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brain cancer
TUESDAY, May 31 (HealthDay News) -- Cell phones may cause brain cancer, a panel of experts reporting to the World Health Organization (WHO) announced Tuesday.
After reviewing dozens of studies that explored a possible link between cancer and the ubiquitous hand-held phones, the experts classified cell phones as "possibly carcinogenic to humans" and placed them in the same category as the pesticide DDT and gasoline engine exhaust.
The panel determined that an increased risk for glioma, a malignant form of brain cancer, appears associated with wireless phone use.
Globally, it's estimated that 5 billion cell phones are in use. "The number of users is large and growing, particularly among young adults and children," the International Agency for Research on Cancer said in a news release issued Tuesday.
The IARC made the announcement in Lyons, France, based on the work of 31 scientists from 14 countries. It will present its findings to the WHO, which may then issue its recommendations on safe cell phone use.
Experts said children are especially vulnerable.
"Children's skulls and scalps are thinner. So the radiation can penetrate deeper into the brain of children and young adults. Their cells are dividing at a faster rate, so the impact of radiation can be much larger," Dr. Keith Black, chairman of neurology at Cedars-Sinai Medical Center in Los Angeles, told CNN.
Until Tuesday's announcement, the WHO had said that cell phones were safe to use.
The international experts behind Tuesday's announcement met for eight days to review exposure data, studies of cancer in humans and in experimental animals, and other relevant data, looking for associations between cancer and the type of electromagnetic radiation found in cell phones, televisions and microwaves.
Dr. Christopher Wild, director of the International Agency for Research on Cancer, said this new paper is important "first and foremost just because of the large number of users worldwide that have access now to this technology."
Also, the scientists found notable gaps in the existing research, he said, which "suggest interesting areas of future research that will improve the evidence base which we have in order to make decisions about the usage of mobile phone in the future."
Responding to Tuesday's announcement, John Walls, vice president of public affairs for CTIA-The Wireless Association, a trade group representing the wireless industry said: "Today, an International Agency for Research on Cancer (IARC) working group in Lyon, France categorized radiofrequency fields from cellphones as possibly carcinogenic based on 'limited evidence.' IARC conducts numerous reviews and in the past has given the same score to, for example, pickled vegetables and coffee. This IARC classification does not mean cell phones cause cancer. Under IARC rules, limited evidence from statistical studies can be found even though bias and other data flaws may be the basis for the results.
"The IARC working group did not conduct any new research, but rather reviewed published studies," Walls added in a news release. "Based on previous assessments of the scientific evidence, the Federal Communications Commission has concluded that '[t]heres no scientific evidence that proves that wireless phone usage can lead to cancer.' The Food and Drug Administration has also stated that '[t]he weight of scientific evidence has not linked cell phones with any health problems.'"
There has been conflicting research in recent years on the health hazards posed by cell phones. As recently as February, British researchers reported that cell phones do not increase the risk of brain cancer.
Their analysis of data on newly diagnosed cases of brain cancer in England between 1998 and 2007 -- when cell phone use was climbing -- revealed no statistically significant change in the incidence of brain cancers in men or women, said the University of Manchester researchers.
There was a very small increase (0.6 more cases per 100,000 people) in the incidence of cancers of the brain's temporal lobe. That works out to 31 extra cases per year in England's population of nearly 52 million people, the researchers said.
But the study authors also noted that cancers of the brain's parietal lobe, cerebrum and cerebellum in English men fell slightly during the study period.
That study was released online in the journal Bioelectromagnetics.
More information
To learn more about brain cancer, visit the U.S. National Library of Medicine.
