Medical

Amyloid Deposits in Cognitively Normal People
May Predict Risk for Alzheimer's Disease

For people free of dementia, abnormal deposits of a protein associated with Alzheimer's disease are associated with increased risk of developing the symptoms of the progressive brain disorder, according to two studies from researchers at Washington University in St. Louis. The studies, primarily funded by the National Institute on Aging (NIA), part of the National Institutes of Health, linked higher amounts of the protein deposits in dementia-free people with greater risk for developing the disease, and with loss of brain volume and subtle declines in cognitive abilities.

The two studies are reported in the Dec. 14, 2009, online issue of Archives of Neurology. The scientists used brain scans and other tests to explore the relationship between levels of beta-amyloid, a sticky protein that forms the hallmark plaques of Alzheimer's disease, and dementia risk in cognitively normal people. John C. Morris, M.D., who directs the NIA-supported Alzheimer's Disease Research Center at Washington University in St. Louis, and his team conducted the research. Martha Storandt, Ph.D., also of Washington University in St. Louis, directed one of the studies.

"Previous studies of brain pathology, cognitive testing, and brain imaging have for some time suggested that Alzheimer's pathology causes changes to the brain many years before memory loss, confusion, and other symptoms of the disease are apparent. But it remains difficult to accurately predict whether a cognitively normal person will — or will not — develop the disease," said NIA Director Richard J. Hodes, M.D. "These new studies suggest that beta-amyloid measured in the brains of cognitively normal individuals may be a preclinical sign of disease."

Morris' team used a variety of measures to look for changes in the brain in the two studies, including positron emission tomography (PET) imaging using a radioactive form of Pittsburgh Compound B (PiB), an agent specially developed to detect levels of beta-amyloid protein in the living brain; magnetic resonance imaging (MRI) to measure brain volume; and standardized clinical tests of memory and thinking abilities to determine cognitive health. Previously, the link between beta-amyloid load and Alzheimer's disease could only be confirmed at autopsy.

The studies indicated that beta-amyloid might be present in the brain even in symptom-free people:

• Between 2004 and 2008, researchers used PiB scans to track 159 volunteers ages 51 to 88, who started the study with no signs of cognitive impairment, to see if there was a correlation between beta-amyloid levels and cognitive health. Over time, 23 participants developed mild impairments, and nine were eventually diagnosed with clinical Alzheimer's disease. Compared with participants who remained cognitively normal, the nine who were eventually diagnosed clinically with Alzheimer's disease had high levels of PiB binding in the brain and experienced cognitive decline as well as volume loss in the parahippocampal gyrus, a part of the brain that controls memory. However, not every person who had beta-amyloid deposition in the brain developed cognitive impairment. Beta-amyloid deposition may be a risk factor for developing Alzheimer's disease but its presence does not constitute a diagnostic finding.
• In 135 cognitively normal older adults aged 65 to 88, the level of beta-amyloid as measured by PiB binding correlated with atrophy, or shrinkage, in many parts of the brain and to declines on memory and thinking tests over many years.

"More study is needed in larger groups for longer periods, but these studies confirm the value of detecting and measuring amyloid load in the brains of living people as soon as possible," said Morris. "These imaging tools are an important part of ongoing effort to create a profile of Alzheimer's in its earliest stages, even before symptoms appear, by linking imaging results with other biomarkers and clinical evaluations."

Additional funding came from the Charles and Joanne Knight Alzheimer's Research Initiative of the Washington University Alzheimer's Disease Research Center, St. Louis, and from an anonymous foundation.

The NIA leads the federal government effort conducting and supporting research on the biomedical, social and behavioral issues of older people. For more information on aging-related research and the NIA, go to www.nia.nih.gov. The NIA provides information on age-related cognitive change and neurodegenerative disease specifically at its Alzheimer's Disease Education and Referral (ADEAR) Center site at www.nia.nih.gov/Alzheimers. To sign up for e-mail alerts about new findings or publications, please visit either website.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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HHS HealthBeat

(December 07, 2009)

Flu and the high-risk kids

Listen to Tip Interested? Take the Next Step

From the U.S. Department of Health and Human Services, I’m Ira Dreyfuss with HHS HealthBeat.

Children with high-risk medical conditions can also face worse problems if they get the flu. That’s especially something to be concerned about this year, because we face 2009 H1N1 as well as seasonal influenza.

