Gene Variation Linked to Neuroblastoma, a Childhood Cancer

By Steven Reinberg
HealthDay Reporter Wed May 7, 11:46 PM ET

WEDNESDAY, May 7 (HealthDay News) -- For the first time, a gene linked to the often fatal childhood cancer neuroblastoma has been identified, researchers report.

"This is the first paper that helps us understand what causes this childhood cancer," said lead researcher Dr. John M. Maris, director of the Center for Childhood Cancer Research at The Children's Hospital of Philadelphia. "We expected for decades that this cancer was a genetic disease, but we have had a hard time understanding what abnormalities in our genetic makeup lead to this cancer."

Neuroblastoma, a cancer of the peripheral nervous system that usually appears as a solid tumor in the chest or abdomen, is the most common solid tumor malignancy seen in early childhood. Among infants, it can disappear with minimal treatment, but in older children, it can be an aggressive cancer spreading throughout the body. Neuroblastoma accounts for 7 percent of all childhood cancers but causes 15 percent of all childhood cancer deaths. There are about 700 new cases diagnosed each year in the United States, the researchers said.

Maris' team found a common genetic variation of the gene 6p22 on chromosome 6, which doubles the risk of getting this disease. "This finding supports our assumption that there are a number of minor variations that work together -- in sort of a perfect storm -- to give a child this disease," he said. "This finding is the discovery of the first of these genetic variants."

Maris noted that this is the first time a childhood cancer has been found to be influenced by rather common genetic changes "that can be in you or me or anyone."

In addition, Maris said that having this particular genetic variation not only increases the risk of developing neuroblastoma, but also increases the risk of developing the more aggressive form of the disease. "This leads us to believe that the disease we call high-risk or low-risk neuroblastoma are really different diseases," he said.

The findings were published in the May 7 online edition of the New England Journal of Medicine.

For the study, Maris' team analyzed blood samples from 1,032 children with neuroblastoma and 2,043 children without the disease. The researchers honed in on three single nucleotide polymorphisms (SNPs) -- which are variations in DNA -- that were more common in patients with neuroblastoma than in patients without the disease. The three SNPs were clustered in the 6p22 region of chromosome 6. There are two genes in this region, but exactly what they do is unknown, the researchers said.

To confirm their findings, Maris' group analyzed blood samples from additional neuroblastoma patients and children without the disease. Among these additional patients, the researchers also found that variants in the 6p22 region were associated with increased risk for neuroblastoma.

"This finding gives us the motivation to continue this line of research to discover all of the different genetic variations that work together," Maris said. "We have already discovered additional variations."

Knowing the complete genetic influences on neuroblastoma may eventually lead to new treatments, he said.

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said that the new findings could one day lead to better diagnosis and treatment of the malignancy. "We still need to understand what these genes do, because little is known about these genes," he said.

Lichtenfeld added that, while the new research is important, it's still very preliminary. "Ultimately, what you want to do is to analyze the cancer and gain clues as to what the prognosis may be and what the appropriate treatment may be," he said. "This does not get us there, but it is one step along that pathway."

Beijing reports first child virus death

By CARA ANNA, Associated Press Writer Wed May 14, 2:58 AM ET

BEIJING - China's capital reported Wednesday its first death from the hand, foot and mouth disease virus that has sickened tens of thousands of children across the country and killed at least 42 people.

The child died Sunday on the way to a hospital, the state-run Xinhua News Agency said, citing Beijing Health Bureau spokeswoman Deng Xiaohong.

The director of the health bureau's publicity office, contacted by telephone, declined to comment on the death.

The health bureau also told Xinhua that another child died of the illness in Beijing, but the death was counted in the victim's home province of Hebei, which neighbors Beijing. A 21-month-old boy also died of the virus Monday in Hubei province, Xinhua reported.

The three newly reported deaths raise the countrywide death toll to 42 since late March. Hand, foot and mouth disease has sickened more than 24,934 children in seven Chinese provinces plus Beijing, Xinhua reported.

It said 3,606 hand, foot and mouth infections had been reported in Beijing as of Monday. It also said 32 patients remained in Beijing hospitals, with eight in serious condition.

