Betsy Bates

In the face of a rising number of pediatric deaths from pandemic influenza A(H1N1) virus, the federal government has drained the Strategic National Stockpile of its remaining 234,000 doses of pediatric-strength oseltamivir, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at a press briefing.

He reported that 19 children died of laboratory-confirmed influenza during the 1-week period between Oct. 23 and Oct. 30, bringing the total of pediatric deaths to 114. More than two-thirds of those cases were in children with underlying conditions, but the remainder were in healthy children, Dr. Frieden said.

Serious H1N1-related illness and deaths also are rising in young and middle-aged adults, following the unusual pattern of illness of this influenza strain. Adults over age 65 represent just 10% of deaths from H1N1 influenza, compared with 90% of deaths in an outbreak of seasonal influenza.

Children and young adults have been particularly hard-hit in the early weeks of the autumn H1N1 surge.

“There is a certain rhythm of flu spread in a community where we see first an increase in the number of cases, generally first in children and then in older people, then an increase in hospitalizations … and then, tragically, deaths. We are expecting, sadly, to see an increasing number of deaths [in the coming weeks and months],” Dr. Frieden said.

Several urgent steps are being taken to increase the supply of antiviral medication available to treat children who show serious signs of illness, he said.

The emergency release of stockpiled pediatric oseltamivir (Tamiflu) follows an initial transfer of 300,000 doses on Oct. 1.

Additionally, the government is working closely with commercial pharmacy chains to supplement reserves by compounding adult doses into liquid, pediatric-strength oseltamivir.

“Please don't try this at home. This is something that should be done by a professional pharmacist,” Dr. Frieden said at the briefing.

He also called attention to new survey data showing that among people with underlying medical conditions such as asthma, heart or lung disease, and pregnancy, just half with flu symptoms have sought medical care.

He stressed that people with such conditions should see their health care providers right away.

At the other end of the spectrum, a large number of otherwise healthy people with mild flu symptoms may be crowding emergency rooms unnecessarily. In most individuals who do not fall into high-risk categories, H1N1 influenza produces a mild illness that can be treated at home.

People at high risk should also be prioritized to receive the 26.6 million doses of vaccine currently available, said Dr. Frieden, who released a chart explaining which type of vaccine can be received by which group.

He went on to debunk the belief that health care workers should not receive the intranasal form of the H1N1 vaccine, emphasizing that it is an attenuated, cold-adapted vaccine that is safe and will not promote the spread of influenza to patients.

“In contrast, an unvaccinated health care worker does present a risk to patients,” he said.

Dr. Frieden briefly commented on the release of a new estimate of the number of probable H1N1 cases in the United States between April and July that was generated by a probability multiplier mathematical model taking into account patients without laboratory-confirmed influenza.

That estimate of 1.8 million to 5.7 million cases was 140 times greater than the number of laboratory-confirmed cases during the period (43,677). The estimate was published online in the CDC's journal Emerging Infectious Diseases.

Federal officials are currently working on a better estimate, he said.

Another unanswered question is whether new findings from the World Health Organization might impact the current U.S. government position that children need two doses of H1N1 vaccine for adequate protection.

On Oct. 30, WHO officials stated that based on evidence reviewed by its Scientific Advisory Group of Experts, one dose of any of the current H1N1 vaccines produces a sufficient immune response to protect populations older than 6 months of age.

The position of the U.S. government has been to “look at the data and follow the data,” and for the time being, the two-dose schedule is still recommended, Dr. Frieden said.

In the face of a rising number of pediatric deaths from pandemic influenza A(H1N1) virus, the federal government has drained the Strategic National Stockpile of its remaining 234,000 doses of pediatric-strength oseltamivir, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at a press briefing.

He reported that 19 children died of laboratory-confirmed influenza during the 1-week period between Oct. 23 and Oct. 30, bringing the total of pediatric deaths to 114. More than two-thirds of those cases were in children with underlying conditions, but the remainder were in healthy children, Dr. Frieden said.

Serious H1N1-related illness and deaths also are rising in young and middle-aged adults, following the unusual pattern of illness of this influenza strain. Adults over age 65 represent just 10% of deaths from H1N1 influenza, compared with 90% of deaths in an outbreak of seasonal influenza.

Children and young adults have been particularly hard-hit in the early weeks of the autumn H1N1 surge.

“There is a certain rhythm of flu spread in a community where we see first an increase in the number of cases, generally first in children and then in older people, then an increase in hospitalizations … and then, tragically, deaths. We are expecting, sadly, to see an increasing number of deaths [in the coming weeks and months],” Dr. Frieden said.

Several urgent steps are being taken to increase the supply of antiviral medication available to treat children who show serious signs of illness, he said.

The emergency release of stockpiled pediatric oseltamivir (Tamiflu) follows an initial transfer of 300,000 doses on Oct. 1.

Additionally, the government is working closely with commercial pharmacy chains to supplement reserves by compounding adult doses into liquid, pediatric-strength oseltamivir.

“Please don't try this at home. This is something that should be done by a professional pharmacist,” Dr. Frieden said at the briefing.

He also called attention to new survey data showing that among people with underlying medical conditions such as asthma, heart or lung disease, and pregnancy, just half with flu symptoms have sought medical care.

He stressed that people with such conditions should see their health care providers right away.

At the other end of the spectrum, a large number of otherwise healthy people with mild flu symptoms may be crowding emergency rooms unnecessarily. In most individuals who do not fall into high-risk categories, H1N1 influenza produces a mild illness that can be treated at home.

People at high risk should also be prioritized to receive the 26.6 million doses of vaccine currently available, said Dr. Frieden, who released a chart explaining which type of vaccine can be received by which group.

He went on to debunk the belief that health care workers should not receive the intranasal form of the H1N1 vaccine, emphasizing that it is an attenuated, cold-adapted vaccine that is safe and will not promote the spread of influenza to patients.

“In contrast, an unvaccinated health care worker does present a risk to patients,” he said.

Dr. Frieden briefly commented on the release of a new estimate of the number of probable H1N1 cases in the United States between April and July that was generated by a probability multiplier mathematical model taking into account patients without laboratory-confirmed influenza.

That estimate of 1.8 million to 5.7 million cases was 140 times greater than the number of laboratory-confirmed cases during the period (43,677). The estimate was published online in the CDC's journal Emerging Infectious Diseases.

Federal officials are currently working on a better estimate, he said.

Another unanswered question is whether new findings from the World Health Organization might impact the current U.S. government position that children need two doses of H1N1 vaccine for adequate protection.

On Oct. 30, WHO officials stated that based on evidence reviewed by its Scientific Advisory Group of Experts, one dose of any of the current H1N1 vaccines produces a sufficient immune response to protect populations older than 6 months of age.

The position of the U.S. government has been to “look at the data and follow the data,” and for the time being, the two-dose schedule is still recommended, Dr. Frieden said.

In the face of a rising number of pediatric deaths from pandemic influenza A(H1N1) virus, the federal government has drained the Strategic National Stockpile of its remaining 234,000 doses of pediatric-strength oseltamivir, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at a press briefing.

He reported that 19 children died of laboratory-confirmed influenza during the 1-week period between Oct. 23 and Oct. 30, bringing the total of pediatric deaths to 114. More than two-thirds of those cases were in children with underlying conditions, but the remainder were in healthy children, Dr. Frieden said.

Serious H1N1-related illness and deaths also are rising in young and middle-aged adults, following the unusual pattern of illness of this influenza strain. Adults over age 65 represent just 10% of deaths from H1N1 influenza, compared with 90% of deaths in an outbreak of seasonal influenza.

Children and young adults have been particularly hard-hit in the early weeks of the autumn H1N1 surge.

“There is a certain rhythm of flu spread in a community where we see first an increase in the number of cases, generally first in children and then in older people, then an increase in hospitalizations … and then, tragically, deaths. We are expecting, sadly, to see an increasing number of deaths [in the coming weeks and months],” Dr. Frieden said.

Several urgent steps are being taken to increase the supply of antiviral medication available to treat children who show serious signs of illness, he said.

The emergency release of stockpiled pediatric oseltamivir (Tamiflu) follows an initial transfer of 300,000 doses on Oct. 1.

Additionally, the government is working closely with commercial pharmacy chains to supplement reserves by compounding adult doses into liquid, pediatric-strength oseltamivir.

“Please don't try this at home. This is something that should be done by a professional pharmacist,” Dr. Frieden said at the briefing.

He also called attention to new survey data showing that among people with underlying medical conditions such as asthma, heart or lung disease, and pregnancy, just half with flu symptoms have sought medical care.

He stressed that people with such conditions should see their health care providers right away.

At the other end of the spectrum, a large number of otherwise healthy people with mild flu symptoms may be crowding emergency rooms unnecessarily. In most individuals who do not fall into high-risk categories, H1N1 influenza produces a mild illness that can be treated at home.

People at high risk should also be prioritized to receive the 26.6 million doses of vaccine currently available, said Dr. Frieden, who released a chart explaining which type of vaccine can be received by which group.

He went on to debunk the belief that health care workers should not receive the intranasal form of the H1N1 vaccine, emphasizing that it is an attenuated, cold-adapted vaccine that is safe and will not promote the spread of influenza to patients.

“In contrast, an unvaccinated health care worker does present a risk to patients,” he said.

Dr. Frieden briefly commented on the release of a new estimate of the number of probable H1N1 cases in the United States between April and July that was generated by a probability multiplier mathematical model taking into account patients without laboratory-confirmed influenza.

That estimate of 1.8 million to 5.7 million cases was 140 times greater than the number of laboratory-confirmed cases during the period (43,677). The estimate was published online in the CDC's journal Emerging Infectious Diseases.

Federal officials are currently working on a better estimate, he said.

Another unanswered question is whether new findings from the World Health Organization might impact the current U.S. government position that children need two doses of H1N1 vaccine for adequate protection.

On Oct. 30, WHO officials stated that based on evidence reviewed by its Scientific Advisory Group of Experts, one dose of any of the current H1N1 vaccines produces a sufficient immune response to protect populations older than 6 months of age.

The position of the U.S. government has been to “look at the data and follow the data,” and for the time being, the two-dose schedule is still recommended, Dr. Frieden said.

LAS VEGAS — Amid the alphabet soup of hepatitis virus types, the one that should most concern physicians these days is hepatitis C.

“This is going to be the big virus in the next 20 years in the U.S.,” Dr. Marsha H. Kay predicted at a meeting sponsored by the American Academy of Pediatrics.

Hepatitis C virus already infects 1.6% of the general U.S. population—4 million people—but “the vast majority of people who are infected do not know it,” said Dr. Kay, a pediatric gastroenterologist and director of pediatric endoscopy at the Cleveland Clinic.

Known to be at risk are infants born to mothers with hepatitis C; young adult survivors of leukemia, childhood malignancies, and childhood cardiac surgery; hemophilia patients; dialysis patients; intravenous drug users; sexual partners of a person with hepatitis C; recipients of blood transfusions prior to 1989; first responders; and health care workers.