At the Centers for Disease Control and Prevention, Georgina Peacock says kids with conditions such as chronic lung disease, heart disease, and diabetes, are more likely to develop severe complications if they get the flu.

Seasonal and H1N1 flu vaccinations are important. And children are in the high-risk group for H1N1 infection. So Dr. Peacock says:

[Dr. Georgina Peacock speaks] "The most important thing you can do is to make sure your child receives the 2009 H1N1 vaccine."

Learn more at hhs.gov.

HHS HealthBeat is a production of the U.S. Department of Health and Human Services. I’m Ira Dreyfuss.

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Medical and science information

National Heart, Lung, and Blood Institute Initiates Thirteen New Projects to Advance Asthma Control

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has approved the award of 13 contracts to local organizations across the country to develop, implement, and test science-based approaches to improve asthma control using evidence-based national guidelines for diagnosing and managing asthma.

The two-year contracts, which total $1.3 million, will be administered by the Academy for Educational Development, based in Washington, D.C., which serves as a contractor for the NHLBI's National Asthma Control Initiative (NACI).

The NACI is a new effort to strengthen collaborative efforts among patients and families, health care providers, and other stakeholders committed to improving the management of asthma — a common and often disabling condition that affects some 23 million Americans, including seven million children under the age of 18.

Each contract will provide insight into practices that can enhance asthma control by implementing at the community level the evidence-based recommendations from two reports published by the National Asthma Education and Prevention Program (NAEPP): the Expert Panel Report 3-Guidelines for the Diagnosis and Management of Asthma (EPR-3), and its companion, the Guidelines Implementation Panel (GIP) Report.

"The guidelines give us the best that science has to offer about how to diagnose and control asthma, but unless health care providers, patients, and others integrate the recommendations into their programs and day-to-day routines for managing asthma, we will fall short of our potential to improve public health," said James P. Kiley, Ph.D., director of the NHLBI Division of Lung Diseases. "The National Asthma Control Initiative's 13 demonstration projects will give us new strategies and practical tools to put the guidelines into practice in a variety of community settings. Taken together, these projects will help us make a difference in asthma control."

The NAEPP is a 20-year-old collaborative effort coordinated by the NHLBI and composed of scientific, professional, governmental, and voluntary organizations to enhance the quality of life of people with asthma and to reduce asthma-related illnesses and death. In October 2008, the NAEPP established the NACI to further advance the implementation and dissemination of guidelines for the diagnosis and management of asthma.

Each of the new demonstration projects will receive approximately $100,000 over two years to implement and evaluate strategies to improve asthma control. The projects include a range of asthma interventions in diverse communities, including rural, urban, or suburban settings. Strategies target health care providers, adult and pediatric patients, or patients' families, school personnel, and others who play a role in helping patients manage asthma. Projects address, for example:

• reducing asthma triggers in the home and at school;
• providing Web-based training programs and in-person educational outreach for health care providers, patients, parents and other childcare providers, and educators;
• helping patients and parents monitor and improve asthma control through symptoms diaries and asthma action plans; and
• developing pilot programs to improve systems of care, such as a standardized electronic assessment form to improve communication between emergency care providers and primary care physicians to better coordinate patient care and reduce emergency room visits by asthma patients.

The 13 contracts have been awarded to:

• Asthma Allies, Albuquerque, N.M.
• Boston Public Health Commission
• Children�s Research Institute, Washington, D.C.
• Dorchester House Multi-Service Center, Dorchester, Mass.
• HHC Woodhull Medical and Mental Health Center, New York City
• Los Angeles Unified School District
• Medical Care Development, Calais, Maine
• Medical Society of Virginia Foundation, Richmond
• Michigan Department of Community Health, Lansing
• Mission Healthcare Foundation, Asheville, N.C.
• National Respiratory Training Center, Suffolk, Va.
• South Bronx Asthma Partnership/Bronx-Lebanon Hospital, New York City
• University of California, San Francisco

Asthma accounts for more than 10 million missed work days and almost 13 million missed school days each year.

"Our goal is to help people who have asthma lead longer, healthier, and fuller lives, thereby reducing asthma�s toll on those who have it. These demonstration projects are aimed at tackling different barriers to quality asthma care, so patients and their families can improve asthma control — and be active at work, school, and play," said Diana Schmidt, M.P.H., NAEPP coordinator for the NHLBI.