"It is likely that the figures may be fluctuating greatly in the next few weeks" because the Health Ministry last week ordered care providers to report cases within 24 hours, ministry spokesman Mao Qunan said, according to the ministry's Web site.

China has also been struggling to handle the magnitude-7.9 earthquake that struck Monday and killed more than 12,000 people.

The hand, foot and mouth virus has been yet another major concern for Chinese authorities as they prepare for the Beijing Olympics in August. Cases have been reported from Guangdong province in the south to Jilin province in the northeast, and in major cities including Beijing and Shanghai.

"What I know is the death rate has gone down drastically since early May," World Health Organization China representative Hans Troedsson said Wednesday. "There are very, very few cases with complications — 99 percent of these are mild cases."

U.S. Health and Human Services Secretary Mike Leavitt was visiting China this week and said the U.S. was willing to help China battle the illness.

Most cases of hand, foot and mouth disease in China this year have been blamed on enterovirus 71.

The virus spreads through contact with saliva, feces, nose and throat mucus or fluid secreted from blisters. There is no vaccine or specific treatment, but most children with mild forms of the illness recover quickly after suffering little more than a fever and rash.

The disease is expected to peak in the hot months of June and July.

Mother's mental health tied to child's development

By Anne Harding Wed May 14, 3:59 PM ET

NEW YORK (Reuters Health) - Evaluating the emotional health and social connectedness of pregnant women may help determine if their children will need extra help to meet developmental goals later on, Canadian researchers say.

If children get this assistance early, there's a good chance they will do just fine, Dr. Suzanne C. Tough of the University of Calgary in Alberta, the study's lead author, told Reuters Health.

But Tough and her team found that more than half of the three-year-olds in their study who were identified as being at high risk for developmental problems had never been referred for assessment to see if they actually did have speech and language delays.

"We miss these children when our early intervention can be most effective," the researcher continued. Kids with mild to moderate delays who could make "huge strides" without extensive help are actually the most likely to fall through the cracks, she added.

To investigate early risk factors for developmental problems, which can, in turn, increase the likelihood that a child will fail in school and have behavioral issues, Tough and her colleagues looked at 791 mothers who had participated in prenatal care study and their children, who were now pre-school-age. All of the women had uncomplicated pregnancies and deliveries.

While 11 percent of the children were gauged to be at high risk for developmental problems, just 43 percent of these high-risk kids had been assessed. Those who were born preterm were more likely to have been identified as at risk, as were children who had undergone hearing tests and those with vision problems.

Children were more likely to be at high risk for developmental problems if they were male, had ear infections, came from a low-income environment, or had a mother with poor mental health during the prenatal period and after the child was born. Problems typically included depression, a history of abuse and a poor level of contentment.

Fifty-three percent of the kids who met each of these criteria were at high risk. However, when the mother's poor mental health was removed from the equation, the risk fell by 30 percent, to 18 percent.

"The big surprise to me in this data was just how important maternal mental health can be," Tough said.

The women typically didn't have serious psychiatric problems, she added, but were simply in poor mental and emotional health and frequently lacked good connections in their community and to friends and family.

Tough and her team are now evaluating whether a program that brings pregnant women together to help them build social networks will improve children's outcomes.

SOURCE: BMC Pregnancy and Childbirth, published online May 6, 2008.

Childhood anxiety may worsen anorexia

Fri May 16, 3:58 PM ET

NEW YORK (Reuters Health) - Anorexic women with a history of childhood anxiety may have particularly severe symptoms of the eating disorder, a study suggests.

It's known that anxiety disorders, like social phobia and obsessive compulsive disorder, are far more common among people with anorexia than in the general population. Often, these anxiety disorders appear before the eating disorder does.

In the new study, published in the International Journal of Eating Disorders, researchers looked at whether a history of childhood "overanxious disorder" was related to the severity of women's anorexia.

Dr. Cynthia M. Bulik, of the University of North Carolina at Chapel Hill, and colleagues found that of 637 women with anorexia, 39 percent reported symptoms of childhood overanxious disorder. In nearly all cases, those symptoms arose before the onset of their anorexia.

In general, the researchers found, women with a history of childhood anxiety exhibited "more extreme personality traits" and attitudes -- like perfectionism and obsessive tendencies related to food -- than women without a history of early anxiety disorders.