skin cancer
Are you confused by all the sunscreen options and ingredients? From information about water resistant sunscreens to SPF 50 to broad spectrum protection, The Skin Cancer Foundation has got you covered. Our guides to sunscreen ingredients, safety, and use will help you navigate the maze of sun protection choices. And be sure to check out The Skin Cancer Foundation’s list of recommended products to help you find sun protection that carries our Seal of Recommendation, the Foundation’s stamp of efficacy and safety. |
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The Skin Cancer Foundation applauds the FDA for issuing its final regulations on sunscreens. According to the FDA, sunscreen ingredients are safe, and the benefit of regular sunscreen use far outweigh any potential risks. Sun protection is an important public health issue, and sunscreen is an integral part of a comprehensive sun protection regimen that also includes seeking shade and wearing protective clothing, including sunglasses. Although science and technology have advanced over the past several years to dramatically improve the efficacy of sunscreens, there has long been a need to update the governmental regulations associated with them – particularly in the areas of UVA protection and product labeling. This announcement is a significant advancement for the FDA, which brings awareness to and acknowledges the importance of UVA protection in the prevention of skin cancer. We hope that these new FDA rules, along with the recently updated standards set by The Skin Cancer Foundation’s Seal of Recommendation will enable consumers to choose sunscreens wisely. - Steven Wang, MD, Committee Member, The Skin Cancer Foundation’s Photobiology Committee; Director of Dermatologic Surgery and Dermatology at Memorial Sloan-Kettering Cancer Center at Basking Ridge, NJ.
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breast cancer
July 23, 2010
Posted by Christine C.
When the U.S. Preventive Services Task Force (USPSTF) released new recommendations in 2009 calling for less frequent screening mammograms for women under age 50, the news caused quite a ruckus.
Many women’s health organizations, such as Our Bodies Ourselves, National Women’s Health Network and Breast Cancer Action, applauded the new guidelines — and had, in fact, been recommending the same approach for pre-menopausal women for many years. But understanding the science behind the logical, if somewhat counter-intuitive, recommendations requires a nuanced analysis.
Now, a New York Times examination of breast cancer cases explains, in very personal terms, the problems with diagnosing breast cancer — especially early detection methods, which are “prone to both outright error and case-by-case disagreement over whether a cluster of cells is benign or malignant.”
As a result, pathologists are over-diagnosing and doctors are over-treating small growths in the breasts that are often benign.
While the initial reaction might be, “Wait, isn’t it better to treat all potential signs of cancer than leave them untreated?” the NYT does a good job explaining the very real dangers that can result. Moreover, the root problem is that we still don’t have a truly accurate diagnostic tool, and diagnosis can vary depending on one person’s reading of a tiny speck.
As the Times explains, ductal carcinoma in situ, or DCIS (also called Stage 0 or non-invasive cancer) was a rare diagnosis before the 1980s, but today more than 50,000 women per year in the United States alone are told they have DCIS. Typically the abnormal cells in the breast ducts are removed via surgery — which can result in disfiguration of the breast — along with drugs and radiation. DCIS may progress to a more invasive cancer about 30 percent of the time, according to estimates in the Times article, but in some women it can take decades to do so.
Stephanie Saul’s reporting chiefly concerns pathologists, who are responsible for determining whether cells from a biopsy are malignant:
Advances in mammography and other imaging technology over the past 30 years have meant that pathologists must render opinions on ever smaller breast lesions, some the size of a few grains of salt. Discerning the difference between some benign lesions and early stage breast cancer is a particularly challenging area of pathology, according to medical records and interviews with doctors and patients.
Diagnosing D.C.I.S. “is a 30-year history of confusion, differences of opinion and under- and overtreatment,” said Dr. Shahla Masood, the head of pathology at the University of Florida College of Medicine in Jacksonville. “There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin.”
There is an increasing recognition of the problems, and the federal government is now financing a nationwide study of variations in breast pathology, based on concerns that 17 percent of D.C.I.S. cases identified by a commonly used needle biopsy may be misdiagnosed. Despite this, there are no mandated diagnostic standards or requirements that pathologists performing the work have any specialized expertise, meaning that the chances of getting an accurate diagnosis vary from hospital to hospital.
In the face of studies that have shown the high risk of misdiagnosis (in anywhere from 7.8 to 20 percent of cases, depending on the study), the College of American Pathologists is vowing to start a voluntary certification program for pathologists who read breast tissue. But as Saul notes, “Some pathologists have found the response to these types of studies slow and inadequate” — especially since studies going back as far as 2002 have revealed the problem.
The physical and psychological scarring that ensues is, in many cases, unnecessary — along with the potential long-term effects of radiation therapy.
Where you live and what kind of insurance coverage you have can also affect the accuracy of the diagnosis. Rural, community hospitals are more likely to have less experienced pathologists on staff. And insurers have not encouraged second opinions.
