Nicotine addiction slashed in test of new cigarette smoking strategy
November 14, 2007 -  Scientists are reporting the first successful strategy to reduce smokers’ nicotine dependence while allowing them to continue smoking. The study provides strong support for proposals now being considered in Congress to authorize FDA regulation of cigarette smoking, according to the research team.

The key to the clinical trial’s success was providing smokers with cigarettes of gradually decreasing nicotine content over a number of weeks. If such cigarettes were federally mandated, smokers would find it easier to quit, and more young smokers could avoid addiction, according to the scientists. Tobacco company products marketed as low-nicotine alternatives, in fact, do not change the level of nicotine taken in by smokers, they added.

The research was carried out by scientists at UCSF and San Francisco General Hospital Medical Center and is reported in the November 14 issue of the journal "Cancer Epidemiology, Biomarkers & Prevention."

Legislation giving the FDA authority to regulate tobacco products is currently being considered in Congress. Such regulatory authority would empower the agency to develop and enforce standards to make cigarettes less harmful — including the reduction of the nicotine yields so that cigarettes would be less addictive, said Neal Benowitz, MD, leader of the study team and an expert on the pharmacology and health effects of nicotine and other smoking products.

Smoking and health experts have been concerned that reducing the nicotine content of cigarettes would lead to smoking a greater number of cigarettes and therefore increased exposure to other tobacco smoke toxins, as is seen in smokers of the currently marketed low-nicotine yield cigarettes, Benowitz said. The new research on reduced-nicotine content cigarettes strongly counters that prediction.

In the study, 20 healthy adult smokers smoked their usual brand for a week and then followed a six-week regimen of smoking cigarettes with progressively decreased nicotine content.

At the end of this period, they were free to return to their usual commercial cigarette brand, and most of them did. When tested one month later, they were smoking about 40 percent fewer cigarettes per day, with a comparable reduction in nicotine intake, compared to when the study began. Even more promising, one fourth of the smokers quit smoking entirely while the study was in progress, the researchers found.

"This study supports the idea that if tobacco companies were required to reduce the levels of nicotine in cigarette tobacco, young people who start smoking could avoid becoming addicted, and long-time smokers could reduce or end their smoking, Benowitz said.

"This could spare millions of people from the severe health effects of long-term smoking," he added.

Benowitz is a UCSF professor of medicine, psychiatry and biopharmaceutical sciences, and chief, Division of Clinical Pharmacology and Experimental Therapeutics at SFGH.

In 1994, Benowitz and colleague Jack Henningfield proposed in the "New England Journal of Medicine" that federal regulations should require cigarette manufacturers to gradually reduce nicotine content of all cigarettes sold in the U.S.

Scientists have conducted studies to test nicotine-reduction strategies, using commercial low-yield cigarettes. Such cigarettes do reduce nicotine yield when tested by smoking machines because manufacturers have engineered the cigarettes to burn faster, and they have used highly porous paper and ventilation holes above the filter. These cigarettes contain significant levels of nicotine and such "cigarette engineering" does not lead to decreased nicotine intake, because smokers are easily able to obtain the nicotine by taking more frequent and bigger puffs, Benowitz and his co-authors noted.

In contrast, in the new study, the absolute content of nicotine in the tobacco was reduced so that it was very difficult or impossible to compensate by smoking more intensely.

In addition to the reduced smoking and nicotine levels, the UCSF scientists looked for changes in exposure to carbon monoxide, tobacco smoke carcinogens and cardiovascular disease risk factors. All these remained stable or decreased, indicating that smokers were not exposed to higher levels of tobacco smoke toxins when they switched, and therefore would not be put at risk by a nicotine reduction intervention.

Benowitz and his colleagues are now conducting a much larger and longer clinical study on the effectiveness and safety of reducing nicotine levels in cigarettes. They plan also to examine whether reduced-nicotine cigarettes result in reduced addiction potential among adolescent experimental smokers.

University of California - San Francisco

Is fear of gaining weight keeping many women from trying to quit smoking?
November 07, 2007 -  ANN ARBOR, Mich. - Is a fear of getting fatter partly to blame for the fact that nearly one in five American women still smokes, and many don’t try to quit"

Although there are many possible reasons for the stubborn persistence of smoking, fear of weight gain is high on the list for many women, says a University of Michigan Health System researcher who has devoted much of her career to studying this issue.