They were also more likely to purge, by vomiting or abusing laxatives, in addition to strictly limiting their food intake.

According to Bulik's team, childhood anxiety disorders "may represent one entree" into anorexia. This, they say, underscores the importance of recognizing and treating these conditions early on.

SOURCE: International Journal of Eating Disorders, May 2008.

Health Tip: Traveling During Pregnancy

Thu May 15, 11:47 PM ET

(HealthDay News) -- If you're planning to take a trip while pregnant, you should check with your doctor to be sure it's safe for you to travel. Unless you have complications with your pregnancy, most women can travel safely.

Here are some travel tips to keep you safe and comfortable during pregnancy, courtesy of the American Pregnancy Association:

* Travel during the second trimester is usually most comfortable -- after morning sickness has passed and the fatigue of the third trimester is still ahead.
* Wear comfortable, loose clothing and comfortable shoes.
* Take things to make you more comfortable, like a pillow from home and some snacks that satisfy you.
* If you're driving, stop to get up and stretch often and take plenty of bathroom breaks.
* Always take your prenatal records with you on the road.
* Be safe: Wear your seat belt and follow safety instructions for whatever transportation you use.

Heart risks high in childhood cancer survivors

By Julie Steenhuysen Thu May 15, 9:27 PM ET

CHICAGO (Reuters) - Children who survive cancer while they are young are five to 10 times more likely than their healthy siblings to develop heart disease, U.S. researchers said on Thursday.

The finding comes from a study of more than 14,000 survivors of childhood cancers, and suggests that cancer survivors and their doctors need to be vigilant about heart risks.

"This study clearly shows for children, and particularly children treated with radiation therapy to the chest or certain drugs that are particularly toxic to the heart, there are significant risks of cardiovascular disease at a far younger-than-expected age," said Dr. Richard Schilsky of the University of Chicago.

The preliminary results were released ahead of a meeting later this month of the American Society of Clinical Oncology.

Schilsky, who is president-elect of ASCO, said the study highlights the challenges faced by cancer survivors, who have to live with the health consequences of having had cancer and having been treated for cancer.

Dr. Daniel Mulrooney of the University of Minnesota and colleagues conducted the study, which looked at 14,358 survivors of childhood leukemia, central nervous system tumors, Hodgkin's and non-Hodgkin's lymphoma, kidney tumors, bone cancers, neuroblastoma and soft-tissue sarcoma between 1970 and 1986.

They compared these to 3,899 of their siblings. Cancer survivors on average were 7 years old at diagnosis and 27 at follow up.

The cancer survivors were 10 times more likely to have clogged arteries, 5.7 times more likely to have heart failure, 4.9 times more likely to have heart attacks, 6.3 times more likely to have pericardial disease -- affecting the sac surrounding the heart -- and 4.8 times more likely to have diseased heart valves compared with their siblings.

"We found 5-year survivors of childhood and adolescent cancers are at an elevated risk for early cardiovascular disease," Mulrooney told reporters in a telephone briefing.

They also found the risks were two to five times greater in people who had been treated with chest radiation and chemotherapy from the anthracycline class of drugs, such as doxorubicin, compared to survivors who did not have those treatments.

Mulrooney said there are about 270,000 childhood cancer survivors in the United States, or about 1 in every 900 young adults. He said the findings may lead to better cancer treatments that protect the heart.

"We still use radiation therapy," he said, but newer radiation treatments are more targeted, and he hopes they will have less impact on the heart.

Schilsky said other studies have found long-term cancer survivors are at greater risk of premature osteoporosis, infertility, thyroid problems, anxiety and depression and the risk of another cancer.

"It becomes incumbent on the patient and the primary care physician to be aware of their cancer history and the potential consequences of their treatment," Schilsky said.

(Editing by Maggie Fox)

Study finds heart risks in young cancer survivors

By MARILYNN MARCHIONE, AP Medical Writer Thu May 15, 9:03 PM ET

Children who survive cancer face a much greater risk of heart problems later in life than their brothers and sisters who did not have cancer, new research shows.

Doctors have long known that certain chemotherapy drugs and radiation can harm the heart, but it has been seen as a relatively small price to pay for beating cancer. Cancer itself may damage the heart. And even though the risk was higher, heart problems still were relatively rare.

