Australia's obesity crisis has forced health officials to revamp their fleet of ambulances to cope with a sharp rise in overweight patients.
Super-sized vehicles have been introduced and new air ambulances will be remodelled to carry heavier people.
Studies estimate that 67% of Australian men and over half of all women aged over 25 are overweight or obese.
So many Australians are now bulging at the waistline that ambulances are being equipped with heavy-duty stretchers.
These are capable of carrying patients weighing up to 220kg (34 st 9 lbs).
In the country's most populous state, New South Wales, officials have said that more super-sized ambulances may well be needed to cope with this health crisis.
Special vehicles with over-sized wheelchairs and a hydraulic tailgate were introduced a few years ago to transport larger people.
Their workload has doubled since 2004.
Obese toddlers
Dealing with the obese or overweight is becoming more common for medical teams and it can be an arduous experience.
In a recent case in Sydney it took 16 people several hours to take an injured man from his home to hospital.
He weighed about 400kg (63 st) and had broken his leg.
Emergency workers had to demolish part of his house to lift him out.
There are strong signs that Australia's obesity epidemic is getting worse.
A lack of exercise and a poor diet, including drinks loaded with sugar and high-fat snacks, are breeding a new generation of fat Australians.
Experts here are warning that by 2030 half of this country's children will be overweight or obese.
They have insisted that breast and colon cancer as well as diabetes and heart disease have strong links to obesity.
It is reported that some Australian hospitals are now treating obese patients who are as young as two years old.
a while back, when replacing the batteries to our scale at home, somehow the units of measurements got fixed on 'st lb' instead of just lb, what we usually measure weight in. at the time we were weighing suitcases and my dad was trying to get the luggage under 50lb (abt 23kg) we couldn't understand why the scale was giving us different numbers. so i went and looked up what 'st-lb' meant in weight measurement. we got it down and since then we actually speak in stone pounds whenever we weight ourselves... funny isn't it?
until now i just can't figure out how to return the units back to lb on our scale.
Reports urge expanded use of MRI for breast cancer prevention
Two reports scheduled for publication in the United States on Wednesday call for greatly expanded use of magnetic resonance imaging for women who have breast cancer or who are at high risk of developing the disease.
The recommendations on the scans, whose technology is commonly referred to as MRI, do not apply to most healthy women, who have only an average risk of developing breast cancer. But even so, the new guidelines could add a million or more women in the United States a year to those who need magnetic resonance imaging of the breasts - a demand that radiologists are not yet equipped to meet, researchers say.
Breast MRI requires special equipment and software and trained radiologists to read the results. A scan costs $1,000 to $2,000 in the United States, sometimes more, which is 10 times the cost of mammography. So a million more scans a year could cost at least $1 billion.
The scans are sometimes covered in the United States by insurance and Medicare, sometimes not, depending on the reason for the test.
One of the reports scheduled for release Wednesday is a set of new U.S. guidelines for using MRI in women at high risk for breast cancer. The other is a study in The New England Journal of Medicine showing that in women who have newly diagnosed cancer in one breast, MRI can find tumors in the other breast that mammograms miss.
MRI has drawbacks. It is so sensitive, much more so than mammography, that it reveals all sorts of suspicious growths in the breast, leading to many repeat scans and biopsies for things that turn out to be benign. For women who are likely to have hidden tumors, the prospect of such false-positive findings may be acceptable. But the risk of needless biopsies and additional scans is not generally considered reasonable for women with just an average risk of breast cancer, and is the main reason MRI is not recommended for them.
The new guidelines, from the American Cancer Society, recommend MRI screening in women who are healthy but at high risk for breast cancer. The guidelines, being published in the society's journal entitled CA: A Cancer Journal for Clinicians, recommend MRI scans and mammograms once a year starting at age 30 for women in the high-risk category.
High risk is defined as a 20 to 25 percent or higher risk of developing breast cancer over the course of a lifetime. (The average lifetime risk for women in the United States is 12 to 13 percent.)
