Hopes raised for MS treatment

Professor Wynick set up research into the effects of galanin on MS

Scientists in Bristol claim results from a research project into multiple sclerosis (MS) could lead to treatment to reduce the severity of the disease.

The team carried out tests on mice and then on human brain tissue and found galanin, a protein within brain nerve cells, was resistant to MS.

Professor David Wraith at the University of Bristol said the results were "extremely promising".

The team said it could be at least 10 years before a drug is developed.

Professor David Wynick, who works on the function of galanin, set up the project with a group of other scientists working on the development of a vaccine for the treatment of multiple sclerosis.

He said: "It has been known for some time that galanin plays a protective role in both the central and peripheral nerve systems - when a nerve is injured levels of galanin increase dramatically in an attempt to limit cell death."

The team discovered that mice with high levels of galanin were completely resistant to the MS-like disease, experimental autoimmune encephalomyelitis (EAE). Transgenic mice that contained no galanin at all developed a more severe form of the disease.

MS is a neurological condition that affects the transfer of messages from the central nervous system to the rest of the body.

It is the most common neurological disorder among young adults, affecting 85,000 people in the UK with 2,500 newly diagnosed each year.

There is no cure for MS, but drugs can be used to reduce the number and severity of relapses, and to reduce the number of new attacks.

Dr Doug Brown, research manager at the MS Society, said: "This is an early study and there's a long way to go before we understand what this means for people with MS, but any insight into how MS might be treated is valuable to researchers.

"This is worth further investigation."

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California jail release vote due

By Rajesh Mirchandani BBC News, Los Angeles

The riot at a south California prison has been blamed on 'racial tensions'

California lawmakers are to vote on a plan to release 27,000 prisoners early.

The proposal is part of a solution to a $26bn dollar budget deficit and the problem of chronic prison overcrowding.

It comes soon after a prison riot in which hundreds of inmates were hurt. The prison was holding well over its official capacity.

A federal court recently ruled that conditions in California's prisons were appalling and ordered inmate numbers to be cut by 40,000.

The early release of thousands of prisoners could save California more than a billion dollars as well as easing overcrowding.

Opponents of the idea say it will put dangerous criminals back on the streets.

Thanks to tough laws the state has nearly 170,000 people in prisons that were designed for far fewer.

California Governor Arnold Schwarzenegger thinks releasing low-level offenders - like those near the end of their sentences - would be a better use of scarce resources.

However, no politician here wants to be seen as soft on crime. So, lawmakers are divided but they must reach agreement.

Just two weeks ago, prisoners rioted at a facility near Los Angeles, setting fire to cell blocks. More than 100 were injured at the California Institution for Men in the southern town of Chino. Racial tensions were blamed.

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1,000 cameras 'solve one crime'

London is one of the world's most monitored cities

Only one crime was solved by each 1,000 CCTV cameras in London last year, a report into the city's surveillance network has claimed.

The internal police report found the million-plus cameras in London rarely help catch criminals.

In one month CCTV helped capture just eight out of 269 suspected robbers.

David Davis MP, the former shadow home secretary, said: "It should provoke a long overdue rethink on where the crime prevention budget is being spent."

The Metropolitan Police has been extraordinarily slow to act to deal with the ineffectiveness of CCTV David Davis MP

He added: "CCTV leads to massive expense and minimum effectiveness.

"It creates a huge intrusion on privacy, yet provides little or no improvement in security.

"The Metropolitan Police has been extraordinarily slow to act to deal with the ineffectiveness of CCTV."

Nationwide, the government has spent £500m on CCTV cameras.

But Det Sup Michael Michael McNally, who commissioned the report, conceded more needed to be done to make the most of the investment.

He said: "CCTV, we recognise, is a really important part of investigation and prevention of crime, so how we retrieve that from the individual CCTV pods is really quite important.

"There are some concerns, and that's why we have a number of projects on-going at the moment."

Among those projects is a pilot scheme by the Met to improve the way CCTV images are used.

Officers from 11 boroughs have formed a new unit which collects and labels footage centrally before distributing them across the force and media.

It has led to more than 1,000 identifications out of 5,260 images processed so far.

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'Oscar's miraculous recovery'

By Jane Elliott Health reporter, BBC News

Oscar is now fully recovered

Oscar Parry has had leukaemia twice, three bone marrow transplants and five brain haemorrhages.