Alarmingly, though, 32% of the current cases involve no known risk factor. “We don't know exactly how this virus is transmitted,”sDr. Kay said. There is no way to prevent hepatitis C, and there is no vaccine.

Among those infected, 80%-85% will develop chronic hepatitis, and of those, half will develop cirrhosis, putting them at highly elevated risk for hepatocellular carcinoma. Hepatitis C is already the leading cause of liver transplantation in the nation.

All things considered, the perfect storm of hepatitis C constitutes “a really terrible outcome compared to hepatitis B infection,” she said,.

Among children, the leading cause of hepatitis C transmission is perinatal exposure, with transmission risk correlated to the mother's viral load at delivery.

Unfortunately, drugs used to treat acute hepatitis C are teratogenic and cannot be used during pregnancy. Hepatitis C acquired via perinatal transmission has an increased likelihood to be chronic. Anti-HCV testing is ideally performed between 15 and 18 months of age. Although HCV RNA testing may be positive at 2 months and 6 months, the results may be a response to the mother's sera at that time.

Other patients who should be considered at risk in a primary care practice include young people who overcame serious illnesses early in life and those who received blood products before 1989.

Individuals who received Gammagard (immune globulin) during 1993 and 1994 may also be at risk.

Health care providers, especially those who work in emergency departments, surgery, or procedurally related specialties, have an estimated 1% prevalence rate that is rising, she said.

“I have to say, the majority of the kids I see in my practice with hepatitis C are the children, typically, of a nurse—a health care provider who likely got it occupationally,” she noted.

New data suggest that prompt treatment with interferon and ribavirin may produce a sustained virologic response in up to 80% of patients with acute hepatitis C. “If you're sure of [acute infection], you want to treat them early,” she said.

Antibody testing has been available for nearly 20 years, but the antibody just signals exposure to the virus, not immunity. Current detection modes include PCR (polymerase chain reaction), which can sometimes detect virus within 1-2 weeks of exposure but may be intermittently negative even in positive patients; ELISA (enzyme-linked immunosorbent assay)-IgG, which is highly sensitive and specific late in the course of the disease but may be inaccurate early; and RIBA (recombinant immunoblot assay)-IgG, a confirmatory test.

Clinically, liver function tests may generate variable results throughout the course of the disease.

Dr. Kay disclosed no relevant conflicts of interest regarding her talk.

Health care providers have an estimated 1% prevalence rate that is rising.

Source DR. KAY

LAS VEGAS — Amid the alphabet soup of hepatitis virus types, the one that should most concern physicians these days is hepatitis C.

“This is going to be the big virus in the next 20 years in the U.S.,” Dr. Marsha H. Kay predicted at a meeting sponsored by the American Academy of Pediatrics.

Hepatitis C virus already infects 1.6% of the general U.S. population—4 million people—but “the vast majority of people who are infected do not know it,” said Dr. Kay, a pediatric gastroenterologist and director of pediatric endoscopy at the Cleveland Clinic.

Known to be at risk are infants born to mothers with hepatitis C; young adult survivors of leukemia, childhood malignancies, and childhood cardiac surgery; hemophilia patients; dialysis patients; intravenous drug users; sexual partners of a person with hepatitis C; recipients of blood transfusions prior to 1989; first responders; and health care workers.

Alarmingly, though, 32% of the current cases involve no known risk factor. “We don't know exactly how this virus is transmitted,”sDr. Kay said. There is no way to prevent hepatitis C, and there is no vaccine.

Among those infected, 80%-85% will develop chronic hepatitis, and of those, half will develop cirrhosis, putting them at highly elevated risk for hepatocellular carcinoma. Hepatitis C is already the leading cause of liver transplantation in the nation.

All things considered, the perfect storm of hepatitis C constitutes “a really terrible outcome compared to hepatitis B infection,” she said,.

Among children, the leading cause of hepatitis C transmission is perinatal exposure, with transmission risk correlated to the mother's viral load at delivery.

Unfortunately, drugs used to treat acute hepatitis C are teratogenic and cannot be used during pregnancy. Hepatitis C acquired via perinatal transmission has an increased likelihood to be chronic. Anti-HCV testing is ideally performed between 15 and 18 months of age. Although HCV RNA testing may be positive at 2 months and 6 months, the results may be a response to the mother's sera at that time.

Other patients who should be considered at risk in a primary care practice include young people who overcame serious illnesses early in life and those who received blood products before 1989.

Individuals who received Gammagard (immune globulin) during 1993 and 1994 may also be at risk.

Health care providers, especially those who work in emergency departments, surgery, or procedurally related specialties, have an estimated 1% prevalence rate that is rising, she said.

“I have to say, the majority of the kids I see in my practice with hepatitis C are the children, typically, of a nurse—a health care provider who likely got it occupationally,” she noted.

New data suggest that prompt treatment with interferon and ribavirin may produce a sustained virologic response in up to 80% of patients with acute hepatitis C. “If you're sure of [acute infection], you want to treat them early,” she said.

Antibody testing has been available for nearly 20 years, but the antibody just signals exposure to the virus, not immunity. Current detection modes include PCR (polymerase chain reaction), which can sometimes detect virus within 1-2 weeks of exposure but may be intermittently negative even in positive patients; ELISA (enzyme-linked immunosorbent assay)-IgG, which is highly sensitive and specific late in the course of the disease but may be inaccurate early; and RIBA (recombinant immunoblot assay)-IgG, a confirmatory test.

Clinically, liver function tests may generate variable results throughout the course of the disease.

Dr. Kay disclosed no relevant conflicts of interest regarding her talk.

Health care providers have an estimated 1% prevalence rate that is rising.

Source DR. KAY

LAS VEGAS — Amid the alphabet soup of hepatitis virus types, the one that should most concern physicians these days is hepatitis C.

“This is going to be the big virus in the next 20 years in the U.S.,” Dr. Marsha H. Kay predicted at a meeting sponsored by the American Academy of Pediatrics.

Hepatitis C virus already infects 1.6% of the general U.S. population—4 million people—but “the vast majority of people who are infected do not know it,” said Dr. Kay, a pediatric gastroenterologist and director of pediatric endoscopy at the Cleveland Clinic.

Known to be at risk are infants born to mothers with hepatitis C; young adult survivors of leukemia, childhood malignancies, and childhood cardiac surgery; hemophilia patients; dialysis patients; intravenous drug users; sexual partners of a person with hepatitis C; recipients of blood transfusions prior to 1989; first responders; and health care workers.

Alarmingly, though, 32% of the current cases involve no known risk factor. “We don't know exactly how this virus is transmitted,”sDr. Kay said. There is no way to prevent hepatitis C, and there is no vaccine.

Among those infected, 80%-85% will develop chronic hepatitis, and of those, half will develop cirrhosis, putting them at highly elevated risk for hepatocellular carcinoma. Hepatitis C is already the leading cause of liver transplantation in the nation.

All things considered, the perfect storm of hepatitis C constitutes “a really terrible outcome compared to hepatitis B infection,” she said,.

Among children, the leading cause of hepatitis C transmission is perinatal exposure, with transmission risk correlated to the mother's viral load at delivery.

Unfortunately, drugs used to treat acute hepatitis C are teratogenic and cannot be used during pregnancy. Hepatitis C acquired via perinatal transmission has an increased likelihood to be chronic. Anti-HCV testing is ideally performed between 15 and 18 months of age. Although HCV RNA testing may be positive at 2 months and 6 months, the results may be a response to the mother's sera at that time.

Other patients who should be considered at risk in a primary care practice include young people who overcame serious illnesses early in life and those who received blood products before 1989.

Individuals who received Gammagard (immune globulin) during 1993 and 1994 may also be at risk.

Health care providers, especially those who work in emergency departments, surgery, or procedurally related specialties, have an estimated 1% prevalence rate that is rising, she said.

“I have to say, the majority of the kids I see in my practice with hepatitis C are the children, typically, of a nurse—a health care provider who likely got it occupationally,” she noted.

New data suggest that prompt treatment with interferon and ribavirin may produce a sustained virologic response in up to 80% of patients with acute hepatitis C. “If you're sure of [acute infection], you want to treat them early,” she said.

Antibody testing has been available for nearly 20 years, but the antibody just signals exposure to the virus, not immunity. Current detection modes include PCR (polymerase chain reaction), which can sometimes detect virus within 1-2 weeks of exposure but may be intermittently negative even in positive patients; ELISA (enzyme-linked immunosorbent assay)-IgG, which is highly sensitive and specific late in the course of the disease but may be inaccurate early; and RIBA (recombinant immunoblot assay)-IgG, a confirmatory test.

Clinically, liver function tests may generate variable results throughout the course of the disease.

Dr. Kay disclosed no relevant conflicts of interest regarding her talk.

Health care providers have an estimated 1% prevalence rate that is rising.

Source DR. KAY

CHICAGO — Few symptoms or clinical examination findings distinguished severely anemic patients from other women who presented for urgent evaluation of abnormal uterine bleeding, a retrospective cohort study showed.

Of 350 patients who presented to the emergency department for heavy menstrual bleeding, 122 (35%) were anemic, defined as having a hemoglobin concentration of less than 12 g/dL, while 48 (14%) were moderately to severely anemic, defined as having a hemoglobin concentration of less than 10 g/dL.

Only increasing age (relative risk, 1.04) and the presence of tachycardia together with hypotension (RR, 3.11) were associated with severe anemia, Dr. Kristen A. Matteson reported at the annual meeting of the American College of Obstetricians and Gynecologists.

“Our take-home message is that clinical symptoms and bleeding history are poorly predictive for moderate to severe anemia,” said Dr. Matteson of the department of obstetrics and gynecology at Brown University, Providence, R.I., following the meeting.

Because no presenting symptom or physical finding is able to rule out clinically important anemia, she suggested that “a low threshold should be maintained for performing a hemoglobin concentration.”

The median age of women in the study was 32 years. Nearly 70% were non-Hispanic white, and 20% were non-Hispanic black.

Almost one in four had received outpatient care for abnormal uterine bleeding in the prior 3 months, but 49% had a concurrent medical condition that could affect treatment options for the condition, Dr. Matteson pointed out.

These concurrent diagnoses included cardiovascular disease, depression, diabetes, gastrointestinal diseases, migraine, seizure disorders, thromboembolic disorders, and breast, endometrial, or ovarian cancer.

The duration of the current bleeding episode was more than 7 days in 55% of the study population.

A combination of heavy and irregular bleeding was reported by 65%, and more than half reported passing clots or flooding.

Neither the amount of bleeding recorded on examination nor bleeding patterns described by the patients were associated with the presence of moderate to severe anemia.

“We were not surprised that the amount of bleeding actually seen by the provider was scant in the majority of patients because abnormal uterine bleeding can be very unpredictable and episodic,” Dr. Matteson noted.

“Diagnosis and management of heavy menstrual bleeding are dependent on what a woman says about her blood loss because clinically we do not have practical means to 'measure' bleeding.”