The study used a national registry to track 14,358 cancer survivors diagnosed in the 1970s and 1980s, when treatments were harsher than those commonly used today, and compared them to about 4,000 healthy siblings.

The survivors had one of eight forms of the disease, including leukemia, brain tumors, Hodgkin's or non-Hodgkin's lymphoma and kidney tumors.

Compared to their healthy siblings, they had five to 10 times greater risk of heart problems, ranging from clogged arteries to heart failure and valve disease.

The risk often showed up when they were still young adults — an age when few doctors would think to check them for heart problems. The survivors were diagnosed with cancer at an average age of 8, and their average age was 28 when the follow-up study was done.

There are about 270,000 childhood cancer survivors in the United States today, said the study's leader, Dr. Daniel Mulrooney at the University of Minnesota.

"They have to live with the health consequences of having had cancer and having been treated for cancer," he said.

Still, the incidence of problems was low: 2 percent had hardening of the arteries, 4 percent had heart failure, 1 percent suffered a heart attack and 4 percent had a valve problem.

Study results were released Thursday by the American Society of Clinical Oncology and will be presented at the group's annual meeting later this month.

France reports leveling childhood obesity rates

By Michael Kahn Thu May 15, 9:40 AM ET

GENEVA (Reuters) - France is the first EU country to report a leveling off of childhood obesity rates, suggesting that healthier diet programs and a ban on vending machines in schools is paying off, researchers said on Thursday.

The findings from two separate studies of school-age children signal a shift in France after decades of increase, researchers told the 2008 European Congress on Obesity.

"The rates of children who are overweight are undergoing an overall stabilization in France among all socio-economic backgrounds," said Sandrine Lioret, an epidemiologist at the French Food Safety Agency, who led one of the studies.

Obesity is a major problem worldwide that increases the risk later in life of type 2 diabetes, cancer and heart disease. The World Health Organization classifies around 400 million people as obese, including 20 million children under age 5.

Many Western governments -- where the obesity problem is greatest -- have adopted programs in recent years to promote healthier diets and lifestyles to keep children from growing up to be overweight and obese.

The French findings are important because they show that government policies are a potential weapon in the fight against childhood obesity, said Tim Lobstein, a director of the International Obesity Task Force in London.

But he cautioned that only time would tell whether the French results are a one-off blip or part of a long-term trend.

"The tidal wave (of obesity) is continuing to surge in most European countries," he said. "We are seeing that wave roll on through to adulthood."

France is about in the middle when it comes to European childhood obesity rates, with the lowest seen in Scandinavia and the highest in poorer nations in Southern Europe, the researchers said.

In one of the studies, Lioret's team at the French Food Safety Agency showed no statistically significant change in the prevalence of obesity rates among randomly-selected school children age 3 to 17 in surveys taken eight years apart.

The other research from the French National Institute for Health Surveillance found that the number of obese children aged 7 to 9 had remained steady at around 18 percent in 2000 and 2007.

Government policies, a growing awareness of the dangers of obesity and the fact that children are eating less all seem to be playing a role, the researchers said.

One worry, though, is that even as the overall rate has flattened, poor children were up to three times more likely to be obese compared to wealthier children, they added.

(Reporting by Michael Kahn, Editing by Jon Boyle)

Childhood obesity levelling in France

Thu May 15, 6:15 AM ET

GENEVA (AFP) - Childhood obesity may be levelling in France in contrast to the general trend in Europe where more youngsters are growing fat, according to two new studies presented Thursday.
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Researchers say they are yet unable to link changes in public health policies to the stabilising trend, but stress that an increased awareness of the obesity problem may have had some impact.

However, the studies presented at the European Congress on Obesity in Geneva also show that children from poorer socio-economic backgrounds are more prone to fat.

France has moved to introduce measures to combat childhood fat, with vending machines banned in schools since 2005.

In latest measures unveiled, Health Minister Roselyne Bachelot in February called for the advertising of certain foods to be stopped voluntarily from children's television programming.

She had warned that if companies do not take voluntary action to remove such advertising, laws will be proposed.

"Public health policy has changed a lot in France since 2000, but we cannot prove that the stabilisation is due to these interventions.