The high-risk group includes women who are prone to breast cancer because they have tested positive for certain genetic mutations, BRCA1 or BRCA2, or those whose mothers, sisters or daughters carry those mutations, even if the woman herself has not been tested. These mutations are not common - they cause less than 10 percent of all breast cancers - but they greatly increase a woman's risk.
Women with even rarer mutations, in genes called TP53 or PTEN, are also advised to be screened, as are women who had radiation treatment to the chest between the ages of 10 and 30, for disorders like Hodgkin's disease.
Others at high risk include women from families in which breast cancer is common, even if no genetic mutation has been identified. Women and their doctors can estimate their odds by using one of several online risk calculators that factor in the medical history of both the woman and her family. A simple calculator is available at Breast Cancer Risk Assessment Tool.
But different calculators can give quite different results, and women may need help from their doctors to interpret the results, said Elizabeth Morris, a member of the expert panel that drew up the guidelines and director of breast MRI at the Memorial Sloan-Kettering Cancer Center in New York.
"Just to figure out who should have it will be the hardest thing," Morris said. "A lot of that onus is put on the referring physician. A lot of women are going to think they're high risk, and they're not."
The cancer society said that for women with certain conditions, there was not enough information to recommend for or against MRI screening, and that those women and their doctors would have to decide. The uncertain group includes women with very dense breast tissue on mammograms, and women who had breast cancer in the past, or growths called carcinoma in situ or atypical hyperplasia.....
Robert Smith, director for screening at the American Cancer Society, estimated that the new guidelines would add between 1 million and 2 million women a year to the number who should have breast MRI in the United States. He said previous recommendations, released in 2003, had been less specific about "who's at risk and who's a candidate for being screened."
Increased demand in the United States for breast MRI could easily outstrip the capacity, even though the number of centers offering the scans has increased markedly in the last five years.
Constance Lehman, another member of the panel that wrote the guidelines and a professor of radiology at the University of Washington and the Seattle Cancer Care Alliance, said that professional societies in radiology were scrambling to provide training and accreditation for breast MRI. Lehman said doctors were worried that not all women who needed the scans could get them, and that some women who did not need them were having them anyway. Examples of misuse, she said, included performing MRI as the first step in a woman with a breast lump, or in a woman with an average breast cancer risk as the next step after an abnormal mammogram (the next step is generally considered to be another type of mammogram).
U.S. insurers will probably cover the scans, because the new guidelines are based on good evidence and promoted by a respected medical group, said Peter Lee, president of the Pacific Business Group on Health, a nonprofit coalition of large purchasers of health care that cover about five million people. Huge amounts of money are now being wasted on unnecessary MRI, Lee said. "Here we have a case where there's evidence. Hallelujah! Let's use it."
Not every imaging center is qualified to perform breast MRI, but some that are not up to par may offer it anyway, so patients should beware. Special equipment is needed: a powerful, "high-field" magnet and a special breast coil to generate a magnetic field around the breast. The scan is done with the woman lying on her stomach on a special table with openings that let the breasts rest in wells surrounded by the coil. "And you have to make sure they're doing enough, not one a week, and make sure they have biopsy capability," Morris said. If the breast scan is done at a center that cannot perform biopsies, a woman with a suspicious finding may have to start all over again at another clinic.
The second new report describes a study showing that in women who had cancer in one breast, an MRI scan of the other breast found tumors that mammograms had missed in 3 percent of the women. Researchers say MRI can help women who already have one cancer by detecting a hidden tumor in the other breast, enabling them to have both cancers treated at once instead of having to go through treatment all over again when the second tumor finally grows big enough to feel or to show up on a mammogram. Research has shown that 10 percent of women in the United States who have cancer in one breast will eventually develop it in the other as well. The fear of recurrence or a new cancer hangs over many cancer patients, and most dread the idea of a second round of surgery, chemotherapy and radiation.
