NEW YORK (Reuters Health) – The percentage of children born with Down syndrome has increased by about one percent per year since 1979, according to new findings from the Centers for Disease Control and Prevention (CDC).

The increase is probably because more and more women 35 and over are having babies, Dr. Adolfo Correa of the CDC’s Center for Disease Control’s National Center on Birth Defects, one of the study’s authors, said. These older women are five times more likely than younger moms to have a baby with Down syndrome, Correa pointed out.

Today, about one in 1,000 children and adolescents in the US has the chromosomal disorder, and about 5,400 children are born with Down syndrome in the US every year, Correa and his colleagues note in the journal Pediatrics.

People with Down syndrome have some degree of mental retardation, and are also at risk of certain health problems; for example many are born with heart defects. But 90 percent will celebrate their fifth birthdays, and the average life expectancy for a person with Down syndrome is over 50.

To date, the researchers note, just one study done in a single city has looked at Down syndrome rates in children and adolescents. Accurate figures are necessary, they add, to plan for health care services for these individuals as they get older, because many may need specialized care.

Correa and his team analyzed birth defect registry data from 1979 to 2003 for 10 different US regions to come up with these numbers.

On average, they found, 9 in every 10,000 babies born live in the US in 1979 had Down syndrome. That figured increased by more than 30 percent over the next 14 years, reaching nearly 12 per 10,000 babies in 2003.

In 2002, the researchers estimate, there were about 83,400 people 19 and under with Down syndrome.

The risk of Down syndrome was higher among boys than girls, Correa and his colleagues found. There was also evidence that Down syndrome was more common among Hispanics and whites, but less common among African-Americans, but Correa said it’s not clear why.

The findings are “a good starting point” to better predict the medical needs of people with Down syndrome, the researcher said. What the findings couldn’t show, he added, is whether or not the increase in women undergoing prenatal screening has meant fewer babies are being born with Down syndrome.

SOURCE: Pediatrics, December 2009.

By Fran Lowry

CHICAGO (Reuters Health) – Every year, many patients undergo unnecessary computed tomography (CT) scans that are not indicated, exposing them to more radiation than is necessary, according to new research presented here at the annual meeting of the Radiological Society of North America (RSNA 2009).

Doctors at the University of Wisconsin in Madison are often asked to help interpret CT scans from other institutions. When Dr. J. Louis Hinshaw and radiology resident Dr. Kristie M. Guite noticed a high number of exams that seemed outside of American College of Radiology guidelines among patients referred for consultation, they became suspicious and decided to investigate further.

They reviewed 978 scans from 500 patients, ranging in age from 9 months to 91 years, with most between 30 and 50 years old.

More than half of their patients — 261, or about 52% — had CT scans that were not indicated by the guidelines. “This was a very large proportion, unfortunately,” Hinshaw said.

The average amount of excess radiation dose per patient from unnecessary scans could mean up to an additional 20,000 radiation-induced cancer cases per year in the U.S., the authors wrote in their abstract for the meeting.

Earlier this year, a study found that 4 million Americans a year are exposed to what is considered a high dose of radiation because of X-rays and CT scans.

However, Hinshaw emphasized, the radiation from diagnostic imaging in general is very low, and there is no evidence to suggest any long term detrimental effects.

But he added this caveat: “The fact of the matter is, we really don’t know what the true risk is, and so in light of that we really need to do whatever we can to minimize the radiation that patients receive.”

By Anne Harding

NEW YORK (Reuters Health) – Where you’re born could influence your risk of dying from a stroke decades later, new research shows.

Being born in one of the seven southeastern U.S. states making up the “Stroke Belt” increased a person’s likelihood of suffering a deadly stroke, whether or not they still lived in one of these states, Dr. M. Maria Glymour of the Harvard School of Public Health in Boston and her colleagues found. And living in one of these states when a person died also boosted the chance that it would be a stroke that was the cause of death.

“Even though stroke is much more common in elderly people than young people,” Glymour noted in an E-mail to Reuters Health, “it seems the roots of the disease reach back to early life.” The findings suggest, she added, that “to understand and prevent strokes, we will need to start early.”

Death from strokes in the Stroke Belt states–North Carolina, South Carolina, Georgia, Tennessee, Arkansas, Mississippi, and Alabama-is higher than it is elsewhere in the US, Glymour and her colleagues point out in Neurology, but the reasons why remain unclear. “This is really a great puzzle,” Glymour said. “It has been hard to study this because there are so few data sources available to show this pattern.”

She and her colleagues looked at death records for 1980, 1990 and 2000 for US-born black and white men and women 30 to 80 years old to examine how living in the Stroke Belt, or being born there, might influence stroke death risks.

Birth in one of the seven states and residence there at the time of death was independently linked to an increased stroke death risk, Glymour and her team found. While the increased risk was far smaller than the risk seen for established stroke risk factors like high blood pressure or smoking, she noted, the effects on a population level are large.

Put another way, if African Americans born in the Stroke Belt had the same risk as those born outside it, Glymour explained, this would have eliminated about 10% of all fatal strokes suffered by African Americans in 2000.

Whatever’s going on in the Stroke Belt doesn’t appear to be genetic, according to Glymour, and it is likely to be something that affects everyone-white and black, rich and poor.

