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Small or slow-growing nodules discovered on a lung scan are unlikely to develop into tumors over the next two years, researchers reported on Wednesday.

The findings, reported in the New England Journal of Medicine, could help doctors decide when to do more aggressive testing for lung cancer. They could also help patients avoid unnecessarily aggressive and potentially harmful testing when lesions are found.

Lung cancer, the biggest cancer killer in the United States and globally, is often not diagnosed until it has spread. It kills 159,000 people a year in the United States alone.

The work is part of a larger effort to develop guidelines to help doctors decide what to do when such growths, often discovered by accident, appear in a scan.

High-tech X-rays called CT scans can detect tumors — but they see all sorts of other blobs that are not tumors, and often the only way to tell the difference is to take a biopsy, a dangerous procedure.

Tested guidelines for dealing with the nodules do not exist, said Dr. James Mulshine of Rush University Medical Center in Chicago and David Jablons of the University of California San Francisco Cancer Center, in a Journal editorial.

Good guidelines could help make lung cancer screening practical, Dr. Rob van Klaveren of the Erasmus Medical Center in Rotterdam, the Netherlands, who led the new study, said in a telephone interview.

At the moment, routine lung cancer screening is considered impractical because of its high cost and because too many healthy people are called back for further testing.

“All these recall CT scans give rise to a lot of anxiety,” said van Klaveren.

SCREENING

The team looked at 7,557 people at high risk for lung cancer because they were current and former smokers. All received multidetector CT scans that measured the size of any suspicious-looking nodules.

Volunteers who had nodules over 9.7 millimeters in width, or had growths of 4.6 millimeters that grew fast enough to more than double in volume every 400 days, were sent for further testing. Of the 196 people who fell into that category, 70 were found to have lung cancer; 10 additional cases were found years later.

But of the 7,361 who tested negative during screening, only 20 lung cancer cases later developed.

In a second round of screening, done one year after the first, 1.8 percent were sent to the doctor because they had a nodule that was large or fast-growing. More than half turned out to have lung cancer.

The result means that if the screening test says you don’t have lung cancer, you probably don’t, the researchers said. “The chances of finding lung cancer one and two years after a negative first-round test were 1 in 1,000 and 3 in 1,000 respectively,” they concluded.

The study is part of a larger project, known as NELSON, designed to see if a screening program can, over the long term, cut lung cancer death rates by 25 percent. Final results are expected in 2015.

A Family Physician’s View

A woman should remember that the guidelines are based on the entire population and that her own decision must be an individual one, said Dr. David Baron, a family physician and chief of staff at Santa Monica-UCLA Medical Center and Orthopaedic Hospital in Santa Monica, Calif., and an assistant clinical professor of family medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

“That’s why communication between a patient and her health-care professional is very important,” Baron said.

The new guidelines, in his view, are encouraging physicians to individualize the screenings.

“Some of this will depend on how risk-adverse a woman is,” Baron said. A 40-year-old woman, for instance, might be afraid of radiation from a mammogram and be at average risk for breast cancer. No matter how much a doctor explains that the radiation amount is minimal, he said, she might not be convinced, and she might be advised to wait.

On the other hand, he said, another 40-year-old woman might be very frightened of breast cancer and want the screening. For her, Baron said, he might advise sticking with annual screening.

To women 50 and up, Baron said he would say: “I think it’s important to have a mammogram. Whether you want to have it every year or every two years is negotiable.”

And for his patients 75 and older? “It’s really a matter of individual choice,” he said.

The task force has drawn criticism for recommending fewer mammograms and starting them later. But Baron offered another perspective. “I respect them a great deal,” he said. “They’ve got no horse in the race. They are independent experts.”

He said the task force did its best to sort through the available evidence and come up with the most scientifically sound guidelines.

Women should also realize that the results of future studies might change the recommendations yet again, Baron said. And no matter what the recommendations are, he said, women must always discuss their own medical history and risks with their doctors when making a decision about screening for breast cancer or any other disease.

The best advice, according to Baron: Know the guidelines. Know your risk. Decide with your health-care professional the best screening schedule for you.

On Wednesday, U.S. Health and Human Services Secretary Kathleen Sebelius issued the following statement on the new screening recommendations:

“There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government.”

“There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.”

“What is clear is that there is a great need for more evidence, more research and more scientific innovation to help women prevent, detect and fight breast cancer, the second leading cause of cancer deaths among women.”

“My message to women is simple. Mammograms have always been an important lifesaving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you,” the statement concluded.

When a U.S. government task force recommended that women wait until they’re 50 to get their first mammogram to check for breast cancer, reaction was swift.

Critics such as the American Cancer Society vowed to stand by its advice that annual screening begin at age 40 for women of average risk. The American College of Radiology agreed.