Several years ago, she and her team reported that 75 percent of all women smokers say they would be unwilling to gain more than five pounds if they were to quit smoking, and nearly half said they would not tolerate any weight gain. In fact, many women started smoking in the first place because they thought it might help them stay slim.

Now, new U-M research findings published in the October issue of Addictive Behaviors show that women who smoke tend to be further from their ideal body image, and more prone to dieting and bingeing, than those who don’t smoke.

Cigarettes are well known to suppress appetite and weight, says Cindy Pomerleau, Ph.D., director of the U-M Nicotine Research Laboratory. "So it’s hardly surprising that women who have trouble managing their weight or are dissatisfied with their bodies are drawn to smoking," she says.

In another recent study, published in August, the U-M team found that overweight women smokers who were overweight as children were far more likely to have started smoking in their early teens than women whose weight problems started later in life. They also had worse withdrawal symptoms when they tried to quit.

Once they make a serious attempt to quit, evidence suggests that most weight-concerned smokers can be just as successful in kicking the habit as others.

"The problem here is getting women who are concerned about their weight to be willing to try to make a quit attempt," says Pomerleau, "and then helping them gain a sense of control over their weight."

Women who are highly concerned about weight tend to be concerned about other aspects of their appearance as well, she notes. What they need to understand, she says, is that smoking has an impact on many aspects of appearance and attractiveness. Among other things, it causes wrinkled skin, thinning hair, cracked fingernails, yellowed teeth and terrible breath.

Pomerleau, a research professor of psychiatry, is working on a book about women, smoking and weight loss that will draw together research findings, helpful tips and real-life examples of women who quit tobacco while also containing their weight.

Some beliefs about smoking and weight are true, she says. For instance, nicotine suppresses the appetite and increases resting metabolic rate. Smokers on average weigh less than people who have never smoked, and that smokers who quit tend to gain weight. Adding to these perceptions are tobacco advertisements that portray female smokers as slim and successful.

Even so, the effect of quitting on weight is often less dramatic than many women fear, Pomerleau says. A rough rule of thumb is that one in four women who quit smoking will gain less than five pounds, and another two out of four will gain five to 15 pounds. Only one in four women who quit will gain 15 pounds or more.

But Pomerleau’s own research suggests that many women smokers start out with an unrealistic image of how they would like their bodies to look. This may make their dread of gaining weight even worse.

In her paper in Addictive Behaviors, she reports the results of a study of 587 women between the ages of 18 and 55, including 420 smokers and 167 women who had never smoked. An equal proportion of both groups was overweight or obese, with a body mass index of 25 or more.

In the study, the smokers and non-smokers were asked to look at silhouette pictures of ten different body types, ranging from thinnest to fattest, and to choose which one their current body type was closest to, and which one they wanted to look most like. They were also asked questions about their self-image and their eating habits, about how concerned they were about gaining weight if they quit smoking, and about how sure they were that they could stay off cigarettes even if they gained weight.

The smokers chose an ideal body shape that was slimmer than the non-smokers chose, and further from how they perceived themselves as looking. They also had more problems with limiting their eating. Smokers who were overweight were especially doubtful about their ability to stay off tobacco if they started to gain weight.

This study, Pomerleau says, suggests that if women smokers are to succeed in quitting, they may need extra help in achieving a more realistic body image and paying attention to unhealthful eating patterns, particularly if they are already overweight.

At the same time, Pomerleau and her team have found that the earlier in life a weight problem starts, the more likely a woman is to start smoking.

In a study of 89 overweight women smokers, those who remembered being overweight before they reached junior high school reported that they had started experimenting with smoking at around age 13 - compared with women whose weight problems didn’t start until junior high or after, who hadn’t tried smoking till they reached age 15.

The women who were overweight as children also reported more nicotine-withdrawal symptoms when they tried to quit smoking, especially symptoms like anger, irritability and trouble concentrating. The study was published in the August issue of Eating Behaviors.

