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New approaches give women more options for breast cancer surgery

CHICAGO – & Treating breast cancer almost always involves surgery, and for years the choice was just having the lump or the whole breast removed. Now, new approaches are dramatically changing the way these operations are done, giving women more options, faster treatment, smaller scars, fewer long-term side effects and better cosmetic results. It has led to a new specialty -- “oncoplastic” surgery -- combining oncology, which focuses on cancer treatment, and plastic surgery to restore appearance. “Cosmetics is very important” and can help a woman recover psychologically as well as physically, said Dr. Deanna Attai, a Burbank, Calif., surgeon who is on the board of directors of the American Society of Breast Surgeons. Its annual meeting in Chicago earlier this month featured many of these new approaches. More women are getting chemotherapy or hormone therapy before surgery to shrink large tumors enough to let them have a breast-conserving operation instead of a mastectomy. Fewer lymph nodes are being removed to check for cancer's spread, sparing women painful arm swelling for years afterward. Newer ways to rebuild breasts have made mastectomy a more appealing option for some women. More of them are getting immediate reconstruction with an implant at the same time the cancer is removed rather than several operations that have been standard for many years. Skin and nipples increasingly are being preserved for more natural results. Some doctors are experimenting with operating on breast tumors through incisions in the armpit to avoid breast scars. There's even a “Goldilocks” mastectomy for large-breasted women -- not too much or too little removed, and using excess skin to create a “just right” natural implant. Finally, doctors are testing a way to avoid surgery altogether, destroying small tumors by freezing them with a probe through the skin. “Breast surgery has become more minimalistic,” said Dr. Shawna Willey of Georgetown's Lombardi Comprehensive Cancer Center. “Women have more options. It's much more complex decision-making.” Breast cancer is the most common cancer in women around the world. In the U.S. alone, about 230,000 new cases are diagnosed each year. Most can be treated by just having the lump removed, but that requires radiation for weeks afterward to kill any stray cancer cells in the breast, plus frequent mammograms to watch for a recurrence. Many women don't want the worry or the radiation, and choose mastectomy even though they could have less drastic surgery. Mastectomy rates have been rising. Federal law requires insurers to cover reconstruction for mastectomy patients, and many of the improvements in surgery are aimed at making it less disfiguring. Here are some of the major trends: IMMEDIATE RECONSTRUCTION Doctors used to think it wasn't good to start reconstruction until cancer treatment had ended -- surgery, chemotherapy, radiation. Women would have a mastectomy, which usually involves taking the skin and the nipple along with all the breast tissue, followed by operations months later to rebuild the breast. Reconstruction can use tissue from the back or belly, or an implant. The first operation often is to place a tissue expander, a balloon-like device that's gradually inflated to stretch the remaining skin and make room for the implant. A few months later, a second surgery is done to remove the expander and place the implant. Once that heals, a third operation is done to make a new nipple, followed by tattooing to make an areola, the darkened ring around it. The new trend is immediate reconstruction, with the first steps started at the time of the mastectomy, either to place a tissue expander or an implant. In some cases, the whole thing can be done in one operation. Nationally, about 25 to 30 percent of women get immediate reconstruction. At the Mayo Clinic, about half do, and at Georgetown, it's about 80 percent. SPARING SKIN, NIPPLES Doctors usually take the skin when they do a mastectomy to make sure they leave no cancer behind. But in the last decade they increasingly have left the skin in certain women with favorable tumor characteristics. Attai compares it to removing the inside of an orange while leaving the peel intact. “We have learned over time that you can save skin” in many patients, Willey said. “Every single study has shown that it's safe.” Now they're going the next step: preserving the nipple, which is even more at risk of being involved in cancer than the skin is. Only about 5 percent of women get this now, but eligibility could be expanded if it proves safe. The breast surgery society has a registry on nipple-sparing mastectomies that will track such women for 10 years. “You really have to pick patients carefully,” because no one wants to compromise cancer control for cosmetic reasons, Attai said. “The preliminary data are that nipple-sparing is quite good,” but studies haven't been long enough to know for sure, Willey said. “It makes a huge difference in the cosmetic outcome. That makes the woman's breast recognizable to her.” Dr. Judy Boughey, a breast surgeon at the Mayo Clinic, said the new approach even has swayed patients' treatment choices. “We're seeing women choosing the more invasive surgery, choosing the mastectomy,” because of doctors' willingness to spare skin and nipples, she said. It helped persuade Rose Ragona, a 51-year-old operations supervisor at O'Hare Airport in Chicago. She had both breasts removed on April 19 with the most modern approach: Immediate reconstruction, with preservation of her skin and nipples. “To wake up and just see your breasts there helped me immensely,” she said. She chose to have both breasts removed to avoid radiation and future worry. “I felt it was a safer road to go,” she said. “I can't live the rest of my life in fear. Every time there's a lump I'm going to worry.” FREEZING TUMORS Attai, the California breast surgeon, is one of the researchers in a national study testing cryoablation. The technique uses a probe cooled with liquid nitrogen that turns tumors into ice balls of dead tissue that's gradually absorbed by the body. This has been done since 2004 for benign breast tumors and the clinical trial is aimed at seeing if it's safe for cancer treatment. “The technology is amazing. This is done in the office under local anesthesia, a little skin puncture,” Attai said. In the study, women still have surgery at some point after the freezing treatment to make sure all the cancer is destroyed. If it proves safe and effective, it could eliminate surgery for certain cancer patients. “I'd love to see the day when we can offer women with small breast tumors a completely non-operative approach, and I do think that's coming soon,” Attai said.source : http://www.foxnews.com/health/2013/05/14/new-approaches-give-women-more-options-for-breast-cancer-surgery/