Outcomes from the demonstration projects will be shared through the NACI with health care providers, patients, families and other caregivers, and communities to promote the adoption of asthma guidelines and improve the quality of asthma care nationwide. The NACI will bring together organizations from local, regional, and national levels to share best practices, leverage resources, identify new directions, and create learning opportunities. In addition to coordinating the 13 demonstration projects, the NACI will build a national partnership program and an asthma championship program.

Published in 2007, EPR-3 provides guidance for selecting treatment based on a patient's individual needs and level of asthma control. The recommendations were developed by a committee of 18 unpaid experts chosen for their scientific and clinical knowledge and experience. The guidelines emphasize that while asthma can be controlled, the condition can change over time and differs among individuals and by age groups. Thus, it is important to monitor regularly the patient's level of asthma control so that treatment can be adjusted as needed.

A diverse group of 17 national experts in asthma policy, clinical practice, research, public health, and education reviewed the expert panel's recommendations to identify priority messages to improve implementation of the guidelines. Known as the Guidelines Implementation Panel, this group of asthma guideline end-users emphasizes that asthma patients and health care providers should:

• Use inhaled corticosteroids to control asthma, as appropriate
• Use asthma action plans
• Assess asthma severity
• Assess asthma control
• Schedule follow-up visits
• Control environmental factors.

Part of the National Institutes of Health, the National Heart, Lung and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases, and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases.
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Task Force Recommends Using Aspirin To Prevent Cardiovascular Disease When the Benefits Outweigh the Harms

Press Release Date: March 16, 2009 Patients and clinicians should consider risk factors—including age, gender, diabetes, blood pressure, cholesterol levels, smoking and risk of gastrointestinal bleeding—before deciding whether to use aspirin to prevent heart attacks or strokes, according to new recommendations from the U.S. Preventive Services Task Force. These recommendations do not apply to people who have already had a heart attack or stroke. The recommendations are published in the March 17 issue of the Annals of Internal Medicine. The Task Force reviewed new evidence from the National Institutes of Health's Women's Health Study published since the last Task Force review of this topic in 2002, including a recent meta-analysis of the risks and benefits of aspirin and found aspirin may have different benefits and harms in men and women. The Task Force found good evidence that aspirin decreases first heart attacks in men and first strokes in women. The more risk factors people have, the more likely they are to benefit from aspirin. The Task Force recommends that men between the ages of 45 and 79 should use aspirin to reduce their risk for heart attacks when the benefits outweigh the harms for potential gastrointestinal bleeding. Women between the ages of 55 and 79 should use aspirin to reduce their risk for ischemic stroke when the benefits outweigh the harms for potential gastrointestinal bleeding. Ischemic strokes occur as a result of an obstruction within a blood vessel supplying blood to the brain and are potentially prevented by aspirin use. The risk of gastrointestinal bleeding with and without aspirin use increases with age and is twice as high in men as in women. Other risk factors for gastrointestinal bleeding include upper gastrointestinal tract pain, gastrointestinal ulcers, and using non-steroidal anti-inflammatory drugs. The Task Force recommended against using aspirin to prevent either strokes or heart disease in men under 45 or women under age 55 because heart attacks are less likely to occur in men younger than 45 and ischemic strokes are less likely to occur in women younger than 55, and because limited evidence exists in these age groups. People age 80 and older could benefit more than younger people from aspirin because of their higher risk of cardiovascular disease, but the harms are also greater because the risk of gastrointestinal bleeding increases with age. The Task Force could not find clear evidence that the benefits of using aspirin outweigh the risks in people 80 years or older. "The decision about whether the benefits of taking aspirin outweigh the harms is an individual one. Patients should work with their clinicians to look at their risk factors and decide if taking aspirin to lower their risk for heart attacks or strokes outweighs the potential risk of gastrointestinal bleeding," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer and state epidemiologist for the Colorado Department of Public Health and Information. Cardiovascular disease is the leading cause of death in the United States. It is the underlying or contributing cause in approximately 58 percent of all deaths. In 2003, 1 in every 3 adults had some type of cardiovascular disease. In adults over the age of 40, the risk of developing cardiovascular disease is 2 in 3 for men and more than 1 in 2 for women. The Task Force could not find evidence about what the optimum dose of aspirin is to prevent heart attacks or strokes. Evidence shows benefits at a range of doses, and the risk of gastrointestinal bleeding may increase with the dose. A dose as low as 75 mg seems as effective as higher doses. Taking aspirin increases a person's chances of gastrointestinal bleeding, the sudden loss of blood or perforation of the digestive tract that can lead to hospitalization or death. Taking aspirin also increases the chance of a hemorrhagic stroke, or bleeding in the brain, which is different than the ischemic stroke that aspirin can prevent. In 2002, the Task Force strongly recommended that clinicians discuss aspirin use with adults at increased risk for coronary heart disease and that discussions with patients should address both the potential benefits and potential harms of aspirin therapy. The new recommendation provides more specific guidance about benefits and harms to specific age groups and gender-specific benefits and provides clinicians with information on how to estimate an individual's risks for heart disease or stroke. The U.S. Preventive Services Task Force is an independent panel of experts in prevention and primary care. The Task Force conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. Its recommendations are considered the gold standard for clinical preventive services. The recommendations and materials for clinicians are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm. Previous Task Force recommendations, summaries of the evidence and related materials are also available on the AHRQ Web site. Clinical information is also available from AHRQ's National Guideline Clearinghouse™ at http://www.guideline.gov. http://medicalinformation-dobi.blogspot.com/search/label/aspirin