But what will doctors who see female patients day after day suggest they do?

The guidelines, released Nov. 16 by a federal panel of experts known as the U.S. Preventive Services Task Force, recommend that women aged 40 to 49 and at average risk for breast cancer talk to their doctor about when it would be best for them to begin mammography screening. Those aged 50 to 74 should have every-other-year screenings, rather than an annual mammogram, according to the new guidelines. As for women aged 75 and older, the task force concluded that there is not enough evidence to assess the benefits and harms of the test.

Whether they agree or disagree with the guidelines, experts seem to agree that women should talk to their health-care providers for guidance based on their individual medical history and other factors.

Three such providers — an internist, a family physician and a gynecologist — weigh in on what they will advise their patients to do.

An Internist’s View

“The evidence supports the recommendation,” said Dr. Karla Kerlikowske, director of the Women Veteran’s Comprehensive Health Center at the San Francisco Veterans Affairs Medical Center, who wrote an editorial accompanying publication of the guidelines in the Annals of Internal Medicine.

“I think for women 40 to 49, we should target women who are at high risk,” she said, such as those with a first-degree relative with breast cancer.

Changing the screening interval from annually to every two years for women 50 to 74, she said, “is one of the best things they did.” At her clinic, Kerlikowske said, biennial screening has been a standard for years.

A Gynecologist’s View

Gynecologist Judi Chervenak, an associate clinical professor of obstetrics-gynecology and women’s health at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, said she will tell her patients this: “From age 39 on, a woman should have a yearly visit to her health-care provider, during which she discusses which routine tests are appropriate for her, including mammography.”

But, she also said she favors mammography for many women.

“Unless the patient is at increased risk of radiation exposure or increased mental health stress of dealing with a false-positive test, I still feel that the use of the mammogram is a potentially lifesaving and quality-of-life improving test for many women,” Chervenak said.

“We know that mammography often picks up a cancer before it can be palpated,” she said. “We have to do everything we can to maintain our quality of life.”

If the stresses of college have put you at risk for high blood pressure, try transcendental meditation.

Blood pressure fell among college students who spent about 20 minutes at least once a day to reach the “restful alertness” state of transcendental meditation, Dr. Sanford I. Nidich, at Maharishi University of Management Research Institute in Maharishi Vedic City, Iowa, and colleagues report.

Their study, in the American Journal of Hypertension, found meditating students also had “reduced psychological distress, anxiety, and depression,” Nidich told Reuters Health in an email.

He and colleagues randomly assigned 298 healthy students with and without high blood pressure to transcendental meditation training or to a training wait list. The students, 40 percent men, were just under 26 years old on average and attended universities in and around Washington, D.C.

Among the 207 students still participating in the study 3 months later, those in the meditation group had slight reductions in blood pressure, while the wait-listed students had slight increases in average blood pressure from the start of the study.

The meditating students also showed greater reductions in overall mood disturbances, anxiety, depression, anger, and hostility, and better coping skills compared with baseline measures and wait-listed students.

Nidich’s team further assessed a subgroup of 48 meditating and 64 wait-listed students who initially had high blood pressure (above 130 over 85 millimeters of mercury) or were at risk for high blood pressure.

In this high-blood-pressure-risk group, the meditating students had blood pressures that were lower, on average, than at the start of the study, while the wait-listed students had increases in blood pressure.

Nidich and colleagues also found these “significant reductions” in blood pressure correlated with lower measures of psychological distress and greater coping measures.

The researchers suggest their findings warrant further investigations into the potential health benefits of longer-term transcendental meditation in college students.

Two new studies add to growing evidence that morphine and other opiate-based painkillers may promote the growth and spread of cancer cells.

The papers, scheduled to be presented Wednesday at an international cancer conference in Boston, also demonstrate how preventing opiates from reaching lung cancer cells reduces cancer cell proliferation, invasion and migration.

The findings from tests with cell cultures and mice suggest that the mu opiate receptor — where morphine acts in the body — may offer a potential treatment target.

“If confirmed clinically, this could change how we do surgical anesthesia for our cancer patients. It also suggests potential new applications for this novel class of drugs which should be explored,” Patrick A. Singleton, an assistant professor of medicine at the University of Chicago and principal author of both studies, said in a university news release.

Morphine can increase tumor cell proliferation, inhibit the immune system, promote the growth of new blood vessels (angiogenesis) that feed tumors and decrease barrier function. In cancer patients undergoing surgery, decreased barrier function may make it easier for tumors to invade tissue and spread to other parts of the body, while increased angiogenesis helps tumors thrive in a new location.

Singleton and colleagues found that mice without the mu opiate receptor didn’t develop tumors when injected with lung cancer cells, while normal mice did develop cancer. The researchers also found that methylnaltrexone — developed to treat opiate-induced constipation — reduced the proliferation of cancer cells in normal mice by 90 percent.