His doctor says it is a "miracle" that the 10-year-old Essex boy is still alive and is back at school as well as fundraising for the hospital that saved him.

His mother Yvonne said: "Even by Great Ormond Street Hospital standards he is doing well."

Oscar was born with a genetic syndrome called Noonan's Syndrome which left him with a minor heart condition and slightly small for his age.

Treatment regime

Doctors thought these were the only side effects, but no one knew that the condition had also made him vulnerable to leukaemia and at the age of three he developed acute lymphoblastic leukaemia (ALL) - one of the most common forms of the disease

To begin with, Oscar was treated with low doses of chemotherapy, which worked well.

However, after three years of treatment his blood counts dropped and he was diagnosed with a rarer, more aggressive, type that could only be cured by a bone marrow transplant.

A lot of special stuff goes on here and a lot of sick children get better, but he is probably at the top of our list Dr Paul Veys

After three months a good match was found and Oscar had his first transplant. But his blood counts remained low and he needed an operation to remove his spleen. For some time this made a difference.

But just as he was set to go home, his leukaemia came back and a second, more experimental, type of transplant was needed.

Oscar's doctor at Great Ormond Street, Paul Veys, head of the bone marrow transplant unit ,said they gave him just a 10% chance of survival.

His mother said this was one of the worst times for the family.

More battles

But Oscar's battles were not over as he then developed a very virulent version of graft-versus-host disease, where the new donor cells start to fight the patient's body.

This is not uncommon following a transplant, but Oscar was very ill and spent weeks in intensive care with infections.

"There were times when Oscar was in intensive care and we thought he wouldn't make it," said his mother.

"It was numbing.

Oscar had leukaemia twice

"The first time he went into intensive care and had brain haemorrhages I was making his funeral arrangements."

Dr Veys agreed that things had been fraught.

"He had one genetic disease and two, or possibly three, leukaemia at various times," he said.

"He needed three transplants, the third with slightly specialised cells - he was the first child to be treated in the UK with this treatment.

"The bottom line is you do a transplant to try and cure the leukaemia, it comes back, you do the second transplant in a different way making the new cells fight like crazy but then they fight too much so we have to switch them off and that is the the reason for the third specialised cells, and the chances of his coming through that were extremely small.

"The horrible irony is that it's often not the leukaemia that gets you, it's the heavy treatment or the after-effects of it, either the infections or the graft-versus-host disease."

Yvonne said things are now looking very rosy, although Oscar does have osteoporosis due to two years on steroids.

His growth also halted while he was taking the drugs, and his teeth were not replaced as he lost them.

This is all starting to improve and Oscar, aged 10 is now even boasting that he's taller than his four year old brother, Finn.

"We came home June 2007 and have not been back since and his immune system is running at about 75%," said Yvonne.

"He went back to school in February 2008 and is absolutely loving it and joining in with everything.

"He is great and we have a normal family life now."

'Not a dry eye'

Dr Veys, said Oscar is a star.

"A lot of special stuff goes on here and a lot of sick children get better, but he is probably at the top of our list.

Oscar is now back at school

"Not many children survive three procedures, but his outlook is very good now and he is helping fundraising by giving presentations to major donors.

"He is very good and will stand up in front of a crowd.

"He looks younger than he is, and when he tells his dramatic story there is not a dry eye in the house."

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A step closer to 'synthetic life'

By Victoria Gill Science reporter, BBC News

The cells replicated to produce a new strain of Mycoplasma mycoides

In what has been described as a step towards the creation of a synthetic cell, scientists have created a new "engineered" strain of bacteria.

A team successfully transferred the genome of one type of bacteria into a yeast cell, modified it, and then transplanted into another bacterium.

This paves the way to the creation of a synthetic organism - inserting a human-made genome into a bacterial cell.

The team describe the work in the journal Science.

This advance, the researchers say, overcomes the obstacle of making a new inserted genome work inside a recipient cell.

The experiment was carried out by a team that included scientist J Craig Venter, a leading figure in the controversial field of synthetic biology.

Sanjay Vashee, a researcher at the J. Craig Venter Institute in Rockville, Maryland, in the US, was one of the authors.

The resulting cell he and his team created went on to undertake multiple rounds of cell division, to produce a new strain of the modified bacteria.

