

Dec. 13, 2011 -- In some respects, the U.S. is winning the war on cancer. Recent reports show an overall decline in the number of new cancer cases and fewer cancer deaths.

But those gains aren't being shared by everyone. A case in point: A new study shows that rates of colon and rectal cancers have climbed in younger adults over the last decade.

That's happening even as colorectal cancer rates have dropped steadily in adults over 50, the age most people are advised to start screening for the disease.

Researchers aren't sure what's causing the increase in younger adults. But they hope their study will raise awareness among younger patients and their doctors, who may dismiss cancer as a cause of their symptoms.

"These young people are getting ignored. They've had symptoms for a year or a year and a half before they finally get diagnosed," says researcher Y. Nancy You, MD, a surgeon at the University of Texas M.D. Anderson Cancer Center in Houston.

Tracking Trends in Colon Cancer

The study looked at nearly 600,000 colorectal cancer cases reported to a national registry between 1998 and 2007.

As expected, cancer was much more common in the older age group. About 89% of the cases were seen in adults over age 50.

But while colorectal cancer cases have dropped steadily in adults over 50, they increased by more than 2% each year in younger adults.

The increase was highest for rectal cancers, which jumped nearly 4% each year. Colon cancer rates rose nearly 3% per year.

To compound the problem, doctors say many people may not suspect cancer when symptoms like bleeding, abdominal pain, or a change in bowel habits strike someone in their 30s or 40s.

"Most young people, when they have these types of symptoms, they are not thinking that they have cancer. Then they go to their physician and the physician isn't thinking that they have cancer," says Rebecca Siegel, MPH, an epidemiologist with the American Cancer Society in Atlanta.

The result is often a delay in diagnosis.

The study found that younger adults were more likely than older adults to be diagnosed with late-stage cancers, which are harder to treat.

People in their 30s were about 20% more likely than other age groups to be diagnosed when their cancers were stage III or IV, with stage IV being the most severe grade of the disease. Other factors that increased the risk for having an advanced cancer at diagnosis were being African-American or lacking health insurance.

"It's cause for concern," says Siegel, who was not involved in the study. "And hopefully, it will spur additional research to try to identify what's causing this trend."

The study is published in the Archives of Internal Medicine. It isn't the first to spot the uptick, but it is the largest so far to note the increase.

Advice to Patients

Experts say the message to patients is clear: "Just because you're under 50 doesn't mean you're not at risk," says Anthony Starpoli, MD, a gastroenterologist at Lenox Hill Hospital in New York City.

"If you have a family history, go talk to your doctor," Starpoli tells WebMD, especially if that relative got colon cancer before they were 50.

SOURCES: You, Y. Archives of Internal Medicine, Dec. 12, 2011.Y. Nancy You, MD, surgical oncologist, University of Texas M.D. Anderson Cancer Center, Houston.Rebecca Siegel, MPH, epidemiologist, American Cancer Society, Atlanta.Anthony Starpoli, MD, gastroenterologist, Lenox Hill Hospital, New York.

©2011 WebMD, LLC. All Rights Reserved.



MONDAY, Dec. 12 -- Severe side effects may be key to why so many older breast cancer patients stop taking drugs that can help prevent a tumor's return, a new study finds.

The research also revealed a large gap between what these breast cancer patients tell their doctors about drug side effects and what they actually experience, according to the study authors from Northwestern University in Chicago.

Their study included 686 postmenopausal women with estrogen-sensitive breast cancer who were asked about their symptoms before treatment with estrogen-blocking drugs called aromatase inhibitors, which include medications such as Arimidex, Aromasin and Femara. The women were tracked at three, six, 12 and 24 months after starting treatment.

After three months, about one-third of the patients had severe joint pain, 28 to 29 percent had hot flashes, nearly one-quarter had decreased libido, 15 to 24 percent had fatigue, 16 to 17 percent had night sweats and 14 to 17 percent had anxiety, the investigators found.

Other symptoms included weight gain, breast sensitivity, mood swings, and feeling bloated, irritable and nauseous.

The number of women who experienced drug side effects rose the longer treatment continued, the investigators noted.

As a result of the side effects, 36 percent of the patients stopped treatment before an average of just over four years, the researchers said. Of this group, 10 percent had quit after two years and the remainder quit between 25 months and about four years.

Patients most likely to stop taking the drugs before the recommended five years were those who still had residual side effects from recent chemotherapy or radiation therapy when they started taking the aromatase inhibitors.

Those most likely to continue taking the drugs included women who had surgery for breast cancer but not chemotherapy or radiation therapy, and those who weren't taking many other medications, the results indicated.

