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Mesothelioma: A Killer
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Even mild kidney disease raises risk of death
Last Updated: 2004-09-22 17:00:21 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Kidney disease need not be severe to cause an increased risk of death and cardiovascular disease, according to the findings from two studies published in The New England Journal of Medicine. Both reports "reinforce the importance of early detection of chronic kidney disease, not only to slow the progression to end-stage [kidney] disease but also in this case to identify risk factors for cardiovascular disease," notes an editorialist.
In one study, Dr. Marc A. Pfeffer, from Brigham and Women's Hospital in Boston, and colleagues assessed the effect of mild kidney disease on cardiovascular outcomes after a heart attack by analyzing data from 14,527 patients.
Compared with other subjects, those with a reduced estimated glomerular filtration rate, a test used to assess kidney function, were more likely to have other risk factors and prior cardiovascular disease. Also, such subjects were less likely to be on drugs to prevent another heart attack or to undergo heart surgery.
The estimated glomerular filtration rate was inversely related to the risk of death as well as the combined outcome of death from cardiovascular causes, congestive heart failure, another heart attack, stroke, or need for resuscitation after cardiac arrest.
Most of the illness seen with a falling glomerular filtration rate was not kidney disease, but cardiovascular disease, the researcher note.
In the other study, Dr. Alan S. Go, from Kaiser Permanente of Northern California in Oakland, and colleagues assessed the impact of mild kidney disease among more than 1 million adults entered in the Kaiser Permanente Renal Registry. The average follow-up period was 2.84 years.
The team found that the risk of death increased as the glomerular filtration rate dropped. A mildly decreased glomerular filtration rate raised the risk of death by 20 percent, whereas a severely low glomerular filtration rate increased the risk nearly six-fold. The risk of cardiovascular events and hospitalization also rose as the glomerular filtration rate fell.
These studies, which used "quite different populations", strengthen the "link between chronic kidney disease and cardiovascular disease," Dr. Thomas H. Hostetter, from the National Institutes of Health in Bethesda, Maryland, states in his editorial.
SOURCE: The New England Journal of Medicine, September 23, 2004.
Copyright © 2004 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
Experts call for team approach to prostate cancer
Last Updated: 2004-09-22 14:14:44 -0400 (Reuters Health)
By Maggie Fox
WASHINGTON (Reuters) - Doctors need to develop a more organized team approach to prostate cancer, with a clear outline of how to screen for and treat the disease, a panel of cancer experts said on Wednesday.
Doctors still do not agree on the best way to screen for prostate cancer, let alone how to treat it, the panel of 24 doctors and researchers said.
"The coordination of care among urologists, radiation oncologists and medical oncologists is crucial to the well-being of patients and to the proper management of prostate cancer, but many patients are not made aware of a multidisciplinary team approach until their cancer has progressed to a late stage," the report from the philanthropic Prostate Cancer Foundation reads.
Standard advice currently is for men to choose their preferred treatment, in consultation with their urologist, who may or may not be a cancer specialist. The usual choices are surgical removal of the prostate, radiation treatment or a hormone-based treatment.
In contrast, when a woman is diagnosed with breast cancer, she usually meets immediately with a surgeon, a radiation specialist, and a medical oncologist who can talk to her about chemotherapy.
Men should have clearer choices, and their doctors should have clearer guidelines on what to recommend, said the report.
"The need for innovation is more urgent than ever, as the baby-boomer men reach the target age for prostate cancer beginning at age 50," said Leslie Michelson, chief executive officer of the Santa Monica, California-based group.
"The number of new prostate cancer cases in the United States is anticipated to increase by 50 percent to more than 300,000 new cases per year by 2012."
Prostate cancer now kills 29,000 Americans a year.
The report calls for better research and efforts to get men with prostate cancer to take part in trials that can help answer questions.
Because prostate cancer is often a slow-growing disease, doctors and patients alike often do not take it seriously until it has spread, said Dr. Anthony D'Amico of Brigham and Women's Hospital and Harvard Medical School in Boston.
About a third of all cases of prostate cancer are dangerously aggressive, D'Amico, a member of the panel, said in a telephone interview.
"A three-month delay in the management of this type of prostate cancer may actually lead to lower control rates," he added -- meaning these patients will be more likely to relapse and perhaps even to die of their disease.
"This is a third of all the guys coming in, out of 230,000 prostate cancer cases a year. It is not a small number."
In June doctors reported that prostate cancer patients can also be helped by Taxotere, a breast cancer drug made by Aventis SA.
"This opens the door now to the testing of chemotherapy in earlier stages of prostate cancer," D'Amico said.
D'Amico has also pressed for new ways to analyze the standard screening test for prostate cancer, a measurement of PSA or prostate specific androgen.
His team has found that how quickly PSA levels rise, rather than the absolute numbers, are the best indication of how dangerous a patient's prostate cancer is. The panel said this theory needs to be validated with more tests and put into practice.
Copyright © 2004 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.
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