Dr Vashee explained to BBC News that the work overcame a hurdle in the quest to create a fully synthetic organism.

J. Craig Venter is a leading figure in this controversial field

"Bacteria have 'immune' systems that protect them from foreign DNA such as those from viruses," he explained.

He and his colleagues managed to disable this immune system, which consists of proteins called restriction enzymes that home in on specific sections of DNA and chop up the genome at these points.

Bacteria can shield their own genomes from this process by attaching chemical compounds called methyl groups at the points which the restriction enzymes attack.

The scientists modified the original genome of the bacterium Mycoplasma mycoides, whilst it was inside the yeast cell. Then they either attached methyl groups to it, or inactivated the restriction enzyme of the recipient bacterium, before transplanting the genome into its new cell.

One of the team's ultimate aims is to transplant a fully synthetic genome into a bacterial cell - creating bacteria that can be programmed to carry out specific functions - for example, digesting biological material to produce fuel.

Race for life

Researchers at the same institute have already synthesised the complete genome of a bacterium they have called Mycoplasma genitalium. Dr Vashee described this work as a "logical extension" of that.

He told BBC News that attempts to create a synthetic bacterium by transplanting M. genitalium into a cell were "ongoing".

"We have as of yet no conclusive proof that we have obtained M. genitalium cells after its genome has been put into various recipient cells," he said.

"[But this] is a major advance in our effort to create a synthetic cell."

Dr Vashee continued: "We were very concerned that the differences between the modifications in... bacterial DNA and [yeast] DNA might be an insurmountable barrier, preventing transplantation into bacteria of genomes that were passed through yeast.

"Now we know how to do this."

Critics have expressed reservations about synthetic biology, and the aim to create what has been widely referred to as artificial life.

Many are concerned that the technology to engineer organisms could end up in the wrong hands.

Dr Vashee concluded: "Dr Venter and the team at JCVI continue to work with bioethicists, outside policy groups, [politicians], and the public to encourage discussion and understanding about the societal implications of their work and the field of synthetic genomics."

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Healthcare around the world : Healthcare Comparisons

Healthcare around the world

United States - Private system

Private sector funded, with more than half from private sources. Private health insurance available through employer, government or private schemes.

Millions of people in the US are not covered by health insurance

15.3% of population (45.7 million people) do not have health insurance.

Federal government is largest healthcare insurer - involved in two main schemes, Medicaid and Medicare, each covering about 13% of population.

Medicaid - joint funded federal-state programme for certain low income and needy groups - eg children, disabled.

Medicare - for people 65 years old and above and some younger disabled people and those with permanent kidney failure undergoing dialysis or transplant.

Most doctors are in private practice and paid through combination of charges, discounted fees paid by private health plans, public programmes, and direct patient fees.

In-patient care is provided in public and private hospitals. Hospitals are paid through a combination of charges, per admission, and capitation.

UK - Universal, tax-funded system

Public sector funded by taxation and some national insurance contributions.

Emergency ambulances are part of free NHS service

About 11% have private health insurance. Private GP services very small.

Healthcare free at point of delivery but charges for prescription drugs (except in Wales), ophthalmic services and dental services unless exempt.

Exemptions include children, elderly, and unemployed. About 85% of prescriptions are exempt.

Most walk-in care provided by GP practices but also some walk-in clinics and 24-hour NHS telephone helpline. Free ambulance service and access to accident and emergency. In patient care through GP referral and follow contractual arrangements between health authorities, Primary Care Trusts and the hospital.

Hospitals are semi-autonomous self-governing public trusts.

France - Social insurance system

All legal residents covered by public health insurance funded by compulsory social health insurance contributions from employers and employees with no option to opt out.

Most people have extra private insurance to cover areas that are not eligible for reimbursement by the public health insurance system and many make out of pocket payments to see a doctor.

Patients pay doctor's bills and are reimbursed by sickness insurance funds.

Government regulates contribution rates paid to sickness funds, sets global budgets and salaries for public hospitals.

In-patient care is provided in public and private hospitals (not-for-profit and for-profit). Doctors in public hospitals are salaried whilst those in private hospitals are paid on a fee-for-service basis. Some public hospital doctors are allowed to treat private patients in the hospital. A percentage of the private fee is payable to the hospital.

Most out-patient care is delivered by doctors, dentists and medical auxiliaries working in their own practices.