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Health Tip: Managing Lupus Symptoms

Here are some suggestions

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_92592.html (*this news item will not be available after 03/03/2010)

HealthDay Diana Kohnle Thursday, December 3, 2009

(HealthDay News) -- Lupus is an autoimmune disease that can cause symptoms including pain and stiffness in the joints, body aches, fever, a rash on the skin and impaired cognitive function.

The National Women's Health Information Center offers these suggestions to help control lupus symptoms:

• See your doctor regularly.
• Establish priorities and goals to better balance your life.
• Minimize your exposure to sunlight and light from halogen and fluorescent bulbs.
• Learn how to reduce and manage stress.
• Eat a healthy diet, get plenty of sleep and exercise when your doctor approves.
• Create or join a network of support people.

HealthDay
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Secretary Sebelius Statement on

New Breast Cancer Recommendations

HHS Secretary Kathleen Sebelius issued the following statement today on new breast cancer screening recommendations from the U.S. Preventive Services Task Force:

“There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government.

“There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.

“What is clear is that there is a great need for more evidence, more research and more scientific innovation to help women prevent, detect, and fight breast cancer, the second leading cause of cancer deaths among women.

“My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years -- talk to your doctor about your individual history, ask questions, and make the decision that is right for you.”

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Healthy Babies: The Importance of Folic Acid

Hispanic babies are at higher risk of brain and spine birth defects

Each year in United States approximately 3,000 infants are born with serious defects of the spine and brain called neural tube defects (NTDs). Hispanic women have a 30-40 percent higher risk of having babies with these birth defects. NTDs occur in the first few weeks of pregnancy, very often before a woman even knows she is pregnant. Folic acid has been found to prevent up to 70 percent of NTDs. Yet, only 21 percent of Hispanic women are consuming enough folic acid compared with over 40 percent of white women.

Folic acid is a B vitamin that it is used in our bodies to make new cells. A woman’s body uses folic acid to make healthy new cells for her baby. If a woman has enough folic acid in her body before she is pregnant, it can help prevent these major birth defects of her baby’s brain (anencephaly) and spine (spina bifida). Every woman who could possibly get pregnant should take 400 micrograms (400 mcg or 0.4 mg) of folic acid daily in a vitamin or in foods that have been enriched with folic acid.

“It is crucial for every woman, but especially for Hispanics, to take folic acid every day even before getting pregnant, so that we can continue to decrease the number of children born with neural tube defects,” said Alina Flores, Health Education Specialist at the CDC’s National Center on Birth Defects and Developmental Disabilities.

The easiest way to get enough folic acid is by taking a supplement with folic acid. “Many Hispanic women believe that vitamins with folic acid are just for pregnant women, that they make you gain weight, that they are very costly or that you need a prescription. None of these myths is true,” says Flores.

It might be hard to remember one more thing to do, but research shows that by pairing taking folic acid supplement with another daily activity, like tooth brushing, can help women remember. Also, some women say that they keep supplements in strategic locations, such as in a purse, so it is easy to take anywhere. Hispanic mothers, grandmothers, sisters, cousins and friends, should remind those considering motherhood to make folic acid intake part of their daily routine.

