Two Nicotine Aids Can Be Better Than One

If you really want to quit smoking, two nicotine substitutes may be better than one, according to researchers in Iceland. They found that using nicotine patches and a nasal spray more than doubled the percentage of people who were not smoking after a year of treatment.

Dr. Thorsteinn Blondal and his colleagues at the National University Hospital in Reykjavik studied 237 longtime smokers between the ages of 22 and 66. Half of the group used nicotine patches and a nicotine nasal spray for five months followed by spray alone for another seven months. The other half followed the same protocol using the patches and a placebo spray.

The researchers reported in Saturday’s British Medical Journal that at the end of a year, 27% of those using the nicotine spray were still not smoking, compared to only 11% of those who had used the placebo.

Researchers speculated that the spray was more effective because it provided a quick jolt of nicotine when the ex-smoker felt an urgent need. The patches, in contrast, release the drug slowly and may not help relieve such cravings.

Similar results have been reported in trials that combined the patches with nicotine-containing gum. But doctors noted that much room for improvement remains in boosting the number of permanent quitters. Even in the best case, seven out of every 10 people resumed smoking within a year.

Chemotherapy Before Surgery Shows Promise

Neoadjuvant chemotherapy for breast cancer--chemotherapy given before surgery to shrink the tumor--can often eliminate the tumor completely, obviating the need for surgery, according to researchers in Texas. In other cases, it shrinks the tumor enough so that less radical surgery is required, said Dr. Henry M. Kuerer of UC San Francisco. Traditionally, chemotherapy is given after breast cancer surgery.

While at the M.D. Anderson Cancer Center in Houston, Kuerer and his colleagues studied 372 women with a median age of 47 who suffered advanced cancer that had not spread to the lymph nodes. All went through four cycles of neoadjuvant chemotherapy using the drug doxorubicin.

Forty-three of the women showed no evidence of tumors after the chemotherapy, the team reports in today’s Journal of Clinical Oncology. They also found that the five-year survival rate for women whose tumors were eliminated by chemotherapy was 89%, compared to 64% for those women who also required surgery.

New Vaccines Combat Middle Ear Infections

Two vaccines against respiratory syncytial virus that are now under development might make a major impact in preventing middle ear infections in children, Texas researchers say.

Dr. Terho Heikkinen and his colleagues at the University of Texas Medical Branch in Galveston studied 456 children with such infections, examining lung and ear cultures to determine which viruses were present. They reported in Thursday’s New England Journal of Medicine that respiratory syncytial virus was the most common virus present among children whose infective agent could be identified.

Vaccines against the virus, they concluded, could therefore significantly reduce the incidence and severity of ear and respiratory infections. In the United States, the annual cost of treating middle ear infections exceeds $3.5 billion.

Procedures Target Gene in Breast Cancer Battle

Screening for breast cancer genes and performing prophylactic removal of breasts and ovaries in women who carry the genes could be cost effective and life saving among Ashkenazi Jewish women, New York doctors say.

Mutations in genes called BRCA1 and BRCA2 predispose women to breast and ovarian cancer. The incidence of such mutations is low in the general population, between one and six per thousand, but climbs as high as 25 per thousand in Ashkenazi Jews.

Dr. Victor R. Grann and his colleagues at Columbia University report in today’s Journal of Clinical Oncology that such screening and prophylactic surgery could prevent 79 deaths for every 10,000 women screened. The lives of each of those patients would be extended by an average of 13.2 years.

Exercise Soon After Heart Transplant Helps

Contrary to the prevailing wisdom, heart transplant recipients can benefit from exercise soon after their surgery, UCLA researchers say. Such exercise was previously thought to be too risky.

Dr. Jon Kobashigawa and his colleagues studied 27 newly transplanted patients. Half were enrolled in a formal exercise program and half were given written exercise instructions without formal training.

They reported in Thursday’s New England Journal of Medicine that patients in the supervised group were able to exercise longer more quickly. Neither group suffered adverse effects from the exercise.

Frequency of High-Tech Pap Tests Questioned

Technologically advanced, computerized enhancements to the traditional Pap smear--a test used to detect early signs of ovarian cancer--aren’t cost-effective to insurers when used every year, new research shows. The tests are more cost-effective when they are used every three years, which ultimately would save more lives at a lower cost than conventional Pap testing every two years, according to a report Wednesday in the Journal of the American Medical Assn.

Dr. Adalsteinn D. Brown from the University of Oxford and Dr. Alan M. Garber from the Stanford University School of Medicine estimated the increased sensitivity and cost of three new tests based on the results of eight previously conducted studies. The new methods increased the cost by $30 to $257 per woman screened, while extending life expectancy by five hours to 1.6 days. “The major barrier to prevention of cervical cancer is not the accuracy of the Pap test, but the failure to be screened at all,” the researchers concluded.

“These technological improvements in the Pap test can be cost-effective when used as part of less frequent screening,” they said. “However, if their high cost deters participation in cervical cancer screening programs, they will not reduce the toll of the disease.”