Posts Tagged ‘United States Preventive Services Task Force’

Multivitamins – Don’t help Extend Life or ward off Heart Disease and Improve state of Memory Loss

Reporter: Aviva Lev-Ari, PhD, RN


Experts: Don’t Waste Your Money on Multivitamins – Three studies find the supplements don’t help extend life or ward off heart disease and memory loss


Monday, December 16, 2013

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MONDAY, Dec. 16, 2013 (HealthDay News) — With three new studies finding that a daily multivitamin won’t help boost the average American’s health, the experts behind the research are urging people to abandon use of the supplements.

The studies found that popping a daily multivitamin didn’t ward off heart problems or memory loss, and wasn’t tied to a longer life span.

The studies, published in the Dec. 17 issue of the journal Annals of Internal Medicine, found that multivitamin and mineral supplements did not work any better than placebo pills.

Dietary supplements are a multibillion-dollar industry in the United States, and multivitamins account for nearly half of all vitamin sales, according to the U.S. Office of Dietary Supplements.

But a growing body of evidence suggests that multivitamins offer little or nothing in the way of health benefits, and some studies suggest that high doses of certain vitamins might cause harm.

As a result, the authors behind the new research said it’s time for most people to stop taking them.

“We believe that it’s clear that vitamins are not working,” said Dr. Eliseo Guallar, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

In a strongly worded editorial on the three studies, Guallar and his co-authors urged people to stop spending money on multivitamins.

Even a representatives of the vitamin industry asked people to temper their hopes about dietary supplements.

“We all need to manage our expectations about why we’re taking multivitamins,” Duffy MacKay, vice president of scientific and regulatory affairs for the Council for Responsible Nutrition, a trade group that represents supplement manufacturers, said in a prepared statement.

“Research shows that the two main reasons people take multivitamins are for overall health and wellness and to fill in nutrient gaps,” MacKay said. “Science still demonstrates that multivitamins work for those purposes, and that alone provides reason for people to take a multivitamin.”

However, Guallar said, it’s not clear that taking supplements to fill gaps in a less-than-perfect diet really translates into any kind of health boost.

“It would be great if all dietary problems could be solved with a pill,” he said. “Unfortunately, that’s not the case.”

For the first study, researchers randomly assigned almost 6,000 male doctors over the age of 65 to take either a daily Centrum Silver multivitamin or a look-alike placebo pill. Every few years, the researchers gave the men a battery of tests over the telephone to check their memories.

The men in the study were in pretty good health to begin with, and 84 percent said they faithfully took their pills each day.

After 12 years, there was no difference in memory problems between the two groups.

“No matter which way we broke it down, there was a null effect,” said study author Jacqueline O’Brien, a research associate at Brigham and Women’s Hospital in Boston. “Supplements are often marketed to have benefits for brain health and things like that, and this is a pretty clear takeaway message.”

The same study, however, had previously found that multivitamins might modestly reduce the risk of cancer and cataracts. Cancer risk was reduced by 8 percent, while the risk of cataracts dropped by 9 percent, compared to a placebo.

In the second study, researchers randomly assigned 1,700 heart attack survivors enrolled in a trial of therapy known as intravenous chelation to a daily regimen of high doses of vitamins and minerals or placebo pills.

Participants were asked to take six large pills a day, and researchers think many developed pill fatigue. Nearly half the participants in each part of the study stopped taking their medication before the end of the study. The average time people stuck with it was about two and a half years.

After an average of 55 months, there was no significant difference between the two groups in a composite measure that counted the number of deaths, second heart attacks, strokes, episodes of serious chest pain and procedures to open blocked arteries.

The third study, a research review, assessed the evidence from 27 studies on vitamin and mineral supplements that included more than 450,000 people. That study, conducted for the U.S. Preventive Services Task Force, found no evidence that supplements offer a benefit for heart disease or that they delay death from any cause. They found only a minimal benefit for cancer risk.

The results of the studies are so clear and consistent, the editorial writers said, that it’s time to stop wasting research money looking for evidence of a benefit.

“The probability of a meaningful effect is so small that it’s not worth doing study after study and spending research dollars on these questions,” Guallar said.