Take folic acid today!

For more information about folic acid, neural tube defects, or fortified foods, please call 1-800-CDC-INFO or visit http://www.cdc.gov/ncbddd/folicacid/spanish/default.htm.
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Don’t Go Overboard:

Before you go swimming this season,

protect yourself and your family from

Recreational Water Illnesses (RWIs)

Swimming season is upon us. The skies are blue, and warm weather has returned. It’s time to break out the swim suits, lather on the sunscreen, and head to the local pool.

Swimming and other water-related activities such as water skiing and boating are excellent ways to spend leisure time and to engage in physical activity. However, it is important for everyone to follow basic guidelines to prevent Recreational Water Illnesses (RWIs).

RWIs are illnesses that are spread by swallowing, breathing in the vapors of, or having contact with contaminated water. Although most water is not contaminated with germs that cause illness, swimming pools, water parks, spas, interactive fountains, lakes, rivers, oceans, and other types of recreational water are all potential sources that can lead to the spread of germs that cause RWIs.

The most common RWI is diarrhea, and it is often caused by germs such as Cryptosporidium (“Crypto”), Giardia, Norovirus, Shigella, and E. coli O157:H7. Other common RWIs include skin, ear, respiratory, eye, neurologic, and wound infections. Anyone can get RWIs; however, children, pregnant women, and people with weakened immune systems are most at risk for these types of illnesses.

The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia reports that since the mid 1980s, there has been a steady increase in outbreaks of diarrheal illness linked to recreational water. This is primarily due to the emergence of the chlorine-resistant parasite Cryptosporidium (or “Crypto”). This one germ now accounts for over two-thirds of all pool-associated diarrheal outbreaks.

Although outbreaks have become more frequent, recreational water illnesses are preventable. There are a number of simple steps the public, aquatics staff, and public health officials can take to help keep germs out of recreational water. For example, some people mistakenly believe that chlorine immediately kills germs in pools. This common misconception might lead people to do risky things, like swimming while ill with diarrhea.

CDC recommends that pool users follow the “Six STEPs” for Healthy Swimming to stop germs from getting in recreational water and causing illness:

1. Please don’t swim when you have diarrhea.
2. Please don’t swallow pool water.
3. Please shower with soap before swimming and wash your hands after using the toilet or changing diapers.
4. Please take your kids on bathroom breaks or check diapers often.
5. Please change diapers in the bathroom or diaper-changing area and not at the poolside.
6. Please wash your children thoroughly (especially the rear end) with soap and water before they go swimming.

When swimming in natural waters, such as lakes, rivers, and oceans, avoid swimming after a heavy rain or near storm drains. Be aware of signs of pollution that may indicate the presence of disease-causing bacteria.

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Clopidogrel (marketed as Plavix)

and Omeprazole

(marketed as Prilosec) -

Drug Interaction

Audience: Cardiovascular healthcare professionals, pharmacists

[Posted 11/17/2009] FDA notified healthcare professionals of new safety information concerning an interaction between clopidogrel (Plavix), an anti-clotting medication, and omeprazole (Prilosec/Prilosec OTC), a proton pump inhibitor (PPI) used to reduce stomach acid. New data show that when clopidogrel and omeprazole are taken together, the effectiveness of clopidogrel is reduced. Patients at risk for heart attacks or strokes who use clopidogrel to prevent blood clots will not get the full effect of this medicine if they are also taking omeprazole. Separating the dose of clopidogrel and omeprazole in time will not reduce this drug interaction.

Other drugs that are expected to have a similar effect and should be avoided in combination with clopidogrel include: cimetidine, fluconazole, ketoconazole, voriconazole, etravirine, felbamate, fluoxetine, fluvoxamine, and ticlopidine.

Recommendations for healthcare professionals are provided in the "Information for Healthcare Professionals" sheet.

[11/17/2009 - Information for Healthcare Professionals - FDA]
[11/17/2009 - Public Health Advisory - FDA]
[11/17/2009 - Follow-Up to January 2009 Early Communication - FDA]

Previous MedWatch Alert:

[01/26/2009] Clopidogrel bisulfate (marketed as Plavix) Early Communication

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FDA Approves Additional Vaccine for 2009 H1N1 Influenza Virus

The U.S. Food and Drug Administration announced that it has approved a fifth vaccine for protection against the 2009 H1N1 influenza virus. The vaccine is manufactured by ID Biomedical Corp. of Quebec, Canada, owned by GlaxoSmithKline PLC.

