SUNDAY, Feb. 17 (HealthDay News) -- It's clear that chemotherapy after breast cancer surgery increases survival rates. But many older women aren't being offered this potentially lifesaving treatment.

But, age shouldn't be a deciding factor -- an older woman's general health appears to be a better predictor of positive results after chemotherapy, according to a study published recently in the Journal of the American Medical Association.

"Age alone should not be a contraindication to the use of optimal chemotherapy regimens in older women who are in good general health," the study authors said.

About half of all breast cancers in the United States occur in women older than 65. Past studies have shown that chemotherapy after breast cancer surgery increases the odds of disease-free survival in women between the ages of 50 and 69. But little information has been available for treating women over 70, the study authors said.

One important concern is that older women may experience more toxic side effects from chemotherapy. That's because the kidneys often function less effectively with age, and there's not as great a bone marrow reserve for generating new blood cells in older people.

"There's always been a concern that older women with breast cancer might be under-treated," said Dr. Yelena Novik, an oncologist at New York University Medical Center in New York City. "In clinical trials, the proportion of women over 70, and especially over 75, is very small, so it's hard to know the benefits and the risks. It's understood that older women are more likely to have other medical problems, such as heart disease, hypertension and diabetes, so the question is, should they be offered the same treatment as younger women?"

To answer that question, researchers from cancer centers around the country reviewed data from four previous trials that included almost 6,500 women with lymph-node positive breast cancer. Five hundred and forty-two of the women in the studies were over 65, and 159 were over age 70.

Each of the studies looked at various doses and regimens of chemotherapy, including regimens considered to be potentially more toxic than the others.

A number of factors influenced survival rates, including smaller tumor size, fewer positive lymph nodes, having more chemotherapy, and using the breast cancer drug tamoxifen. Age alone, however, didn't appear to influence survival rates, the study authors found.

Women over 65 were more likely to die of causes other than breast cancer. And they were slightly more likely to die as a result of the treatment than younger women were. Overall treatment-related mortality was 0.5 percent, and 1.5 percent for those women over 65.

"What this study basically showed is that we shouldn't prejudice our treatment decisions based on chronological age," said Dr. Jay Brooks, chairman of hematology and oncology at Ochsner Health System in Baton Rouge, La. "We have a lot of very healthy, older individuals, and to simply preclude someone from taking potentially lifesaving therapy because they've reached some chronological age is just wrong. Would you tell someone who's 68 with coronary vessel disease not to get a bypass?"

Both Novik and Brooks said that recent advances in tailoring breast cancer treatments to the individual patient have likely made the age disparity less of an issue.

"We're hopefully getting smarter in understanding cancer behaviors, which gives us better insight into which drugs to use," Novik said.

Brooks advised older women with breast cancer to "sit down and talk with their doctor about what their individualized risk of recurrence is. We have good tools to offer individualized treatment options, whatever your age."

More information

To learn more about chemotherapy treatment for breast cancer, visit the American Cancer Society  .

THURSDAY, Jan. 31 (HealthDay News) -- The three-year-old Medicare Part D drug program is seeing the number of its enrollees climb, even as costs for the program fall, U.S. health officials announced Thursday.

"Overall, costs for beneficiaries and taxpayers are considerably lower than originally projections, enrollment continues to rise and customer satisfaction remains very high," Kerry Weems, acting administrator at the U.S. Centers for Medicare and Medicaid Services (CMS), told reporters.

But critics aren't so enthusiastic, with many still faulting the program for its complexity, its high co-pays on some drugs and its inability to negotiate lower prices with the drug industry.

According to Weems, the projected cost for Medicare part D is $117 billion lower over the next decade than experts estimated just last summer. "This means that over the 10-year period [from] 2008 to 2017, the estimated $915 billion cost of Part D fell to $798 billion," he said.

These reductions in costs are due to the slowing of price increases, lighter administrative costs and higher rebates from drug manufacturers, Weems added.