SOURCES: Eliseo Guallar, M.D., professor of epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore; Jacqueline O’Brien, Sc.D., research associate, Brigham and Women’s Hospital, Boston; Dec. 16, 2013, news release, Council for Responsible Nutrition, Washington, D.C.; Dec. 17, 2013, Annals of Internal Medicine

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Reporter: Aviva Lev-Ari, PhD, RN



Changes in breast density point to tamoxifen‘s effectiveness

By Kate Madden Yee, AuntMinnie.com staff writer

April 22, 2013 — If women being treated with tamoxifen for breast cancer see their breast density drop, they may have a 50% lower risk of dying from the disease, according to a new study by Swedish researchers published online April 22 in the Journal of Clinical Oncology.

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In a study that hints at a role for breast density measurement in predicting therapy response, researchers at Karolinska Institutet in Stockholm found that women who had a relative reduction of more than 20% in the absolute dense area of their breast tissue during the course of tamoxifen treatment had a 50% reduction in breast cancer mortality over a span of 15 years, compared with women who had little or no change (JCO, April 22, 2013).

Tamoxifen is usually given over five years to prevent the recurrence of breast cancer in women who have completed their primary treatment. The researchers conducted the study to assess whether there was a link between reduced tissue density and the effectiveness of tamoxifen therapy.

Dr. Per Hall

Dr. Per Hall from Karolinska Institutet.

No method has been available for assessing which women are likely to respond to tamoxifen and not relapse with breast cancer, according to Dr. Per Hall and colleagues.

“To the best of our knowledge, this is the first time mammographic density change has been used as a prognostic marker of response to tamoxifen,” Hall and colleagues wrote. “We observed that women treated with tamoxifen who experienced mammographic density reduction were associated with substantially better long-term breast-cancer-specific survival. If validated, mammographic density change has the potential to be an early marker for therapy response.”

For the study, Hall and colleagues included data collected in Sweden between 1993 and 1995 from 974 postmenopausal patients with breast cancer who had both baseline and follow-up mammograms. Of these, 474 patients received tamoxifen treatment and 500 did not. The team measured mammographic density using a statistical method that expressed the data as absolute dense area.

During the follow-up period, 121 patients (12.4%) died from breast cancer. But women who were treated with tamoxifen and who experienced a relative density reduction of more than 20% had a 50% lower risk of death, compared with women whose breast density didn’t change, the team found.

In the group that was not treated with tamoxifen, there was no statistically significant association between mammographic density change and survival, and the survival advantage was not found when absolute dense areas at baseline or follow-up were evaluated separately.

The findings come on the heels of a recommendation issued on April 15 from the U.S. Preventive Services Task Force (USPSTF) regarding the use of tamoxifen and a related drug, raloxifene, as preventive measures against breast cancer in asymptomatic women. The USPSTF suggests that women who are at increased risk for breast cancer talk to their physician about the potential benefits and harms of the drugs to prevent breast cancer; women who are not at increased risk should not use them.

If further research confirms the Swedish group’s findings, mammographic density change has the potential to be an early marker for therapy response, Hall and colleagues wrote. In fact, given ongoing developments in automatic algorithms for mammographic density measurement, using density change to monitor the effectiveness of treatment could be a cost-effective clinical tool.

“What’s needed is accurate measurement of mammographic density,” Hall said in a statement released by the Karolinska Institutet. “Measuring changes in density can be a simple and cheap means of assessing the effect of the treatment. If a patient is not responding to tamoxifen, maybe they should be given a different drug.”

Related Reading

ARRS: Breast US spots missed cancers in dense breasts, April 18, 2013

AHRA backs Are You Dense Advocacy, April 10, 2013

Calif. breast density bill goes into effect, April 1, 2013

Rads judge breast density the same for digital, analog mammo, February 28, 2013

Yearly screening breast US benefits women with dense tissue, December 4, 2012
Copyright © 2013 AuntMinnie.com



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Prostate Cancers Plunged After USPSTF Guidance, Will It Happen Again?

