WEDNESDAY, May 21 (HealthDay News) -- Heavy smoking and drinking, especially beer, may hasten the onset of pancreatic cancer, according to researchers who presented their data Tuesday at the Digestive Disease Week 2008 conference in San Diego.

Beer appears to exert a stronger influence than hard liquor or wine in lowering the age of onset of pancreatic cancer, said researcher Dr. Michelle A. Anderson, assistant professor of medicine at the University of Michigan.

Anderson and her colleagues evaluated patients from The Pancreatic Cancer Collaborative Registry, a multi-center, international patient registry, looking at whether the patients drank or smoked, and if so, how much and what type of liquor.

They evaluated the smoking and drinking (or abstinence) patterns of 453 patients in all, about equal numbers of men and women.

Patients who smoked did tend to develop pancreatic disease at a younger age and there were dose-related effects, Anderson said. Heavy smokers (such as those who have smoked more than a pack a day for 40 years, or more than two packs for 20 years) presented with pancreatic cancer an average of seven years before nonsmokers.

The average age of onset of pancreatic cancer is between 70 to 80, experts noted.

Heavy drinkers, defined as having more than three daily drinks, presented with pancreatic cancer 10 years younger than those who did not drink.

Comparing beer, wine and hard liquor, the team found that beer lowered the age of developing pancreatic cancer most, Anderson said. When she compared beer drinkers to non-beer drinkers, the effect was statistically significant; however, when she considered other variables that may affect cancer onset, the effect disappeared.

Cigarette smoking is already a well-known risk factor for pancreatic cancer. Heavy alcohol intake may induce chronic inflammatory changes that are also linked with cancer, Anderson said.

The combination of chronic smoking plus drinking had no stronger effect on pancreatic risk than either habit alone, the researchers found.

Pancreatic cancer is expected to be diagnosed in nearly 38,000 people in the United States this year, according to the American Cancer Society, and about 34,000 will die of the disease. The lifetime risk is about 1 in 79 but is affected by factors such as advancing age, obesity and family history.

Because it is often emerges without symptoms, pancreatic cancer is often not detected until its later stages, when treatment is less effective. But even if caught at stage one the outlook is bleak, researchers said. At stage one, the 5-year survival from pancreatic malignancy is about 33 percent.

The pancreas, about 6 inches long and less than 2 inches wide, extends across the abdomen. It makes key hormones, including insulin, and helps to balance blood sugar.

Finding pancreatic tumors earlier -- especially important for people with a family history, or other factor indicating high risk -- is the focus of much research. And a new study suggests that combining two methods may provide better screening, according to another researcher, Dr. Richard Zubarik, associate professor of medicine and chief of endoscopy at Fletcher Allen Health Care in Burlington, Vt.

His research team used a blood test called CA19-9 -- a test to detect a tumor marker most often used to monitor disease progress and predict survival rates. They then combined that screen with an endoscopic ultrasound to try to detect the cancer in the earliest stages.

Of the 272 patients enrolled, one patient was diagnosed with pancreatic cancer and one with abnormal pancreatic cell growth.

However, the method is expensive -- it cost $14,000 to detect the cancer and about $11,000 to detect the abnormal cell growth, Zubarik said.

Other strategies are being studied to see if they can increase the bleak survival rates. In another study, researchers compared the records of more than 4,000 patients with pancreatic cancer and divided them into two groups -- those who had the ultrasound (about 12 percent of the sample) and those who did not.

Those who received the ultrasound at diagnosis had a somewhat longer average survival time, said Dr. Ananya Das, associate chair of medicine, Mayo Clinic in Scottsdale, Ariz. Undergoing this screen increased average survival time for patients from 5 months to 9 months.

Going to a center that offers this method may mean that patients receive better overall care, he said. Endoscopic ultrasound is available at leading medical centers, he said.

In patients at very high risk of pancreatic cancer, such as those with a family history, surveillance performed by a team of specialists can also help, said Dr. Teresa A. Brentnall, associate professor of medicine at the University of Washington, Seattle.

"Our goal is to protect them from pancreatic cancer," she said. Her team found that two tests could help. One is the endoscopic ultrasound, the other is called an endoscopic retrograde cholangiopancreatography.

Brentnall's team followed 100 patients using these methods. Of the 100 patients, two developed cancer (one inoperable), and 20 had abnormal cell growths. The combination can help lead to detection of pancreatic pre-cancer, she said.

More information

To learn more about pancreatic cancer, visit the American Cancer Society  .

MONDAY, May 19 (HealthDay News) -- Men undergoing external beam radiation for localized prostate cancer may have a slightly increased risk of developing other cancers, researchers report.

The findings could have implications for men trying to decide which treatment is best for their prostate cancer, the researchers said.

