Longer tamoxifen use cuts breast cancer deaths

Breast cancer patients taking the drug tamoxifen can cut their chances of having the disease come back or kill them if they stay on the pills for 10 years instead of five years as doctors recommend now, a major study finds.

The results could change treatment, especially for younger women. The findings are a surprise because earlier research suggested that taking the hormone-blocking drug for longer than five years didn't help and might even be harmful.

In the new study, researchers found that women who took tamoxifen for 10 years lowered their risk of a recurrence by 25 percent and of dying of breast cancer by 29 percent compared to those who took the pills for just five years.

In absolute terms, continuing on tamoxifen kept three additional women out of every 100 from dying of breast cancer within five to 14 years from when their disease was diagnosed. When added to the benefit from the first five years of use, a decade of tamoxifen can cut breast cancer mortality in half during the second decade after diagnosis, researchers estimate.

Some women balk at taking a preventive drug for so long, but for those at high risk of a recurrence, "this will be a convincer that they should continue," said Dr. Peter Ravdin, director of the breast cancer program at the UT Health Science Center in San Antonio.

He reviewed results of the study, which was being presented Wednesday at a breast cancer conference in San Antonio and published by the British medical journal Lancet.

About 50,000 of the roughly 230,000 new cases of breast cancer in the United States each year occur in women before menopause. Most breast cancers are fueled by estrogen, and hormone blockers are known to cut the risk of recurrence in such cases.

Tamoxifen long was the top choice, but newer drugs called aromatase inhibitors — sold as Arimidex, Femara, Aromasin and in generic form — do the job with less risk of causing uterine cancer and other problems.

But the newer drugs don't work well before menopause. Even some women past menopause choose tamoxifen over the newer drugs, which cost more and have different side effects such as joint pain, bone loss and sexual problems.

The new study aimed to see whether over a very long time, longer treatment with tamoxifen could help.

Dr. Christina Davies of the University of Oxford in England and other researchers assigned 6,846 women who already had taken tamoxifen for five years to either stay on it or take dummy pills for another five years.

Researchers saw little difference in the groups five to nine years after diagnosis. But beyond that time, 15 percent of women who had stopped taking tamoxifen after five years had died of breast cancer versus 12 percent of those who took it for 10 years. Cancer had returned in 25 percent of women on the shorter treatment versus 21 percent of those treated longer.

Tamoxifen had some troubling side effects: Longer use nearly doubled the risk of endometrial cancer. But it rarely proved fatal, and there was no increased risk among premenopausal women in the study — the very group tamoxifen helps most.

"Overall the benefits of extended tamoxifen seemed to outweigh the risks substantially," Dr. Trevor Powles of the Cancer Centre London wrote in an editorial published with the study.

The study was sponsored by cancer research organizations in Britain and Europe, the United States Army, and AstraZeneca PLC, which makes Nolvadex, a brand of tamoxifen, which also is sold as a generic for 10 to 50 cents a day. Brand-name versions of the newer hormone blockers, aromatase inhibitors, are $300 or more per month, but generics are available for much less.

The results pose a quandary for breast cancer patients past menopause and those who become menopausal because of their treatment — the vast majority of cases. Previous studies found that starting on one of the newer hormone blockers led to fewer relapses than initial treatment with tamoxifen did.

Another study found that switching to one of the new drugs after five years of tamoxifen cut the risk of breast cancer recurrence nearly in half — more than what was seen in the new study of 10 years of tamoxifen.

"For postmenopausal women, the data still remain much stronger at this point for a switch to an aromatase inhibitor," said that study's leader, Dr. Paul Goss of Massachusetts General Hospital. He has been a paid speaker for a company that makes one of those drugs.

Women in his study have not been followed long enough to see whether switching cuts deaths from breast cancer, as 10 years of tamoxifen did. Results are expected in about a year.

The cancer conference is sponsored by the American Association for Cancer Research, Baylor College of Medicine and the UT Health Science Center.

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Blue chips lead Wall Street bounce back

NEW YORK (Reuters) - Stocks swung back to positive territory in late morning trading on Wednesday, led by gains in Dow components Caterpillar and The Travelers , while Citigroup's 5 percent gain boosted bank stocks.