Singapore - Dual system

Dual system funded by private and public sectors. Public sector provides 80% of hospital care 20% primary care.

Financed by combination of taxes, employee medical benefits, compulsory savings in the form of Medisave, insurance and out-of-pocket payments.

Patients expected to pay part of their medical expenses and to pay more for higher level of service. Government subsidises basic healthcare.

Public sector health services cater for lower income groups who cannot afford private sector charges. In private hospitals and outpatient clinics, patients pay the amount charged by the hospitals and doctors on a fee-for-service basis.

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Corporal Punishment in U.S. Schools

By M.J. Stephey Wednesday, Aug. 12, 2009

Dorling Kindersley / Getty

Impairing Education
American Civil Liberties Union and Human Rights Watch
Aug. 11, 2009
62 pages

The Gist:

It seems like a scene from Oliver Twist — a young pupil being beaten by a 300-lb man wielding an inch-thick wooden paddle — but according to a new report by Human Rights Watch and the American Civil Liberties Union, nearly a quarter of a million children were subjected to corporal punishment in public schools in the U.S. during the 2006-2007 academic year. Based on 202 interviews with parents, students, teachers and administrators, and supplemented with data from the U.S. Department of Education, the report reveals how the spare-the-rod-spoil-the-child philosophy continues to rule thousands of classrooms across America, and how students with disabilities are disproportionately affected by such draconian methods of discipline.

Highlight Reel:
1. What "corporal punishment" means: "Corporal punishment is defined under human-rights law as "any punishment in which physical force is used and intended to cause some degree of pain or discomfort." There is no comprehensive definition of corporal punishment under U.S. state or federal law. The ACLU and Human Rights Watch documented cases of corporal punishment including hitting children with a belt, a ruler, a set of rulers taped together or a toy hammer; pinching, slapping or striking very young children in particular; grabbing children around the arm, the neck or elsewhere with enough force to bruise; throwing children to the floor; slamming a child into a wall; dragging children across floors; and bruising or otherwise injuring children in the course of restraint."

2. On its widespread use in classrooms, especially in punishing disabled students: "Corporal punishment is legal under domestic law in 20 states ... Texas paddles the most students in the nation, as well as the most students with disabilities ... The total number of students, with and without disabilities, who were subjected to corporal punishment in the 2006-2007 school year was 223,190. ... Nationwide, students with disabilities receive corporal punishment at disproportionately high rates. In Tennessee, for example, students with disabilities are paddled at more than twice the rate of the general student population. ... Students with autism are particularly likely to be punished for behaviors common to their condition, stemming from difficulties with appropriate social behavior. ... Anna M., whose son with autism was physically punished repeatedly when he was seven years old, noted, "The teacher felt he was doing some stuff on purpose. If you met him, you wouldn't know he was autistic straight away. People thought we were making an excuse for him.' "

3. On why corporal punishment is still condoned: "Educators, who face the difficult task of maintaining order in the classroom, may resort to corporal punishment because it is quick to administer, or because the school lacks resources and training for alternative methods of discipline. One teacher pointed out that corporal punishment can be considered 'cost-effective. It's free, basically. You don't have to be organized. All you need is a paddle.' Logistical or financial obstacles may prevent teachers from using other methods of discipline. One 18-year-old student who was critical of the use of corporal punishment in his rural school district stated that 'we couldn't have after school detention. There was no busing. Kids who got detention would have to find another way home.' "

4. On the aftermath: "The Society for Adolescent Medicine has documented serious medical consequences resulting from corporal punishment, including severe muscle injury, extensive blood-clotting (hematomas), whiplash damage and hemorrhaging. ... Corporal punishment led to deterioration in family life, as parents were forced to withdraw children from school, resort to homeschooling and give up jobs. ... Rose C.'s son was unable to tell her that he was repeatedly punished in school, but she learned of some of the abuse after watching a security video. She said, 'I don't trust my own eyes anymore.' "

The Lowdown:
As the report notes, corporal punishment is banned in most juvenile correction facilities in the U.S., and yet it continues in public schools. The legal paradox can be traced to a 1977 Supreme Court ruling that found the Eighth Amendment only protects convicted criminals from cruel and unusual punishment — not students confined to a classroom. In its plea to convince federal and state lawmakers to impose a national ban on the practice, the authors point out yet another paradox, using the words of a special-ed teacher in Mississippi: "I see these children who get in fights and then get paddled. So you're supposed to teach them not to hit by hitting them?"