New research suggests that having multiple sclerosis puts pregnant women at slightly higher risk for giving birth via cesarean deliveries or having babies that grow at a slower rate in the womb.

But the researchers, whose findings were published online in Neurology, also reported that pregnant women with MS were not more likely than other women to develop such conditions as preeclampsia or premature rupture of membranes.

The findings came from an examination of a national database that included details on about 18.8 million childbirths in 38 states, including deliveries by an estimated 10,000 women with MS.

The two groups of pregnant women differed somewhat. Those with MS were more likely than those without chronic medical conditions to have fetuses that suffered from restricted growth, as defined by weight measured through ultrasound. Among women with MS, 2.7 percent had fetuses in that category, compared with 1.9 percent of other women.

Women with MS were also more likely to have a cesarean delivery: 42 percent had a c-section, compared with 33 percent of other women.

However, the study found that women with MS had lower pregnancy complication rates than did women who had diabetes before becoming pregnant.

“These results are reassuring for women with MS,” study author Dr. Eliza Chakravarty. of Stanford University School of Medicine. said in a news release from the American Academy of Neurology.

“Women and their doctors have been uncertain about the effect of MS on pregnancy, and some women have chosen to delay or even avoid pregnancy due to the uncertainty,” Chakravarty said. “We found that women with MS did not have an increased risk of most pregnancy complications.”

Women undergoing a second round of in-vitro fertilization should get one embryo instead of two, suggests new Swedish research that found the first approach is almost as successful as the second and greatly reduces the risk of multiple births.

A previous study produced the same result, but this latest report examined the women for a longer period of time, through more embryo implantations.

The findings “should provide comfort for those who want to perform single-embryo transfers that the pregnancy rates are equivalent,” said Dr. William E. Gibbons, president of the American Society for Reproductive Medicine and a professor at Baylor College of Medicine in Houston.

Gibbons said debate over the number of embryos to implant began about a decade ago, when in-vitro fertilization (IVF) began to be more successful.

“Since only a fraction of eggs released by a woman are capable of producing a baby, the pregnancy rate is higher when more than one embryo is put back in,” he said. “However, in the late ’90s the standard number of embryos replaced at that time resulted in an increasing rate of triplets and quadruplets.”

Multiple births can lead to a variety of medical complications that can put the lives of some babies at risk.

In the new study, the Swedish researchers examined the records of 661 women who first underwent implantation with a fresh embryo, followed by implantation with one or two frozen embryos if the first attempt was unsuccessful. If those attempts failed, they went through more attempts; the scientists followed them for up to four more tries.

The findings appear in the Oct. 29 issue of the New England Journal of Medicine.

Forty-four percent of those who received one embryo the first time got pregnant and gave birth to live babies; 51 percent of those who got two embryos did.

But only 2.3 percent of those in the first group had multiple births, compared to 27.5 percent in the second group. Those in the first group were also much less likely to have babies born before 37 weeks of gestation, 11.8 percent vs. 25.5 percent for the two-embryo group.

So why not always implant one embryo and then another if necessary? Because it can be more expensive to try multiple times instead of boosting the odds at the start, and “the stress and disappointment of a failed cycle is hard to put a value on,” noted Dr. Laurel Stadtmauer, an associate professor of obstetrics and gynecology at the Jones Institute for Reproductive Medicine in Norfolk, Va.

The economic wrinkle is a real one. In Sweden, Gibbons explained, IVF is covered by national insurance. That’s not the case in the United States.

“For American couples,” he said, “putting two embryos back has a higher pregnancy rate, and twins mean that they can have their family all at once and don’t have to pay for a second child.”

Programs in the workplace designed to get people to exercise can improve fitness, cut cholesterol levels, reduce job stress and even improve attendance, a new analysis of the medical literature shows.

But it’s still not clear what makes for the most effective type of program, Dr. Vicki S. Conn of the University of Missouri in Columbia, the lead author of the research, told Reuters Health.

“We do have really good evidence that the interventions do work,” she said. “What we couldn’t say from this is that this intervention works better than that intervention.”

Conn and her colleagues looked at dozens of studies of workplace physical activity interventions. The studies included about 38,000 people.

They found significant positive effects for the interventions on “physical activity behavior,” meaning whether or not people became more active, and also on fitness level. The programs also helped fuel healthy changes in lipids (meaning harmful fats in the blood such as triglycerides), measures of body size, work attendance, and job stress, the researchers report.

The more effective programs had several characteristics in common: a facility for exercising on site; they were developed with the help of the company; and people were able to exercise during the workday rather than having to come in early or stay late. But it wasn’t clear whether offering rewards helped.