When a woman reports extremely heavy bleeding that affects her life at home and work, but has little bleeding during a 30-minute medical appointment, the disparity can lead to frustration on the part of both the physician and patient, she said.

Studies have shown that such patients “often report dissatisfaction with their interactions with health care providers,” she said.

Dr. Matteson said mild anemia is generally asymptomatic in patients who do not have cardiovascular disease.

Severe anemia, on the other hand, can lead to cardiac events in some patients and may require blood transfusions.

Anemia that is moderate to severe can cause extreme fatigue, reducing productivity and quality of life.

Dr. Matteson reported no financial conflicts of interest relevant to the study.

CHICAGO — Few symptoms or clinical examination findings distinguished severely anemic patients from other women who presented for urgent evaluation of abnormal uterine bleeding, a retrospective cohort study showed.

Of 350 patients who presented to the emergency department for heavy menstrual bleeding, 122 (35%) were anemic, defined as having a hemoglobin concentration of less than 12 g/dL, while 48 (14%) were moderately to severely anemic, defined as having a hemoglobin concentration of less than 10 g/dL.

Only increasing age (relative risk, 1.04) and the presence of tachycardia together with hypotension (RR, 3.11) were associated with severe anemia, Dr. Kristen A. Matteson reported at the annual meeting of the American College of Obstetricians and Gynecologists.

“Our take-home message is that clinical symptoms and bleeding history are poorly predictive for moderate to severe anemia,” said Dr. Matteson of the department of obstetrics and gynecology at Brown University, Providence, R.I., following the meeting.

Because no presenting symptom or physical finding is able to rule out clinically important anemia, she suggested that “a low threshold should be maintained for performing a hemoglobin concentration.”

The median age of women in the study was 32 years. Nearly 70% were non-Hispanic white, and 20% were non-Hispanic black.

Almost one in four had received outpatient care for abnormal uterine bleeding in the prior 3 months, but 49% had a concurrent medical condition that could affect treatment options for the condition, Dr. Matteson pointed out.

These concurrent diagnoses included cardiovascular disease, depression, diabetes, gastrointestinal diseases, migraine, seizure disorders, thromboembolic disorders, and breast, endometrial, or ovarian cancer.

The duration of the current bleeding episode was more than 7 days in 55% of the study population.

A combination of heavy and irregular bleeding was reported by 65%, and more than half reported passing clots or flooding.

Neither the amount of bleeding recorded on examination nor bleeding patterns described by the patients were associated with the presence of moderate to severe anemia.

“We were not surprised that the amount of bleeding actually seen by the provider was scant in the majority of patients because abnormal uterine bleeding can be very unpredictable and episodic,” Dr. Matteson noted.

“Diagnosis and management of heavy menstrual bleeding are dependent on what a woman says about her blood loss because clinically we do not have practical means to 'measure' bleeding.”

When a woman reports extremely heavy bleeding that affects her life at home and work, but has little bleeding during a 30-minute medical appointment, the disparity can lead to frustration on the part of both the physician and patient, she said.

Studies have shown that such patients “often report dissatisfaction with their interactions with health care providers,” she said.

Dr. Matteson said mild anemia is generally asymptomatic in patients who do not have cardiovascular disease.

Severe anemia, on the other hand, can lead to cardiac events in some patients and may require blood transfusions.

Anemia that is moderate to severe can cause extreme fatigue, reducing productivity and quality of life.

Dr. Matteson reported no financial conflicts of interest relevant to the study.

CHICAGO — Few symptoms or clinical examination findings distinguished severely anemic patients from other women who presented for urgent evaluation of abnormal uterine bleeding, a retrospective cohort study showed.

Of 350 patients who presented to the emergency department for heavy menstrual bleeding, 122 (35%) were anemic, defined as having a hemoglobin concentration of less than 12 g/dL, while 48 (14%) were moderately to severely anemic, defined as having a hemoglobin concentration of less than 10 g/dL.

Only increasing age (relative risk, 1.04) and the presence of tachycardia together with hypotension (RR, 3.11) were associated with severe anemia, Dr. Kristen A. Matteson reported at the annual meeting of the American College of Obstetricians and Gynecologists.

“Our take-home message is that clinical symptoms and bleeding history are poorly predictive for moderate to severe anemia,” said Dr. Matteson of the department of obstetrics and gynecology at Brown University, Providence, R.I., following the meeting.

Because no presenting symptom or physical finding is able to rule out clinically important anemia, she suggested that “a low threshold should be maintained for performing a hemoglobin concentration.”

The median age of women in the study was 32 years. Nearly 70% were non-Hispanic white, and 20% were non-Hispanic black.

Almost one in four had received outpatient care for abnormal uterine bleeding in the prior 3 months, but 49% had a concurrent medical condition that could affect treatment options for the condition, Dr. Matteson pointed out.

These concurrent diagnoses included cardiovascular disease, depression, diabetes, gastrointestinal diseases, migraine, seizure disorders, thromboembolic disorders, and breast, endometrial, or ovarian cancer.

The duration of the current bleeding episode was more than 7 days in 55% of the study population.

A combination of heavy and irregular bleeding was reported by 65%, and more than half reported passing clots or flooding.

Neither the amount of bleeding recorded on examination nor bleeding patterns described by the patients were associated with the presence of moderate to severe anemia.

“We were not surprised that the amount of bleeding actually seen by the provider was scant in the majority of patients because abnormal uterine bleeding can be very unpredictable and episodic,” Dr. Matteson noted.

“Diagnosis and management of heavy menstrual bleeding are dependent on what a woman says about her blood loss because clinically we do not have practical means to 'measure' bleeding.”

When a woman reports extremely heavy bleeding that affects her life at home and work, but has little bleeding during a 30-minute medical appointment, the disparity can lead to frustration on the part of both the physician and patient, she said.

Studies have shown that such patients “often report dissatisfaction with their interactions with health care providers,” she said.

Dr. Matteson said mild anemia is generally asymptomatic in patients who do not have cardiovascular disease.

Severe anemia, on the other hand, can lead to cardiac events in some patients and may require blood transfusions.

Anemia that is moderate to severe can cause extreme fatigue, reducing productivity and quality of life.

Dr. Matteson reported no financial conflicts of interest relevant to the study.

SAN FRANCISCO — A revolutionary new staging system for lung cancer will profoundly influence treatment decisions and patients' eligibility for clinical trials.

Fully one in six lung cancer patients will receive a different staging category based on the 7th edition of the tumor, node, metastases (TNM) staging system, Dr. Peter Goldstraw, chair of the staging project of the International Association for the Study of Lung Cancer (IASLC), reported at the association's World Conference on Lung Cancer.

“Some of these patients, if not the majority of these patients, will therefore be considered for different modalities of care, and—commonly now, of course—multimodality care,” said Dr. Goldstraw, consultant and professor of thoracic surgery at Royal Brompton Hospital in London.

The revisions to the TNM system are based on multidisciplinary contributions from the world lung cancer community, drawing on data from more than 100,000 lung cancer cases from 46 centers in 19 countries. The IASLC led the revision effort, but both the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC) have accepted the recommendations.

“This represents the first real change [in staging] for the last 20 years … [and a] radical departure from the past,” Dr. Goldstraw said during a press briefing.

In the past, staging classifications were dictated by a small panel of experts, mostly surgeons, and were based on limited numbers of mostly surgical patients, he explained.

For staging non–small cell lung cancer (NSCLC), new subcategories of stage T1 (early-stage) disease are based on size: Tumors measuring 2 cm or smaller will now be classified as T1a, whereas tumors larger than 2 cm and up to 3 cm will be classified as T1b. T2 disease will also be subdivided into T2a (tumors larger than 3 cm and up to 5 cm) and T2b (tumors larger than 5 cm and up to 7 cm). A new category (T3) will be used to describe tumors larger than 7 cm.

The “N” classification within TNM that describes the number of involved lymph nodes will remain unchanged in the 7th edition.

“We should recognize that this simple statement reflects an enormous step forward, because this is the first time that these 'N' descriptions we have been using for decades have actually been validated,” Dr. Goldstraw said. The “N” subcommittee, after exhaustive review, concluded that the current system is accurate and required no revisions, he explained.

By analyzing survival in large databases based on tumor size and disease proliferation, the new staging system is expected to assess an individual patient's prognosis more accurately. It promises to considerably alter the discussion between clinicians and patients about the potential advantages of surgery, radiation, and/or chemotherapy, as well as to better categorize patients enrolled in clinical trials.

For example, patients who are down-staged because additional tumors are found in the same lobe as the primary tumor may now be considered candidates for adjunctive chemotherapy along with surgery. Similarly, there may be a greater role for surgery in patients with metastatic nodules in the bilateral lobe who previously would have been assigned a stage IV diagnosis, but are now stage IIIA.

The multidisciplinary nature of the new system is evident in the specificity of pathological and radiologic parameters used to characterize each stage of disease.

“Pathologists asked us to look at the issue of visceral pleural invasion,” Dr. Goldstraw said. In the past, this has been difficult to define and categorize, he explained; as a result, a uniform definition has now been agreed upon for the first time.

The new guidelines address a host of prognostic variables, including performance status, age, sex, laboratory values, initial maximum standard uptake variable on initial PET scan, an biological markers.

In addition to changes in the staging of NSCLC, analysis of more than 13,000 cases of small cell lung cancer (SCLC)—the largest such database in the world—reaffirmed the usefulness of the TNM system in that disease.

Previously, staging guidelines for SCLC were used primarily by surgeons, whereas medical oncologists have tended to simply dichotomize patients as having extensive or limited disease, Dr. Goldstraw explained during the press briefing.

Upcoming steps in efforts to modernize lung cancer staging will include the correction of geographical and treatment biases within retrospective data, the inclusion of prospective data based on the new staging system, implementation of a Web-based system for world data collection, and the extension of staging updates to include neuroendocrine tumors and mesothelioma.

Dr. Edward F. Patz Jr., professor of radiology, pharmacology, and cancer biology at Duke University in Durham, N.C., said the new size criteria within the guidelines will require precise specificity by radiologists.

“We need to be enormously careful about this,” he said, cautioning that an overenthusiastic reading of tiny, likely benign nodules could serve to up-stage a patient, with significant treatment implications. “You can't write the patient off, because we do see small nodules,” he said.

Dr. Patz recalled a mentor once telling him, “A radiologist with a ruler is a radiologist in trouble.” He urged colleagues to be circumspect in writing their reports, and simply characterize what they see rather than make inferences about the malignant potential of the small lesions on a scan.

He also warned that current imaging modalities are not uniformly accurate when it comes to lymph nodes and nodal groups. CT scans are about 60% sensitive and specific in identifying involved nodes; PET scans increase the accuracy to about 80%.

A related video is at www.youtube.com/InternalMedicineNews

New subcategories of stage T1 disease based on tumor size have been created in an effort to more accurately assess an individual patient's prognosis.

Source COURTESY INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER (IASLC). COPYRIGHT 2008 ALETTA ANN FRAZIER, M.D.

SAN FRANCISCO — A revolutionary new staging system for lung cancer will profoundly influence treatment decisions and patients' eligibility for clinical trials.