“Some insurance plans pay as little as $10 to pathologists who are performing second opinions on DCIS,” Saul notes in response to a comment left by “MK,” who made an excellent point: “If insurers had a requirement that any slides in which cancer was suspected were automatically sent to a board-certified pathologist, it would save patients having to search for a second opinion and save the insurers the cost of unnecessary treatment.”
It should be noted that percentages of misdiagnosis, as Saul reminds “MK,” includes both false negatives and false positives. Under-diagnosis and under-treatment is also an issue. The danger of a positive diagnosis, however, goes beyond whether it is false:
Fear compounds the confusion, and even though D.C.I.S. is 90 percent curable, there is growing concern that women and their doctors opt for more aggressive surgery, radiation and drug therapy than is needed.
A mastectomy is sometimes offered as an option for D.C.I.S., although experts say it is usually not advisable unless the D.C.I.S. is large or appears in several sites in the breast.
Yet more women who are faced with the diagnosis of D.C.I.S. become so fearful that they elect to have both breasts removed, often against their doctor’s recommendations.
“The patient gets paralyzed with a fear of cancer,” Dr. Masood said. “They want the breast off.”
Among women who had surgery for D.C.I.S., the rate of double mastectomy rose to 5 percent in 2005, from 2 percent in 1998, according to a study last year.
Dr. Ira J. Bleiweiss, chief of surgical pathology at Mount Sinai Medical Center in New York, said that ideally, all breast cancer diagnoses would be referred for a second opinion. He warns patients and their doctors: “Don’t rush to the operating room.”
In related news …
New Study Links Breast Cancer Risk, Household Products: Speaking of caution and prevention, a new study in Environmental Health found a higher breast cancer risk among women with higher use of household cleaning products.
The study by Silent Spring Institute was based on telephone interviews with 787 women diagnosed with breast cancer and 721 comparison women. Many of the products contain endocrine disrupting chemicals or mammary gland carcinogens, making them suspect as contributors.
There are, of course, limitations inherent to this type of study, including the potential for recall bias. Researchers recommend further study.
Julia Brody, executive director of the Silent Spring Institute, said, “When women are diagnosed with breast cancer, they often think about what happened in the past that might have contributed to the disease. As a result, it may be that women with breast cancer more accurately recall their past product use or even over-estimate it. Or, it could also be that experience with breast cancer influences beliefs about its causes. For example, women diagnosed with breast cancer are less likely to believe heredity contributes ‘a lot’, because most are the first in their family to get the disease.”
Plus: Interested in taking action — personally and politically? The Silent Spring Institute offers a number of action kits full of helpful information, including how to reduce risks in your home.
Recommendation to Revoke Avastin: An FDA advisory committee has recommended revoking approval of the drug Avastin, for which the FDA had given conditional approval in 2008 to treat breast cancer (part of an accelerated process for drugs that treat life-threatening diseases but have less than complete evidence of effectiveness).
If the FDA, which usually follows these recommendations, takes the very unusual step of revoking approval of a drug, Avastin will still be available, since it is approved for a variety of other cancers. This would leave it open to “off-label” use for breast cancer, but insurers would be reluctant to pay for it and it would no longer be part of a program that caps its annual cost to patients.
Breast Cancer Action program manager Kimberly Irish responds to the decision: “We agree with the committee’s recommendation, and we’re saddened that after all this time there’s still no good option to offer patients when current treatments have failed.”
throat cancer
An alarming trend indicates a change in the incidence of oral cancer in young patients, and statistics show the number of cases of oral cancer, tongue cancer and throat cancer is on the rise. Internationally, a review of trends in Europe over the last thirty-five years revealed that a number of countries in Central and Eastern Europe had as high as twice as many oral cancer cases. This increase principally involved males and females that were under 45 years of age.
In the last decade, scientists have been able to pinpoint the surge in new throat cancer cases and they have presented a theory as to at least two possible causes of the upswing in the number of cases reported. It is theorized that the spike in new cases is due in-part to HPV (human papillary virus). The connection between HPV Virus and throat cancer is outlined in great details at the Health Science News web site. In summary, the virus attacks the area of the upper throat called the oropharynx.