The Verdict: Read

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Pay Raises Are the Worst in 33 Years

By Barbara Kiviat Wednesday, Aug. 12, 2009

Photographer's Choice / Getty

Feel like your company has been particularly stingy on the raises this year? You're not imagining it. For 2009, the typical non-hourly worker will see a 1.8% bump in salary, according to a survey by the human-resources consultancy Hewitt Associates. That increase, the smallest in at least 33 years, doesn't even keep up with inflation.

Yes, it's true, we're in a recession, and nearly 1 in 10 workers is unemployed. There are plenty of people willing to work for less money. But in other recent recessions salary growth hasn't slowed this much. Going back to the early 1990s, base salaries never increased by less than 3.4% a year, according to Hewitt, which polled 1,156 large companies to get its latest data. Companies desperate to slash costs are turning to worker salaries more deliberately than they have in the past. Some 48% of companies have frozen salaries this year, compared to just 2% last year. (See 10 things to buy during the recession.)

Numbers from the Society for Human Resource Management (SHRM) speak to the same effect for new employees. Each month the human-resources trade group surveys more than 1,000 manufacturing and service-sector companies. The number of firms reducing new-hire salaries and benefits now outstrips the number of companies increasing packages. Falling compensation for new hires is unusual too, even during a downturn, according to analysts at SHRM — smaller increases are the more typical response.

One silver lining, according to the Hewitt survey, is that performance-based compensation is on the rise. If you've got the numbers to prove you're a top worker, your earnings are somewhat insulated from the broader trend. For 2009, a full 12% of corporate payrolls have been devoted to bonuses, according to Hewitt. That's up substantially in recent years, from just 9.5% in 2004.

The other hope on the horizon is 2010. Right now, companies are anticipating raising salaries an average of 2.7% next year. Of course, if the fledgling economic recovery doesn't stick, that could change quickly. When Hewitt ran its survey in the summer of 2008, companies thought 2009 raises would come in at 3.8% — a far cry from the 1.8% we were left with.

The Hewitt numbers also highlight differences across cities and industries. For 2010, raises are expected to be the largest in Houston (3.4%), Minneapolis/St. Paul (3%), Washington, D.C., (3%) and Des Moines (2.9%), with the smallest increases to be seen in San Francisco (2.4%), Los Angeles (2.2%) and Detroit (2.1%). In terms of industries, workers are projected to fare the best in energy (3.7%) and not as well in education (2%). Minnesota-based windmill repairmen have nothing to worry about. Just don't get a job teaching in Detroit.

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Ezekiel Emanuel, Obama's 'Deadly Doctor,' Strikes Back

By Michael Scherer / Washington Wednesday, Aug. 12, 2009

Dr. Ezekiel J. Emanuel, special adviser for health care at the Office of Management and Budget, speaks March 11 at the American Medical Association's annual conference in Washington

J. Scott Applewhite / AP

Dr. Ezekiel Emanuel, the medical ethicist and oncologist who advises President Obama, does not own a television, and if you catch him in a typically energized moment, when his mind speeds even faster than his mouth, he is likely to blurt out something like, "I hate the Internet." So it took him several days in late July to discover he had been singled out by opponents of health-care reform as a "deadly doctor," who, according to an opinion column in the New York Post, wanted to limit medical care for "a grandmother with Parkinson's or a child with cerebral palsy." (Read an interview with Obama on health care.)

"I couldn't believe this was happening to me," says Emanuel, who in addition to spending his career opposing euthanasia and working to increase the quality of care for dying patients is the brother of White House chief of staff Rahm Emanuel. "It is incredible how much one's reputation can be besmirched and taken out of context." (See pictures of health care for the uninsured.)

It would only get worse. Within days, the Post article, with selective and misleading quotes from Emanuel's 200 or so published academic papers, went viral. Minnesota Representative Michelle Bachmann, a fierce opponent of Obama's reform plans, read large portions of it on the House floor. "Watch out if you are disabled!" she warned. Days later, in an online posting, former Alaska Governor Sarah Palin attacked Emanuel's "Orwellian thinking," which she suggested would lead to a "downright evil" system that would employ a "death panel" to decide who gets lifesaving health care. By Aug. 10, hysteria had begun to take over in places. Mike Sola, whose son has cerebral palsy, turned up at a Michigan town-hall meeting to shout out concerns about what he regarded as Obama and Emanuel's plans to deny treatment to their family. Later, in an interview on Fox News, Sola held up the Post article. "Every American needs to read this," he declared. (Read "What Health-Care Reform Really Means.")