The Dow Jones industrial average <.dji> rose 72.71 points, or 0.56 percent, to 13,024.49. The S&P 500 <.spx> edged up 1.49 points, or 0.11 percent, to 1,408.54. The Nasdaq Composite <.ixic> dropped 17.86 points, or 0.60 percent, to 2,978.82.

Apple shares, down more than 4 percent, were the biggest drag on the Nasdaq.

(Reporting by Rodrigo Campos; Editing by Jan Paschal)

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Royal Baby a ‘Delight,’ Especially to Britain’s Tabloids

LONDON — The speculation began virtually the moment Kate Middleton said “I will” to Prince William in April 2011, leaving an industry of tabloid newspapers and gossip magazines with a big black hole where their wedding coverage used to be.

Why, they asked, was the former Ms. Middleton, now the duchess of Cambridge, drinking water instead of wine at an official dinner, in what appeared to be a deliberate manner? And those photographs in which her stomach seemed microscopically less flat than normal — what was that about?

On Monday, everyone who had incorrectly guessed what was going on before could now finally claim to be right. Yes, St. James’s Palace announced, the duchess had become pregnant.

The news should help everyone forget the previous big news about the duchess this year: the embarrassing publication of a series of topless — and one or two bottomless — photographs taken illicitly while she and the duke were on vacation in France.

Announcing the news on the royal Web site, the duke and duchess said they were “very pleased.” Meanwhile, other members of the royal family, which is not prone to effusions of public emotion, allowed that they were “delighted.”

On Twitter, Prime Minister David Cameron declared that he, too, was delighted.

The pregnancy is in its very early stages and has not yet reached the three-month threshold that would normally have prompted the announcement. But the duchess is in the hospital suffering from “acute morning sickness,” the palace said, and hospitalizations are hard to keep secret.

“Her royal highness is expected to stay in hospital for several days and will require a period of rest thereafter,” the palace said.

There are many interesting things about a future royal baby. First, it will be third in line to the throne, even if it is a girl; the laws of succession are poised to be changed for this very reason, with the new rule applying to Kate and William’s child. Second, its presence would make the chances of the current No. 3, Prince Harry, becoming king ever more remote, barring some bizarre development in which four generations of his family — his grandmother, his father, his brother and his future niece or nephew — all stepped aside.

Also, it gives Britain something to be excited about at a time when life here has not been so exciting, what with austerity and widespread flooding across huge parts of England after a period of nearly biblical rainfall.

“A royal baby is something the whole nation will celebrate,” the Labour leader, Ed Miliband, observed on Twitter. “Fantastic news for Kate, William and the country.”

In addition to being delighted, the prime minister revealed that in his opinion, the duke and duchess of Cambridge would be “wonderful parents.”

But few people could be more excited than the editors of the newspapers and magazines that cover the royal family, who with any luck will have months of things to write about: What will it be, boy or girl? How fat will the duchess look in her pregnancy clothes? What is happening behind closed doors?

Already, The Daily Mail has revealed a gaggle of purportedly insider-ish details about what is really going on, including the news that the duchess began feeling sick over the weekend and was “unable to keep any food or water down.”

It continued, “Sources suggested that the duchess was hooked up to an intravenous drip to increase her fluid and nutrient levels.”

The papers have also made much of a retrospectively significant incident from last Wednesday, when a member of the public handed Prince William a baby outfit decorated with a helicopter and the words “Daddy’s little co-pilot” — and William smiled as he accepted it.

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Prince William and Kate: What Will They Name the Baby?

By Anya Leon

12/04/2012 at 11:30 AM EST

Kate and Prince William

Pascal Le Segretain/Getty

The much-awaited news may be confirmed, but there's still plenty to buzz about when it comes to Prince William and wife Kate's baby announcement. Namely, well, the name.

With much speculation that the baby's moniker will honor William's late mother Diana, Europe's largest betting company is putting all their cards on the table for a spot in the name game.