Most recently, however, scientists have pin-pointed another possible cause for the increase in these types of cancer. A recent article in the India Express stated that tongue and throat cancers are up among youth in the region. And researchers attribute this sudden spike in tongue and throat cancer statistics to the use of Gutka. “The incidence of head and neck cancer is really high and most of us treat at least 10-15 patients in the age group of 30-35 every month,” says Dr Sujai Hegde, cancer surgeon at Sahyadri Hospital.
Gutka is a preparation of crushed areca nut, tobacco, catechu, paraffin, lime and flavorings. It is manufactured in India and exported to a few other countries. It is sold in individual-sized packets and costs very little. Gutka causes the user to feel a slight "buzz" that is somewhat more intense than that of tobacco. Its use is much like chewing tobacco, and also like chewing tobacco, it is considered responsible for oral cancer and other severe negative health effects. The use of Gutka is on the rise.
The good news is that certain types of cancer have declined. Rates of the most common cancer types in men such as prostate, colorectal, and lung are on the decline. And among women, there is also good news on horizon of the ever-persistant battle against cancer. Statistics for new cases of the two most common cancers in women, breast and colorectal, have declined to a certain degree.
The bad news is that the numbers of patients diagnosed with other types of cancer, such as oral cancer, are on the rise. Specifically tongue and throat cancer numbers are higher than they were thirty-five years ago. Other cancers also on the rise among women include thyroid cancer, pancreatic, bladder, and kidney cancer, as well as non-Hodgkin lymphoma, melanoma, and leukemia.
The symptoms of tongue cancer are outlined in great detail in a previous blog article.
The key is early detection and your dentist is the means at which people who have oral cancer are able to spot it early. And with regular dental visits, it is now easier than ever to recognize it at an early time. This is important because this is when the opportunity for a cure is great. You and your dentist can fight and win the battle against oral cancer. Know the early signs and see your dentist regularly.
cervical cancer
From the American Cancer Society
CERVICAL CANCER FACTS
UNDERSTANDING TESTS FOR CERVICAL CANCER
Today, there are two types of Pap tests:
In both types of tests, cells from the cervix are checked under a microscope in order to find cervical cancer at a stage that is easy to cure. They can also find early changes in the cells, which can be treated to stop a cancer from developing.
Pap tests are good, but not perfect. Their results sometimes appear normal even when a woman has abnormal cells of the cervix or cancer. Fortunately, most cervical precancers grow slowly. So having a Pap test at least every three years will find almost all cervical abnormalities before they progress to cancer. Cervical cancer is very curable if found early.
HPV AND CERVICAL CANCER
Almost all cervical cancers contain DNA from certain types of HPV. Infection with these HPV types may lead to changes in the cells of the cervix. Certain changes, called high-grade lesions, may progress to cervical cancer if not treated. Most HPV infections, however, go away by themselves and cause no symptoms or cell changes. One purpose of cervical cancer screening is to find high-grade changes that can progress to cancer. If found, they can be removed. This can prevent them from becoming cervical cancer.
Research has shown that tests for HPV may be a useful addition to Pap tests in women older than age 30. HPV tests are already used to help doctors decide which women with certain kinds of small changes in the cells of their cervix need further testing. However, the US Food and Drug Administration has not approved HPV tests (as of October 2002) for use in routine testing for women who have not had an abnormal Pap test result.
THE AMERICAN CANCER SOCIETY RECOMMENDATIONS
INCREASING THE ACCURACY OF YOUR PAP TEST
There are things you can do to make your Pap test as accurate as possible:
PELVIC EXAMINATION VERSUS PAP TEST
Many people confuse pelvic examinations with Pap tests. The pelvic exam is part of a woman’s routine health care. During a pelvic exam, the doctor looks at and feels the reproductive organs, including the uterus and the ovaries, and may screen for sexually transmitted diseases. But the pelvic exam will not find cervical cancer at an early stage, and cannot find abnormal cells of the cervix. The Pap test is usually done just before the pelvic exam, when the doctor removes cells from the cervix by gently scraping or brushing with a special instrument. Pelvic exams may help find other types of cancers and reproductive problems, but only Pap tests will provide information on early cervical cancer or precancers.
uterine cancer
In most cases, noticing any signs and symptoms of endometrial cancer, such as abnormal vaginal bleeding or discharge, and reporting them right away to your doctor allows the disease to be diagnosed at an early stage. Early detection improves the chances that your cancer will be treated successfully. But some endometrial cancers may reach an advanced stage before signs and symptoms can be noticed. More information about the signs and symptoms of endometrial cancer can be found in the section, "How is endometrial cancer diagnosed?"