Reporter: Aviva Lev-Ari, PhD, RN

Declines in Prostate Cancer Incidence After Changes in Screening Recommendations

David H. Howard, PhD

Arch Intern Med. 2012;():1-2. doi:10.1001/archinternmed.2012.2768

On August 5, 2008, the US Preventive Services Task Force (USPSTF) recommended against screening men 75 years or older for prostate cancer.For men younger than 75 years, the USPSTF maintained its previous recommendation: “ . . . the evidence is insufficient to recommend for or against routine screening for prostate cancer. . . ”(p915) (although this recommendation was changed to “do not screen” younger men in the 2011 guidelines). This study evaluates trends in prostate cancer incidence following the release of the 2008 USPSTF recommendation. If the revised recommendation led to a decline in prostate cancer screening rates, there should be a corresponding decline in the incidence of early-stage tumors among men 75 and older relative to trends in the incidence of late-stage tumors and early-stage tumors in younger men.


I measured trends in prostate cancer incidence rates by age group using the Surveillance, Epidemiology and End Results (SEER) 18 registry data, covering 28% of the US population. The SEER registries collect information on all newly diagnosed cancer cases in their respective catchment areas.

Prostate tumors were identified using International Classification of Diseases for Oncology version 3 code 619. I classified cases by stage at diagnosis using the derived American Joint Committee on Cancer summary stage variable: early (T1 or T2), late (T3 or T4), or unknown. I grouped patients into 3 age categories (30-64 years, 65-74 years, and 75 years and older). I calculated incidence rates per 100 000 persons, standardized within age categories by age (in 5-year age groups), race (white, black, American Indian, or other), and ethnicity (Hispanic or not Hispanic) to the 2009 population. I used an unpaired t test for proportions to assess the significance of differences in rates between years. The data were analyzed in Stata version 11 (StataCorp) statistical software.


The data included 254 184 prostate cancer cases. There were 198 417 early-stage cases, 34 695 late-stage cases, and 21 072 cases of unknown stage. There were 109 053 cases (all stages) among men aged 30 to 64 years, 91 868 cases among men aged 65 to 74 years, and 53 263 cases among men 75 years and older.

The Figure displays the age and race/ethnicity-adjusted incidence rates of early-stage tumors among men aged 65 to 74 years (the upper line) and 75 years and older (the lower line). The trend lines generally mirror each other, but there is a sudden decrease in the incidence of early-stage tumors among men 75 and older after the release of the revised USPSTF recommendation.

Figure. Trends in the incidence of early-stage prostate tumors by age group. Rates are standardized by 5-year age groups and race/ethnicity to the 2009 population. Source: analysis of Surveillance, Epidemiology and End Results (SEER) 18 registry data. USPSTF indicates US Preventive Services Task Force.

Image not available.

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Between 2007 and 2009, the adjusted incidence rate for early-stage tumors among men 75 years and older decreased from 443 to 330 per 100 000 (−25.4%; P < .001). The absolute number of cases declined from 8137 to 6162. The incidence of late-stage tumors decreased from 83 to 71 (−14.3%; P < .001), and the incidence of tumors with unknown stage decreased from 124 to 103 (−16.8%; P < .001). The incidence of early-stage tumors among men aged 65 to 74 years decreased from 697 to 591 (−15.2%; P < .001). The incidence of early-stage tumors among men aged 30 to 64 years decreased from 105 to 93 (−11%; P < .001). Incidence trends for all age and stage groups are given in the eTable.

July 25, 2012 — Nick Mulcahy reports in


In the past, clinicians and the public have heeded the advice of the United States Preventative Services Task Force (USPSTF) about prostate cancer screening, suggests researchpublished online July 23 in the Archives of Internal Medicine.

After the group’s 2008 guidance, which recommended against screening men older than 75 years, the incidence of early-stage disease in older men plunged 25% in the United States.

“There was an immediate decline in the incidence of early-stage prostate cancer tumors among men 75 years and older after the USPSTF recommended against screening this group,” writes author David Howard, PhD, from the Department of Health Policy and Management at Emory University in Atlanta, Georgia.

The incidence of early-stage disease is an indicator of the amount of prostate-specific antigen (PSA) testing in a population, he explained.