According to Paddy Power, the odds that the royal couple will call their firstborn Mary, Victoria or John are 8-1; the popular choices of Diana and Frances stand at 9-1; while Charles, Philip, Anne and George round out the top picks at 10-1.

Will a little princess be named after her paternal grandmother? Or her paternal great-grandmother, Elizabeth? (Not likely with odds at 16-1). Or will the new parents choose to pay homage to William's grandfather and decide on Prince Philip?

No matter how the chips fall, don't expect to hear any crazy Hollywood baby names – the couple will more than likely keep their choice classic.

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Tapping citizen-scientists for a novel gut check

WASHINGTON (AP) — The bacterial zoo inside your gut could look very different if you're a vegetarian or an Atkins dieter, a couch potato or an athlete, fat or thin.

Now for a fee — $69 and up — and a stool sample, the curious can find out just what's living in their intestines and take part in one of the hottest new fields in science.

Wait a minute: How many average Joes really want to pay for the privilege of mailing such, er, intimate samples to scientists?

A lot, hope the researchers running two novel citizen-science projects.

One, the American Gut Project, aims to enroll 10,000 people — and a bunch of their dogs and cats too — from around the country. The other, uBiome, separately aims to enroll nearly 2,000 people from anywhere in the world.

"We're finally enabling people to realize the power and value of bacteria in our lives," said microbiologist Jack Gilbert of the University of Chicago and Argonne National Laboratory. He's one of a team of well-known scientists involved with the American Gut Project.

Don't be squeamish: Yes, we share our bodies with trillions of microbes, living communities called microbiomes. Many of the bugs, especially those in the intestinal tract, play indispensable roles in keeping us healthy, from good digestion to a robust immune system.

But which combinations of bacteria seem to keep us healthy? Which ones might encourage problems like obesity, diabetes or irritable bowel syndrome?

And do diet and lifestyle affect those microbes in ways that we might control someday?

Answering those questions will require studying vast numbers of people. Getting started with a grassroots movement makes sense, said National Institutes of Health microbiologist Lita Proctor, who isn't involved with the new projects but is watching closely.

After all, there was much interest in the taxpayer-funded Human Microbiome Project, which last summer provided the first glimpse of what makes up a healthy bacterial community in a few hundred volunteers.

Proctor, who coordinated that project, had worried "there would be a real ick factor. That has not been the case," she said. Many people "want to engage in improving their health."

Scott Jackisch, a computer consultant in Oakland, Calif., ran across American Gut while exploring the science behind different diets, and signed up last week. He's read with fascination earlier microbiome research: "Most of the genetic matter in what we consider ourselves is not human, and that's crazy. I wanted to learn about that."

Testing a single stool sample costs $99 in that project, but he picked a three-sample deal for $260 to compare his own bacterial makeup after eating various foods.

"I want to be extra, extra well," said Jackisch, 42. Differing gut microbes may be the reason "there's no one magic bullet of diet that people can eat and be healthy."

It's clear that people's gut bacteria can change over time. What this new research could accomplish is a first look at how different diets may play a role, said American Gut lead researcher Rob Knight of the University of Colorado, Boulder.

One challenge is making sure participants don't expect that a map of their gut bacteria can predict their future health, or suggest lifestyle changes, anytime soon.

"I understand I'm not going to be able to say, 'Oh, my gosh, I'll be susceptible to this,'" said Bradley Heinz, 26, a financial consultant in San Francisco. He is paying uBiome $119 to analyze both his gut and mouth microbiomes; just the gut is $69.

"The more people that participate, the more information comes out and the more that everybody benefits," he added.

Participants can sign up for either project via the social fundraising site Indiegogo.com over the next month. They also can send scrapings from the skin, mouth and other sites, to analyze that bacteria. Sign up enough family members or body sites, or be tracked over time, and the price can rise into the thousands. American Gut researchers plan some free testing for those who can't afford the fees, to try to increase the experiment's diversity.

Don't forget the pets: "We sleep with them, play with them, they often eat our food," said American Gut co-founder Jeff Leach, an anthropologist. What bacteria we have in common is the next logical question.