Fully one in six lung cancer patients will receive a different staging category based on the 7th edition of the tumor, node, metastases (TNM) staging system, Dr. Peter Goldstraw, chair of the staging project of the International Association for the Study of Lung Cancer (IASLC), reported at the association's World Conference on Lung Cancer.

“Some of these patients, if not the majority of these patients, will therefore be considered for different modalities of care, and—commonly now, of course—multimodality care,” said Dr. Goldstraw, consultant and professor of thoracic surgery at Royal Brompton Hospital in London.

The revisions to the TNM system are based on multidisciplinary contributions from the world lung cancer community, drawing on data from more than 100,000 lung cancer cases from 46 centers in 19 countries. The IASLC led the revision effort, but both the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC) have accepted the recommendations.

“This represents the first real change [in staging] for the last 20 years … [and a] radical departure from the past,” Dr. Goldstraw said during a press briefing.

In the past, staging classifications were dictated by a small panel of experts, mostly surgeons, and were based on limited numbers of mostly surgical patients, he explained.

For staging non–small cell lung cancer (NSCLC), new subcategories of stage T1 (early-stage) disease are based on size: Tumors measuring 2 cm or smaller will now be classified as T1a, whereas tumors larger than 2 cm and up to 3 cm will be classified as T1b. T2 disease will also be subdivided into T2a (tumors larger than 3 cm and up to 5 cm) and T2b (tumors larger than 5 cm and up to 7 cm). A new category (T3) will be used to describe tumors larger than 7 cm.

The “N” classification within TNM that describes the number of involved lymph nodes will remain unchanged in the 7th edition.

“We should recognize that this simple statement reflects an enormous step forward, because this is the first time that these 'N' descriptions we have been using for decades have actually been validated,” Dr. Goldstraw said. The “N” subcommittee, after exhaustive review, concluded that the current system is accurate and required no revisions, he explained.

By analyzing survival in large databases based on tumor size and disease proliferation, the new staging system is expected to assess an individual patient's prognosis more accurately. It promises to considerably alter the discussion between clinicians and patients about the potential advantages of surgery, radiation, and/or chemotherapy, as well as to better categorize patients enrolled in clinical trials.

For example, patients who are down-staged because additional tumors are found in the same lobe as the primary tumor may now be considered candidates for adjunctive chemotherapy along with surgery. Similarly, there may be a greater role for surgery in patients with metastatic nodules in the bilateral lobe who previously would have been assigned a stage IV diagnosis, but are now stage IIIA.

The multidisciplinary nature of the new system is evident in the specificity of pathological and radiologic parameters used to characterize each stage of disease.

“Pathologists asked us to look at the issue of visceral pleural invasion,” Dr. Goldstraw said. In the past, this has been difficult to define and categorize, he explained; as a result, a uniform definition has now been agreed upon for the first time.

The new guidelines address a host of prognostic variables, including performance status, age, sex, laboratory values, initial maximum standard uptake variable on initial PET scan, an biological markers.

In addition to changes in the staging of NSCLC, analysis of more than 13,000 cases of small cell lung cancer (SCLC)—the largest such database in the world—reaffirmed the usefulness of the TNM system in that disease.

Previously, staging guidelines for SCLC were used primarily by surgeons, whereas medical oncologists have tended to simply dichotomize patients as having extensive or limited disease, Dr. Goldstraw explained during the press briefing.

Upcoming steps in efforts to modernize lung cancer staging will include the correction of geographical and treatment biases within retrospective data, the inclusion of prospective data based on the new staging system, implementation of a Web-based system for world data collection, and the extension of staging updates to include neuroendocrine tumors and mesothelioma.

Dr. Edward F. Patz Jr., professor of radiology, pharmacology, and cancer biology at Duke University in Durham, N.C., said the new size criteria within the guidelines will require precise specificity by radiologists.

“We need to be enormously careful about this,” he said, cautioning that an overenthusiastic reading of tiny, likely benign nodules could serve to up-stage a patient, with significant treatment implications. “You can't write the patient off, because we do see small nodules,” he said.

Dr. Patz recalled a mentor once telling him, “A radiologist with a ruler is a radiologist in trouble.” He urged colleagues to be circumspect in writing their reports, and simply characterize what they see rather than make inferences about the malignant potential of the small lesions on a scan.

He also warned that current imaging modalities are not uniformly accurate when it comes to lymph nodes and nodal groups. CT scans are about 60% sensitive and specific in identifying involved nodes; PET scans increase the accuracy to about 80%.

A related video is at www.youtube.com/InternalMedicineNews

New subcategories of stage T1 disease based on tumor size have been created in an effort to more accurately assess an individual patient's prognosis.

Source COURTESY INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER (IASLC). COPYRIGHT 2008 ALETTA ANN FRAZIER, M.D.

SAN FRANCISCO — A revolutionary new staging system for lung cancer will profoundly influence treatment decisions and patients' eligibility for clinical trials.

Fully one in six lung cancer patients will receive a different staging category based on the 7th edition of the tumor, node, metastases (TNM) staging system, Dr. Peter Goldstraw, chair of the staging project of the International Association for the Study of Lung Cancer (IASLC), reported at the association's World Conference on Lung Cancer.

“Some of these patients, if not the majority of these patients, will therefore be considered for different modalities of care, and—commonly now, of course—multimodality care,” said Dr. Goldstraw, consultant and professor of thoracic surgery at Royal Brompton Hospital in London.

The revisions to the TNM system are based on multidisciplinary contributions from the world lung cancer community, drawing on data from more than 100,000 lung cancer cases from 46 centers in 19 countries. The IASLC led the revision effort, but both the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC) have accepted the recommendations.

“This represents the first real change [in staging] for the last 20 years … [and a] radical departure from the past,” Dr. Goldstraw said during a press briefing.

In the past, staging classifications were dictated by a small panel of experts, mostly surgeons, and were based on limited numbers of mostly surgical patients, he explained.

For staging non–small cell lung cancer (NSCLC), new subcategories of stage T1 (early-stage) disease are based on size: Tumors measuring 2 cm or smaller will now be classified as T1a, whereas tumors larger than 2 cm and up to 3 cm will be classified as T1b. T2 disease will also be subdivided into T2a (tumors larger than 3 cm and up to 5 cm) and T2b (tumors larger than 5 cm and up to 7 cm). A new category (T3) will be used to describe tumors larger than 7 cm.

The “N” classification within TNM that describes the number of involved lymph nodes will remain unchanged in the 7th edition.

“We should recognize that this simple statement reflects an enormous step forward, because this is the first time that these 'N' descriptions we have been using for decades have actually been validated,” Dr. Goldstraw said. The “N” subcommittee, after exhaustive review, concluded that the current system is accurate and required no revisions, he explained.

By analyzing survival in large databases based on tumor size and disease proliferation, the new staging system is expected to assess an individual patient's prognosis more accurately. It promises to considerably alter the discussion between clinicians and patients about the potential advantages of surgery, radiation, and/or chemotherapy, as well as to better categorize patients enrolled in clinical trials.

For example, patients who are down-staged because additional tumors are found in the same lobe as the primary tumor may now be considered candidates for adjunctive chemotherapy along with surgery. Similarly, there may be a greater role for surgery in patients with metastatic nodules in the bilateral lobe who previously would have been assigned a stage IV diagnosis, but are now stage IIIA.

The multidisciplinary nature of the new system is evident in the specificity of pathological and radiologic parameters used to characterize each stage of disease.

“Pathologists asked us to look at the issue of visceral pleural invasion,” Dr. Goldstraw said. In the past, this has been difficult to define and categorize, he explained; as a result, a uniform definition has now been agreed upon for the first time.

The new guidelines address a host of prognostic variables, including performance status, age, sex, laboratory values, initial maximum standard uptake variable on initial PET scan, an biological markers.

In addition to changes in the staging of NSCLC, analysis of more than 13,000 cases of small cell lung cancer (SCLC)—the largest such database in the world—reaffirmed the usefulness of the TNM system in that disease.

Previously, staging guidelines for SCLC were used primarily by surgeons, whereas medical oncologists have tended to simply dichotomize patients as having extensive or limited disease, Dr. Goldstraw explained during the press briefing.

Upcoming steps in efforts to modernize lung cancer staging will include the correction of geographical and treatment biases within retrospective data, the inclusion of prospective data based on the new staging system, implementation of a Web-based system for world data collection, and the extension of staging updates to include neuroendocrine tumors and mesothelioma.

Dr. Edward F. Patz Jr., professor of radiology, pharmacology, and cancer biology at Duke University in Durham, N.C., said the new size criteria within the guidelines will require precise specificity by radiologists.

“We need to be enormously careful about this,” he said, cautioning that an overenthusiastic reading of tiny, likely benign nodules could serve to up-stage a patient, with significant treatment implications. “You can't write the patient off, because we do see small nodules,” he said.

Dr. Patz recalled a mentor once telling him, “A radiologist with a ruler is a radiologist in trouble.” He urged colleagues to be circumspect in writing their reports, and simply characterize what they see rather than make inferences about the malignant potential of the small lesions on a scan.

He also warned that current imaging modalities are not uniformly accurate when it comes to lymph nodes and nodal groups. CT scans are about 60% sensitive and specific in identifying involved nodes; PET scans increase the accuracy to about 80%.

A related video is at www.youtube.com/InternalMedicineNews

New subcategories of stage T1 disease based on tumor size have been created in an effort to more accurately assess an individual patient's prognosis.

Source COURTESY INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER (IASLC). COPYRIGHT 2008 ALETTA ANN FRAZIER, M.D.

Los Angeles — Adolescents with type 1 diabetes who are treated with statins early in the course of their disease may have measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.

A pilot study of 26 children with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.

Two-dimensional ultrasound measurement of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, said Dr. Kaufman.

An earlier, long-term study of carotid IMT in 115 adolescent subjects with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism, and is director of the comprehensive childhood diabetes center. Investigators found that individuals aged 12-21 years with diabetes had significantly thicker IMT measurements than did controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452-7).

The current study explored whether early treatment of type 1 diabetes with statins would affect carotid IMT. Adolescents assigned to receive statins or placebo were similar in age (15-16 years), baseline hemoglobin A_1c values (8.4%-8.5%), and baseline IMT (mean 0.5510-0.5656 mm); 70% were females. Mean LDL cholesterol levels were lower in the placebo group (133 mg/dL), compared with the statin group (147 mg/dL).

After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by 0.0156 mm, reported Dr. Kaufman, professor of pediatrics at the University of Southern California, Los Angeles.

The American Diabetes Association, American Academy of Pediatrics, and American Heart Association agree that children with type 1 diabetes should be screened for dyslipidemia, she said. The question is how to manage dyslipidemia in adolescents with type 1.

“Most people suggest that we should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” she said.

Dr. Kaufman said she has had no relevant conflicts of interest.

After a year, IMT increased in controls by a mean 0.0065 mm, but regressed in statin takers by 0.0156 mm.