These studies, and others that the U-M team have done, all point to the importance of finding new strategies to help women quit smoking without losing control of their weight. Although severe dieting during a smoking cessation attempt has not been shown to be helpful in either quitting smoking or controlling weight, it may be unrealistic to expect women with strong weight concerns to put these concerns on hold for several weeks or months while they try to quit tobacco.

"What we would like to work for is a kind of compromise strategy, where the focus is on the smoking cessation, but women can also take some passive and active measures to control their weight," Pomerleau says.

Passive measures include things like nicotine patches and gum, and medicines like bupropion, which can help in controlling weight gain while keeping nicotine withdrawal symptoms at bay.

Another option for women is to launch their stop-smoking effort early in their menstrual cycle, so that the bloating that can happen soon after they snuff out their last cigarette won’t be compounded by the bloating that comes along right before their period begins.

Finally, although strenuous dieting is not recommended, Pomerleau says, women can start immediately to rebalance the energy-in/energy-out equation by not substituting eating for smoking, and by increasing their physical activity. Even brief bouts of exercise, such as stretching or walking, can be effective in distracting a woman when the urge to smoke strikes, she says, and they burn a few calories too.

University of Michigan Health System

Should UK Lower Age For Prostate Cancer Detection?

Prostate cancer screening occurs in many countries ahead of evidence from ongoing trials. In many countries, early detection (including the UK, when practised), and opportunistic screening commences at 50 years, but a lower age limit has recently been adopted in the USA based on two studies that found elevated prostate specific antigen (PSA) levels in men in their 40s was associated with subsequent prostate cancer.So a team of UK researchers set out to investigate the feasibility of prostate cancer testing, disease prevalence and characteristics in a random group of younger men. Their findings are published on bmj.com today.The study involved 473 men aged 45-49 years randomly selected from eight general practices in one UK city.Of 442 men (34%) who agreed to PSA testing, 54 (12%) had an elevated PSA result. These men were invited for further testing (an ultrasound-guided prostate biopsy, a repeat PSA test, and a digital rectal examination).Ten prostate cancers were detected (a 2.3% detection rate, similar to that in older men). The five men whose tumours were potentially risky to health agreed to have one of three treatment options (radiotherapy, surgery, or active monitoring).This study shows that men younger than 50 years will accept prostate cancer testing, but at a much lower rate than older men, say the authors, so if screening were introduced, greater efforts would be needed to maximize uptake in this age group.If the UK male population aged 45-49 years (2,236,000) were to undergo PSA screening they estimate that 272,905 men would have a raised PSA and of these 51,449 would have prostate cancer.Some of these cancers may benefit from treatment, they say, but this has to be set against the likely distress caused to the 221,456 men with negative biopsy results and the risks of over-treatment and associated side-effects to those diagnosed with cancer.This study will inform the debate about PSA thresholds and age limits only if prostate cancer screening is proven to be effective in ongoing trials, they conclude.Until the results from ongoing trials are available, policy should advocate informed discussion between clinicians and patients about the benefits, potential harms, and limitations of prostate cancer screening, says an accompanying editorial.

High death toll after severe urinary complications in men over 45

Men’s health comes to spotlight as study reveales high mortality in men with acute urinary retention admitted to hospital.

As many as one in four men admitted to hospital with acute urinary retention will die within a year, finds a study published on bmj.com today.

The risk of death in men after acute urinary retention is close to that seen in patients who had a broken hip. The problem is set to get worse as the population ages, warn the researchers.

Acute urinary retention (AUR) is the sudden inability to pass urine and is often a progression of benign prostatic hyperplasia (an increase in size of the prostate in middle-aged and elderly men which can interfere with the normal flow of urine). It is a medical emergency and is thought to be linked to the presence of other disorders such as high blood pressure and diabetes.

So to investigate the risk of death associated with AUR, researchers analysed data on all men aged over 45 years who were admitted to NHS hospitals in England with a first episode of AUR between 1998 and 2005. Mortality in the first year after AUR was compared to mortality among the general male population of similar age.

During the study period, 176,046 men over 45 were admitted to hospital with primary AUR.