The finding that Stroke Belt birth boosts risk suggests that childhood influences may be involved, she added.

These could include “social norms influencing dietary patterns in childhood, the quality of public resources such as the school system, stress pathways relating to community conflict, lifelong access to high quality preventive medical care, or physical risks associated with environmental conditions are plausible possibilities,” Glymour explained. “This does not mean these are the reasons, but they are possibilities we need to study.”

SOURCE: Neurology, December 1, 2009.

By Julie Steenhuysen

CHICAGO (Reuters) – A software program that helps determine the stiffness of a breast lump may help some women avoid unnecessary breast biopsies, U.S. researchers said on Monday.

They said the technique called elastography, which is used in tandem with a standard ultrasound, correctly identified 98 percent of cancers in women who had an ultrasound to evaluate a suspicious lump in their breast.

It also correctly ruled out breast cancer in 78 percent of women whose lumps were later found to be harmless, Dr. Stamatia Destounis of Elizabeth Wende Breast Care in Rochester, New York told reporters at the Radiological Society of North America meeting in Chicago.

“The addition of elastography could potentially help decrease the need to perform a biopsy or could reduce the need for additional imaging, thus reducing the anxiety and stress on the patient and also the financial hardship that unnecessary biopsy procedures may cause,” Destounis told the meeting.

That might help ease some of the concerns about routine mammography screening, which can result in excess biopsies, especially in women who get regular mammograms starting at age 40.

The U.S. Preventive Services Task Force earlier this month recommended against routine breast mammograms for women in their 40s to spare them from some of the worry and expense of extra tests to distinguish between cancer and harmless lumps. About 80 percent of breast biopsies find harmless or benign lumps.

AVOIDING BIOPSIES

Often, when a mammogram turns up a suspicious spot, women get a breast ultrasound, which uses sound waves to create pictures of internal structures of the breast.

“The problem with ultrasound is that it is very sensitive. It will find it for us, but it is not specific enough. It doesn’t tell us if that is a benign lesion or a cancerous lesion,” Destounis said.

She said many ultrasound machines have elastography software, which can also measure the stiffness of a breast lump.

“The premise is that a malignant tumor will be stiffer than the surrounding normal breast tissue,” Destounis said.

Her team has been studying the effectiveness of elastograms compared to regular ultrasounds. So far, they have studied 193 women aged 18 to 92 with a total of 198 lesions.

They did routine mammograms and compared the size of the tumors with the elastogram images done using ultrasound equipment and elastogram software from Siemens AG. Some 58 breast lesions did not require a biopsy.

Of the 140 biopsies, 59 revealed cancers. When they checked the result with the elastogram prediction, they found it was 98 percent accurate at identifying cancers.

The program was 78 percent accurate at identifying lumps that turned out to be harmless, but in some cases it did suggest a tumor might be dangerous when it was not.  Continued…

By Donna Smith and John Whitesides

WASHINGTON (Reuters) – The U.S. Senate began work on a sweeping healthcare overhaul on Monday, with senators on both sides pouncing on the findings in a nonpartisan budget report on insurance premiums to bolster their arguments.

With the debate expected to last up to three weeks, Senate Democratic leader Harry Reid warned senators they would work on weekends if necessary to hammer out compromises on thorny issues like a government-run insurance plan, abortion coverage and holding down costs.

“The next few weeks will tell us a lot about whether senators are more committed to solving problems or creating them,” Reid said.

In a report that gave ammunition to both sides, the Congressional Budget Office estimated on Monday that the 70 percent of Americans who receive insurance through employer-sponsored plans would see little change or slight reductions in their insurance premiums by 2016.

Those who buy coverage independently could see premiums rise by 10 percent to 13 percent by 2016, although the federal subsidies given to lower-income individuals to help them purchase coverage would reduce the actual costs for about half of the group, the CBO said.

The higher premiums would be incurred in part because they would get more comprehensive coverage, it said.

“The analysis we received today indicates that whether you work for a small business, a large company or you work for yourself, the vast majority of Americans will see lower premiums than they would if we don’t pass health reform,” said Democrat Max Baucus, chairman of the Senate Finance Committee.

Senate Republican leader Mitch McConnell said Americans do not want the healthcare bill to pass and the CBO report showed why.

“A bill that’s being sold as a way to reduce costs actually drives them up,” said McConnell, who has vowed to do whatever he can to block or delay the bill.

The Senate plan is designed to rein in costs, expand coverage to about 30 million uninsured Americans and halt industry practices such as denying coverage to those with pre-existing medical conditions.

The U.S. House of Representatives passed its version of the healthcare overhaul on November 7. If the Senate passes a plan, the two versions will have to be reconciled and passed again by each chamber before they are sent to Obama for his signature.

SHARES OF INSURERS FALL

Shares of health insurers were weak as the broader market showed modest gains. The Morgan Stanley Healthcare Payor stock index and the S&P Managed Health Care stock index were both off more than 1 percent in mid-afternoon trade.

The insurance industry’s trade group, America’s Health Insurance Plans, said the CBO report showed the Senate bill would not slow the growth in healthcare costs to consumers.

“This is the latest report to confirm that the current healthcare reform proposal fails to bend the health care cost curve and will result in double-digit premium increases for millions of Americans,” said spokesman Robert Zirkelbach.  Continued…