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Many male breast cancers diagnosed late, making it more lethal

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Breast cancer in men is rare. But because it’s not often suspected in men, diagnosis often comes only after a tumor has begun to spread throughout the body, new research shows.

“Approximately one-half of males with breast cancer received a diagnosis after it had already spread,” either to nearby or distant tissues, said a team of researchers at the U.S. Centers for Disease Control and Prevention.

Late diagnosis can be lethal: Overall, five-year survival with male breast cancer diagnosed early was nearly 99%, but it dropped to about 26% for men whose tumors had already spread to “distant” sites upon diagnosis.

Nearly one in every 10 cases of male breast cancer — 8.7% — were diagnosed at a late stage, the CDC team found.

“Men tend to get diagnosed later because they and their primary care physicians are not looking for breast cancer,” explained Dr. Alice Police, who directs breast surgery at Northwell Health Cancer Institute in Sleepy Hollow, N.Y.

The new study “encourages primary care physicians to question men about breast lumps and family history [of breast cancer],” added Police, who wasn’t involved in the research.

Still, male breast cancers remain rare: According to the CDC, about 2,300 cases — or 1% of the total breast cancer burden in the United States — occur in men. Risk rises with age, “and compared with women, men receive diagnoses later in life and often at a later stage of disease,” said the team led by Taylor Ellington, of the CDC’s Division of Cancer Prevention and Control.

Ellington and colleagues used U.S. health data to track outcomes for nearly 15,000 men diagnosed with breast cancer between 2007 and 2016.

The researchers found that, if spotted early, these cancers are highly curable, with nearly all men diagnosed with a localized tumor surviving for at least five years.

But cancers that had spread offered a much more dire prognosis, and minority males were more likely to get diagnosed at a later stage. Overall, just over 12% of Black men with breast cancer were diagnosed after the tumor had spread to a distant site, compared to just over 8% of white men and about 7% of Hispanic men.

Timely and aggressive treatment seemed key to long-term survival, too. “The 5-year overall survival among males with breast cancer was worse for those who did not receive any treatment or who received primary radiation therapy [only] than it was for those who received any type of mastectomy,” Ellington’s group reported.

The signs of breast cancer in men aren’t different from those in women. These symptoms can “include a painless lump or thickening in breast tissue skin dimpling, puckering, thickening, redness or scaling and nipple discharge, ulceration, or retraction,” according to the study authors.

Also, family history is key since the same genes that can raise breast cancer risks in women — BRCA1 and BRCA2 — work similarly in men.

Police said, “We know that men with breast cancer have a higher rate of genetic mutations than women, and therefore there is an opportunity to identify these individuals, which may result in earlier stage at diagnosis.”

According to Ellington’s team, “Routinely discussing family health history with patients might help health care providers identify men who could be at increased risk.” Once a worrisome family history is established, breast self-exams — beginning at the age of 35 — should be encouraged and these men should also “undergo counseling and testing for genetic mutations,” the authors said.

And Police added that there’s one subgroup who might face special risks.

“Transgender females [people who have transitioned from male to female gender] have a higher risk for breast cancer than cisgender males,” she said, “while transgender males have a lower risk of breast cancer than cisgender females. This seems consistent with what we know about hormonal changes in this group of individuals.”

The study was published in the Oct. 16 issue of the CDC’s Morbidity and Mortality Weekly Report.

More information

There’s more on male breast cancer at the American Cancer Society.

Copyright 2020 HealthDay. All rights reserved.



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‘Green prescriptions’ could cancel mental health benefits for some

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So-called “green prescriptions” may end up being counterproductive for people with mental health conditions, researchers say.

Spending time in nature is believed to benefit mental health, so some doctors are beginning to “prescribe” outdoor time for their patients.

That led researchers to investigate whether being in nature helps actually does help people with issues such as anxiety and depression. They collected data from more than 18,000 people in 18 countries.

The takeaway: Time in nature does provide several benefits for people with mental health conditions, but only if they choose on their own to visit green spaces.

While being advised to spend time outdoors can encourage such activity, it can also undermine the potential emotional benefits, according to the authors of the study published this month in the journal Scientific Reports.

The researchers said they were surprised to find that people with depression were spending time in nature as often as folks with no mental health issues, and that people with anxiety were doing so much more often.

While in nature, those with depression and anxiety tended to feel happy and reported low anxiety. But those benefits appeared to be undermined when the visits were done at others’ urging, the investigators found.

The more external pressure people with depression and anxiety felt to visit nature, the less motivated they were to do so and the more anxious they felt.

“These findings are consistent with wider research that suggests that urban natural environments provide spaces for people to relax and recover from stress,” said study leader Michelle Tester-Jones, a postdoctoral research associate at the University of Exeter in the United Kingdom.

But the findings also show that health care practitioners and loved ones should be sensitive about recommending time in nature for people who have mental health issues.

“It could be helpful to encourage them to spend more time in places that people already enjoy visiting, so they feel comfortable and can make the most of the experience,” Tester-Jones said in a university news release.

More information

For more on the benefits of green spaces, go to the National Recreation and Park Association.

