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People with lung cancer who are screened for a genetic mutation and then given a drug called Tarceva, which is believed to work well with that mutation, live longer than those without the mutation who take the drug, new research has found.

According to the Spanish authors of a study in the Aug. 20 issue of the New England Journal of Medicine, this type of widespread screening is actually doable and could lead to better decisions about treatment.

“They proved that it is worthy to test patients for the [epidermal growth factor receptor gene] mutations, and that if you have the mutations you are going to do well,” said Dr. Edgardo Santos, an assistant professor of medicine in the hematology and oncology section at the University of Miami’s Sylvester Comprehensive Cancer Center. “If we are moving toward personalized medicine in the future, I think this is the way to go — that patients be tested and use the drug if indicated.”

People who have advanced non-small-cell lung cancer who also have certain mutations in the epidermal growth factor receptor gene (EGFR) tend to respond better to Tarceva and Iressa. Both of these drugs are tyrosine kinase inhibitors, which interfere with cancer cells’ ability to multiply. Non-small-cell lung cancer is the most common form of lung cancer.

The researchers screened lung cancer samples from 2,105 people at 129 institutions in Spain for two different EGFR mutations.

Those with mutations (16.6 percent of the sample, considered a sizable proportion) were put on Tarceva. They survived a median of 14 months without progression of their disease and 27 months overall, more than twice as long as the rates seen in other treatment groups, Santos said. This was true regardless of whether Tarceva was given as first-line, second-line or third-line therapy.

“Basically, this highlights the fact that patients with EGFR mutations should, sometime during the course of their illness, get erlotinib [Tarceva],” said Dr. George Simon, director of thoracic oncology at Fox Chase Cancer Center in Philadelphia. “However, I think for reasons of quality of life and ease of administration and differences in toxicity profiles, it may still be preferable to give gefitinib [Iressa] first-line.”

But a big question still to be worked out is why people still succumbed to the disease.

“They all had progressive disease, which basically means they had developed mechanisms of resistance,” Simon said. “We need to study what were these mechanisms of resistance and how can we counteract them, developing methods of either prevention of the emergence of resistance or treatment once resistance has emerged.”

A second study in the same issue of the journal, conducted in East Asia, found that Iressa worked better than a chemotherapy regimen of carboplatin-paclitaxel as a first-line treatment for nonsmokers and former light smokers who also had non-small-cell lung cancer.

Here again, people with the EGFR mutation responded better to Iressa.

At one year, almost 25 percent of those on Iressa had continued without a recurrence, compared with nearly 7 percent in the other group.

“Overall, patients who got gefitinib [Iressa] had a longer time from the start of treatment to the worsening of disease,” Simon said. “And it appeared that the drug’s benefit was primarily seen in patients with EGFR mutations.”

Overall survival, however, did not differ between the two groups, probably because many people started the other type of treatment after they had relapsed on the first treatment, Simon said.

The study was funded by AstraZeneca, which makes Iressa.

“This basically confirmed what we have thought, that in selected populations [light smokers or those who never smoked], those testing positive for EGFR mutations will do much better in progression-free survival than if you put the patient on chemo,” Santos said.

“For the first time in a selected population, you have a drug which can compete with systemic chemotherapy,” he said. “There is a pill that matches systemic chemotherapy.”

Smokeless tobacco increases the risk of fatal heart attack and stroke, say researchers who reviewed the results of 11 studies conducted in North America and Sweden.

In recent decades, the researchers noted, the use of smokeless tobacco products has increased in Europe and North America, particularly among people younger than 40, partly because the products are promoted as safer alternatives to cigarettes.

However, their review found that users of smokeless tobacco products had a slightly higher risk of death from heart attack and stroke than non-users. Smokeless tobacco was linked with 0.5 percent of all heart attacks in the United States and 5.6 percent in Sweden, and 1.7 percent of all deaths from stroke in the United States and 5.4 percent in Sweden, according to the report in the Aug. 18 online edition of BMJ.

The increased risk is small, but the consistency of the results among the studies included in the review suggests that the findings are credible, according to the researchers, led by Dr. Paolo Boffetta, of the International Agency for Research on Cancer in France.

If the association between smokeless tobacco products and increased risk for fatal heart attack and stroke is proven, the public health and clinical implications could be substantial, they said in urging more studies into the issue.

A new test for endometriosis, the painful gynecologic condition that can impair fertility, requires no surgery and is extremely accurate, two studies show.

However, other experts said the accuracy of the new approach, which spots the telltale presence of nerve fibers, needs to be replicated, which the researchers also acknowledged.

Until now, a diagnosis of endometriosis — in which the tissue that lines the uterus, called the endometrium, grows outside the uterus — was made by inspection of the pelvis via laparoscopy, a procedure that requires anesthesia.

“Laparoscopy is invasive,” said Dr. Thomas D’Hooghe, a professor of medicine at Leuven University in Belgium and co-author of one of the studies. “Our test is semi-invasive — office-based, done by a gynecologist, limited discomfort.”

Both studies were published online Aug. 19 in the journal Human Reproduction.

The condition affects about 5.5 million women and girls in the United States and Canada, according to the Endometriosis Association. The tissue that grows outside the uterus develops into growths or lesions that respond to the menstrual cycle in the way the uterine lining does, building and breaking down each month.

But the blood and tissue shed from these growths can’t leave the body as menstrual blood does, so internal bleeding, pain, inflammation and infertility can result.