Dr. Howard found that from 2007 to 2009, the adjusted incidence rate for early-stage tumors in men 75 years and older decreased from 443 to 330 per 100,000 (−25.4%; P < .001). The absolute number of cases declined from 8137 to 6162.

Dr. Howard used data from the Surveillance, Epidemiology, and End Results (SEER) 18 registry, which collects information on newly diagnosed cancer cases in catchment areas.

He challenges recent results that indicated that there was no change in PSA screening rates from 2005 to 2010 (JAMA. 2012;307:1692-1694). The data source for that study was the National Health Interview Surveys, in which American residents self-report health behaviors and diseases. “Self-reported PSA testing measures have poor sensitivity and specificity,” scolds Dr. Howard.

An immediate question arises from Dr. Howard’s analysis: Will it happen again because of the 2012 USPSTF recommendation against routine testing for all healthy men?

In an unrelated essay (J Clin Oncol. 2012;30:2581-2584), a group of experts assert that the answer is no.

The USPSTF’s “blanket rejection” of the PSA test is “unlikely to influence practice,” according to Sigrid Carlsson, MD, PhD, from the Memorial-Sloan Kettering Cancer Center in New York City and Göteborg University in Sweden, and colleagues. Dr. Carlsson and her fellow experts wrote an essay criticizing the new USPSTF guideline for a number of “very important errors,” as reported by Medscape Medical News.

“PSA testing is not likely to go away,” wrote Dr. Carlsson and coauthors.

Dr. Howard voiced similar thoughts in an email to Medscape Medical News.

“Physicians are probably more willing to discontinue screening older patients. There might be more resistance to discontinuing screening among younger, healthier men,” he said.

But Dr. Howard also said: “I think it will have an impact. There is growing publicity about the problem of ‘overdiagnosis’, which might make physicians and some patients more receptive to the USPSTF recommendation.”

The recently published PIVOT study might also contribute to the way the new guidance is received, noted Dr. Howard. This major randomized controlled trial found that prostatectomy did not improve survival significantly, compared with observation, in men with localized disease. “This research also casts doubt on the benefits of early detection, which may amplify the impact of the USPSTF recommendation,” said Dr. Howard about PIVOT.

Nonetheless, “many men will continue to receive regular PSA tests,” he added.

More Details

In addition to finding that the rate of early-stage prostate cancers dropped among older men after the 2008 recommendation, Dr. Howard found that other indicators of PSA testing also dropped.

The incidence of late-stage tumors decreased by 14.3% (P < .001), and the incidence of tumors of unknown stage decreased by 16.8% (P < .001). The incidence of early-stage tumors in men 65 to 74 years decreased by 15.2% (P < .001); in men 30 to 64 years, the incidence decreased by 11% (P < .001).

Overall, Dr. Howard found that 254,184 prostate cancer cases were newly diagnosed during the study period. There were 198,417 early-stage cases, 34,695 late-stage cases, and 21,072 cases of unknown stage. There were 109,053 cases (all stages) in men 30 to 64 years of age, 91,868 cases in men 65 to 74 years, and 53,263 cases in men 75 years and older.

As noted above, the incidence rate trends turned sharply downward in 2009, after the 2008 USPSTF report.


US Preventive Services Task Force.  Screening for prostate cancer: US Preventive Services Task Force recommendation statement.  Ann Intern Med. 2008;149(3):185-191

US Preventive Services Task Force.  Screening for prostate cancer: recommendation and rationale.  Ann Intern Med. 2002;137(11):915-916

Prasad SM, Drazer MW, Huo D, Hu JC, Eggener SE. 2008 US Preventive Services Task Force recommendations and prostate cancer screening rates.  JAMA. 2012;307(16):1692-1694

Hall HI, Van Den Eeden SK, Tolsma DD,  et al.  Testing for prostate and colorectal cancer: comparison of self-report and medical record audit.  Prev Med. 2004;39(1):27-35

Chan EC, Vernon SW, Ahn C, Greisinger A. Do men know that they have had a prostate-specific antigen test? accuracy of self-reports of testing at 2 sites.  Am J Public Health. 2004;94(8):1336-1338