Already, American Gut researchers are preparing to compare what they find in the typical U.S. gut with a few hundred people in rural Namibia, who eat what's described as hunter-gatherer fare. Also, Leach will spend three months living in Namibia next year, and is storing his own stool samples for before-and-after comparison.

But diet isn't the only factor. Your bacterial makeup starts at birth: Babies absorb different microbes when they're born vaginally than when they're born by C-section, a possible explanation for why cesareans raise the risk for certain infections. Taking antibiotics, especially in early childhood, can alter this teeming inner world, and it's not clear if there are lasting consequences.

Then there's your environment, such as the infections spread in hospitals. In February, a new University of Chicago hospital building opens and Gilbert will test the surfaces, the patients and their health workers to see how quickly bad bugs can move in and identify which bacteria are protective.

Whatever the findings, all the research marks "a huge teachable moment" about how we interact with microbes, Leach said.

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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Online:

www.indiegogo.com/americangut

www.indiegogo.com/ubiome

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Wall Street flat, awaits movement on fiscal cliff talks

NEW YORK (Reuters) - Stocks were little changed in early trading on Tuesday as the market remains hostage to negotiations in Washington on how to avert a "fiscal cliff" that could push the U.S. economy into recession.

Republicans in Congress proposed steep spending cuts to bring down the budget deficit on Monday but gave no ground on President Barack Obama's call to raise taxes on the wealthiest Americans, and the proposal was quickly dismissed by the White House.

Headlines about the back-and-forth preliminary proposals by Republicans and Democrats have fixated the market. Still, many investors expect the two sides to come up with a deal before the year-end deadline, which could trigger a rally in equities.

"Support (for the market) is based on a belief that Washington will come to some agreement before we go over the fiscal cliff," said Art Hogan, managing director of Lazard Capital Markets in New York.

Hogan added, "On the first show of flexibility from either side, we'll get a relief rally."

Despite sudden moves in the market on the latest headlines about the fiscal cliff in recent days, a measure of investor anxiety has held surprisingly flat.

The CBOE volatility index <.vix>, a gauge of market anxiety, slipped to 16 and has not traded above 20 since July following its 2012 high near 28 hit in June. The VIX's 10-day Average True Range, an internal volatility measure, is at its lowest since early 2007.

Obama will meet with U.S. governors at the White House on Tuesday to talk about the fiscal cliff, a $600 billion package of tax hikes and federal spending cuts that would begin January 1.

The president is also expected to talk about the fiscal cliff during an interview scheduled for 12:30 p.m. (1730 GMT) on Bloomberg TV.

Coach became the latest company to advance the date of its next dividend payment. Expectations of higher taxes on dividends kicking in in 2013 have pushed many companies to pay special dividends this year or advance their next pay-back to investors.

The Dow Jones industrial average <.dji> rose 27.92 points, or 0.22 percent, to 12,993.52. The S&P 500 <.spx> edged up 0.44 points, or 0.03 percent, to 1,409.90. The Nasdaq Composite <.ixic> fell 4.44 points, or 0.15 percent, to 2,997.76.

Toll Brothers shares rose 1.8 percent to $33.01 after the largest U.S. luxury homebuilder reported a higher quarterly profit and said new orders rose sharply.

MetroPCS Communications shares dropped 6.5 percent to $10.07 after Sprint Nextel appeared unlikely to make a counter-offer for the wireless service provider.

Shares of Pep Boys-Manny Moe and Jack were down 12.4 percent at $9.36 a day after the release of the auto parts retailer's results.

(Reporting by Rodrigo Campos; Editing by Kenneth Barry)

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Pope Starts Personal Twitter Account

Osservatore Romano, via Reuters

Pope Benedict XVI using an iPad at the Vatican last year.

On Monday, the Vatican announced that the 85-year-old pontiff would begin posting messages on Twitter next week under the handle @pontifex, a term for pope that means bridge-builder in Latin. Within hours, he had more than 100,000 followers.

Benedict is expected to hit “send” on his first post at a general audience at the Vatican on Dec. 12 — a response to questions about matters of the faith that he is now accepting via the hashtag #askpontifex, officials said.