Mortality among these men was very high. One in seven men with spontaneous AUR (no evidence of precipitating factors other than benign prostatic hyperplasia) and one in four with precipitated AUR died in the first year.

The risk of dying increased with age and the presence of other disorders (comorbidity). Consequently, about half the men aged over 85 years with comorbid conditions died within the first year after AUR.

Overall mortality at one year in men admitted to hospital for AUR was two to three times higher than for the general male population. However, in men aged between 45 and 54 years with precipitated AUR, there was an almost 24-fold increase in mortality compared to the general population.

The authors conclude that mortality of hospitalised men with AUR is high and increases strongly with age and the presence of other conditions. As a result, patients with AUR may benefit from urgent multi-disciplinary care to identify and treat comorbidity early.

An accompanying editorial discusses the importance of this study and supports the call for multidisciplinary care in these men.

Medication plus counseling may help teens kick the smoking habit
November 06, 2007 -  The medication bupropion plus counseling appears to help adolescents quit cigarette smoking in the short term, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Almost one-fourth of U.S. high school students currently smoke cigarettes, according to background information in the article. Many teen smokers want to quit, but studies estimate that only about 4 percent of those who try are successful each year. The antidepressant bupropion has been shown to help adults quit smoking and also is used to treat attention deficit disorders in children.

Myra L. Muramoto, M.D., M.P.H., Scott J. Leischow, Ph.D., and colleagues at the University of Arizona, Tucson, conducted a clinical trial of 312 adolescents age 14 to 17 who smoked six or more cigarettes per day and had tried to quit at least twice before. They were randomly assigned to receive 150 milligrams (105 teens) or 300 milligrams (104 teens) of bupropion per day, or placebo (103 teens). Participants visited the clinic weekly for seven weeks-six weeks of treatment plus one week post-treatment-and received 10- to 20-minute individual cessation counseling sessions. They were interviewed by phone after 12 weeks and in person after 26 weeks.

During treatment, quit rates were higher for the 300-milligram group than for placebo every week except the fourth week. After six weeks, 5.6 percent of those in the placebo group, 10.7 percent of those in the 150-milligram bupropion group and 14.5 percent of those in the 300-milligram group had quit smoking. At the 26-week follow-up, 10.3 percent of those who took placebo, 3.1 percent of those who took 150 milligrams of bupropion and 13.9 percent of those who took 300 milligrams were still abstaining from cigarettes. The teens’ reported quit rates were verified by checking the level of cotinine, a byproduct of nicotine processing, in the urine.

Though the results suggest that 300 milligrams of bupropion plus brief counseling sessions may help teens quit smoking over the short term, abstinence rates at the end of the treatment period were lower than those seen in adults taking the same medication, the authors note. In addition, the high rate of relapse after stopping medication suggests that a longer treatment period-such as the 12 weeks recommended for adult smokers-may be needed.

"Nonetheless, this study provides hope for helping a generation of smokers quit before they become adults," the authors conclude. "These results are critically important because few effective treatment options are available for adolescent smokers who want to quit."

JAMA and Archives Journals

Radiation Seeds Effectively Cure Prostate Cancer In Young Men

Radiation seed implants (brachytherapy) are just as effective at curing prostate cancer in younger men (aged 60 and younger) as they are in older men, according to a study presented at a scientific session on October 31, 2007, at the American Society for Therapeutic Radiology and Oncology’s 49th Annual Meeting in Los Angeles.Brachytherapy is a minimally invasive procedure where a radiation oncologist places small radioactive seeds into the prostate in order to kill the cancer cells. It is an attractive treatment option for patients with prostate cancer because it has a much shorter recovery time than surgery and studies have shown brachytherapy to be just as effective as surgery. However, surgeons have usually advised younger men to undergo surgery to remove all or part of the prostate (prostatectomy) over other treatments like seed implants because they believed younger men could physically tolerate surgery, plus they believed surgery was more effective than brachytherapy at curing prostate cancer long term. This meant that many younger men would undergo surgery without ever learning about other treatment options, like brachytherapy or external beam radiation therapy.“These results suggest that brachytherapy is extremely effective in curing localized prostate cancer for men aged 60 and younger. When younger men are diagnosed with localized prostate cancer, they should be presented with all viable treatment options, including brachytherapy,” said Alice Ho, M.D., the lead author of the study and a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York. “Every man with prostate cancer, regardless of his age, should have access to the treatment that is best for his cancer and lifestyle.”The large, retrospective study examined the outcomes of more than 1,700 men with localized prostate cancer who were treated with brachytherapy between 1990 and 2005 at Mount Sinai Medical Center in New York. Results show that younger men had the same excellent outcomes after undergoing brachytherapy as older patients.