Guerra CE, Jacobs SE, Holmes JH, Shea JA. Are physicians discussing prostate cancer screening with their patients and why or why not? a pilot study.  J Gen Intern Med. 2007;22(7):901-907

Linder SK, Hawley ST, Cooper CP, Scholl LE, Jibaja-Weiss M, Volk RJ. Primary care physicians’ reported use of pre-screening discussions for prostate cancer screening: a cross-sectional survey.  BMC Fam Pract. 2009;1019


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New Prostate Cancer Screening Guidelines Face a Tough Sell, Study Suggests

Reporter: Prabodh Kandala, PhD

Recent recommendations from the U.S. Preventive Services Task Force (USPSTF) advising elimination of routine prostate-specific antigen (PSA) screening for prostate cancer in healthy men are likely to encounter serious pushback from primary care physicians, according to results of a survey by Johns Hopkins investigators.

In a survey of 125 primary care doctors, the researchers found that while doctors agreed with older recommendations to curtail routine screening in men over age 75 and among those not expected to live 10 or more years, a large number said they faced significant barriers to stopping PSA testing in men who had been receiving it regularly. The most frequently cited reason by 74.4 percent of physicians was, “My patients expect me to continue getting yearly PSA tests,” followed by 66 percent of them who said, “It takes more time to explain why I’m not screening than to just continue screening.” More than half of those surveyed in the new study believed that, “By not ordering a PSA, it puts me at risk for malpractice.”

The survey was conducted in November 2011, right after draft recommendations were made to end routine screening of all men, but before last week, when the draft recommendations were officially approved.

“It can be very difficult for doctors to break down the belief that all cancer screening tests are invariably good for all people all the time,” says Craig E. Pollack, M.D., M.H.S., an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, and leader of the study published online in the journal Cancer. “Everyone agrees that PSA screening isn’t as good as we want it to be. If we had a test that was a slam dunk, it would be different. But now we know that for many men, the benefits may be small and the harms significant.”

Each year, more than 33,000 American men die of prostate cancer, and 20 million get the PSA test to detect the disease early.

According to the USPSTF, evidence suggests the potential harms caused by PSA screening of healthy men as a means of identifying prostate cancer outweigh its potential to save lives and that routine annual screening should be eliminated in the healthy. Elevated PSA readings are not necessarily evidence of prostate cancer, and can lead to unnecessary prostate biopsy. In addition, even when biopsies reveal signs of prostate cancer cells, evidence shows that a large proportion will never cause harm, even if left untreated. The disease in older men often progresses slowly so that those who have it frequently die of other causes.

Treatments for prostate cancer can include the removal of the prostate, radiation or other therapies, each of which has the potential to cause serious problems like erectile dysfunction, complete impotence, urinary incontinence or bowel damage. And men who choose to “watch and wait” after elevated PSA readings must live with the anxiety of knowing they have an untreated cancer that could start to progress.

In the new study, Pollack and his colleagues found that while most physicians said they took age and life expectancy into account when deciding to order PSA screening, many also said they had a hard time estimating life expectancy in their patients and could use a better tool. H. Ballentine Carter, M.D., a professor of urology at Johns Hopkins and the senior investigator on the study, is planning to investigate the potential of individualized prostate cancer screening recommendations. Specifically, he and colleagues plan to create a decision-making tool that incorporates age, life expectancy, family history and prior PSA results in order to help doctors and their patients make better choices for prostate cancer screening.

In another report derived from results of Pollack’s and Carter’s survey, published in April in the Archives of Internal Medicine, the researchers say nearly half of the providers agreed with the new USPSTF recommendations to eliminate routine screening for healthy men. Still, less than two percent said they would no longer order routine PSA screening in response to the draft recommendations; 21.9 percent said they would be much less likely to do so; 38.6 percent said they would be somewhat less likely to do so; and 37.7 percent said they would not change their screening practices.

“Men often expect PSA screening to be part of their annual physical,” Pollack says. “To change their minds, we need to address their perceptions about screening, allow time for screening discussions and reduce concerns regarding malpractice litigation.”

Ref: http://www.sciencedaily.com/releases/2012/05/120526191324.htm

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