February 25th, 2014
07:47 AM ET

Study: Women With BRCA1 Mutations Should Remove Ovaries by 35

A new study on healthy women with genetic mutations that sharply increase the risk of breast and ovarian cancer supports the old adage: An ounce of prevention is worth a pound of cure.

The report, published online Monday in the Journal of Clinical Oncology, studied nearly 5,800 women with specific genetic mutations called BRCA1 and BRCA2.

Researchers found that women with BRCA1 and BRCA2 mutations who protectively had their ovaries removed reduced their risk of ovarian, fallopian tube, or peritoneal cancer by 80%, and their overall risk of death by 77%.

BRCA stands for breast cancer susceptibility genes, a class of genes known as tumor suppressors. Mutations of the BRCA1 and BRCA2 genes have been linked to hereditary breast and ovarian cancer.

According to Monday's study, women with BRCA1 mutations should have preventive ovarian surgery– known as prophylactic oophorectomy - by age 35, as waiting appears to increase the risk of ovarian cancer. In contrast, women with BRCA2 mutations can safely delay surgery until their 40s, the study suggests, as their risk of ovarian cancer is not as strong.

The new research provides doctors with additional information to support the risk-reducing surgery, said ovarian cancer expert Dr. Shannon Westin.

Removing the ovaries in these patients "provides more benefits than just the reduction in ovarian cancer because this study shows there's a survival benefit that has not been shown this clearly before," she said.

Westin is an assistant professor in the Department of Gynecologic Oncology and Reproductive Medicine at the MD Anderson Cancer Center in Houston. She was not involved in the study.

According to the American Cancer Society, previous studies have shown that removing the ovaries of a premenopausal woman with BRCA mutations can reduce the risk of ovarian cancer by 85% to 95%, and the risk of breast cancer is cut by 50% to 60%.

But Monday's study is the first study to show an overall mortality reduction benefit.

"To me, waiting to have oophorectomy until after 35 is too much of a chance to take," said Steven Narod, professor of medicine at the University of Toronto in Canada, and the study's lead author. "These data are so striking that we believe prophylactic oophorectomy by age 35 should become a universal standard for women with BRCA1 mutations."

BRCA mutations grabbed national headlines last year when actress Angelina Jolie announced she carries a mutation of the BRCA1 gene and had underwent a preventive double mastectomy at age 37 to reduce her risk of breast caner.

Jolie's mother, actress and producer Marcheline Bertrand, died of ovarian cancer in 2007 at the age of 56.

"My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman," Jolie wrote in a New York Times op-ed article in May.

"Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could," she said. "I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex."

Dr. Agustin Garcia, an associate professor of Clinical Medicine at Keck Medicine of University of Southern California, said another important aspect of the study is how it breaks down the differences researchers saw between BRCA1 and BRCA 2 carriers.

"In most of the guidelines, we don't distinguish between the two, but this study separated the two groups for potential age for prophylactic oophorectomy," said Garcia, who was not involved in the research.

He said the study tells women with the BRCA2 mutation they can probably wait until they are 50 to have their ovaries and fallopian tubes removed.

"These results could make a real difference for women with BRCA mutations, who face tough decisions about whether and when to undergo a prophylactic oophorectomy," Don Dizon, a member of the cancer communications committee at the American Society of Clinical Oncology, said in a statement.

"Importantly, for women who will be undergoing this surgery early in life, it's reassuring to see that it carries long-lasting benefits, substantially reducing ovarian cancer risk as well as total mortality risk," he added.

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February 25th, 2014
06:52 AM ET

Cold Arctic Air Returns

Just like in the movies, the sequel just never lives up to the original.

Polar Vortex, Part II (or is it III or IV?) is drawing some gasps and shrieks, as it gears up to roll across most of the country this week, dropping lows in the north-central United States to more than 10-below.

But there's no need for too much excitement - although it will be unpleasant enough.

Temperatures will drop Tuesday to 10 to 30 degrees below normal for this time of year in places like Minnesota and the Dakotas. Then the arctic blast will roll east.

By the middle of the week, the freeze zone will sweep the Midwest and the East Coast, plunging lows into the single digits in places like Indiana and Massachusetts.

It will cover two thirds of the country; even parts of the Deep South will drop down below freezing - but just for a night or two, the NWS said.

There will probably be some snow here and there, but the good news is that things should stay pretty dry, the NWS said.

Many of us will shiver. That's about it.

This snap won't live up to the weather thriller, Polar Vortex - The Original.

It debuted in early January, when a large frigid air mass broke free from the arctic, and flopped down over North America for days, littering the country with record lows and freezing pipes all the way down to Alabama.