"We saw an increased risk for lung, bladder and rectal cancer among patients treated with external beam radiation for prostate cancer," lead researcher Dr. Naeem Bhojani, from the University of Montreal's Department of Urology, said during a Monday teleconference at the American Urological Association annual meeting, in Orlando, Fla.

"However, in absolute terms, the absolute risk associated with the development of secondary malignancies in patients exposed to external beam radiation therapy is quite small," Bhojani said.

Among the treatments for prostate cancer are surgical removal of the prostate, called radical prostatectomy; implanted radioactive seeds that deliver radiation specifically to the prostate gland; and external beam radiation, which is a non-surgical procedure that delivers radiation to the prostate from outside the body.

Bhojani said external beam radiation is probably a better treatment choice for older patients rather than younger patients with longer life expectancies, who may be at risk for developing these secondary cancers.

For the study, by researchers from Canada, Italy and the United States, Bhojani's group collected data on 10,333 men being treated for localized prostate cancer. Among these men, 6,196 had their prostate surgically removed, and 4,137 underwent external beam radiation.

The researchers then looked at the later development of bladder, lung and rectal cancer, to see which treatment was more likely to increase the risk of these malignancies.

They found that men who'd undergone external beam radiation had a threefold increased rate of bladder cancer, a 1.8-fold increased rate of lung cancer, and a 1.7-fold increased rate of colorectal cancer, compared with men who underwent radical prostatectomy.

One cancer expert said he couldn't explain why external beam radiation would increase the risk of these cancers, especially lung cancer.

"I'm not sure how external beam radiation to the pelvis for prostate cancer would increase the risk for lung cancer," said Dr. Bruce Roth, professor of medicine and urologic surgery at Vanderbilt University.

The radiation therapy would be more likely to increase the risk for bladder cancer and colorectal cancer, which are nearer the prostate, he noted.

Roth said it's important to give prostate cancer patients several treatment choices. "I will give them a number of options and let them pick based on the side effect profile. There are many patients who may not be good surgical candidates, therefore you might lean toward external beam radiotherapy," he said.

In another study presented Monday, researchers found that survivors of childhood cancers treated with the chemotherapy drug cyclophosphamide were five times likelier to develop bladder cancer later in life, compared with the general population.

Children up to 4 years old treated with the drug for retinoblastoma, leukemia and non-Hodgkin lymphoma had a particular risk for developing bladder cancer, the researchers found.

Cyclophosphamide is an immunosuppressive drug used to treat several types of cancers and is known to cause bladder damage that can lead to bladder cancer.

In patients followed for up to 50 years, the researchers found that the chances of developing bladder cancer increased over time. The percentage of patients diagnosed with bladder cancer at 20, 30, 40 and 50 years of age was 0.02 percent, 0.08 percent, 0.37 percent and 0.71 percent, respectively, the researchers reported.

More information

For more about prostate cancer, visit the National Cancer Institute.

FRIDAY, May 16 (HealthDay News) -- After years of declining rates, the number of mastectomies performed on women with breast cancer is on the rise again, the Mayo Clinic now reports.

The increase coincided with heavier usage of magnetic resonance imaging (MRI) before surgery, according to the authors, who were expected to present their findings May 31 at the American Society of Clinical Oncology (ASCO) annual meeting, in Chicago.

Guidelines introduced in 1990 pronouncing that lumpectomy was equally effective as mastectomy for overall survival in women with early-stage breast cancer resulted in a rise in lumpectomies, also known as breast-conserving surgery, along with a decline in the number of mastectomies performed.

"But in the last 10 years, more changes have occurred in the preoperative work-up of breast cancer, and some of the changes have included the introduction of new imaging modalities such as MRI," senior study author Dr. Matthew Goetz, an assistant professor of oncology at the Mayo Clinic in Rochester, Minn., said during a May 15 teleconference. "There are also improved breast reconstruction options, as well as the introduction of genetic testing."

Previously published trials have shown that mastectomy rates may be increasing in general in the United States, Dr. Julie Gralow, an associate professor of medical oncology at the University of Washington, Seattle, added at the same news conference.

Dr. Richard J. Bleicher, co-director of the Breast Fellowship Program at Fox Chase Cancer Center in Philadelphia, confirmed this. "This is a real finding. This is not something that is isolated to Mayo. We see the same thing," he said.

Breast MRIs may detect cancer in more than one part of the breast, which, in turn, may prompt surgeons and patients to choose mastectomy over lumpectomy. MRIs also pick up noncancerous masses, which leads women to choose a mastectomy, even though the lesion doesn't need to be removed immediately.