Source DR. KAUFMAN

Los Angeles — Adolescents with type 1 diabetes who are treated with statins early in the course of their disease may have measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.

A pilot study of 26 children with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.

Two-dimensional ultrasound measurement of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, said Dr. Kaufman.

An earlier, long-term study of carotid IMT in 115 adolescent subjects with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism, and is director of the comprehensive childhood diabetes center. Investigators found that individuals aged 12-21 years with diabetes had significantly thicker IMT measurements than did controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452-7).

The current study explored whether early treatment of type 1 diabetes with statins would affect carotid IMT. Adolescents assigned to receive statins or placebo were similar in age (15-16 years), baseline hemoglobin A_1c values (8.4%-8.5%), and baseline IMT (mean 0.5510-0.5656 mm); 70% were females. Mean LDL cholesterol levels were lower in the placebo group (133 mg/dL), compared with the statin group (147 mg/dL).

After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by 0.0156 mm, reported Dr. Kaufman, professor of pediatrics at the University of Southern California, Los Angeles.

The American Diabetes Association, American Academy of Pediatrics, and American Heart Association agree that children with type 1 diabetes should be screened for dyslipidemia, she said. The question is how to manage dyslipidemia in adolescents with type 1.

“Most people suggest that we should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” she said.

Dr. Kaufman said she has had no relevant conflicts of interest.

After a year, IMT increased in controls by a mean 0.0065 mm, but regressed in statin takers by 0.0156 mm.

Source DR. KAUFMAN

Los Angeles — Adolescents with type 1 diabetes who are treated with statins early in the course of their disease may have measurable improvement in their carotid intima-media thickness, an important risk factor for stroke and heart disease, preliminary data showed.

A pilot study of 26 children with type 1 diabetes found that those randomized to receive simvastatin (Zocor) for a year demonstrated a regression from baseline of the progression of carotid intima-media thickness (IMT), while those receiving a placebo had continued worsening of their IMT, Dr. Francine R. Kaufman reported at the annual meeting of the Society of Adolescent Medicine.

Two-dimensional ultrasound measurement of the IMT of the carotid artery is an indirect but useful way to assess the presence and progression of atherosclerosis, said Dr. Kaufman.

An earlier, long-term study of carotid IMT in 115 adolescent subjects with diabetes and 87 controls was conducted at Children's Hospital Los Angeles, where Dr. Kaufman heads the center for diabetes, endocrinology, and metabolism, and is director of the comprehensive childhood diabetes center. Investigators found that individuals aged 12-21 years with diabetes had significantly thicker IMT measurements than did controls, and that there was an association between higher IMT and elevated levels of LDL cholesterol, apolipoprotein B, and lysophosphatidic acid (J. Pediatrics 2004;145:452-7).

The current study explored whether early treatment of type 1 diabetes with statins would affect carotid IMT. Adolescents assigned to receive statins or placebo were similar in age (15-16 years), baseline hemoglobin A_1c values (8.4%-8.5%), and baseline IMT (mean 0.5510-0.5656 mm); 70% were females. Mean LDL cholesterol levels were lower in the placebo group (133 mg/dL), compared with the statin group (147 mg/dL).

After a year, IMT had increased in the control group by a mean 0.0065 mm, while it regressed among statin takers by 0.0156 mm, reported Dr. Kaufman, professor of pediatrics at the University of Southern California, Los Angeles.

The American Diabetes Association, American Academy of Pediatrics, and American Heart Association agree that children with type 1 diabetes should be screened for dyslipidemia, she said. The question is how to manage dyslipidemia in adolescents with type 1.

“Most people suggest that we should start thinking about treatment when LDL is over 100 [mg/dL], and we should treat when LDL is in the 130 range,” she said.

Dr. Kaufman said she has had no relevant conflicts of interest.

After a year, IMT increased in controls by a mean 0.0065 mm, but regressed in statin takers by 0.0156 mm.

Source DR. KAUFMAN

LOS ANGELES — Asian American/Pacific Islander high school students perceived sex to be riskier than did peers of other ethnicities and engaged in sex at much lower rates, in a study conducted in large public schools in Northern California.

The study of 411 adolescents (average age 16 years) uncovered widespread misconceptions across all racial/ethnic groups about the risks of vaginal and oral sex, but these misperceptions were greatest among Asian American/Pacific Islander students, Dr. Dzung X. Vo reported at the annual meeting of the Society for Adolescent Medicine.

Responses were analyzed from three groups: whites (44%), Hispanics (27%), and Asian American/Pacific Islanders (29%), said Dr. Vo of the division of adolescent medicine at the University of California, San Francisco. More than half—58%—were girls.

Students were asked to estimate the risk of various health consequences, as well as the potential damage to their social standing and relationships, of engaging in one act of vaginal intercourse or one act of oral sex. The researchers found that among students of all racial/ethnic groups, those who had actually engaged in sex perceived fewer risks and more potential benefits of having either vaginal or oral sex.

Hispanics were most likely to report having engaged in vaginal sex (44%), followed by whites (37%) and Asian American/Pacific Islanders (21%). Whites were most likely to have engaged in oral sex at 50%, followed by Hispanics (45%). Asian American/Pacific Islanders were far less likely than their peers to have engaged in oral sex, at 17%.

In 7 of 14 categories of potential risk from having vaginal sex, Asian Americans perceived a greater level of risk than did whites.

For example, whites thought there was a 56% chance of becoming pregnant after one episode of vaginal sex, while Asian American/Pacific Islanders calculated the risk at 65% and Hispanics, at 62%. (These differences were statistically significant for white students versus the other groups.)

Asian American/Pacific Islander students thought there was a 67% chance that vaginal sex might be pleasurable, compared with whites, who estimated a 76% chance and Hispanics, who estimated a 74% chance.

Asian American/Pacific Islander students equated as significantly higher than their peers the following potential risks of having oral sex: pregnancy, acquiring a sexually transmitted disease, getting HIV, harming one's relationship, getting in trouble with parents, and experiencing guilt.

Many students overestimated the actual known risks of sexual activity, Dr. Vo noted. For example, students believed one act of intercourse was far more likely to cause pregnancy than is truly the case. Even in the case of unprotected intercourse (which wasn't specified), the risk of pregnancy per act is probably less than 10%, even at a time of maximum risk in the ovulatory cycle. A significant number of students believed oral sex would put them at risk for pregnancy.

White students estimated the risk of becoming pregnant through oral sex at 7%, significantly lower than the 19% risk perceived by both Asian American/Pacific Islander students and Hispanic students.

LOS ANGELES — Asian American/Pacific Islander high school students perceived sex to be riskier than did peers of other ethnicities and engaged in sex at much lower rates, in a study conducted in large public schools in Northern California.

The study of 411 adolescents (average age 16 years) uncovered widespread misconceptions across all racial/ethnic groups about the risks of vaginal and oral sex, but these misperceptions were greatest among Asian American/Pacific Islander students, Dr. Dzung X. Vo reported at the annual meeting of the Society for Adolescent Medicine.

Responses were analyzed from three groups: whites (44%), Hispanics (27%), and Asian American/Pacific Islanders (29%), said Dr. Vo of the division of adolescent medicine at the University of California, San Francisco. More than half—58%—were girls.

Students were asked to estimate the risk of various health consequences, as well as the potential damage to their social standing and relationships, of engaging in one act of vaginal intercourse or one act of oral sex. The researchers found that among students of all racial/ethnic groups, those who had actually engaged in sex perceived fewer risks and more potential benefits of having either vaginal or oral sex.

Hispanics were most likely to report having engaged in vaginal sex (44%), followed by whites (37%) and Asian American/Pacific Islanders (21%). Whites were most likely to have engaged in oral sex at 50%, followed by Hispanics (45%). Asian American/Pacific Islanders were far less likely than their peers to have engaged in oral sex, at 17%.

In 7 of 14 categories of potential risk from having vaginal sex, Asian Americans perceived a greater level of risk than did whites.

For example, whites thought there was a 56% chance of becoming pregnant after one episode of vaginal sex, while Asian American/Pacific Islanders calculated the risk at 65% and Hispanics, at 62%. (These differences were statistically significant for white students versus the other groups.)

Asian American/Pacific Islander students thought there was a 67% chance that vaginal sex might be pleasurable, compared with whites, who estimated a 76% chance and Hispanics, who estimated a 74% chance.

Asian American/Pacific Islander students equated as significantly higher than their peers the following potential risks of having oral sex: pregnancy, acquiring a sexually transmitted disease, getting HIV, harming one's relationship, getting in trouble with parents, and experiencing guilt.

Many students overestimated the actual known risks of sexual activity, Dr. Vo noted. For example, students believed one act of intercourse was far more likely to cause pregnancy than is truly the case. Even in the case of unprotected intercourse (which wasn't specified), the risk of pregnancy per act is probably less than 10%, even at a time of maximum risk in the ovulatory cycle. A significant number of students believed oral sex would put them at risk for pregnancy.

White students estimated the risk of becoming pregnant through oral sex at 7%, significantly lower than the 19% risk perceived by both Asian American/Pacific Islander students and Hispanic students.

LOS ANGELES — Asian American/Pacific Islander high school students perceived sex to be riskier than did peers of other ethnicities and engaged in sex at much lower rates, in a study conducted in large public schools in Northern California.

The study of 411 adolescents (average age 16 years) uncovered widespread misconceptions across all racial/ethnic groups about the risks of vaginal and oral sex, but these misperceptions were greatest among Asian American/Pacific Islander students, Dr. Dzung X. Vo reported at the annual meeting of the Society for Adolescent Medicine.

Responses were analyzed from three groups: whites (44%), Hispanics (27%), and Asian American/Pacific Islanders (29%), said Dr. Vo of the division of adolescent medicine at the University of California, San Francisco. More than half—58%—were girls.

Students were asked to estimate the risk of various health consequences, as well as the potential damage to their social standing and relationships, of engaging in one act of vaginal intercourse or one act of oral sex. The researchers found that among students of all racial/ethnic groups, those who had actually engaged in sex perceived fewer risks and more potential benefits of having either vaginal or oral sex.

Hispanics were most likely to report having engaged in vaginal sex (44%), followed by whites (37%) and Asian American/Pacific Islanders (21%). Whites were most likely to have engaged in oral sex at 50%, followed by Hispanics (45%). Asian American/Pacific Islanders were far less likely than their peers to have engaged in oral sex, at 17%.

In 7 of 14 categories of potential risk from having vaginal sex, Asian Americans perceived a greater level of risk than did whites.

For example, whites thought there was a 56% chance of becoming pregnant after one episode of vaginal sex, while Asian American/Pacific Islanders calculated the risk at 65% and Hispanics, at 62%. (These differences were statistically significant for white students versus the other groups.)

Asian American/Pacific Islander students thought there was a 67% chance that vaginal sex might be pleasurable, compared with whites, who estimated a 76% chance and Hispanics, who estimated a 74% chance.