Copyright 2020 HealthDay. All rights reserved.



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Study: Nearly half of ‘essential workers’ in U.S. at risk for severe COVID-19

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Nov. 9 (UPI) — Nearly half of those classified as “essential workers” in the United States are at increased risk for severe COVID-19, according to an analysis published Monday by JAMA Internal Medicine.

This means that more than 74 million workers and those with whom they live could be at risk for serious illness, based on disease risk guidelines developed by the U.S. Centers for Disease Control and Prevention, the researchers said.

“Many parts of the country face high and rising infection rates, [and] we should not think about work exposure and health risks in isolation, given that workers and persons at increased risk often live in the same households,” study co-author Thomas M. Selden told UPI.

“Insofar as we can reduce the prevalence of COVID-19 in our communities, we can reduce the extent to which policymakers have to choose between the economy and keeping the population safe,” said Selden, an economist with the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

Since the COVID-19 pandemic spread to the United States in March, states and cities across the country have instituted lockdown measures designed to limit the spread of the disease.

Many of these measures entailed closing schools and non-essential businesses, with only banks, grocery stores, pharmacies and other businesses deemed to provide vital services allowed to stay open.

For this study, Selden and his colleagues analyzed data on the U.S. workforce to examine how many people were in essential jobs, how often they were able to work at home, their risk for severe COVID-19 and the potential health risks for their household members.

Of the more than 157 million workers across the country, 72% are in jobs deemed essential — based on U.S. Department of Homeland Security criteria — and more than three-fourths of all essential workers are unable to work at home, Selden said.

Essential workers include those in the medical and healthcare, telecommunications, information technology systems, defense, food and agriculture, transportation and logistics and energy, water and wastewater industries, as well as those in law enforcement and public works, the DHS criteria stipulates.

The study notes that up to 60% of these workers have underlying health issues, placing them at increased risk for severe COVID-19 if they get infected, as defined by U.S. Centers for Disease Control and Prevention guidelines.

Those with diabetes, heart disease, high blood pressure and chronic respiratory conditions like asthma are considered to be at high risk for serious illness, the CDC says.

Based on these findings, between roughly 57 million and 74 million adults working in on-site essential jobs — and their families — are at increased risk for serious illness, Selden and his colleagues estimated.

“Policymakers face important decisions about how to balance the economic benefits of keeping workers employed and the public health benefits of protecting those with increased risk of severe COVID-19,” Selden said.

“These issues arise in the context of decisions to close segments of the economy and decisions about how to distribute vaccines, which will initially be available only with limited supply, [and] become all the more difficult when the prevalence of infection rises in parts of the country,” he said.



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Study: Hydroxychloroquine no better than placebo for hospitalized COVID-19 patients

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Nov. 9 (UPI) — COVID-19 patients treated with hydroxychloroquine showed no signs of significant improvement in “clinical status” compared with those given a placebo, a study published Monday by JAMA found.

Patients given a five-day course of the drug were scored as “category six” based on the World Health Organization’s seven-category COVID Ordinal Outcomes Scale, the same as those given a placebo, the researchers said.

Also, 28 days after they started treatment, 10.4% of those treated with hydroxychloroquine died, just slightly lower than the 10.6% fatality rate in the placebo group.

“The results show that hydroxychloroquine did not help patients recover from COVID-19,” study co-author Dr. Wesley H. Self told UPI.

“In the study, patients treated with hydroxychloroquine and those treated with a placebo had nearly identical outcomes, [so] I do not foresee any role for hydroxychloroquine in acutely ill patients hospitalized with COVID-19,” said Self, an infectious disease specialist at Vanderbilt University Medical Center.

Hydroxychloroquine is an immunosuppressive and anti-parasitic drug that is used to treat malaria.

Early in the COVID-19 pandemic, it was touted by President Donald Trump and others as a potential treatment for the virus, despite the lack of any scientific data supporting its use.

Given its effectiveness helping those sickened with malaria — a mosquito-borne infection — to recover, “there was a strong rationale for why hydroxychloroquine may have been beneficial for patients with COVID-19,” according to Self.

However, in July, the U.S. Food and Drug Administration warned against the drug’s use in the treatment of those infected with the new coronavirus, due to potentially serious heart-related side effects.

For this study, Self and his colleagues treated 433 COVID-19 patients at 34 hospitals across the United States with either the drug or a placebo for a period of five days.

Patients assigned to the hydroxychloroquine group received 400 milligrams of the drug in pill form twice a day for the first two doses and then 200 mg. in pill form twice a day for the next eight doses, for a total of 10 doses over the five days.

All of the patients were then assessed based on the WHO’s COVID Ordinal Outcomes Scale, which categorizes those infected according to disease severity.

Most of the patients in both the hydroxycholorquine group and the placebo group were in “category six,” meaning they were hospitalized and receiving extracorporeal membrane oxygenation or invasive mechanical ventilation to maintain their breathing, the researchers said.

“Our results, especially when combined from other studies conducted in the United Kingdom and Brazil, are good evidence that hydroxychloroquine does not provide benefit for patients hospitalized with COVID-19,” Self said.



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