The study was presented Friday at the San Antonio Breast Cancer Symposium.

"Clinicians consistently underestimate the side effects associated with treatment," lead investigator Lynne Wagner, an associate professor in medical social sciences at Northwestern University Feinberg School of Medicine and a clinical psychologist at Robert H. Lurie Comprehensive Cancer Center of Northwestern University, said in a university news release.

"[Doctors] give patients a drug they hope will help them, so they have a motivation to underrate the negative effects. Patients don't want to be complainers and don't want their doctor to discontinue treatment. So no one knew how bad it really was for patients," she explained.

Wagner said the findings are "a wake-up call to physicians that says if your patient is feeling really beaten up by treatment, the risk of her quitting early is high. We need to be better at managing the symptoms of our patients to improve their quality of life."

Research presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

-- Robert Preidt

SOURCE: Northwestern University, news release, Dec. 9, 2011



MONDAY, Dec. 12 -- Many older Americans get screened for colon, breast, prostate and cervical cancer even though guidelines recommend against routinely screening the elderly, a new study finds.

As the population of the United States continues to age, balancing good health care with costs will be a continuing battle, experts say. "In an era of escalating health care utilization and expenditures in the United States, identifying areas for cost containment while concurrently improving quality of care in our health care system is increasingly paramount," said lead researcher Keith Bellizzi, an assistant professor of human development and family studies at the University of Connecticut in Storrs.

"Perhaps this area of health care warrants further attention," Bellizzi added.

Currently, nearly 37 million people in the United States are 65 and older, and that number will probably double by 2030. Historically, older adults have been excluded from cancer clinical trials, so what is known about the effectiveness of screening in seniors is limited, he said.

The U.S. Preventive Services Task Force recommends against routinescreening for breast, colorectal, and prostate cancer at age 75 and beyond, and advises against cervical cancer testing after 65, according to the study.

But many older adults today live longer, healthier lives than earlier generations, so it is likely that continued screening for certain segments of the older adult population is warranted, he said.

"At the same time, there are segments of the older adult population with limited life expectancy, poor health status and concommitant health conditions that would likely not benefit from screening. The challenge is, how do we make this determination?" Bellizzi said.

To asses the prevalence of screening among the elderly, Bellizzi's team collected data on almost 50,000 men and women who took part in the U.S. National Health Interview Survey.

Among women 75 to 79 years old, 62 percent had received a mammogram to screen for breast cancer in the past two years, as had 50 percent of women 80 and older. Pap screens for cervical cancer were done on 53 percent of women 75 to 79, and 38 percent of women 80 and older, the researchers found.

Fifty-seven percent of men and women 75 to 79 were screened for colon cancer in the previous two years.

Prostate cancer screening was undertaken by 57 percent of those 75 to 79; 42 percent of men 80 and older; and 40 percent of those 50 to 74, the researchers found.

The study is published in the Dec. 12/26 issue of the Archives of Internal Medicine.

People over 75 were most likely to be screened for breast, colorectal, and prostate cancer if a doctor recommended it, Bellizzi's team found. Also, college-educated men and women were most likely to be screened, while those without a high school diploma were least likely to get screened.

There is no "one size fits all solution," Bellizzi said. "Screening decisions should be individualized based on life expectancy, health status, an informed discussion with the patient about the potential harms and benefits, and patient values and preferences."

Dr. Louise C. Walter, an assistant professor of medicine at the University of California, San Francisco, and author of an accompanying journal editorial, agreed that age should not be the sole determinant of screening.

"What you really want to do is encourage individualized decisions," Walter said, suggesting that doctors weigh general health and life expectancy before recommending cancer screening.

"There are lots of very healthy people that have long life expectancy, and cancer increases as you get older, so it makes sense to get screened," she said.

But there are also a lot of very ill people for whom screening can be harmful, she added, referring to the hazards of certain procedures and treatments that might not save lives.

Dr. Otis Brawley, chief medical officer at the American Cancer Society, conceded some elderly Americans might be candidates for screening, but said "the overwhelming majority of folks over 75 should not be getting these screening tests, because we have no science that shows these tests are going to benefit these folks by making them live longer."

"This is an example of waste," he said. "We need to think about the rational use of health care and stop talking about the rationing of health care.

"Many docs are ordering these test purely to cover themselves" from a lawsuit, he added.

SOURCES: Keith M. Bellizzi, Ph.D., M.P.H., assistant professor, Human Development and Family Studies, University of Connecticut, Storrs; Louise C. Walter, M.D., assistant professor, medicine, University of California, San Francisco; Otis Brawley, M.D., chief medical officer, American Cancer Society; Dec. 12/26, 2011, Archives of Internal Medicine