"There has been an increased awareness of the issue of obesity in children and it's possible that this general awareness has had some impact," said Katia Castetbon, who heads the nutritional epidemiology and surveillance unit at the French National Institute for Health Surveillance.

Castetbon's group looked at the prevalence of obesity among seven to nine-year-olds in 2000 and 2007, and found that there was little change in the rates in seven years.

In the second survey by the French Food Safety Agency's dietary unit, results for 2006-2007 were compared with 1998-1999 and found not to show significant deviation.

However, the survey found that overweight rates were 2.5 to three times higher in children from the lowest socio-economic group than those from the highest level.

Castetbon's study also garnered similar findings.

"That indicates that more work needs to be done to adapt the approaches to address the needs of these children so that the gap can be narrowed," she said.

The EU said in 2007 that an estimated three million Europeans are obese, with about 85,000 more children becoming obese every year.

Childhood Cancer Survivors Prone to Early Heart Trouble

By Amanda Gardner
HealthDay Reporter Fri May 16, 11:46 PM ET

FRIDAY, May 16 (HealthDay News) -- Adults who had cancer as children or teens are more likely to experience cardiovascular disease, a new study found.

And the heart problems surface at a much earlier age than in people who did not suffer cancer as children.

Childhood cancer survivors "have approximately a five to 10 times increased risk of having heart disease compared to their healthy siblings," said study lead author Dr. Daniel A. Mulrooney, assistant professor of pediatrics at the Masonic Cancer Center of the University of Minnesota, Minneapolis.

Mulrooney was expected to present his findings Thursday night at the American Society of Clinical Oncology annual meeting, in Chicago.

There are an estimated 270,000 survivors of childhood cancer in the United States, and 11 million cancer survivors total.

While the cancer survivors in the new study ranged in age from 8 to 51, the average age of those with heart problems was only 27.5 years.

"We're talking about a very young population that's having very significant cardiac disease and is likely not being monitored appropriately," Mulrooney added. "It is very important that they be followed and that risk factors and cardiovascular monitoring that we would think of in an older population be implemented in a younger population."

The findings aren't entirely surprising. Previous research, much of it with the same group of survivors, has shown an increased risk of cardiovascular disease in survivors of childhood and adolescent cancer.

The new analysis, the longest follow-up to date, provides updated information on 14,358 five-year survivors of childhood cancer. All the participants were diagnosed with one of eight cancers (including leukemia, lymphoma and brain malignancies) at 21 years of age or younger, between 1970 and 1986.

The study participants provided information on their own heart health, which was then compared to a control group of 3,899 healthy siblings.

Compared to the healthy brothers and sisters, the survivors of childhood cancer were almost six times more likely to report congestive heart failure; about five times more likely to report having had a heart attack or valvular heart disease; more than six times likelier to have pericardial disease (the pericardium is the sac that surrounds the heart); more than eight times as likely to have had an angiography; and 10 times more likely to have atherosclerosis, or hardening of the arteries.

Exposure to the chemotherapy drug anthracycline increased the risk of congestive heart failure about fourfold, roughly doubled the risk of pericardial and valvular disease, and almost tripled the odds of having had an angiography, the study found.

Radiation treatment to the heart doubled the risk of congestive heart failure, heart attack and pericardial disease, almost tripled the risk of valvular disease, and increased the risk of atherosclerosis by a factor of more than five, according to the study.

Dr. Karen Burns is clinical director of the ATP5+ Clinic for Childhood Cancer Survivors at Cincinnati Children's Hospital. She said most of the heart problems seen in survivors of childhood cancer come from the class of chemotherapy drugs called anthrocyclines, which cause problems with cardiac muscle, and from radiation, if the radiation field included the heart.

Although monitoring for heart disease in childhood cancer survivors is already in place in many specialized facilities, Burns said she hoped that, "if this study is available to the general public, it will encourage people who are survivors to get closer follow-up."

Mulrooney added: "We see this in our long-term follow-up clinic. We identify patients who are at risk based on this analysis and may do an echocardiogram or a lipid panel, things we might not typically do in a 20-year-old. There are tools out there, and getting this knowledge out there as well would be helpful so primary-care physicians will be more aware, oncologists and cardiologists will be aware, and patients as well."