So, is this week's cold snap really a polar vortex?

"It's not the same sort of setup," Javaheri said. "It's a lot shorter lived."

In fact, weather officials are getting tired of arctic snaps like the one coming this week being stamped with the same "polar vortex" moniker that January's storm so deservedly got, he said.

This week's cold air does have the same origins as January's monster freeze, but it may be better described as a slice of polar vortex.

The National Weather Service refers to it as "a cold mass of arctic air."

"Pieces of it will settle in the Upper Midwest and in Canada," Javaheri said.

So, it may remain cold there for a few days, but over the weekend things should lighten up.

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February 25th, 2014
06:27 AM ET

Polio-Like Illness Found in Five California Children

Doctors are looking for more information about a "polio-like syndrome" that has caused paralysis in a few children in California.

Neurologists have identified five patients who developed paralysis in one or more of their limbs between August 2012 and July 2013. All five children had been vaccinated against the poliovirus. Treatment did not seem to help the children regain their motor function.

Samples from two of the children tested positive for enterovirus 68, a rare virus that has been linked to severe respiratory illness in the past. Samples from the other three children were not collected or tested soon enough to yield conclusive results, said Dr. Emmanuelle Waubant, a neurologist at the University of California, San Francisco.

Waubant and her colleagues will present a case report about these patients' illnesses at the American Academy of Neurology's annual meeting in late April. They are asking health care providers to be on the lookout for similar cases and send in samples from any patient exhibiting these symptoms.

Dr. Carol Glaser, chief of the Encephalitis and Special Investigation Section at the California Department of Public Health, said the state is aware of the paralysis cases but believes the risk to families is very low.

"We are evaluating cases as they are reported to us," Glaser said in an e-mail to CNN. "We have not found anything at this point that raises any public health concerns."

The poliovirus has been eradicated in the United States for more than 30 years. Only three countries in the world are not yet free of the disease: Afghanistan, Pakistan and Nigeria, according to the World Health Organization.

Why polio hasn't gone away yet

Poliovirus is part of the Picornaviridae family, which also includes enteroviruses and rhinoviruses (better known as the common cold). There are more than 100 types of enterovirus that cause 10 million to 15 million infections in the United States each year, according to the Centers for Disease Control and Prevention.

Most people who become infected with an enterovirus do not get sick or experience only mild symptoms, said Dr. Steven Oberste, chief of the Polio and Picornavirus Laboratory Branch at the CDC. Common symptoms include fever, runny nose, cough, skin rash and body aches.

Enterovirus is often the cause of "summer colds," whose cases spike in July, August and September. Children and teens are more likely to fall ill because they have not yet built up immunity to these common viruses.

However, some types of enterovirus are more serious. These can cause hand, foot and mouth disease; viral meningitis; encephalitis (inflammation of the brain); an infection of the heart; and paralysis in some patients.

Enterovirus 68 was first identified in a California lab in 1962, after four children came down with a severe respiratory illness. Between 1970 and 2005, only 26 cases of enterovirus 68 in the United States were reported to the CDC. Since 2000, the government agency has kept a closer watch and has seen 47 cases, Oberste said. Outbreaks have occurred over the years in Asia and Europe, but it's still one of the rarest types of enterovirus.

More common - and more concerning to health officials - is enterovirus 71, which was discovered by the same California lab in 1969, Oberste said. Enterovirus 71 is usually associated with severe neurological issues, including aseptic meningitis, polio-like paralysis and encephalitis.

According to a CDC report, several outbreaks of paralysis caused by enterovirus 71 were seen in Europe in the 1960s and 1970s. In the late 1990s and early 2000s, fatal encephalitis was a big problem in Malaysia and Taiwan.

"Ever since then, the virus has circulated in high levels in Southeast Asia," Oberste said.

In recent years, the outbreaks have spread to Australia; a cluster of cases near Sydney drew media attention in 2013.

Between 1983 and 2005, 270 cases of enterovirus 71 were reported in the United States. But none has resulted in a larger outbreak, despite the virus's infectious nature.

"That's the really odd thing," Oberste said. "We see cases from time to time in the United States. Occasionally they'll be severe. Basically it's identical to what's circulating in Asia ... but it doesn't cause the same big outbreak in disease. And we really don't know why."

The CDC is aware of the small cluster of cases in California but is not actively involved in an investigation, a spokesman told CNN. Waubant and her colleagues don't want to alarm anyone with their case report presentation; they're simply seeking help in finding the cause of these seemingly connected cases.

"We would like to stress that this syndrome appears to be very, very rare," one of Waubant's colleagues, Dr. Keith Van Haren, said in a prepared statement.

