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    <recommendedItem id="20100101_19_440"
                     title="Soft Drinks Linked to Pancreatic Cancer Risk (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18354?impressionId=1265812444314"
                     
      &lt;p&gt;Regular consumers of sugary soft drinks are at higher risk for pancreatic cancer than fruit juice drinkers or the general population, a new Singaporean study has found.&lt;/p&gt;
&lt;p&gt;Chinese men and women living in Singapore who drank two or more soft drinks per week were 87% more likely to contract pancreatic cancer after the researchers adjusted for factors such as smoking (95% CI 1.10 to 3.15), according to the report published Feb. 8 in &lt;em&gt;Cancer Epidemiology, Biomarkers &amp;amp; Prevention.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&quot;In this large prospective cohort of Chinese men and women in Singapore, those who reported regular soft drink consumption were at increased risk of pancreatic cancer when compared with those who largely abstained,&quot; Mark Pereira, PhD, of the School of Public Health at the University of Minnesota, and colleagues wrote. &quot;There was no association between consumption of juice and risk of pancreatic cancer.&quot;&lt;/p&gt;
&lt;p&gt;While pancreatic cancer is relatively rare, it is one of the most deadly cancers, with less than 5% of patients surviving five years after diagnosis. Although rates have generally plateaued in the U.S., they continue to climb in some Asian countries, including Singapore.&lt;/p&gt;
&lt;p&gt;&quot;This increase may reflect demographic and socioeconomic shifts as well as a transition towards a more westernized lifestyle and diet,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Research has shown that insulin promotes pancreatic cancer cell growth, and some researchers think sugary foods could result in blood sugar and insulin fluctuations that expose the pancreas to high concentrations of insulin.&lt;/p&gt;
&lt;p&gt;While fruit juices contain sugar, soft drinks are the major sources of added sugar in the U.S. diet and major contributors to hyperglycemia and hyperinsulinemia.&lt;/p&gt;
&lt;p&gt;Pereira and colleagues followed 60,524 men and women who enrolled in the Singapore Chinese Health Study between April 1993 and December 1998 and were followed for 14 years.&lt;/p&gt;
&lt;p&gt;At enrollment, the participants completed a 146-question food frequency questionnaire, which contained three items related to soft drinks and juice. The questions asked the participants how much, if any, they drank of soft drinks such as Coca-Cola and 7-Up, orange juice, and other fruit and vegetable juices.&lt;/p&gt;
&lt;p&gt;The dietary data was later cross-referenced with records from the Singapore Cancer Registry and the Singapore Registry of Births and Deaths, to determine which of the participants had died of pancreatic cancer and whether it might be related to their soft drink or juice consumption.&lt;/p&gt;
&lt;p&gt;Overall, researchers found that 140 participants had contracted pancreatic cancer.&lt;/p&gt;
&lt;p&gt;The results were largely consistent with three of four previous U.S. studies on the links between pancreatic cancer and soft drinks. Three of the U.S. studies found an association between soft drinks and cancer.&lt;/p&gt;
&lt;p&gt;The author acknowledged that soft drink consumers are more likely than abstainers to participate in other unhealthy behaviors, including smoking and overeating, which makes it difficult to determine that soft drink consumption is an independent risk factor for pancreatic cancer.&lt;/p&gt;
&lt;p&gt;For instance, smokers in their study were at higher risk for pancreatic cancer. &quot;We could not rule out the possibility of residual confounding by factors associated with the habit of drinking soft drinks or other unascertained factors such as waist circumference,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;They also noted that the study was limited in statistical power because pancreatic cancer is rare, which limited the sample size of cancer cases. &quot;Also, because we were unable to collect repeated dietary measurements in this study, we were unable to account for changes in consumption of soft drinks and juices,&quot; they wrote, &quot;especially when the diagnosis of diabetes occurred after the baseline interview.&quot;&lt;/p&gt;
&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Cancer Institute.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_304"
                     title="&apos;Virtual&apos; Colon Scans Effective in Seniors (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/HematologyOncology/ColonCancer/tb/18164?impressionId=1265812444314"
                     