By this point, Emanuel, who has a sister who suffers from cerebral palsy, had arrived in northern Italy, where he planned to spend a week on vacation, hiking in the Dolomites. Instead, he found himself calling the White House, offering to book a plane home to defend his name. "As an academic, what do you have? You have the quality of your work and the integrity with which you do it," he said by phone from the Italian Alps. "If it requires canceling a week's long vacation, what's the big deal?" (Read TIME's cover story "Can Obama Find a Cure?")

The attacks on Emanuel are a reminder that there is a narrow slice of Americans who not only don't trust government, but also have come to regard it as a dark conspirator in their lives. This peculiar brand of distrust helps create the conditions for fast-moving fear-mongering, especially on complex and emotionally charged topics like the life and death of the elderly and infirm. Prairie fires of that kind are hard to douse when the Administration's own plan for health care remains vague, weeks away from being ready for a public rollout. The health-care bill that recently passed the House does not contain, as some have suggested, any provisions that would deny treatment to the elderly, infirm or disabled like Sola's son. One provision allows doctors to be reimbursed for voluntary discussions of so-called living wills with patients, but does not in any way threaten to deny treatment to dying patients against their will. The legislation anticipates saving hundreds of billions of dollars by reforming the health-care system itself, a process that would try to increase the efficiency of medical care by better connecting payments to health outcomes and discouraging doctors from unnecessary tests and procedures. The Obama Administration hopes that many of these reforms will be made in the coming years by independent panels of scientists, who will be appointed by the President and overseen by Congress. (See 10 health-care-reform players.)

This is where the criticism of Emanuel enters the picture, since he is just the sort of scientist who might be appointed to one of those panels. For decades, Emanuel has studied the ethics of medical care, especially in situations where a scarcity of resources requires hard decisions to be made. His work sometimes deals with the hardest possible decisions, like how to choose who gets a single kidney if there are three patients in need, or the reasons that doctors order tests with little medical value. Emanuel's reputation ranks him among the top members of his field. He is published often in the best journals; he has been given multiple awards for work to improve end-of-life care. At the White House, he has taken a free-floating role at the Office of Management and Budget, advising on a wide range of health issues.

But in a country where trust is in short supply, Emanuel has become a proxy for all the worst fears of government efforts to rein in costs by denying care. "The fundamental danger is that the American people are being asked to delegate all these life-influencing decisions," explains Betsy McCaughey, the conservative scholar who wrote the New York Post attack on Emanuel. "There is a lack of transparency here."

In her Post article, McCaughey paints the worst possible image of Emanuel, quoting him, for instance, endorsing age discrimination for health-care distribution, without mentioning that he was only addressing extreme cases like organ donation, where there is an absolute scarcity of resources. She quotes him discussing the denial of care for people with dementia without revealing that Emanuel only mentioned dementia in a discussion of theoretical approaches, not an endorsement of a particular policy. She notes that he has criticized medical culture for trying to do everything for a patient, "regardless of the cost or effects on others," without making clear that he was not speaking of lifesaving care but of treatments with little demonstrated value. "No one who has read what I have done for 25 years would come to the conclusions that have been put out there," says Emanuel. "My quotes were just being taken out of context."

For Emanuel, the entire experience has been a painful education in the sometimes brutal ways of politics, something his brother has long endured and dolled out. "I guess I have a better appreciation for what Rahm had to go through for years and years," Emanuel says. But that appreciation does not solve the question raised by the controversy. There is universal understanding that the nation's fiscal course is doomed without major changes to health care, but whom will the American people trust to carry it out?

Emanuel, for his part, plans to continue his work, which is focused on finding the most equitable and ethical way for this reform to be carried out, even if he has opted against returning from the Italian Alps. "I am an Emanuel," he says. "We are pretty thick-skinned. I am not going to change my colors. I am not going to crawl under a rock."