Small amounts of formula may promote breastfeeding in some babies

Feeding newborn babies small amounts of carefully regulated formula before a mother’s milk comes in does not disrupt the child’s ability to breastfeed – and may ultimately improve breastfeeding success in the future, the New York Times reported. In a new study published in the journal Pediatrics, researchers examined 38 newborns who had lost 5 percent or more of their body weight in the first few days after birth.  Each infant was randomly assigned to either breastfeed alone or breastfeed along with a formula supplement – administered through a syringe to avoid so-called “nipple confusion” between the mother’s nipple and the bottle’s nipple. This concept is up for debate among mothers and pediatricians.  The supplement was given after a feeding, to boost the child’s hunger for the next breastfeeding. After the first week of observation, all of the babies were still breastfeeding, but nine of the 19 infants who began exclusively with breastfeeding were now using formula.  After three months, 79 percent of the babies who had been given an early formula supplement were breastfeeding exclusively, compared to 42 percent of those who had begun with just breastfeeding. Many mothers and doctors encourage women to exclusively breastfeed their children, but this new study suggests small amounts of formula may help struggling newborns get the nutrition they need in the early stages of life. “Most babies don’t need formula,” said the lead author, Dr. Valerie J. Flaherman, a pediatrician at the University of California, San Francisco, Benioff Children’s Hospital. “But some kids are at risk for weight loss, and this could be an option.” Click for more from the New York Times.source : http://www.foxnews.com/health/2013/05/13/small-amounts-formula-may-promote-breastfeeding-in-some-babies/