"This study supports the recommendation that women who are diagnosed with breast cancer consider the benefits of a breast MR," said Lehman, the senior author of the study. "What we think is most important is that we understand the full extent of a woman's breast cancer before her therapy is initiated."The scans are recommended in newly diagnosed cases, but not for most women who had breast cancer treated in the past. Currently, women with newly diagnosed cancer in one breast are given mammograms of the other, but only a minority are offered MRI, Lehman said.
This year, about 180,000 new cases of breast cancer are expected in the United States.Some surgeons think every woman with a new diagnosis of breast cancer should have an MRI of the other breast, and some think no one should, Morris said. "It all depends on your surgeon's belief that this is important information. Some surgeons use it religiously, others do not," Morris said. She said the scans were most likely to be useful in younger women with breast cancer and dense breast tissue that hides tumors from mammograms. In older women with small, early tumors and clear mammograms, she said, MRI is less important.
The findings will make it harder for insurance companies to refuse to pay for MRI of the second breast in women with breast cancer, said Dr. Etta Pisano, another author of the study and a professor of radiology at the University of North Carolina. The study, conducted at 25 medical centers, included 969 women with recently diagnosed cancer in one breast and a normal mammogram on the other. All were given MRI scans, which discovered cancers in the supposedly healthy breast in 30 women, 3.1 percent of the group. Nearly all the cancers were at an early stage, and were treated at the same time as the ones originally discovered.
A diagnosis rate of 3.1 percent may seem small, but the researchers said it actually was high, 10 times as many tumors as screening mammograms find. Without the MRI, Lehman said, the tumors would not have been found until later, and then the women would have had to go through surgery, and perhaps radiation and chemotherapy as well, all over again.
"We know cancers diagnosed later in these women don't do as well as cancers diagnosed initially," she said." We can cure breast cancer when we detect it early and treat it effectively. Early is better than late. "But to find the 30 cancers, 121 women had biopsies, which were ordered because of abnormalities on MRI. That means 91 false-positive scans and biopsies of healthy tissue, and a false-positive rate of about 10 percent. Lehman said most cancer patients were willing to accept the risk of a false-positive and a biopsy in order to find out whether there was anything to worry about in the other breast. The study was paid for by the National Cancer Institute.
Interesting, preventions should be number one concern of any health care institution/ governemnts but unfortunately it is not and it seems to be expensive too.
there should be screenings of whole populations, especially in ones with a higher risk for breast cancer.
NEW YORK: A highly touted and widely used computerized system for examining mammograms is leading to less accuracy, not more, a new study finds.
Computer software programs, known as computer-aided detection, or CAD, did not find more breast cancer, researchers reported Wednesday. But they did lead to many more false alarms that resulted in additional testing and biopsies for spots on a mammogram that turned out to be harmless.
Computer-aided detection is being used in 30 percent of mammography facilities, according to the National Cancer Institute. The equipment is expensive, costing $50,000 to $175,000, but Medicare pays an extra $20 for each mammogram read with it, making it profitable for large centers to use it. Many administrators at large centers felt they had to have it to be competitive. Doctors also worried about lawsuits if they were not using it and missed a cancer.
But all along, as more and more mammography centers bought the software, the assumption was that the computer would find cancers that radiologists would miss, saving women's lives.
The new findings are likely to surprise radiologists, said Dr. Ferris Hall, a radiology professor at Harvard Medical School and a radiologist at Beth Israel Deaconess Medical Center in Boston. Hall wrote an editorial accompanying the paper, which was published today in the New England Journal of Medicine.
"I was surprised," Hall said. "A lot of people will be amazed."
The study's lead author, Dr. Joshua Fenton of the University of California at Davis, stressed that women should continue to have mammograms.
But, he said, women might want to ask if their mammography facility uses computer-aided detection.
His study, he said, "does raise concerns that technology is causing harm without clear benefit."
