Issue link: https://www.epageflip.net/i/577975
ByMaryClareJalonick TheAssociatedPress WASHINGTON The En- vironmental Protection Agency is strengthening 20-year-old rules designed to protect farmworkers from toxic pesticides. New rules announced by the EPA on Monday will bar almost anyone under 18 from handling pesticides and require buffer zones around treated fields to protect workers from drift and fumes. Farm owners and their family members would be exempt from the rules. Under the new stan- dards, workers would have to be trained annually on the risks of pesticides, in- cluding how to protect their families when they re- turn home with potentially contaminated clothes and shoes. Currently they only have to be trained every five years. Farms would also be required to post signs when the most toxic pesticides are applied. EPA Administrator Gina McCarthy said the rules are "a long time coming" and would affect millions of ag- ricultural workers across the country. "Farmworkers deserve to be healthy and safe while they are earning a living," she said. The EPA says that be- tween 1,800 and 3,000 cases of pesticide exposure are reported each year at farms, nurseries and other agricultural operations covered by the current standards. McCarthy said those rules haven't been working and that many cases of exposure aren't reported. Fewer of these incidents would mean healthier work- ers and fewer lost wages, medical bills and work ab- sences, the agency says. EPA also said it is concerned about low-level, repetitive exposure to pesticides that could contribute to chronic illness. Farmworkers are unique in that many of the work- place protection standards issued by the Occupational Safety and Health Adminis- tration for other industries do not apply to them. Many farmworkers are migrants who move from farm to farm, making it difficult to track health problems from pesticide exposure that can develop over time. Follow Mary Clare Jalonick on Twitter at http://twitter.com/ MCJalonick. NEW STANDARDS EP A ru le s wi ll s tr en gt he n pes ti ci de s af et y on f ar ms By Marilynn Marchione The Associated Press Many women with early- stage breast cancer can skip chemotherapy with- out hurting their odds of beating the disease — good news from a major study that shows the value of a gene-activity test to gauge each patient's risk. The test accurately iden- tified a group of women whose cancers are so likely to respond to hormone- blocking drugs that adding chemo would do little if any good while exposing them to side effects and other health risks. In the study, women who skipped chemo based on the test had less than a 1 per- cent chance of cancer recur- ring far away, such as the liver or lungs, within the next five years. "You can't do better than that," said the study leader, Dr. Joseph Sparano of Mon- tefiore Medical Center in New York. An independent expert, Dr. Clifford Hudis of New York's Memorial Sloan Kettering Cancer Center, agreed. "There is really no chance that chemotherapy could make that number better," he said. Using the gene test "lets us focus our chemo- therapy more on the higher risk patients who do bene- fit" and spare others the or- deal. The study was sponsored by the National Cancer In- stitute. Results were pub- lished online Monday by the New England Journal of Medicine and discussed at the European Cancer Congress in Vienna. The study involved the most common type of breast cancer — early stage, without spread to lymph nodes; hormone-posi- tive, meaning the tumor's growth is fueled by estro- gen or progesterone; and not the type that the drug Herceptin targets. Each year, more than 100,000 women in the United States alone are diagnosed with this. The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo, to help kill any stray cancer cells that may have spread beyond the breast and could seed a new cancer later. Doctors know that most of these women don't need chemo but there are no great ways to tell who can safely skip it. A California company, Genomic Health Inc., has sold a test called Oncotype DX since 2004 to help gauge this risk. The test measures the activity of genes that control cell growth, and others that indicate a likely response to hormone ther- apy treatment. Past studies have looked at how women classified as low, intermediate or high risk by the test have fared. The new study is the first to assign women treatments based on their scores and track recurrence rates. Of the 10,253 women in the study, 16 percent were classified as low risk, 67 percent as intermediate and 17 percent as high risk for recurrence by the test. The high-risk group was given chemotherapy and hormone-blocking drugs. Women in the middle group were randomly assigned to get hormone therapy alone or to add chemo. Results on these groups are not yet ready — the