Asian American/Pacific Islander students equated as significantly higher than their peers the following potential risks of having oral sex: pregnancy, acquiring a sexually transmitted disease, getting HIV, harming one's relationship, getting in trouble with parents, and experiencing guilt.

Many students overestimated the actual known risks of sexual activity, Dr. Vo noted. For example, students believed one act of intercourse was far more likely to cause pregnancy than is truly the case. Even in the case of unprotected intercourse (which wasn't specified), the risk of pregnancy per act is probably less than 10%, even at a time of maximum risk in the ovulatory cycle. A significant number of students believed oral sex would put them at risk for pregnancy.

White students estimated the risk of becoming pregnant through oral sex at 7%, significantly lower than the 19% risk perceived by both Asian American/Pacific Islander students and Hispanic students.

SAN FRANCISCO — An unusual pattern of sudden, effortless smoking cessation in long-term smokers may herald the onset of lung cancer in a small subgroup of patients, researchers reported at the World Conference on Lung Cancer.

It has been well documented that lung cancer patients often stop smoking shortly before their diagnosis, with the assumption that symptoms such as shortness of breath, coughing, or pain create a strong motivation for behavior change.

Now a pilot study suggests that, in certain lung cancer patients—even some with long-term smoking histories and significant levels of nicotine addiction—cessation occurs in the absence of symptoms or even a focused effort to quit.

“This has led us to speculate that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction,” said Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia.

In a study conducted at the Philadelphia VA Medical Center, 115 smokers and former smokers diagnosed with lung cancer were compared to 101 smokers and former smokers with prostate cancer or to 99 with myocardial infarction.

Former smokers with prostate cancer had quit smoking an average of 23 years before their diagnosis; for myocardial infarction, the average interim was 10 years. But smoking cessation was a more recent event for lung cancer patients, occurring, on average, just 2.7 years before diagnosis.

Further comparisons among former smokers revealed striking differences among the 3 groups.

“In the general population, you would expect that those who succeeded in quitting smoking would be those who smoked less and were less severely addicted, she said at the meeting sponsored by the International Association for the Study of Lung Cancer. “That is exactly what we found in patients with prostate cancer and myo-cardial infarction.”

In contrast, current and former smokers with lung cancer had similar levels of cumulative tobacco exposure and identical median scores on a scale measuring severity of addiction-scoring 7 on a scale of 0 (“Didn't even think about it”) to 10 (“The hardest thing I've ever done”).

Surprisingly, many of these lung cancer patients reported they had quit smoking with ease and with no symptomatic “alarm bell” that compelled them to stop.

Among the 55 patients who quit smoking before being diagnosed with lung cancer, 49 (89%) were reportedly asymptomatic at the time.

Nearly a third (17 of 55) reported quitting “with no difficulty,” (0 on a scale of 0-7), even though they were moderately to severely addicted to nicotine based on the Fagerström Test for Nicotine Dependence scale.

“The way some of these patients stop smoking is really quite peculiar,” Dr. Campling said. A typical patient was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette … [and then] realizes they don't need it anymore.”

Dr. Campling and her associates hope their findings will be followed up with a long-term, prospective study of smokers to identify any unusual patterns of smoking cessation that may precede a diagnosis of lung cancer. In the meantime, she suggested that clinicians pay attention to any highly unusual pattern of smoking cessation in a long-term, heavy smoker, just as they would a sudden loss of appetite.

Dr. Campling and her associates reported no financial disclosures with respect to their study.

'Someone who had smoked a pack of cigarettes a day for 50 years … wakes up one day and forgets to light a cigarette.'

Source DR. CAMPLING

SAN FRANCISCO — An unusual pattern of sudden, effortless smoking cessation in long-term smokers may herald the onset of lung cancer in a small subgroup of patients, researchers reported at the World Conference on Lung Cancer.

It has been well documented that lung cancer patients often stop smoking shortly before their diagnosis, with the assumption that symptoms such as shortness of breath, coughing, or pain create a strong motivation for behavior change.

Now a pilot study suggests that, in certain lung cancer patients—even some with long-term smoking histories and significant levels of nicotine addiction—cessation occurs in the absence of symptoms or even a focused effort to quit.

“This has led us to speculate that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction,” said Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia.

In a study conducted at the Philadelphia VA Medical Center, 115 smokers and former smokers diagnosed with lung cancer were compared to 101 smokers and former smokers with prostate cancer or to 99 with myocardial infarction.

Former smokers with prostate cancer had quit smoking an average of 23 years before their diagnosis; for myocardial infarction, the average interim was 10 years. But smoking cessation was a more recent event for lung cancer patients, occurring, on average, just 2.7 years before diagnosis.

Further comparisons among former smokers revealed striking differences among the 3 groups.

“In the general population, you would expect that those who succeeded in quitting smoking would be those who smoked less and were less severely addicted, she said at the meeting sponsored by the International Association for the Study of Lung Cancer. “That is exactly what we found in patients with prostate cancer and myo-cardial infarction.”

In contrast, current and former smokers with lung cancer had similar levels of cumulative tobacco exposure and identical median scores on a scale measuring severity of addiction-scoring 7 on a scale of 0 (“Didn't even think about it”) to 10 (“The hardest thing I've ever done”).

Surprisingly, many of these lung cancer patients reported they had quit smoking with ease and with no symptomatic “alarm bell” that compelled them to stop.

Among the 55 patients who quit smoking before being diagnosed with lung cancer, 49 (89%) were reportedly asymptomatic at the time.

Nearly a third (17 of 55) reported quitting “with no difficulty,” (0 on a scale of 0-7), even though they were moderately to severely addicted to nicotine based on the Fagerström Test for Nicotine Dependence scale.

“The way some of these patients stop smoking is really quite peculiar,” Dr. Campling said. A typical patient was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette … [and then] realizes they don't need it anymore.”

Dr. Campling and her associates hope their findings will be followed up with a long-term, prospective study of smokers to identify any unusual patterns of smoking cessation that may precede a diagnosis of lung cancer. In the meantime, she suggested that clinicians pay attention to any highly unusual pattern of smoking cessation in a long-term, heavy smoker, just as they would a sudden loss of appetite.

Dr. Campling and her associates reported no financial disclosures with respect to their study.

'Someone who had smoked a pack of cigarettes a day for 50 years … wakes up one day and forgets to light a cigarette.'

Source DR. CAMPLING

SAN FRANCISCO — An unusual pattern of sudden, effortless smoking cessation in long-term smokers may herald the onset of lung cancer in a small subgroup of patients, researchers reported at the World Conference on Lung Cancer.

It has been well documented that lung cancer patients often stop smoking shortly before their diagnosis, with the assumption that symptoms such as shortness of breath, coughing, or pain create a strong motivation for behavior change.

Now a pilot study suggests that, in certain lung cancer patients—even some with long-term smoking histories and significant levels of nicotine addiction—cessation occurs in the absence of symptoms or even a focused effort to quit.

“This has led us to speculate that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction,” said Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia.

In a study conducted at the Philadelphia VA Medical Center, 115 smokers and former smokers diagnosed with lung cancer were compared to 101 smokers and former smokers with prostate cancer or to 99 with myocardial infarction.

Former smokers with prostate cancer had quit smoking an average of 23 years before their diagnosis; for myocardial infarction, the average interim was 10 years. But smoking cessation was a more recent event for lung cancer patients, occurring, on average, just 2.7 years before diagnosis.

Further comparisons among former smokers revealed striking differences among the 3 groups.

“In the general population, you would expect that those who succeeded in quitting smoking would be those who smoked less and were less severely addicted, she said at the meeting sponsored by the International Association for the Study of Lung Cancer. “That is exactly what we found in patients with prostate cancer and myo-cardial infarction.”

In contrast, current and former smokers with lung cancer had similar levels of cumulative tobacco exposure and identical median scores on a scale measuring severity of addiction-scoring 7 on a scale of 0 (“Didn't even think about it”) to 10 (“The hardest thing I've ever done”).

Surprisingly, many of these lung cancer patients reported they had quit smoking with ease and with no symptomatic “alarm bell” that compelled them to stop.

Among the 55 patients who quit smoking before being diagnosed with lung cancer, 49 (89%) were reportedly asymptomatic at the time.

Nearly a third (17 of 55) reported quitting “with no difficulty,” (0 on a scale of 0-7), even though they were moderately to severely addicted to nicotine based on the Fagerström Test for Nicotine Dependence scale.

“The way some of these patients stop smoking is really quite peculiar,” Dr. Campling said. A typical patient was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette … [and then] realizes they don't need it anymore.”

Dr. Campling and her associates hope their findings will be followed up with a long-term, prospective study of smokers to identify any unusual patterns of smoking cessation that may precede a diagnosis of lung cancer. In the meantime, she suggested that clinicians pay attention to any highly unusual pattern of smoking cessation in a long-term, heavy smoker, just as they would a sudden loss of appetite.

Dr. Campling and her associates reported no financial disclosures with respect to their study.

'Someone who had smoked a pack of cigarettes a day for 50 years … wakes up one day and forgets to light a cigarette.'

Source DR. CAMPLING

SAN FRANCISCO – An unusual pattern of sudden, effortless smoking cessation in long-term smokers may herald the onset of lung cancer in a small subgroup of patients, researchers reported at the World Conference on Lung Cancer.

It has been well documented that lung cancer patients often stop smoking shortly before their diagnosis, with the assumption that symptoms such as shortness of breath, coughing, or pain create a strong motivation for behavior change.

Now a pilot study suggests that in certain lung cancer patients–even some with long-term smoking histories and significant levels of nicotine addiction–smoking cessation occurs in the absence of symptoms or even a focused effort to quit.

“This has led us to speculate that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction,” said Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia.

In a study conducted at the Philadelphia VA Medical Center, 115 smokers and former smokers diagnosed with lung cancer were compared to 101 smokers and former smokers with prostate cancer or to 99 with myocardial infarction.

Former smokers with prostate cancer had quit smoking an average of 23 years before their diagnosis; for myocardial infarction, the average interim was 10 years.

But smoking cessation was a more recent event for lung cancer patients, occurring, on average, just 2.7 years before diagnosis. Further comparisons among former smokers revealed striking differences among the 3 groups.

“In the general population, you would expect that those who succeeded in quitting smoking would be those who smoked less and were less severely addicted, she said at the meeting sponsored by the International Association for the Study of Lung Cancer. “That is exactly what we found in patients with prostate cancer and myocardial infarction.” In contrast, current and former smokers with lung cancer had similar levels of cumulative tobacco exposure and identical median scores on a scale measuring severity of addiction–scoring 7 on a scale of 0 (“Didn't even think about it”) to 10 (“The hardest thing I've ever done.”)

Surprisingly, many of these lung cancer patients reported they had quit smoking with ease and with no symptomatic “alarm bell” that compelled them to stop.

Among the 55 patients who quit smoking before being diagnosed with lung cancer, 49 (89%) were reportedly asymptomatic at the time. Nearly a third (17 of 55) reported quitting “with no difficulty,” (0 on a scale of 0-7), even though they were moderately to severely addicted to nicotine based on the Fagerström Test for Nicotine Dependence scale.