That is not such a concern in Europe, Hall said, where the technology is used much less often.
"They feel they shouldn't spend that much money," for screening, he explained. "In this country, for breast cancer, the money is infinite."
But in the United States, the new look at computer-aided detection is the latest sally in the changing era of breast cancer detection. New technology, like computer-aided detection and digital mammography and MRIs and ultrasound can be so sensitive that doctors have trouble deciding which findings are worrisome and which are not. The only screening method that has been rigorously evaluated is old fashioned X-ray film mammograms, but it is likely to be replaced by something, or some combination of things, whose benefits and risks are largely unknown.
"We are getting ourselves out on thinner and thinner ice," said Dr. Suzanne Fletcher, an emerita professor of medicine at Harvard Medical School.
"With mammography, we have multiple studies showing this is what happens to mortality rates if you get this versus if you don't," Fletcher said. "With these newer technologies, we don't."
The new study of computer-aided detection was an analysis of 429,345 mammograms obtained between 1998 and 2002 at 43 mammography centers. During that time, seven of the centers switched to the new system, computer-aided detection. That enabled the investigators to compare results with and without computer software to help radiologists find suspicious spots.
Computer-aided detection, the researchers wrote, "was associated with significantly higher false positive rates, recall rates, and biopsy rates and with significantly lower overall accuracy."
With computer-aided detection, 31 percent more women were called in for additional tests and 20 percent more had biopsies. There was another potential problem. CAD did not clearly increase the detection of breast cancer. If anything, it seemed to increase the detection of a precancerous condition, DCIS, for ductal carcinoma in situ.
While all invasive breast cancer is believed to start as DCIS, DCIS is often harmless. It either never develops into cancer or it grows so slowly that it is not a danger during the woman's lifetime. But, unable to tell which DCIS lesions will become deadly, doctors generally treat them all.
When computer-aided detection was introduced at the seven facilities, the number of cancers detected did not change. But percentage of cancers that were DCIS increased significantly from 28.1 percent to 37.4 percent.
Fenton is agnostic about the DCIS implications. One way of looking at the data is to say that if the point of screening is to find cancers early, before they are dangerous, then finding more DCIS is good. But, he said, doctors had hoped CAD would find more invasive cancers that are on a road to metastasis.
"We didn't find that," he said.
Others were more adamant, saying that the detection of DCIS is unlikely to have much effect if any on the breast cancer death toll but it will lead to more women being told they have cancer and undergoing treatment.
"There is enormous uncertainty about what the significance of these lesions is," said Dr. Rebecca Smith-Bindman, an associate professor of Associate Professor of Radiology, Epidemiology and Biostatistics, Obstetrics, Gynecology and Reproductive Medicine at the University of California, San Francisco. When a test finds more DCIS and less invasive cancer, she added, "personally, I consider it a harm, not a benefit."
In a sense, it might be expected that computer-aided detection performed the way it did, researchers said. The computer program marks four or five spots on the average screening mammogram. A radiologist then looks at those marks and decides if they are cause for concern. That means that a radiologist will see about 2000 computer marks that are inconsequential for every one that is a real cancer. To the computer software, tiny flecks of calcium, which are hallmarks of DCIS, are much easier to spot than invasive cancers.
"If you put five extra dots on every mammogram, radiologists will call or will be tempted to call many more things abnormal," Smith-Bindman said.
"One way to put the whole package together is to say CAD really is not helping us much," Smith-Bindman said. "It's tricky because places have invested in this technology."
But, she said, if other studies confirm the results, "I think you have to take it as a loss and move on."
Hall, however, doubts that many centers will abandon their expensive investment, especially when it is so profitable. He expects that CAD will be refined and improved while breast cancer screening keeps changing with new technologies.
"The primary reasons we got CAD are that is was financially good for us and that everyone else was getting it. It was a competitive thing." Hall said. But, he said, although the new results were a substantial hit, "there is no way CAD is dead."