The Vatican acknowledged that it had chosen the @pontifex handle not only because of its meaning but also because many other handles had been taken.

The move is aimed at drawing in the church’s 1.2 billion followers, especially young people. “The pope’s presence on Twitter can be seen as the ‘tip of the iceberg’ that is the church’s presence in the world of new media,” the Vatican said in a statement.

Just do not expect the pope to start following you on Twitter or retweeting your posts, Greg Burke, a former Fox News correspondent in Rome who was named a Vatican communications adviser this year, said at a news conference. “He won’t follow anyone for now,” Mr. Burke added. “He will be followed.”

Benedict’s posts will go out in Arabic, English, French, German, Italian, Polish, Portuguese and Spanish. Other languages are expected to be added in the future. The messages will mostly feature the contents of the pope’s speeches at his weekly general audience and Sunday blessings, as well as homilies on major holidays and reaction to major world events, like natural disasters.

Aides will write the texts of Benedict’s posts, but the pope himself will “engage and approve” the content. The pope will post messages however often he feels like it.

“The pope is not the kind of person like the rest of us who in a meeting or a lunch is looking at their BlackBerrys to see if any messages have come in,” Mr. Burke said. “He is not walking around with an iPad, but all the pope’s tweets are the pope’s words.”

The pope’s account will not have special security, the Vatican said, but precautions have been taken to make sure the pope’s certified account is not hacked. All the posts will come from one computer in the Vatican’s Secretariat of State.

The prospect of the pope’s using Twitter has raised some puzzling theological questions. Asked whether the pope’s posts would be infallible, Msgr. Claudio Maria Celli, the president of the Pontifical Council for Social Communications, laughed and said that they would be part of the church Magisterium, or collective teaching, but should be considered “pearls of wisdom,” not exactly doctrine.

“In any case, it’s a papal teaching,” Monsignor Celli said. “The message is just entrusted to a new technology.”

A shy theologian who directed the Vatican’s doctrinal office for 25 years before becoming pope in 2005, Benedict is best known for complex theological positions that require far more than 140 characters to explain. His book “Jesus’s Childhood,” the last in his three-volume biography of Jesus, appeared last month and is a best seller in Italy.

The Catholic Church may be one of the slowest-changing institutions in the world, but when it comes to communicating with the faithful, it has generally been a pretty early adopter. In 1896, Pope Leo XIII became the first pope to appear on film. In 1931, Vatican Radio was founded, and Pope Piux XI was the first pope to make a radio broadcast. In 1949, Pope Pius XII was the first to appear on television.

In 2009, a Vatican Web site, www.pope2you.net, went live, offering an application called “The pope meets you on Facebook,” and another that allows readers to upload the pope’s speeches and messages to their smartphones. In 2011, the Vatican started its own news Web site, Newsva.va.

Last year, Benedict wrote that new media and social networks offered “a great opportunity,” but he also warned that they carried the risk of alienation and self-indulgence.

Gaia Pianigiani reported from Vatican City, and Rachel Donadio from Rome.

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Nokia debunks rumor that it may be considering shift to Android

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Kate's Morning Sickness Is 'Acute'

By Simon Perry

12/03/2012 at 11:50 AM EST

Kate is still in the early stages of her pregnancy – less than 12 weeks – and already the next royal is making his or her presence dramatically known.

The Palace has described the Duchess of Cambridge's morning sickness as "acute" and she is at King Edward VII Hospital in Central London, joined by her husband, Prince William. According to a source at St James's Palace, Kate arrived at the hospital from her parents' new home in Bucklebury.

The source adds that the couple decided to "be open" about Kate's pregnancy because she was admitted to the hospital. But, since it's so early, "we aren't going into detail about the pregnancy itself," the source says.

Kate, 30, also has canceled her next three official engagements.

According to the Palace, Kate is suffering from hyperemesis gravidarum, characterized by severe and persistent nausea and vomiting during pregnancy. If untreated, the patient can suffer dehydration and dangerous weight loss.

This is the first child for the royal couple, who wed in April 2011.

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Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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