The cause is unknown, and the severity of the condition and the level of pain and other symptoms don’t always correlate, experts said.

To do the new test, physicians take a small sample of the lining of the uterus by inserting the device used for taking an endometrial biopsy through the vagina. Then they test the sample for the presence of nerve fibers.

This enables them to determine whether or not endometriosis is present with nearly 100 percent accuracy, as D’Hooghe and his colleagues report. For the study, they compared samples of the endometrium from 40 women who had confirmed disease with samples from 20 women without the condition. The density of the small nerve fibers was about 14 times higher in the samples from patients with endometriosis than in those with a normal pelvis.

In a second study, researchers from Australia and Jordan took endometrial samples from 99 women presenting with pelvic pain or infertility, or both, who had undergone laparoscopy. They compared the laparoscopy and biopsy results. In 64 women who had endometriosis confirmed by laparoscopy, all but one tested positive for the presence of nerve fibers in the biopsy.

In the 35 women who did not have endometriosis diagnosed in the laparoscopy, no nerve fibers were found in 29 of the biopsies.

The new research builds on previous work, said study co-author Dr. Moamar Al-Jefout, an assistant professor of reproductive medicine at Mu’tah University in Karak, Jordan. That research, led by Dr. Ian Fraser in Australia, found that “women with endometriosis have nerve fibers in the functional layer of the endometrial, while women without endometriosis have no nerve fibers,” Al-Jefout said.

Other experts lauded the results, but also had some caveats. “This test is [still] semi-invasive,” said Mary Lou Ballweg, a spokeswoman for the Endometriosis Association. The biopsy procedure can be painful, she added.

Another expert, Dr. Pamela Stratton, chief of the gynecology consult service for the National Institutes of Health, who does endometriosis research, called the new studies “provocative.”

“This is a very novel way of thinking about this,” she said. “Everyone has been focusing on the lesions themselves.”

Still, she said, more research is needed. “Its clinical usefulness isn’t really known yet,” she said of the new approach.

“Let’s say the jury is out,” agreed Dr. Karen J. Berkley, professor emerita of neuroscience at Florida State University in Tallahassee. “The underlying idea [linking nerve fibers and endometriosis] is not yet understood.”

While the technique can be done in the office, it’s not trivial, she said. “An endometrial biopsy can be a big deal for someone with a lot of pain,” she said.

Even so, news of simpler tests “is very exciting,” said Dr. David Healy, of Monash University in Melbourne, Australia, and president-elect of the International Federation of Fertility Societies. In a statement, he said: “If other doctors can confirm this test, this might become the standard way of diagnosing endometriosis. This would mean that the condition could be identified earlier, which could give real benefits for the infertile woman.”

Caring for obese people is eating up an ever-bigger slice of the US health care spending pie, a new government report shows.

From 2001 to 2006, health care expenditures on obese adults rose from $167 billion to $303 billion, an 82 percent jump, according to an analysis by Marie N. Stagnitti, a senior survey statistician at the Agency for Healthcare Research and Quality in Rockville, Maryland.

Costs for overweight individuals rose 36 percent, from $202 billion to $275 billion, while spending on normal-weight people rose 25 percent, from $208 billion to $260 billion.

“Obviously we need to get this under control,” Stagnitti told Reuters Health. “This is just another way to cut the data show that, especially for the obese population, we need to figure out what’s going on there.”

Obese people accounted for 28 percent of total health care spending in 2001, and 35 percent in 2006, the researcher found, while normal-weight people’s share of these costs dropped from 35 percent to 30 percent.

During that time the number of obese adults in the US rose from 48 million to 59 million, while the number of normal weight adults actually fell slightly, from 79.6 million to 78.3 million.

The figures come from the Medical Expenditure Panel Survey, which samples US households on their health care spending, and account for the entire non-institutionalized civilian US population.

During the survey period, the proportion of overweight and obese people in the US population grew, which likely accounts for some of the increases in costs; in 2001, 23.6 percent of US adults were obese and 39 percent were normal-weight, compared to 27.2 percent and 36.1 percent, respectively, in 2006.

Stagnitti’s analysis also showed that obese people accounted for the lion’s share of the US population with at least a single chronic disease, like heart disease or diabetes. In 2001, 57.1 percent were obese, and in 2006 59.7 percent were obese.

Prion, an abnormal protein, is a biomarker of early pancreatic cancer, a new study suggests.

Prion accumulation causes mad cow disease, but very little is known about prions outside of the brain. This study identified the mechanism by which prions cause pancreatic tumors to grow more aggressively, said researchers at Case Western Reserve University School of Medicine in Cleveland.

They found that prion is incompletely processed in pancreatic cancer cells and binds to a molecule inside the cells called filamin A, which is a regulator of the cell’s skeleton and its signaling machineries. By binding to filamin A, incompletely processed prion disrupts the tumor cells’ organization and signaling, causing more aggressive cancer growth.

When the prion level is reduced, the cancer cell loses the ability to grow in tissue culture and in animals.

The researchers also found that patients with incompletely processed prion protein in their pancreatic cancer had significantly shorter survival than patients whose tumors didn’t have prion.

“Currently, there is no early diagnostic marker for pancreatic cancer. Detection of the incompletely processed prion may provide such a marker. Preventing the binding of prion to filamin A may open new avenues for therapeutic intervention of this deadly disease,” study co-author Man-Sun Sy, professor of pathology, said in a university news release.