The new research involved more than 5,000 patients with early-stage breast cancer who underwent surgery between 1997 and 2006. Information on whether an MRI was performed before surgery became available in Mayo Clinic records, starting in 2003.

In 1997, the mastectomy rate was 44 percent. That number declined to 30 percent in 2003, then rose again from 2004 to 2006, to 43 percent.

"That's similar to the rate seen in the late 1990s," Goetz said.

In 2003, 11 percent of women underwent MRI before their surgery; by 2006, that number had risen to 23 percent.

Fifty-two percent of all patients receiving MRI had a mastectomy, versus 38 percent of women who did not have an MRI.

Mastectomy rates in women who did not have an MRI also increased, from 28 percent in 2003 to 41 percent in 2006.

Nevertheless, Goetz said, "patients who had preoperative MRI were significantly more likely to undergo mastectomy."

But the greater sensitivity of MRI may, in fact, be a double-edged sword.

"Although there has been a lot of excitement about the sensitivity of MRI, there is a significant downside. We don't have evidence that MRI improves our outcome. What we do know is that it finds a lot of things that we don't know the significance of, and many aren't significant," Bleicher.

He added, "I would say this data is phenomenally important, because we're starting to take a step back about the excitement of MRI and look at it through more realistic non-rose-colored glasses."

"Future studies are needed to determine those factors most likely to influence changes in surgical management and whether the changes influence breast cancer outcomes or quality of life," Goetz said.

More information

The National Cancer Institute has more on surgery options for breast cancer patients.

FRIDAY, May 16 (HealthDay News) -- Adults who had cancer as children or teens are more likely to experience cardiovascular disease, a new study found.

And the heart problems surface at a much earlier age than in people who did not suffer cancer as children.

Childhood cancer survivors "have approximately a five to 10 times increased risk of having heart disease compared to their healthy siblings," said study lead author Dr. Daniel A. Mulrooney, assistant professor of pediatrics at the Masonic Cancer Center of the University of Minnesota, Minneapolis.

Mulrooney was expected to present his findings Thursday night at the American Society of Clinical Oncology annual meeting, in Chicago.

There are an estimated 270,000 survivors of childhood cancer in the United States, and 11 million cancer survivors total.

While the cancer survivors in the new study ranged in age from 8 to 51, the average age of those with heart problems was only 27.5 years.

"We're talking about a very young population that's having very significant cardiac disease and is likely not being monitored appropriately," Mulrooney added. "It is very important that they be followed and that risk factors and cardiovascular monitoring that we would think of in an older population be implemented in a younger population."

The findings aren't entirely surprising. Previous research, much of it with the same group of survivors, has shown an increased risk of cardiovascular disease in survivors of childhood and adolescent cancer.

The new analysis, the longest follow-up to date, provides updated information on 14,358 five-year survivors of childhood cancer. All the participants were diagnosed with one of eight cancers (including leukemia, lymphoma and brain malignancies) at 21 years of age or younger, between 1970 and 1986.

The study participants provided information on their own heart health, which was then compared to a control group of 3,899 healthy siblings.

Compared to the healthy brothers and sisters, the survivors of childhood cancer were almost six times more likely to report congestive heart failure; about five times more likely to report having had a heart attack or valvular heart disease; more than six times likelier to have pericardial disease (the pericardium is the sac that surrounds the heart); more than eight times as likely to have had an angiography; and 10 times more likely to have atherosclerosis, or hardening of the arteries.

Exposure to the chemotherapy drug anthracycline increased the risk of congestive heart failure about fourfold, roughly doubled the risk of pericardial and valvular disease, and almost tripled the odds of having had an angiography, the study found.

Radiation treatment to the heart doubled the risk of congestive heart failure, heart attack and pericardial disease, almost tripled the risk of valvular disease, and increased the risk of atherosclerosis by a factor of more than five, according to the study.

Dr. Karen Burns is clinical director of the ATP5+ Clinic for Childhood Cancer Survivors at Cincinnati Children's Hospital. She said most of the heart problems seen in survivors of childhood cancer come from the class of chemotherapy drugs called anthrocyclines, which cause problems with cardiac muscle, and from radiation, if the radiation field included the heart.

Although monitoring for heart disease in childhood cancer survivors is already in place in many specialized facilities, Burns said she hoped that, "if this study is available to the general public, it will encourage people who are survivors to get closer follow-up."

Mulrooney added: "We see this in our long-term follow-up clinic. We identify patients who are at risk based on this analysis and may do an echocardiogram or a lipid panel, things we might not typically do in a 20-year-old. There are tools out there, and getting this knowledge out there as well would be helpful so primary-care physicians will be more aware, oncologists and cardiologists will be aware, and patients as well."

More information

To learn more, visit the National Childhood Cancer Foundation  .