Cancer-treatment-induced bone loss, part 2.

PURPOSE: The pathophysiology, frequency, sequelae, diagnosis, and treatment of cancer-treatment-induced bone loss (CTIBL) are discussed. SUMMARY: CTIBL is a long-term complication associated with cancer therapies that can directly or indirectly affect bone metabolism. Although CTIBL can occur in any patient receiving a cancer therapy known to cause bone loss, CTIBL is most common in patients with breast or prostate cancer who receive chemotherapy, hormone therapy, or surgical castration, as these can cause hypogonadism and induce bone loss. CTIBL causes bone fragility and an increased susceptibility to fractures; therefore, prevention, early diagnosis, and treatment of CTIBL are essential to decrease the risk of fracture. Bone loss occurs more rapidly and tends to be more severe in patients with CTIBL compared with those with normal age-related bone loss. Fractures of the hip, vertebra, and wrist are the fractures most commonly associated with bone loss. CTIBL is diagnosed by measuring bone mass using bone densitometry. Treatment of CTIBL consists of changing diet and lifestyle such as optimizing calcium and vitamin D intake, exercising, modifying behaviors known to increase the risk of CTIBL and pharmacologic therapy with hormone replacement therapy (HRT), selective estrogen-receptor modifiers (SERMs), calcitonin, or a bisphosphonate. CONCLUSION: Early identification and treatment of CTIBL are essential to prevent fractures. Patients should be instructed to optimize calcium and vitamin D intake, exercise regularly, and modify lifestyle behaviors known to cause bone loss. Patients with CTIBL should be treated with an oral or i.v. bisphosphonate; SERMs or HRT may be an option in some patients if contraindications do not exist.     

Developing a brucellosis public health information and awareness campaign in Iraq

U.S. Army civil affairs public health professionals are deployed worldwide in support of current contingency operations to promote and to preserve the public health of the citizens of the occupied territory or host nation. In Iraq, they face the challenge of assisting a health care system plagued by years of neglect and inefficient bureaucracy. Iraqi efforts to track and to control infectious diseases, especially zoonotic diseases, are in their infancy. Brucellosis, a worldwide zoonotic disease of ruminants, is of particular concern in Iraq because of the close proximity of animals to humans and the cultural habits that favor disease dissemination among the population. A public health education and awareness campaign was recently developed in Ninewa Province, Iraq, to educate Iraqi citizens about brucellosis and ways to prevent it. The public health campaign used a two-pronged approach to effect change, i.e., (1) development of a social marketing campaign (public health education) about brucellosis and its prevention, with billboards, flyers, and public service announcements, and (2) mobilization of key veterinary institutions to participate in educating and training the public and farmers about brucellosis. The campaign used culturally relevant messages and was targeted to address local cultural practices, to lower disease transmission. Efforts were made to state messages using local terms and references. This approach may have utility in other public health efforts in Iraq and other postconflict stabilization operations.     

Cancer incidence among women and girls environmentally and occupationally exposed to blue asbestos at Wittenoom, Western Australia

The impact of crocidolite exposure on the health of former Wittenoom miners and millers (largely male) has been well documented. Less is known about the health outcomes of the 2,968 women and girls who lived (N = 2,552) and worked (N = 416) in the blue asbestos milling and mining town of Wittenoom between 1943 and 1992. Quantitative exposure measurements were derived from dust studies undertaken over the lifetime of the mine and mill and the township. Incident cancers were obtained from the Western Australian (WA) Cancer Registry and the National Cancer Clearing House. Standardized incidence ratios (SIRS) compared Wittenoom females with the WA female population. Exposure-response relationships were examined using a matched case-control study design. There were (47) mesothelioma and (55) lung cancer cases among the 437 cancers in the Wittenoom females over the period 1960-2005. When compared to the WA female population, Wittenoom women and girls had higher rates of mesothelioma and possibly lung cancer. Mesothelioma incidence rates are increasing with the incidence rate of 193 per 100,000 in the period 2000-2005 being more than double that for the period 1995-1999 at 84 per 100,000. A significant exposure-response relationship was present for mesothelioma, but not for lung cancer. Forty years after the asbestos mine and mill at Wittenoom were closed, there is a high toll from cancer among the former female residents of the town and company workers.     

Actinic granuloma

A 45-year-old man presented with a 3-year history of asymptomatic, annular, erythematous plaques on the face and neck. Histopathologic examination showed sarcoidal granulomas with an associated mixed-cell infiltrate, loss of elastic fibers, and no increase in mucin. These findings were consistent with a diagnosis of actinic granuloma, which is an uncommon, idiopathic disease that is characterized by granuloma annulare-like plaques on sun-exposed areas.