At the same time, he reported, after the third open enrollment period that ended in December, the plan now has an additional 1.5 million people.

"Overall, there are about 25.4 million people enrolled in Part D," Weems said.

And, he noted, "there are now 39.5 million people, most in Medicare, with some form of drug coverage."

When the new drug plan rolled out in 2006, health officials estimated that 43 million Americans would be eligible for some drug benefit.

Most people surveyed today -- more than 85 percent -- are satisfied with the plan, Weems noted.

But a critic was less than impressed by those numbers.

"The administration has set a pretty low bar for measuring success," said Robert M. Hayes, president of the Medicare Rights Center. "Is Part D better than nothing? Absolutely. But do taxpayers get a dollar's worth of coverage for every dollar put into this program? Absolutely not."

Hayes believes several things need to be done to improve the program. "It's discouraging that the administration wants to pat itself on the back rather than make those changes," he said.

For one, the program needs to be less complex so that seniors have an easier time choosing a drug plan, Hayes said. In addition, drug plans need to be prevented from lumping out-of-pocket costs onto the sickest people. As an example, Hayes pointed to the high co-pays associated with chemotherapy.

Moreover, Medicare needs to be able to negotiate prices with drug companies, which it is currently prohibited from doing, Hayes said. "The program continues to pump tens of billion of dollars into the drug market, but cannot use that market power to drive prices of medicine [down] to worldwide levels," he said.

While Weems touted Part D's success, the Bush administration is about to ask for large cuts in the growth of Medicare -- cuts that go far beyond those proposed last year, The New York Times reported Thursday. In addition, President Bush will also ask for cuts in Medicaid, the newspaper said.

According to the Times, cuts in Medicare will total $6 billion in the next year and $91 billion from 2009 to 2013. For Medicaid, proposed cuts would top $1.2 billion next year and almost $14 billion over five years.

Most of the Medicare savings would come from reduced payments to hospitals, nursing homes, hospices, ambulances and home care agencies, the article said.

More information

For more information on Medicare part D, visit the U.S. Centers for Medicare and Medicaid Services.

FRIDAY, Jan. 4 (HealthDay News) -- Arthritic disease is the most common cause of disability in the United States and now affects 46 million Americans, or more than 21 percent of the adult population, a major new report finds.

That number is expected to rise even higher as baby boomers age, so that by 2030, 40 percent of American adults will suffer from some form of arthritic disease, the researchers said.

Today, almost two-thirds of people with arthritis are under 65, and more than 60 percent are women. The disease hits whites and blacks equally, but the rate is lower among Hispanics, according to the report.

"Arthritis remains a large and growing problem," said lead researcher Dr. Charles G. Helmick, an epidemiologist with the U.S. Centers for Disease Control and Prevention. "Cases of osteoarthritis has risen, while rheumatoid arthritis has gone down since our last estimate," he added.

Rheumatoid arthritis is a painful autoimmune disorder of uncertain origin leading to chronic inflammation at the joints. Osteoarthritis is a more common illness caused by a gradual breakdown of cartilage in the joints.

The reasons why there are now fewer cases of rheumatoid arthritis is unclear, Helmick said. One reason may be that experts have changed the way they estimate the number of cases. Today, they use a more specific and restrictive definition of the condition, he said. But there has been a real decreases in cases of rheumatoid arthritis worldwide, and no one is sure why, Helmick added.

The main reason that osteoarthritis is increasing is an aging population, Helmick said. "As more people age, there will be more people with osteoarthritis. That's what's driving the numbers upward," he said.

Also, the obesity epidemic in the Unites States is taking its toll, Helmick noted. "Obesity is a risk factor for knee osteoarthritis, one of the most common types of arthritis," Helmick said. "We don't have any cures, we treat the symptoms and, when it gets bad enough, we do knee replacements, which are very expensive," he said.