April 26, 2007 -- Two couples whose families have been ravaged by breast cancer are to become the first to screen embryos to prevent them having children at risk of the disease, The Times has learnt.
Tests will allow the couples to take the unprecedented step of selecting embryos free from a gene that carries a heightened risk of the cancer but does not always cause it. The move will reignite controversy over the ethics of embryo screening.
An application to test for the BRCA1 gene was submitted yesterday by Paul Serhal, of University College Hospital, London. It is expected to be approved within months as the Human Fertilisation and Embryology Authority (HFEA) has already agreed in principle.
Opponents say that the test is unethical because it involves destroying some embryos that would never contract these conditions if allowed to develop into children. Even those that did become ill could expect many years of healthy life first.
Some critics fear that the tests move society farther down a slope that will lead ultimately to the creation of “designer babies” chosen for looks or intelligence.
However, the first patients say that the technology will allow them to spare their children a devastating genetic inheritance. One couple in their twenties, who would only be named as Matthew and Helen, have lost three generations to breast cancer.
Last May, the watchdog ruled it acceptable for doctors to screen embryos for genes such as BRCA1, which raise the risk of cancer in adulthood by between 60 and 80 per cent. Embryo screening was previously restricted to genes that carry a 90 to 100 per cent chance of causing disease.
The application is the first to be made under the new regime after a year of research to identify the precise mutations that affect Mr Serhal’s patients. Approval is likely in three to four months, once the HFEA has confirmed that the tests are reliable.
Women with a defective BRCA1 gene also have a 40 per cent risk of ovarian cancer. It is linked to prostate and breast cancer in men, who can also inherit it benignly and pass it on to their daughters.
Mr Serhal said that objections to screening ignored the harrowing family histories of the patients he is seeking to help, who have a chance to ensure their children avoid similar experiences. “We are talking about a killer that wipes out generation after generation of women,” Mr Serhal said. “You can have a preventive mastectomy, but this is traumatic and mutilating surgery that does not eliminate the risk.
“What we are trying to do here is to prevent this inherited disease from being a possibility in the first place. At least with these people’s children, we can annihilate the gene from the family tree.” Genes have also been identified that raise the risk of conditions such as obesity, heart disease and mental illness. However, more than one gene is usually involved and the HFEA will not currently approve screening for these.
Supporters of screening point out that patients must use IVF even if fertile, and that many couples carrying defective genes will not choose this option. The HFEA code of practice also makes it clear that screening is allowed only for serious conditions.
When the licence is awarded, the couples will have IVF. This will allow a single cell to be removed from the embryo at the eight-cell stage, and tested for the defective BRCA1 gene. Only unaffected embryos will then be transferred to the womb.
Though the HFEA decided last May to accept applications to do this, after a public consultation was supportive, it has taken Mr Serhal’s team a year to develop a robust test for the specific mutations in the gene that each family carries.
The HFEA will not reconsider the ethics of screening, but will ask independent experts to review the reliability of the tests before awarding a licence. “We are very confident because the HFEA has already said in principle that this is OK,” Mr Serhal said.The HFEA said: “Each application for conditions such as this must be considered on a case-by-case basis because of the difference in the way that families are affected by these conditions.”
Josephine Quintavalle, of the embryo rights group, Comment on Reproductive Ethics, said: “There has to be a better way of curing disease than this. It is very likely that in the not-too-distant future there will be a way of treating breast cancer that doesn’t rely on eliminating the carrier instead of curing the disease.”
Last year, The Times revealed the conception of Britain’s first “designer baby”, screened as an embryo for inherited cancer. The baby has since been born healthy, free from the gene carried by her mother that would have given her a 90 per cent chance of developing retinoblastoma, an eye tumour.
Favorites
Digg
Del.icio.us
Furl
Magnolia
StumbleUpon
Google
Yahoo MyWeb
Linear Mode