“The way some of these patients stop smoking is really quite peculiar,” Dr. Campling said. A typical patient was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette … [and then] realizes they don't need it anymore.”

Dr. Campling and her associates hope their findings will be followed up with a long-term, prospective study of smokers to identify any unusual patterns of smoking cessation that may precede a diagnosis of lung cancer. In the meantime, she suggested that clinicians pay attention to any highly unusual pattern of smoking cessation in a long-term, heavy smoker, just as they would a sudden loss of appetite.

Dr. Campling and her associates reported no financial disclosures with respect to their study.

A typical patient smoked a pack a day for 50 years and 'wakes up one day and forgets to light a cigarette.'

Source Dr. Campling

SAN FRANCISCO – An unusual pattern of sudden, effortless smoking cessation in long-term smokers may herald the onset of lung cancer in a small subgroup of patients, researchers reported at the World Conference on Lung Cancer.

It has been well documented that lung cancer patients often stop smoking shortly before their diagnosis, with the assumption that symptoms such as shortness of breath, coughing, or pain create a strong motivation for behavior change.

Now a pilot study suggests that in certain lung cancer patients–even some with long-term smoking histories and significant levels of nicotine addiction–smoking cessation occurs in the absence of symptoms or even a focused effort to quit.

“This has led us to speculate that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction,” said Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia.

In a study conducted at the Philadelphia VA Medical Center, 115 smokers and former smokers diagnosed with lung cancer were compared to 101 smokers and former smokers with prostate cancer or to 99 with myocardial infarction.

Former smokers with prostate cancer had quit smoking an average of 23 years before their diagnosis; for myocardial infarction, the average interim was 10 years.

But smoking cessation was a more recent event for lung cancer patients, occurring, on average, just 2.7 years before diagnosis. Further comparisons among former smokers revealed striking differences among the 3 groups.

“In the general population, you would expect that those who succeeded in quitting smoking would be those who smoked less and were less severely addicted, she said at the meeting sponsored by the International Association for the Study of Lung Cancer. “That is exactly what we found in patients with prostate cancer and myocardial infarction.” In contrast, current and former smokers with lung cancer had similar levels of cumulative tobacco exposure and identical median scores on a scale measuring severity of addiction–scoring 7 on a scale of 0 (“Didn't even think about it”) to 10 (“The hardest thing I've ever done.”)

Surprisingly, many of these lung cancer patients reported they had quit smoking with ease and with no symptomatic “alarm bell” that compelled them to stop.

Among the 55 patients who quit smoking before being diagnosed with lung cancer, 49 (89%) were reportedly asymptomatic at the time. Nearly a third (17 of 55) reported quitting “with no difficulty,” (0 on a scale of 0-7), even though they were moderately to severely addicted to nicotine based on the Fagerström Test for Nicotine Dependence scale.

“The way some of these patients stop smoking is really quite peculiar,” Dr. Campling said. A typical patient was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette … [and then] realizes they don't need it anymore.”

Dr. Campling and her associates hope their findings will be followed up with a long-term, prospective study of smokers to identify any unusual patterns of smoking cessation that may precede a diagnosis of lung cancer. In the meantime, she suggested that clinicians pay attention to any highly unusual pattern of smoking cessation in a long-term, heavy smoker, just as they would a sudden loss of appetite.

Dr. Campling and her associates reported no financial disclosures with respect to their study.

A typical patient smoked a pack a day for 50 years and 'wakes up one day and forgets to light a cigarette.'

Source Dr. Campling

SAN FRANCISCO – An unusual pattern of sudden, effortless smoking cessation in long-term smokers may herald the onset of lung cancer in a small subgroup of patients, researchers reported at the World Conference on Lung Cancer.

It has been well documented that lung cancer patients often stop smoking shortly before their diagnosis, with the assumption that symptoms such as shortness of breath, coughing, or pain create a strong motivation for behavior change.

Now a pilot study suggests that in certain lung cancer patients–even some with long-term smoking histories and significant levels of nicotine addiction–smoking cessation occurs in the absence of symptoms or even a focused effort to quit.

“This has led us to speculate that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction,” said Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia.

In a study conducted at the Philadelphia VA Medical Center, 115 smokers and former smokers diagnosed with lung cancer were compared to 101 smokers and former smokers with prostate cancer or to 99 with myocardial infarction.

Former smokers with prostate cancer had quit smoking an average of 23 years before their diagnosis; for myocardial infarction, the average interim was 10 years.

But smoking cessation was a more recent event for lung cancer patients, occurring, on average, just 2.7 years before diagnosis. Further comparisons among former smokers revealed striking differences among the 3 groups.

“In the general population, you would expect that those who succeeded in quitting smoking would be those who smoked less and were less severely addicted, she said at the meeting sponsored by the International Association for the Study of Lung Cancer. “That is exactly what we found in patients with prostate cancer and myocardial infarction.” In contrast, current and former smokers with lung cancer had similar levels of cumulative tobacco exposure and identical median scores on a scale measuring severity of addiction–scoring 7 on a scale of 0 (“Didn't even think about it”) to 10 (“The hardest thing I've ever done.”)

Surprisingly, many of these lung cancer patients reported they had quit smoking with ease and with no symptomatic “alarm bell” that compelled them to stop.

Among the 55 patients who quit smoking before being diagnosed with lung cancer, 49 (89%) were reportedly asymptomatic at the time. Nearly a third (17 of 55) reported quitting “with no difficulty,” (0 on a scale of 0-7), even though they were moderately to severely addicted to nicotine based on the Fagerström Test for Nicotine Dependence scale.

“The way some of these patients stop smoking is really quite peculiar,” Dr. Campling said. A typical patient was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette … [and then] realizes they don't need it anymore.”

Dr. Campling and her associates hope their findings will be followed up with a long-term, prospective study of smokers to identify any unusual patterns of smoking cessation that may precede a diagnosis of lung cancer. In the meantime, she suggested that clinicians pay attention to any highly unusual pattern of smoking cessation in a long-term, heavy smoker, just as they would a sudden loss of appetite.

Dr. Campling and her associates reported no financial disclosures with respect to their study.

A typical patient smoked a pack a day for 50 years and 'wakes up one day and forgets to light a cigarette.'

Source Dr. Campling

SAN FRANCISCO — An unusual pattern of sudden, effortless smoking cessation in long-term smokers may herald the onset of lung cancer in a small subgroup of patients, researchers reported at the World Conference on Lung Cancer.

It has been well documented that lung cancer patients often stop smoking shortly before their diagnosis, with the assumption that symptoms such as shortness of breath, coughing, or pain create a strong motivation for behavior change.

Now a pilot study suggests that in certain lung cancer patients—even some with long-term smoking histories and significant nicotine addiction—smoking cessation occurs in the absence of symptoms or even a focused effort to quit.

“This has led us to speculate that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction,” said Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia.

In a study conducted at the Philadelphia VA Medical Center, 115 smokers and former smokers diagnosed with lung cancer were compared to 200 smokers and former smokers with prostate cancer (101) or MI (99).

Former smokers with prostate cancer had quit smoking an average of 23 years before their diagnosis; for MI, the average interim was 10 years.

But smoking cessation was a more recent event for lung cancer patients, occurring an average of 2.7 years before diagnosis.

Further comparisons among former smokers revealed striking differences among the three groups.

“In the general population, you would expect that those who succeeded in quitting smoking would be those who smoked less and were less severely addicted,” she said at the meeting sponsored by the International Association for the Study of Lung Cancer. “That is exactly what we found in patients with prostate cancer and myocardial infarction.”

In contrast, current and former smokers with lung cancer had similar levels of cumulative tobacco exposure and identical median scores on a scale measuring severity of addiction, scoring 7 on a scale of 0 (“Didn't even think about it”) to 10 (“The hardest thing I've ever done”).

Surprisingly, many of these lung cancer patients reported they had quit smoking with ease and with no symptomatic “alarm bell” that compelled them to stop.

Among the 55 patients who quit smoking before being diagnosed with lung cancer, 49 (89%) were reportedly asymptomatic at the time.

Nearly a third (17 of 55) reported quitting “with no difficulty” (0 on a scale of 0-7), even though they were moderately to severely addicted to nicotine based on the Fagerström Test for Nicotine Dependence.

“The way some of these patients stop smoking is really quite peculiar,” Dr. Campling said. A typical patient was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette … [and then] realizes they don't need it anymore.”

Dr. Campling and her associates hope their findings will be followed up with a long-term, prospective study of smokers to identify any unusual patterns of smoking cessation that may precede a diagnosis of lung cancer. In the meantime, she suggested that clinicians pay attention to any highly unusual pattern of smoking cessation in a long-term, heavy smoker, just as they would a sudden loss of appetite.

Dr. Campling and her associates reported no financial disclosures with respect to their study.

'The way some of these patients stop smoking is really quite peculiar.'

Source DR. CAMPLING

SAN FRANCISCO — An unusual pattern of sudden, effortless smoking cessation in long-term smokers may herald the onset of lung cancer in a small subgroup of patients, researchers reported at the World Conference on Lung Cancer.

It has been well documented that lung cancer patients often stop smoking shortly before their diagnosis, with the assumption that symptoms such as shortness of breath, coughing, or pain create a strong motivation for behavior change.

Now a pilot study suggests that in certain lung cancer patients—even some with long-term smoking histories and significant nicotine addiction—smoking cessation occurs in the absence of symptoms or even a focused effort to quit.

“This has led us to speculate that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction,” said Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia.

In a study conducted at the Philadelphia VA Medical Center, 115 smokers and former smokers diagnosed with lung cancer were compared to 200 smokers and former smokers with prostate cancer (101) or MI (99).

Former smokers with prostate cancer had quit smoking an average of 23 years before their diagnosis; for MI, the average interim was 10 years.

But smoking cessation was a more recent event for lung cancer patients, occurring an average of 2.7 years before diagnosis.

Further comparisons among former smokers revealed striking differences among the three groups.

“In the general population, you would expect that those who succeeded in quitting smoking would be those who smoked less and were less severely addicted,” she said at the meeting sponsored by the International Association for the Study of Lung Cancer. “That is exactly what we found in patients with prostate cancer and myocardial infarction.”

In contrast, current and former smokers with lung cancer had similar levels of cumulative tobacco exposure and identical median scores on a scale measuring severity of addiction, scoring 7 on a scale of 0 (“Didn't even think about it”) to 10 (“The hardest thing I've ever done”).

Surprisingly, many of these lung cancer patients reported they had quit smoking with ease and with no symptomatic “alarm bell” that compelled them to stop.

Among the 55 patients who quit smoking before being diagnosed with lung cancer, 49 (89%) were reportedly asymptomatic at the time.

Nearly a third (17 of 55) reported quitting “with no difficulty” (0 on a scale of 0-7), even though they were moderately to severely addicted to nicotine based on the Fagerström Test for Nicotine Dependence.

“The way some of these patients stop smoking is really quite peculiar,” Dr. Campling said. A typical patient was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette … [and then] realizes they don't need it anymore.”