      Patients 65 and older are as suitable as younger individuals for CT colonography, said researchers conducting a large retrospective study.&lt;br&gt;
&lt;br&gt;Advanced neoplasias were detected with CT colonography  --  often called &quot;virtual colonoscopy&quot;  --  in older patients at more than double the rate in the general screening population, reported David H. Kim, MD, of the University of Wisconsin in Madison, Wis., and colleagues in the February issue of &lt;em&gt;Radiology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;They found that 7.6% of older patients had advanced neoplasias, compared with 3.2% of all patients screened in the university&apos;s clinic (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;On the basis of this and other findings in 577 individuals 65 and older versus the entire group of 3,120 patients undergoing the procedure, Kim and colleagues concluded that &quot;CT colonography performance is maintained in an older cohort.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Overall, the observations from this clinical experience confirm that CT colonography may be a valuable screening modality in the older population,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, the study did not address several objections raised by the Centers for Medicare and Medicaid Services (CMS) in its decision last year to deny Medicare coverage for the procedure. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; target=&quot;_blank&quot;&gt;Medicare Finalizes Denial of Virtual Colonoscopy Coverage&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;CMS had pointed to relatively low sensitivity of CT colonography compared with optical colonoscopy in prospective trials, especially for small lesions.&lt;/p&gt;
&lt;p&gt;The agency also determined that CT colonography increased the costs of positive findings, since abnormalities in the CT scans must be confirmed with optical colonoscopy. In addition, CMS said there was no evidence to support claims that the less invasive imaging procedure would be more acceptable to patients and therefore would raise screening rates.&lt;/p&gt;
&lt;p&gt;The data analyzed by Kim and colleagues did not allow for calculations of false-negative rates or predictive values of positive or negative findings. Nor did the researchers report cost information.&lt;/p&gt;
&lt;p&gt;Mean age of their older cohort was 69.2 (SD 3.8). The oldest was 79.&lt;/p&gt;
&lt;p&gt;The researchers reported that 15.3% of the older patients were referred for optical colonoscopy on the basis of the CT results, compared with 7.9% of the overall screening group.&lt;/p&gt;
&lt;p&gt;Less than 4% of positive findings were determined to be false with the optical procedure (3.6% for polyps 6 to 10 mm in diameter, 2.1% for larger lesions).&lt;/p&gt;
&lt;p&gt;Of the 59 advanced neoplasias identified in the older patients, all but three were at least 10 mm in size.&lt;/p&gt;
&lt;p&gt;The scans also suggested abnormalities outside the colon in 89 (15.4%) patients. Of these, 45 received a full workup, which revealed substantial and previously unsuspected diagnoses in 21 cases  -- 18 were vascular aneurysms. The other three included one lung tumor, a femoral hernia, and a malrotation.&lt;/p&gt;
&lt;p&gt;Kim and colleagues reported that no &quot;substantial complications&quot; such as perforations or major hemorrhage occurred in the older patients, either with the CT scan or follow-up colonoscopy.&lt;/p&gt;
&lt;p&gt;They also indicated that the ratio of large to small neoplasias was similar in the older patients compared with their CT screening group as a whole. Histologic and morphologic findings were similar as well.&lt;/p&gt;
&lt;p&gt;The researchers cited the observational nature of the study, in which negative findings were not corroborated with optical colonoscopy, and its restriction to a single center as its main limitations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;Kim and one co-author reported relationships with Viatronix and Medicsight and are co-founders of a company called VirtuoCTC, which produces educational materials on CT colonography.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_242"
                     title="Ultrasound Aids Early Ovarian Cancer Detection (CME/CE)"
                     score="-0.002"
                     href="http://www.medpagetoday.com/Radiology/DiagnosticRadiology/tb/18096?impressionId=1265812444314"
                     
      &lt;p&gt;Serum biomarkers identified through proteomic analysis, coupled with contrast-enhanced ultrasound, ultimately may provide a means for early diagnosis of ovarian cancer, researchers say.&lt;/p&gt;