Early detection tests
Early detection refers to the use of tests to find a disease such as cancer in people who do not have symptoms of that disease.
Women at average endometrial cancer risk
At this time, there are no screening tests or exams to find endometrial cancer early in women who are at average endometrial cancer risk and have no symptoms.
The American Cancer Society recommends that, at the time of menopause, all women should be told about the risks and symptoms of endometrial cancer and strongly encouraged to report any vaginal bleeding, discharge, or spotting to their doctor.
Women should talk to their doctors about getting regular pelvic exams. A pelvic exam can find some cancers, including some advanced uterine cancers, but it is not very effective in finding early endometrial cancers.
The Pap test (or Pap smear) can find some early endometrial cancers, but it is not used to look for endometrial cancer because it is not a good screening test for this type of cancer. The Pap test is very effective in finding early cancers of the cervix (the lower part of the uterus). For this reason, the American Cancer Society recommends that:
Women at increased endometrial cancer risk
The American Cancer Society recommends that most women at increased risk should be informed of their risk and be advised to see their doctor whenever there is any abnormal vaginal bleeding. This includes women whose risk of endometrial cancer is increased due to increasing age, late menopause, never giving birth, infertility, obesity, diabetes, high blood pressure, estrogen treatment, or tamoxifen therapy.
Women who have (or may have) hereditary nonpolyposis colon cancer (HNPCC, Lynch syndrome) have a very high risk of endometrial cancer. These women should be offered yearly testing for endometrial cancer with endometrial biopsy beginning at age 35. This includes women known to carry HNPCC-linked gene mutations, women who are likely to carry such a mutation (those with a mutation known to be present in the family), and women from families with a tendency to get colon cancer where genetic testing has not been done.
Another option for a woman who has (or may have) HNPCC would be to have a hysterectomy once she is finished having children. One study found that none of 61 women who had prophylactic hysterectomies developed endometrial cancer, while 1/3 of the women who didn't have the surgery did get endometrial cancer.
Last Medical Review: 03/28/2011
colon cancer
Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The American Cancer Society's most recent estimates for the number of colorectal cancer cases in the United States are for 2011:
the lifetime risk for developing colorectal cancer is about 1 in 20 (5.1%). This risk is slightly higher in men than in women. A number of other factors (described in the section, "Risk factors for colorectal cancer") may also affect a person's risk for developing colorectal cancer.
Colorectal cancer is the third leading cause of cancer-related deaths in the United States when men and women are considered separately, and the second leading cause when both sexes are combined. It is expected to cause about 49,380 deaths during 2011.
The death rate (the number of deaths per 100,000 people per year) from colorectal cancer has been dropping for more than 20 years. There are a number of likely reasons for this. One is that polyps are being found by screening and removed before they can develop into cancers. Screening also allows more colorectal cancers to be found earlier, when the disease is easier to cure. In addition, treatment for colorectal cancer has improved over the last several years. As a result, there are now more than 1 million survivors of colorectal cancer in the United States.
Regular colorectal cancer screening or testingis one of the most powerful weapons for preventing colorectal cancer. Screening is the process of looking for cancer in people who have no symptoms of the disease.
From the time the first abnormal cells start to grow into polyps, it usually takes about 10 to 15 years for them to develop into colorectal cancer. Regular screening can, in many cases, prevent colorectal cancer altogether. This is because some polyps, or growths, can be found and removed before they have the chance to turn into cancer. Screening can also result in finding colorectal cancer early, when it is highly curable.
Several tests are used to screen for colorectal cancer in people with an average risk of colorectal cancer. Ask your doctor which tests are available where you live and which options might be right for you.
People who have no identified risk factors (other than age) should begin regular screening at age 50. Those who have a family history or other risk factors for colorectal polyps or cancer (see section, “Risk factors for colorectal cancer”) should talk with their doctor about starting screening when they are younger and/or getting screened more frequently.
Last Medical Review: 03/02/2011
Last Revised: 03/02/2011
prostate cancer
The word screening refers to testing to find a disease like cancer in people who do not have symptoms of that disease. For some types of cancer, screening can help find cancers in an early stage when they are more easily cured. The goal of screening is to help people live healthier, longer lives.