Parents need to know that vaccination is key to preventing polio from returning to the United States, Glaser said. While there is no vaccine to protect you from a non-polio enterovirus, washing your hands frequently and avoiding close contact with others who are sick can help.

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February 25th, 2014
05:14 AM ET

Five Things to Know for Your New Day – Tuesday, February 25

Arizona's governor has a choice to make on a controversial right-to-deny-service bill. Researchers are looking for answers after a mystery disease paralyzes limbs in five children. And Ukrainian lawmakers are in a hurry to create a new government with an ousted President on the run.

Welcome to the Tuesday edition of "5 Things to Know for Your New Day."

1. ARIZONA CONTROVERSY

Veto or not: It is decision time for Arizona Gov. Jan Brewer, and this one may not be easy. She has to decide if she will sign a bill that supporters say promotes religious freedom and opponents say discriminates against gays and lesbians. The bill could let business owners, as long as they assert their religious beliefs, deny service to gay and lesbian customers.

She has until Saturday morning to sign or veto the bill. If she does nothing, it automatically becomes law. What will she do? She's been a conservative champion, but Arizona GOP sources say she also considers herself pro-business, and some business leaders are encouraging her to oppose the measure.

Miguel Marquez reports at 6.

2. UKRAINE UNREST

Short-order government: After months of protests came to a head with deadly clashes and the ouster of President Viktor Yanukovych last week, Ukrainian lawmakers are in a hurry to come up with an interim government that can steer the country until presidential elections in May. The interim President said that he aims to have a unity government by Thursday.

But even with Yanukovych gone - he's on the run, evading an arrest warrant - those in power face lots of challenges, including a division between the east and west of the country, and the intentions of Russia, a key backer of the former President.

Nick Paton Walsh will have the latest at 6.

3. MYSTERY ILLNESS

Polio-like syndrome in California: What caused five California children to be paralyzed in an arm or leg? Neurologists in that state are alerting the public about a polio-like syndrome that appeared in those children in 2012 and 2013. The emphasize that it appears to be very rare, but they want other doctors to be aware to help them determine the cause, and they want any other cases identified quickly. Researchers don't know what caused these cases, though it's not poliovirus, and they say similar syndromes pop up every couple of years elsewhere in the world.

On Monday evening, the parents of one of the children, 4-year-old Sofia Jarvis of Berkeley, told reporters that they've been told her left arm is permanently paralyzed. She goes to preschool and can write with her right hand. The difficulties? "Day to day getting dressed, tying her shoes, those things that she would normally be learning right now ... we are going to have to find a new way of doing," said her mother, Jessica Tomei.

Dan Simon will have the latest at 6.

4. SHRINKING THE ARMY

Smallest Army in 70 years? If U.S. Secretary of Defense Chuck Hagel has his way, the nation's Army would be cut to its lowest number of active-duty troops since the buildup to World War II. Hagel on Monday proposed a scaled-back military spending plan, one that he said would reflect the country's fiscal challenges but still let it dominate one war while still maintaining effective defenses for a second.

Expect a fight over this. Republican hawks have previously battled President Barack Obama's attempts to reduce defense spending as part of overall deficit reduction. And South Carolina Gov. Nikki Haley says proposed cuts to the National Guard are a "slap in the face" to anyone who has served in the reserve military force.

Barbara Starr will report live at 6.

5. TED NUGENT

Done with name calling? Republicans weren't happy with conservative rocker Ted Nugent after he called Obama a "subhuman mongrel," and apparently Nugent is listening. He apologized last week, and on Monday he told CNN that criticism by fellow conservatives persuaded him to give up name calling. He says he represents many of the people they do, and "I think I owe it to those great Americans to be more civil when I represent them." He also insisted that his "mongrel" remarks, made in an interview last month, were not racist.

Those are your five biggies for the day. Here are a few others that are brewing and have the Internet buzzing.

- Harold Ramis' debilitating disease: People are mourning Harold Ramis, the actor, writer and director whose films include "Stripes," "Ghostbusters," "Groundhog Day" and "Analyze This." The disease that led to his death, vasculitis, is one of a family of maladies that can starve organs and cause painful tissue damage.

- Waffle taco: Taco Bell has announced a breakfast menu that's debuting in late March. The waffle taco in particular is getting attention on social media.

- If only it had thumbs: This dog would like to open a bag of marbles. It's not having much luck.

- That sinking feeling: BBC reporter Caroline Bilton drops from view during a live report.

There you go. All you need to know to get an early start to your morning.

Be sure to tune in to "New Day" from 6 to 9 a.m. ET. Join us at NewDayCNN.com, and go and have a GREAT NEW DAY!

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