Dr. Campling and her associates hope their findings will be followed up with a long-term, prospective study of smokers to identify any unusual patterns of smoking cessation that may precede a diagnosis of lung cancer. In the meantime, she suggested that clinicians pay attention to any highly unusual pattern of smoking cessation in a long-term, heavy smoker, just as they would a sudden loss of appetite.

Dr. Campling and her associates reported no financial disclosures with respect to their study.

'The way some of these patients stop smoking is really quite peculiar.'

Source DR. CAMPLING

SAN FRANCISCO — An unusual pattern of sudden, effortless smoking cessation in long-term smokers may herald the onset of lung cancer in a small subgroup of patients, researchers reported at the World Conference on Lung Cancer.

It has been well documented that lung cancer patients often stop smoking shortly before their diagnosis, with the assumption that symptoms such as shortness of breath, coughing, or pain create a strong motivation for behavior change.

Now a pilot study suggests that in certain lung cancer patients—even some with long-term smoking histories and significant nicotine addiction—smoking cessation occurs in the absence of symptoms or even a focused effort to quit.

“This has led us to speculate that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction,” said Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia.

In a study conducted at the Philadelphia VA Medical Center, 115 smokers and former smokers diagnosed with lung cancer were compared to 200 smokers and former smokers with prostate cancer (101) or MI (99).

Former smokers with prostate cancer had quit smoking an average of 23 years before their diagnosis; for MI, the average interim was 10 years.

But smoking cessation was a more recent event for lung cancer patients, occurring an average of 2.7 years before diagnosis.

Further comparisons among former smokers revealed striking differences among the three groups.

“In the general population, you would expect that those who succeeded in quitting smoking would be those who smoked less and were less severely addicted,” she said at the meeting sponsored by the International Association for the Study of Lung Cancer. “That is exactly what we found in patients with prostate cancer and myocardial infarction.”

In contrast, current and former smokers with lung cancer had similar levels of cumulative tobacco exposure and identical median scores on a scale measuring severity of addiction, scoring 7 on a scale of 0 (“Didn't even think about it”) to 10 (“The hardest thing I've ever done”).

Surprisingly, many of these lung cancer patients reported they had quit smoking with ease and with no symptomatic “alarm bell” that compelled them to stop.

Among the 55 patients who quit smoking before being diagnosed with lung cancer, 49 (89%) were reportedly asymptomatic at the time.

Nearly a third (17 of 55) reported quitting “with no difficulty” (0 on a scale of 0-7), even though they were moderately to severely addicted to nicotine based on the Fagerström Test for Nicotine Dependence.

“The way some of these patients stop smoking is really quite peculiar,” Dr. Campling said. A typical patient was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette … [and then] realizes they don't need it anymore.”

Dr. Campling and her associates hope their findings will be followed up with a long-term, prospective study of smokers to identify any unusual patterns of smoking cessation that may precede a diagnosis of lung cancer. In the meantime, she suggested that clinicians pay attention to any highly unusual pattern of smoking cessation in a long-term, heavy smoker, just as they would a sudden loss of appetite.

Dr. Campling and her associates reported no financial disclosures with respect to their study.

'The way some of these patients stop smoking is really quite peculiar.'

Source DR. CAMPLING

CHICAGO — Many women with severe hyperemesis gravidarum experience clinical symptoms that persist well beyond delivery, a survey shows.

A 2-year online survey coordinated through the nonprofit Hyperemesis Education & Research Foundation compared postpartum symptoms in 891 women diagnosed with hyperemesis gravidarum (HG) (162 of whom received parenteral nutrition) and 541 controls who did not experience weight loss during pregnancy from severe nausea and vomiting, researchers reported at the annual meeting of the American College of Obstetricians and Gynecologists.

Highly significant differences were seen in both the prevalence and duration of numerous postpartum symptoms between women with HG and controls, reported Dr. Gerson D. Hernandez of the University of Southern California, Los Angeles.

These symptoms included:

▸ Food aversions (34% vs. 6%).

▸ Gastroesophageal reflux (23% vs. 5%).

▸ Digestive problems (21% vs. 3%).

▸ Continued nausea (13% vs. 5%).

▸ Gallbladder problems (9% vs. 2%).

▸ Persistent fatigue (52% vs. 25%).

▸ Muscle weakness (24% vs. 8%).

The subgroup of women who required parenteral nutrition during pregnancy had the highest prevalence of persistent postpartum nausea, fatigue, and muscle weakness—symptoms that in some cases lasted months or even longer.

Fatigue, for example, persisted beyond a year in 23% of these women, and food aversions, in 17%.

“It has been the common clinical impression that all symptoms associated with HG resolve after pregnancy. This is the case for the majority of HG cases, but not all, as we can see in our results,” Dr. Hernandez said in an interview.

Clearly, more needs to be known about what is different about the subgroup of women with severe HG, particularly those with long-lasting postpartum symptoms, he added.

“The etiology of these symptoms, as well as the cause of their intensity and duration in this subgroup of the pregnant population remains unknown,” he said.

Hypotheses range from psychological—behavior modification during months of pregnancy leading to long-term food aversion—to physical, including theories about long-term consequences of “the marked nutritional deprivation that these women undergo,” Dr. Hernandez noted.

“We do know that there is something different about them that makes them still have problems after pregnancy,” he said.

A goal of the research team is to focus on ways to identify women most at risk for severe HG and to develop and implement a comprehensive management plan for them during and after their pregnancies, said Dr. Hernandez.

He was assisted in the research by associates from the USC department of obstetrics and gynecology and division of maternal-fetal medicine in Los Angeles, and the Hyperemesis Education & Research Foundation of Leesburg, Va.

None of the investigators reported conflicts of interest relevant to the study.

Fatigue persisted beyond a year in 23% of these women, and food aversions, in 17%.

Source DR. HERNANDEZ

CHICAGO — Many women with severe hyperemesis gravidarum experience clinical symptoms that persist well beyond delivery, a survey shows.

A 2-year online survey coordinated through the nonprofit Hyperemesis Education & Research Foundation compared postpartum symptoms in 891 women diagnosed with hyperemesis gravidarum (HG) (162 of whom received parenteral nutrition) and 541 controls who did not experience weight loss during pregnancy from severe nausea and vomiting, researchers reported at the annual meeting of the American College of Obstetricians and Gynecologists.

Highly significant differences were seen in both the prevalence and duration of numerous postpartum symptoms between women with HG and controls, reported Dr. Gerson D. Hernandez of the University of Southern California, Los Angeles.

These symptoms included:

▸ Food aversions (34% vs. 6%).

▸ Gastroesophageal reflux (23% vs. 5%).

▸ Digestive problems (21% vs. 3%).

▸ Continued nausea (13% vs. 5%).

▸ Gallbladder problems (9% vs. 2%).

▸ Persistent fatigue (52% vs. 25%).

▸ Muscle weakness (24% vs. 8%).

The subgroup of women who required parenteral nutrition during pregnancy had the highest prevalence of persistent postpartum nausea, fatigue, and muscle weakness—symptoms that in some cases lasted months or even longer.

Fatigue, for example, persisted beyond a year in 23% of these women, and food aversions, in 17%.

“It has been the common clinical impression that all symptoms associated with HG resolve after pregnancy. This is the case for the majority of HG cases, but not all, as we can see in our results,” Dr. Hernandez said in an interview.

Clearly, more needs to be known about what is different about the subgroup of women with severe HG, particularly those with long-lasting postpartum symptoms, he added.

“The etiology of these symptoms, as well as the cause of their intensity and duration in this subgroup of the pregnant population remains unknown,” he said.

Hypotheses range from psychological—behavior modification during months of pregnancy leading to long-term food aversion—to physical, including theories about long-term consequences of “the marked nutritional deprivation that these women undergo,” Dr. Hernandez noted.

“We do know that there is something different about them that makes them still have problems after pregnancy,” he said.

A goal of the research team is to focus on ways to identify women most at risk for severe HG and to develop and implement a comprehensive management plan for them during and after their pregnancies, said Dr. Hernandez.

He was assisted in the research by associates from the USC department of obstetrics and gynecology and division of maternal-fetal medicine in Los Angeles, and the Hyperemesis Education & Research Foundation of Leesburg, Va.

None of the investigators reported conflicts of interest relevant to the study.

Fatigue persisted beyond a year in 23% of these women, and food aversions, in 17%.

Source DR. HERNANDEZ

CHICAGO — Many women with severe hyperemesis gravidarum experience clinical symptoms that persist well beyond delivery, a survey shows.

A 2-year online survey coordinated through the nonprofit Hyperemesis Education & Research Foundation compared postpartum symptoms in 891 women diagnosed with hyperemesis gravidarum (HG) (162 of whom received parenteral nutrition) and 541 controls who did not experience weight loss during pregnancy from severe nausea and vomiting, researchers reported at the annual meeting of the American College of Obstetricians and Gynecologists.

Highly significant differences were seen in both the prevalence and duration of numerous postpartum symptoms between women with HG and controls, reported Dr. Gerson D. Hernandez of the University of Southern California, Los Angeles.

These symptoms included:

▸ Food aversions (34% vs. 6%).

▸ Gastroesophageal reflux (23% vs. 5%).

▸ Digestive problems (21% vs. 3%).

▸ Continued nausea (13% vs. 5%).

▸ Gallbladder problems (9% vs. 2%).

▸ Persistent fatigue (52% vs. 25%).

▸ Muscle weakness (24% vs. 8%).

The subgroup of women who required parenteral nutrition during pregnancy had the highest prevalence of persistent postpartum nausea, fatigue, and muscle weakness—symptoms that in some cases lasted months or even longer.

Fatigue, for example, persisted beyond a year in 23% of these women, and food aversions, in 17%.

“It has been the common clinical impression that all symptoms associated with HG resolve after pregnancy. This is the case for the majority of HG cases, but not all, as we can see in our results,” Dr. Hernandez said in an interview.

Clearly, more needs to be known about what is different about the subgroup of women with severe HG, particularly those with long-lasting postpartum symptoms, he added.

“The etiology of these symptoms, as well as the cause of their intensity and duration in this subgroup of the pregnant population remains unknown,” he said.

Hypotheses range from psychological—behavior modification during months of pregnancy leading to long-term food aversion—to physical, including theories about long-term consequences of “the marked nutritional deprivation that these women undergo,” Dr. Hernandez noted.

“We do know that there is something different about them that makes them still have problems after pregnancy,” he said.

A goal of the research team is to focus on ways to identify women most at risk for severe HG and to develop and implement a comprehensive management plan for them during and after their pregnancies, said Dr. Hernandez.

He was assisted in the research by associates from the USC department of obstetrics and gynecology and division of maternal-fetal medicine in Los Angeles, and the Hyperemesis Education & Research Foundation of Leesburg, Va.

None of the investigators reported conflicts of interest relevant to the study.

Fatigue persisted beyond a year in 23% of these women, and food aversions, in 17%.

Source DR. HERNANDEZ