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Why MRIs Don't Lead to Better Cancer Survival

By Alice Park Thursday, Aug. 13, 2009

Darren Kemper / Corbis

Women diagnosed with early stage breast cancer are faced with a tough choice — either to have parts of the affected breast removed, followed by several weeks of potentially toxic radiation therapy; or opt for mastectomy, removing the entire breast and contending with the disfigurement that entails. The decision typically rests on where and how widespread the tumors are. It's no wonder, then, that more and more women are relying on high-tech MRI scans to help them examine their cancer and choose the right treatment.

But that may not be such a good idea, say researchers in a commentary appearing in CA : A Cancer Journal for Clinicians, a publication of the American Cancer Society. The authors looked at studies of such pre-operative use of MRI (magnetic resonance imaging), which relies on magnetic waves, versus mammograms and similar tests that use radiation to take pictures of breast tissue. Researchers found that women choosing MRIs often ended up with more aggressive surgery — much of which wasn't necessary — than women who did not use the scans. What's more, employing the newer and more sensitive MRI technology did not improve a woman's chance of surviving cancer or her chances of avoiding a recurrence of tumors. (See portraits of breast cancer survivors.)

While there is no doubt that MRIs are more sensitive than mammograms, says Dr. Daniel Hayes, clinical director of breast oncology at the University of Michigan Comprehensive Cancer Center and a co-author of the commentary, it's not clear that the technique is more specific than mammography. Studies of each diagnostic screen have shown that compared to mammograms, MRIs can pick up additional cancer lesions 16% of the time. "But," says Hayes, "the question is whether they are biologically important."

The risk of recurrence in women treated for early stage breast cancer ranges from 5% to 10% in the 10 years after diagnosis. Three decades of studies also support the fact that lumpectomy combined with radiation therapy yields the same survival and recurrence rates as mastectomy; while more cancer may remain in a breast following lumpectomy, these lesions are generally destroyed by the radiation, which gives the two procedures the same outcomes. Yet women receiving an MRI tend to choose the more invasive approach. (Read about the benefits of post-cancer weightlifting.)

Why? Because MRI is particularly good at diagnosing small tumors — and picking up abnormalities that mammograms may miss in young women with dense breast tissue — which may cause undue anxiety. Evidence suggests that women who opt for MRIs tend to react to seeing their lesions, whether they are cancerous or not, by removing their entire breast rather than just a portion of the tissue. "I just saw two patients who both had MRIs done at an outside institution, and both came in wanting mastectomies based on the MRI findings," says Dr. Anthony Lucci, a surgical oncologist at MD Anderson Cancer Center in Houston. Neither of the MRIs showed cancer, just abnormalities, says Lucci, but more and more patients are coming in and similarly requesting MRI not as a diagnostic screening tool, but as a prognostic one. And in those situations, "they are much more likely to request a mastectomy if the MRI reveals an abnormality," he says.

According to the studies that Hayes and his co-author, Dr. Nehmat Houssami, analyzed, such mastectomies are often unnecessary; earlier studies have shown that many of the small cancers that a lumpectomy may leave behind are in the same region as the surgery site, and therefore will most likely be destroyed by the radiation treatment that follows. "Radiation is very good," says Dr. Larry Norton, a breast cancer specialist at Memorial Sloan Kettering Cancer Center in New York City. "We do know that if you don't irradiate a breast after surgery, you get local recurrence." (Read "The Year in Medicine 2008: From A to Z.")

Aside from increasing the rate of radical surgery, the use of MRIs may also harm patients who already have a diagnosis. Patients may take several weeks to investigate the lesions, get biopsies and wait for pathology results, delaying the actual treatment of cancer.

So why do women continue to insist on MRI? Part of it has to do with the culture of technology: we believe that newer and more is better. Part of it also can be traced to a me-too spillover from the diagnostic arena. As a diagnostic tool, MRIs can be useful in picking up what mammograms may not find — which is why the American Cancer Society, for example, recommends both screens for otherwise healthy women with a strong family history of the disease and younger women with dense breast tissue.

Hayes acknowledges that MRIs may also prove useful in detecting spread of a breast cancer from one breast to the other, but even here, he says, the data are still preliminary; MRIs may pick up about 3% to 5% of tumors that mammograms miss, but there is little evidence suggesting whether those additional tumors are malignant or benign. To find out the true benefit of MRI, he says, more research needs to be conducted. "Without randomized trials we really don't know everything," says Norton.

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