New Prostate Cancer Technology Saving Lives

JM, a 71 year old business executive from Tennessee, had a negative biopsy using gray scale ultrasound despite a PSA of 7.1. The following year, the PSA rose to 11.5 prompting a second biopsy that was negative despite adding Color Flow Doppler Ultrasound. At this point, the patient and all doctors in attendance were frustrated without a clear path to identify a disease process that was begging to be discovered. JM came to the Diagnostic Center for Disease in Sarasota, Florida, as he had heard about an exciting new scan offered that promised to solve his personal dilemma while erasing his fear of the unknown.Presently, a new case of Prostate cancer is diagnosed every 3 minutes while 90 men die from prostate cancer every day. Prostate Biopsy, the "gold standard" for finding cancer of the prostate is associated with trauma, infection, bleeding and sampling bias. National statistics show that 10 men must undergo an ultrasound and biopsy to find 2-3 cancers. Translated another way, 7-8 men must undergo a procedure that is unnecessary as documented by a negative biopsy. Moreover, it is well known that a biopsy of the prostate is associated with the possibility that cancer cells, if encountered, may be carried outside of the prostate capsule through a phenomenon called, "needle tracking". Data from Pathologists show that this phenomenon is real. The problem is compounded when it is realized that prostate cancer is not just a disease of older men as originally thought but rather a disease of young men as well. In fact, data from the Detroit Autopsy Study and Memorial Sloan- Kettering shows 30% of 30 year old men have prostate cancer.Given the inability to diagnose prostate cancer using the traditional system, our attention has turned to imaging to determine the presence or absence of prostate cancer. Currently data, primarily from Europe, suggests that prostate cancer detection with MRI-Spectroscopy (MRI-S) has a sensitivity and specificity in the range of 89-92%. In fact, Peter Scardino, M.D., Chairman of the Departments of Urology and Surgery at Memorial Sloan-Kettering has called MRI-S with the 3.0 Tesla magnet, "the next greatest diagnostic tool for prostate cancer detection". The Diagnostic Center for Disease, led by Urologist, Ronald E. Wheeler, M.D., is using this new imaging technology to assist in finding prostate cancer in patients like JM where traditional biopsies continue to miss the lesion. MRI-S evaluates the integrity of prostate tissue through spatial resolution as well as the biochemical makeup of cells through a spectral analysis. Together, this technology establishes a "finger-print" of disease when the PSA is elevated. Once a lesion is identified, a series of targeted biopsies can be performed, as we localize the disease in question.Using a parametric approach, the center is utilizing all sequences of the 3.0 T MRI-S scan including Dynamic Contrast Enhancement with traditional prostate cancer diagnostic detection markers such as Color Flow Doppler Ultrasound, PSA & DRE to establish a clear picture of the disease process present. Interestingly, this technology often times allows physicians to alter their treatment course when cancer has escaped the prostate capsule. Furthermore, preliminary data from the Diagnostic Center for Disease shows that the use of MRI-S coupled with DRE, PSA and Ultrasound data provides a 75% yield in diagnosing prostate cancer compared to the traditional 20-30% yield while using blind or random biopsies. Dr. Wheeler’s mission is to provide a comprehensive approach to Prostate Disease detection that while reproducible, is more patient friendly, allowing Urologists to improve their diagnostic skills, thereby improving their patient treatment outcomes.While using the MRI-S scan as a "road map", JM needed only 5 targeted biopsies to find the elusive cancer while preventing "needle tracking". Subsequent pathology showed a Gleason Score of 7 (3+4). According to Dr. Wheeler, "while many options of treatment remain for JM, he can at least sleep better knowing the hidden disease that was chasing him had been found".