As more people suffer from arthritis, the costs associated with the disease will also keep going up. Currently, the costs to the country from arthritis top more than $128 billion a year in lost earnings and medical care, Helmick said.

The researchers, from the National Arthritis Data Workgroup, used data from the U.S. Census Bureau, national surveys, and findings from community-based studies across the United States to determine the prevalence of arthritis in 2005 and beyond. The results were published in two papers in the January issue of Arthritis & Rheumatism.

Key findings in the report include:

• By 2030, almost 67 million people will have arthritis -- an increase of 40 percent. Osteoarthritis, the most common type of arthritis, affects almost 27 million Americans. That's a big increase from 1990, when 21 million suffered from the condition.
• The prevalence of rheumatoid arthritis has declined to 1.3 million Americans, from 2.1 million in 1990.
• The prevalence of gout, a form of inflammatory arthritis, has risen in 2005 to about 3 million up, from 2.1 million in 1990.
• Currently, juvenile arthritis affects some 294,000 children between infancy and age 17.
• An estimated 59 million Americans have suffered an episode of low back pain over the past three months, the researchers said, while 30 million have suffered neck pain over the same time period.

In addition, the report includes estimates for related conditions such as fibromyalgia, spondylarthritides, systemic lupus erythematosus (lupus), systemic sclerosis, Sjögren's syndrome, carpal tunnel syndrome, polymyalgia, and rheumatic/giant cell arteritis.

One expert advised staying active and keeping your weight under control to help prevent or treat arthritis.

"We know that cases of osteoarthritis are likely to grow, because it's age-related," said Dr. Patience White, chief public health officer at the Arthritis Foundation. "In addition, weight plays a big role in risk, as well as lack of physical activity, in keeping your muscles strong," she said.

Losing weight and keeping physically active can help to reduce pain and keep the disease at bay, White said. "If you lose as little as 10 pounds, you can decrease pain in the knees and hips by 50 percent," she said. "With exercise, you can decrease progression."

More information

For more information on arthritis, visit the Arthritis Foundation  .

WEDNESDAY, Jan. 2 (HealthDay News) -- Testosterone supplements increase lean body mass and decrease body fat in men over age 60 who have unusually low testosterone but do not improve strength, mobility or mental abilities, researchers report.

Testosterone levels normally decrease as men age, although the amount of decrease varies among men. Losing testosterone is associated with a loss of muscle mass, strength, mental facility and bone mass as well as an increase in body fat, the team noted in the Jan. 2 issue of the Journal of the American Medical Association.

Clinical trials of the effectiveness of testosterone supplementation have not been conclusive, added the team from the University Medical Center Utrecht, the Netherlands.

They analyzed quality of life and health data from 207 men between the ages of 60 and 80 who had lower than average testosterone levels. Participants took 80 milligrams of testosterone or a placebo twice daily for six months. The men did not know whether they were taking testosterone or the placebo.

The researchers found that the men who took testosterone had more lean body mass and less fat than their peers but no increase in mobility of strength. Although not statistically significant, the men taking testosterone were slightly more likely to have metabolic syndrome by the end of the study. Metabolic syndrome is a predictor of type 2 diabetes and is characterized by obesity and unhealthy cholesterol levels.

Men taking testosterone also had improved insulin sensitivity but lower levels of "good" high-density lipoprotein (HDL) cholesterol. Testosterone supplementation was associated with an increase of creatinine in the blood, as well as hemoglobin and hematocrit, measures of red blood cell health. There were no negative effects of testosterone on prostate health, reported the researchers.

"This study is, as far as we know, the largest study of testosterone supplementation with the most end points and a randomized, double-blind design. Adherence was high, and the dropout rate was low," the authors wrote in a prepared statement. "The findings in this study do not support a net benefit on several indicators of health and functional and cognitive performance with six months of modest testosterone supplementation in healthy men with circulating testosterone levels in the lower range."

More information

To learn more about building strength through strength training, visit the U.S. Centers for Disease Control and Prevention.