&lt;p&gt;&quot;Exciting preliminary data have shown that specific combinations of peptides from molecules, such as &lt;em&gt;BRCA2&lt;/em&gt;, exist in the serum of epithelial ovarian cancer patients,&quot; Sonia Dutta, MD, of Mount Sinai School of Medicine in New York, and colleagues reported in the February&lt;em&gt; American Journal of Roentgenology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;This discovery suggests that &quot;highly discriminatory proteins&quot; may serve as biomarkers for early epithelial cell ovarian cancer, although the findings must be further validated, the authors wrote.&lt;/p&gt;
&lt;p&gt;Despite advances in surgery and chemotherapy, survival from advanced stage ovarian cancer is only 30%, and the authors cite a &quot;dire need&quot; for a validated screening method to detect the disease early.&lt;/p&gt;
&lt;p&gt;Unsuccessful efforts find a biomarker for this deadly malignancy have focused primarily on a single cancer-specific marker, which the authors concede is a &quot;mission impossible.&quot;&lt;/p&gt;
&lt;p&gt;Impediments to the identification of cancer-specific markers include the molecular heterogeneity that characterizes different tumors, the sharing of pathophysiologic events among cancer and other diseases, and low marker production and concentration.&lt;/p&gt;
&lt;p&gt;To overcome these difficulties, a new approach known as proteomics is being used to analyze the entire protein complement of a cell.&lt;/p&gt;
&lt;p&gt;The rationale for this analytical technique lies in a significantly greater understanding of the tumor microenvironment. It is now known that tumor cells participate in complex interactions with surrounding structures and other cell populations.&lt;/p&gt;
&lt;p&gt;&quot;This biochemical cross-talk is hypothesized to generate a cascade of specific and sensitive biomarkers elaborated directly from the tumor cell population, indirectly from the interacting non-tumor cells or extracellular molecules, or a specific product of the microecology,&quot; they explained.&lt;/p&gt;
&lt;p&gt;In fact, the most specific cancer markers may turn out to be molecules that normally are not malignant but that have been modified by that tumor microenvironment  --  clipped, cleaved, phosphorylated, or glycosylated  --  and carry a detailed picture of the local pathophysiology.&lt;/p&gt;
&lt;p&gt;Previous techniques used in the hunt for markers, such as two-dimensional gel electrophoresis, were unable to detect these altered or clipped molecules, which occupy the low molecular weight range of the proteome.&lt;/p&gt;
&lt;p&gt;Mass spectrometry, which is most sensitive in the low molecular weight range, is now a tool used to explore these modified protein molecules and has already revealed a vast number of previously unknown biomarkers.&lt;/p&gt;
&lt;p&gt;The next steps, the researchers explained, will be to develop capture reagents that can measure the markers and, using reverse-phase protein array, to further characterize proteins of interest.&lt;/p&gt;
&lt;p&gt;But any diagnostic information gained through proteomic analysis must be verified by some imaging technique. Conventional ultrasound has proven inadequate, but pulse-inversion harmonic ultrasound currently appears to differentiate malignant from benign lesions.&lt;/p&gt;
&lt;p&gt;For example, although the time to peak enhancement with contrast-enhanced ultrasound is similar in benign and malignant masses, a small study found that malignant lesions have: &lt;ul&gt; &lt;li&gt;Greater peak enhancement (23.3 versus 12.3 dB, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Longer half wash-out time (139.9 versus 46.3 seconds, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Greater area under the enhancement curve (2,012.9 versus 523.9 seconds, &lt;em&gt;P&lt;/em&gt;=0.07)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors noted that these enhancement kinetics data were from just 17 patients and are therefore limited, but stated that the technique &quot;shows great promise.&quot;&lt;/p&gt;
&lt;p&gt;In addition, the diagnostic capacity of ultrasound can be further increased by the use of intravenous contrast agents, which may help visualize the early microvascular changes typical of malignancy.&lt;/p&gt;
&lt;p&gt;The researchers predicted that, by using a combination of clinically relevant biomarkers identified through proteomic analyses plus contrast-enhanced ultrasound, &quot;we will likely be able to shift from an era of diagnosing advanced-stage ovarian cancer to that of early-stage disease and, most important, save the lives of many women.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No disclosures were provided.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_6_807"
                     title="Evidence &apos;Equivocal&apos; for Antioxidants in Cancer Treatment"
                     score="-0.006"
                     href="