As with the four previous H1N1 influenza vaccines licensed by the FDA on Sept.15, 2009, ID Biomedical Corporation will manufacture its H1N1 vaccine using the established, licensed egg-based manufacturing process used for producing seasonal flu vaccine.

Potential side effects of this H1N1 vaccine are expected to be similar to those of the seasonal and H1N1 flu vaccines. The most common side effect is soreness at the injection site. Others may include mild fever, body aches and fatigue for a few days after the inoculation.

As with any medical product, unexpected or rare serious adverse events may occur. The FDA is collaborating with other government agencies to enhance adverse event safety monitoring during and after the H1N1 2009 vaccination program.

ID Biomedical’s H1N1 monovalent vaccine will be produced in multi-dose vials, in a formulation that contains thimerosal.

As with any medical product, unexpected or rare serious adverse events may occur. FDA is collaborating with the U.S. Department of Health and Human Services, including the Centers for Disease Control and Prevention, and other government agencies to enhance the capacity for adverse event safety monitoring during and after the 2009 H1N1 vaccination program.

For more information
FDA Page on Influenza A (H1N1) 2009 Monovalent Vaccine

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Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.

The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies behind the stomach and in front of the spine.

Enlarge

Anatomy of the pancreas. The pancreas has three areas: head, body, and tail. It is found in the abdomen near the stomach, intestines, and other organs.

The pancreas has two main jobs in the body:

• To produce juices that help digest (break down) food.
• To produce hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.

The digestive juices are produced by exocrine pancreas cells and the hormones are produced by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

This summary provides information on exocrine pancreatic cancer. Refer to the PDQ summary on Islet Cell Tumors (Endocrine Pancreas) Treatment ¹ for information on endocrine pancreatic cancer.

Smoking and health history can affect the risk of developing pancreatic cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for pancreatic cancer include the following:

• Smoking.
• Long-standing diabetes.
• Chronic pancreatitis.
• Certain hereditary conditions, such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndrome (FAMMM).

Possible signs of pancreatic cancer include jaundice, pain, and weight loss.

These and other symptoms may be caused by pancreatic cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• Jaundice (yellowing of the skin and whites of the eyes).
• Pain in the upper or middle abdomen and back.
• Unexplained weight loss.
• Loss of appetite.
• Fatigue.

Pancreatic cancer is difficult to detect (find) and diagnose early.

Pancreatic cancer is difficult to detect and diagnose for the following reasons:

• There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.
• The signs of pancreatic cancer, when present, are like the signs of many other illnesses.
• The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.

Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.

Pancreatic cancer is usually diagnosed with tests and procedures that produce pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery. The following tests and procedures may be used:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radionuclide glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
• Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy.
• Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.
• Percutaneous transhepatic cholangiography (PTC): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of the abdomen).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• Whether or not the tumor can be removed by surgery.
• The stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body).
• The patient’s general health.
• Whether the cancer has just been diagnosed or has recurred (come back).

Pancreatic cancer can be controlled only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.

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Medical

HHS HealthBeat

(November 16, 2009)

Weight off the knees

Listen to Tip Interested? Take the Next Step

From the U.S. Department of Health and Human Services, I’m Ira Dreyfuss with HHS HealthBeat.

A study indicates losing a little weight can raise your chances of avoiding osteoarthritis of the knee.

Lauren Abbate of the University of North Carolina at Chapel Hill saw that in data on close to 1,500 North Carolinians who were followed for about six years. All of them were healthy at the start.

Abbate says the study found signs that people who lost weight could lower their risk:

[Lauren Abbate speaks] ``We are actually looking at only 5 percent weight loss, so that’s pretty modest. So for someone who is 200 pounds, we are only suggesting they need to lose 10 pounds to see a benefit.’’

People who didn’t lose weight – or who gained weight – didn’t benefit.

The study presented at a meeting of the American College of Rheumatology was supported by the Centers for Disease Control and Prevention.

Learn more at hhs.gov.

HHS HealthBeat is a production of the U.S. Department of Health and Human Services. I’m Ira Dreyfuss.

Last revised: November, 15 2009

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