The goal of screening for prostate cancer is to find it early, in the hope that it can be treated more effectively.
Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in your blood. Another way to find prostate cancer early is the digital rectal exam (DRE). For this exam, your doctor puts a gloved finger into the rectum to feel the prostate gland. These 2 tests are described in more detail in the section, “What tests can detect prostate cancer?”
If prostate cancer is found during screening with the PSA test or DRE, your cancer will likely be at an early, more treatable stage than if no screening were done.
Since using early detection tests for prostate cancer became relatively common (about 1990), the prostate cancer death rate has dropped. But it isn't clear yet that this drop is a direct result of screening. It could also be caused by something else, like improvements in treatment.
There are limits to prostate cancer screening tests used today. Neither the PSA test nor the DRE is 100% accurate. These tests can have abnormal results even when cancer is not present (known as false positive results). In addition, normal results can occur even when cancer is present (known as false negative results). Unclear test results can cause confusion and anxiety. False positive results can lead some men to undergo a prostate biopsy (with small risks of pain, infection, and bleeding) when cancer is not present. And false negative results may give some men a false sense of security even though they actually have cancer.
There is no question that the PSA test can help spot many prostate cancers early, but it's important to know that this test can't tell how dangerous the cancer is. Finding and treating all prostate cancers early may seem like a no-brainer. But some prostate cancers grow so slowly that they would likely never cause problems. Because of an elevated PSA level, some men may be diagnosed with a prostate cancer that they would have never even known about at all -- it would never have lead to their death or even caused any symptoms. But they may still be treated for these cancers, either because the doctor can't be sure how aggressive (fast growing and fast spreading) the cancer might be, or because the men are uncomfortable not having any treatment. Treatments like surgery and radiation can have side effects that may seriously affect a man's quality of life. These treatments can lead to urinary, bowel, and/or sexual problems. In some men these problems may be minimal and/or short-term, but for others these problems can be severe and long-lasting (or even permanent). Doctors and patients are still struggling to decide who should receive treatment and who might be able to be followed without being treated right away (an approach called watchful waiting or active surveillance). Even when patients are not treated right away, they still need regular blood tests and prostate biopsies to determine the need for future treatment. These tests are linked with risks of anxiety, pain, infection, and bleeding.
Studies are being done to try to figure out if early detection tests for prostate cancer in large groups of men will lower the prostate cancer death rate. The most recent results from 2 large studies were conflicting, and didn't offer clear answers.
Early results from a study done in the United States found that annual screening with PSA and DRE did detect more prostate cancers, but this screening did not lower the death rate from prostate cancer. A European study did find a lower risk of death from prostate cancer with PSA screening (done about once every 4 years), but the researchers estimated that about 1,400 men would need to be screened (and 48 treated) in order to prevent one death from prostate cancer. Neither of these studies has shown that PSA screening helps men live longer (lowered the overall death rate).
Recently, early results of a Swedish study of prostate cancer screening were published. One group of men was offered PSA testing every other year, with follow-up tests including biopsy if the PSA was over a certain level. This study did not test elderly men - those over 71 years old were not tested. Cancer and death rates in the group offered testing were compared to a group of men who were not offered testing. After 15 years, the group that was offered testing had a lower risk of death from prostate cancer, but the overall death rate was the same in both groups.
Prostate cancer tends to be a slow growing cancer, so the effects of screening in these studies may become clearer in the coming years. Both of these studies are being continued to see if longer follow-up will give clearer results.
At this time, the American Cancer Society recommends that men thinking about prostate cancer screening should make informed decisions based on available information, discussion with their doctor, and their own views on the benefits and side effects of screening and treatment. (See the section called “American Cancer Society recommendations for prostate cancer early detection.”)
Until more information is available, you and your doctor can decide whether you should have tests to screen for prostate cancer. There are many factors to take into account, including your age and health. If you're young and develop prostate cancer, it may shorten your life if it's not caught early. Screening men who are older or in poor health in order to find early prostate cancer is less likely to help them live longer. This is because most prostate cancers are slow-growing and men who are older or sicker are likely to die from other causes before their prostate cancer grows enough to cause problems.
Last Medical Review: 12/01/2010
Last Revised: 12/01/2010
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