New fitness centers cater to aging baby boomers

Baby boomers, the generation that vowed to stay forever young, are getting older, designing senior-friendly gyms and becoming their own personal trainers. In exercise havens for the over-50 set, the cardio machines are typically low impact, the resistance training is mainly air-powered and some group fitness classes are taken sitting down. At Welcyon gyms, founded by husband-and-wife boomers Suzy and Tom Boerboom, the average age of members is 62. “The environment is really designed for those 50 and over,” said Suzy Boerboom. The couple created Welcyon, which has locations in Minnesota and South Dakota, in 2009. It has no tread-mills and no free weights and workouts are customized to members' levels of fitness. A smart card sets resistance, counts repetitions and adjusts workouts. An important attraction for many boomers: background music is a combination of '40s, '50s and '60s tunes played at a much lower volume than in traditional gyms. “It was something I could manage,” said 66-year-old Bill Zortman, one of an estimated 78 million baby boomers, defined as the group born between 1946 and 1964, who make up about 26 percent of the U.S. population, according to U.S. Census reports. His thrice-weekly workouts at a Welcyon in Sioux Falls, South Dakota, consists of riding a bicycle or using air-powered resistance machines to strengthen his legs, arms and back. “They make sure I'm not overdoing it,” Zortman said of the staff, who Boerboom said are often boomers themselves. The absence of clanging free weights also cuts down on the racket, Boerboom said, noting that many people over 50 prefer a quieter gym. Group fitness classes for boomers are also modified. “We're just beginning to develop a group fitness interval training program,” Boerboom said. “It will be four to six people and low impact.” The American Council on Exercise says many of their fitness professionals are baby boomers who specialize in working with older adults. “People in their early 60's are becoming personal trainers and group fitness instructors,” said Todd Galati, ACE's director of credentialing. But they are far from the majority, as the average age of ACE's 50,000 certified fitness professionals is 42, and more than 37 percent are 40. “Every year I talk to newly certified personal trainers, retired from their career in another field, who want to help people their age become more fit,” Galati said. A recent study published in JAMA Internal Medicine showed that a sample of baby boomers had higher rates of hypertension, diabetes, obesity and high cholesterol than their parents' generation. “There is a big bad myth about the boomer generation being more fit,” said Dr. Sheldon S. Zinberg, founder of Nifty after Fifty fitness centers for older adults. “In fact, the boomer generation is less fit than their parents were at same age.” The chain has locations in Arizona, California, Nevada, Texas, Virginia and New York. Its programs target muscle power, muscle strength, reaction time, balance and cognitive skills, he said. “At age 40 people lose 0.8 to 1 percent muscle mass each year. By age 60 this accelerates to 1.5 percent,” Zinberg said. At Nifty after Fifty, group fitness classes range from yoga and Zumba to seated volleyball and cane fu, a self-defense class in which participants use a cane. As with Welcyon, there are no tread-mills. “We used to use tread-mills, but we had people falling off,” Zinberg said. “We use recumbent stair steppers, among other exercisers.” He advises people to get fit in their 40s and 50s, “and when you do become older, enjoy a supervised, customized program.” Boerboom said Welcyon plans to open more gyms later this year. “There are over 70 million of us boomers,” she said, “and we have to take care of ourselves.”source : http://www.foxnews.com/health/2013/05/13/new-fitness-centers-cater-to-aging-baby-boomers/

iPad 2 could interfere with pacemaker, study shows

A California teen discovered the magnets in iPad 2 tablets and covers are capable of interfering with cardiac rhythm devices, like pacemakers, according to the Heart Rhythm Society. The research, conducted by 14-year-old Gianna Chien of Stockton, Calif , was presented Thursday at Heart Rhythm 2013, the Society’s 34th Annual Scientific Sessions. “iPad 2s use magnets to help secure the cover to the tablet. Since people hold tablets so close to their chest, I wanted to see if these magnets could affect cardiac device performance,â€� said Chien, who initially organized the study as part of a school science fair project. …

Potential therapeutic target for Cushing’s disease

The protein, called TR4 (testicular orphan nuclear receptor 4), is one of the human body’s 48 nuclear receptors, a class of proteins found in cells that are responsible for sensing hormones and, in response, regulating the expression of specific genes. Using a genome scan, the Salk team discovered that TR4 regulates a gene that produces adrenocorticotropic hormone (ACTH), which is overproduced by pituitary tumors in Cushing’s disease (CD). …