study is con- tinuing. But independent moni- tors recommended the re- sults on the low-risk group be released, because it was clear that adding chemo would not improve their fate. After five years, about 99 percent had not relapsed, and 98 percent were alive. About 94 percent were free of any invasive cancer, in- cluding new cancers at other sites or in the oppo- site breast. "These patients who had low risk scores by Oncotype did extraordinarily well at five years," said Dr. Hope Rugo, a breast cancer spe- cialist at the University of California, San Francisco, with no role in the study. "There is no chance that for these patients, that che- motherapy would have any benefit." Dr. Karen Beckerman, a New York City obste- trician diagnosed with breast cancer in 2011, said she was advised to have chemo but feared com- plications. A doctor sug- gested the gene test and she scored very low for re- currence risk. "I was convinced that there was no indication for chemotherapy. I was thrilled not to have to have it," and has been fine since then, she said. Mary Lou Smith, a breast cancer survivor and advocate who helped design the trial for ECOG, the Eastern Cooperative Oncology Group, which ran it, said she thought women "would be thrilled" to skip chemo. "Patients love the idea of a test" to help reduce uncer- tainty about treatment, she said. "I've had chemother- apy. It's not pretty." The test costs $4,175, which Medicare and many insurers cover. Others be- sides Oncotype DX also are on the market, and Hu- dis said he hopes the new study will encourage more, to compete on price and ac- curacy. "The future is bright" for gene tests to more precisely guide treatment, he said. Marilynn Marchione can be followed at http://twitter.com/ MMarchioneAP. BREAST CANCER Ge ne t es t fin ds w hi ch p at ie nt s can s ki p ch em ot he ra py THEASSOCIATEDPRESS Chemotherapy is administered to a cancer patient via intravenous drip in Durham, N.C. In a study sponsored by the National Cancer Institute and results published online Monday by the New England Journal of Medicine, a gene-activity test that was used to gauge early- stage breast cancer patient's risk accurately identified a group of women whose cancers are so likely to respond to hormone-blocking drugs that adding chemo would do little if any good while exposing them to side effects and other health risks. The Associated Press CHICAGO Txt msgs may b gud 4U. That's the message in a study that suggests just four monthly text mes- sages might spur health improvements for heart patients. The simple, heart-re- lated advice led to substan- tial changes in blood pres- sure, cholesterol and physi- cal activity levels, according to the results published in Tuesdays' Journal of the American Medical Associ- ation. Smaller studies have linked health-oriented text messages with improvement in a single measure, but this is the largest to find multi- ple benefits, the researchers said, led by Dr. Clara Chow of the University of Sydney's George Institute for Global Health. Thebasics The researchers ran- domly assigned heart pa- tients to receive usual care alone, or usual care plus automated healthy text messages for six months. Almost one-third of the text message group reached target levels for four or more heart disease risk factors, versus only 10 percent of the usual care group. The texts A few of the messages: • Try avoiding adding salt to your foods by using other spices or herbs. • Walking is cheap. It can be done almost anywhere. All you need is comfortable shoes & clothing. • Try identifying the trig- gers that make you want a cigarette & plan to avoid them. The limitations The study didn't last long enough to see if improve- ment in heart disease risk factors led to fewer heart attacks. A journal editorial notes other weaknesses included relying on patients self-re- porting physical activity levels, and no attempt to measure whether adding more text messages would lead to bigger improve- ments. The quote The benefits could po- tentially "reduce risk of re- current heart attacks by at least a quarter if they were maintained long-term," said Chow. "We think it is really important to see if they can be repeated elsewhere in Australia and internation- ally, and maintained long- term." Future research Chow said she's involved in a broader study at about 20 centers in Australia in urban, rural and indige- nous settings, and will be following patients to see it the text message program results in lasting benefits. AP Medical Writer Lindsey Tanner can be reached at http:// www.twitter.com/ LindseyTanner. HEART HEALTH Text messages may have benefits, study says Thankyou! PLEASE RECYCLE THIS NEWSPAPER. Online: Journal HTTP://JAMA.JAMANET- WORK.COM I T only T A K E S A S P A R K . 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