While evidence is scarce on the long-term costs of workplace physical activity interventions, Conn noted, the fact that they reduce absenteeism suggests they could indeed save money.

The current investigation is part of a larger, National Institutes of Health-funded study of physical activity interventions in general, Conn noted. While there’s no lack of evidence to show that exercise is good for you, she added, “what we don’t know is how to get people to exercise,” and the study may help answer that question.

A new type of gene therapy for injured lungs that were previously rejected for transplantation may increase the number of lungs available for transplant, researchers say.

Successful transplants require healthy lungs, but more than 80 percent of donor lungs are highly inflamed and only mildly functional, which means many of them are rejected by surgeons, according to researchers with the University Health Network in Toronto.

The investigators found that infusion with the regulatory gene IL-10 before transplant can heal damaged donor lungs. This procedure involves placing the lungs in a glass chamber outside the body and keeping them breathing using a perfusion system that continuously pumps a solution of oxygen, proteins and nutrients into the lungs.

The study, published in the Oct. 28 issue of Science Translational Medicine, noted that the current method of preserving donor organs is to keep them on ice. But the new lung perfusion system would enable the lung’s cellular machinery to keep working by maintaining the lungs at a normal body temperature, the study authors explained in a news release from the journal’s publisher.

In one experiment, pig lungs that underwent IL-10 gene therapy and lung perfusion for 12 hours had better function and less swelling when transplanted into recipient pigs. The researchers also found that this treatment produced similar results in human lungs previously rejected for transplant.

Further investigation showed that IL-10 reduced inflammation, refurbished the alveoli (tiny branching sacs where gas exchange occurs), and improved function in the injured donor lungs.

Another study published in the same issue of the journal identified two types of immune cells that play a major role in the destruction of smokers’ lungs.

Smoking-related irritation of the lungs triggers a complex immune response that includes an accumulation of different types of immune cells. An analysis of lung tissue from emphysema patients revealed the normally helpful immune cells called dendritic cells travel to the lung and induce T-helper 1 and T-helper 17 cells to destroy lung tissue and proteins responsible for lung elasticity.

The T-helper 17 cells secrete a protein that triggers a reaction that attracts more dendritic cells to the lungs, leading to a repeat of the destructive cycle, the researchers found.

The findings offer more evidence that emphysema (primarily caused by cigarette smoke) is an autoimmune disease. This line of research may lead to new drugs that can control lung damage, the study authors said.

Tackling just five health factors could prevent millions of premature deaths and increase global life expectancy by almost 5 years, the United Nations World Health Organization (WHO) said Tuesday.

Poor childhood nutrition, unsafe sex, alcohol, bad sanitation and hygiene, and high blood pressure are to blame for around a quarter of the 60 million premature deaths around the world each year, the WHO said in a report.

But while not having enough nutritious food is a big health risk for those in poorer countries, obesity and being overweight pose yet bigger risks in richer nations — leading to a situation in which obesity and being overweight causes more deaths worldwide than being underweight.

“The world faces some large, widespread and certain risks to health,” the WHO said in its Global Health Risks report. It examined 24 major health risks, and said recognizing and assessing them would help policy makers draw up strategies to improve health in the broadest and most cost-effective ways.

“As health improves, gains can multiply,” it said. “Reducing the burden of disease in the poor may raise income levels, which in turn will further help to reduce health inequalities.”

The report warned that although some major health risk factors, such as smoking, obesity and being overweight, were usually associated with high-income countries, more than three-quarters of the total global burden of diseases they cause now occurs in poor and developing countries.

“Health risks are in transition: populations are aging owing to successes against infectious diseases; at the same time, patterns of physical activity and food, alcohol and tobacco consumption are changing,” it said.

“Understanding the role of these risk factors is important for developing clear and effective strategies for improving global health.”

The Geneva-based U.N. health agency listed the world’s top mortality risks as high blood pressure (responsible for 13 percent of deaths globally), tobacco use (9 percent), high blood glucose (6 percent), physical inactivity (6 percent), and obesity or being overweight (5 percent).

These factors raised the risk of chronic diseases and some of the biggest killers such as heart disease, diabetes and cancers, and affected “countries across all income groups — high, middle and low,” it said.

The WHO said its study, which used data from 2004 — the latest available — showed how health was becoming “globalised” and warned that developing countries now increasingly face a double burden of risks to health.

“The poorest countries still face a high and concentrated burden from poverty, undernutrition, unsafe sex, unsafe water and sanitation,” it said. “At the same time, dietary risk factors for high blood pressure, cholesterol and obesity, coupled with insufficient physical activity, are responsible for an increasing proportion of the total disease burden.”

The WHO added that if the risks in its report had not existed, life expectancy would have been on average almost a decade longer in 2004 for the entire global population.