Researchers at the Mayo Clinic analyzed the additional costs of smoking and obesity among more than 30,000 Mayo Clinic employees and retirees. All had continuous health insurance coverage between 2001 and 2007.

The study, by James P. Moriarty  and his coauthors give new insight into the long-term costs of obesity and smoking, which both caused higher health costs in the seven-year follow-up period of the study.Their report shows obesity and smoking were both associated with excess costs for health care. In a comparison with nonsmokers, average health costs were $ 1,275 higher for smokers.

The incremental costs associated with obesity were even higher: $ 1,850 more than for normal-weight individuals. For those with morbid obesity, the excess costs were up to $ 5,500 per year.

The additional costs associated with obesity appeared lower after adjustment for other accompanying health problems (comorbidity). “This may lead to underestimation of the true incremental costs, since obesity is a risk factor for developing chronic conditions,” Moriarty and colleagues write.

Smoking and obesity place a growing strain on an already stretched healthcare system. Many employers are now evaluating wellness programs to lower their costs by reducing health risk factors.

The results of the 4,000-plus-participant clinical study are being presented at the 32nd annual meeting of the Society for Maternal-Fetal Medicine in Dallas on Feb. 9, 2012. The study was recently published in the American Journal of Obstetrics & Gynecology.

In women having routine prenatal diagnosis, CMA detected additional genetic abnormalities in about 1 out of every 70 fetal samples that had a normal karyotype. When a birth defect was imaged by ultrasound, CMA found additional important genetic information in 6 percent of cases.

“These results suggest that CMA may soon replace karyotyping for prenatal testing.”  - Dr. Ronald Wapner Director Reproductive Genetics NewYork-Presbyterian Hospital

“Why would anyone want to continue to use the standard method, which gives only part of the answer?” says Dr. Wapner.

Wagner led the 34-center study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

CMA is not routinely used for prenatal testing but has become the primary genetic test to evaluate newborns with birth defects, as well as infants and young children with developmental delays.

Dr. Wapner describes the observed difference in accuracy between the two tests this way: “With karyotyping, we can see only when pieces of the genome of about 5 million base pairs are missing from a chromosome. With CMA, we can see missing pieces of fewer than 100,000 base pairs.”

CMA is based on a method that determines whether the right amount of genetic material is present at numerous locations in the fetus’ genome.

This study was the first to examine the two methods in a blinded head-to-head comparison. Fetal samples were collected from the amniotic fluid or placenta of 4,450 participants. “These were women who were seeking prenatal testing for the usual reasons, which could be age, increased risk of inheritable disease, or a structural abnormality in the fetus,” Dr. Wapner says.

Each participant’s sample was split and sent, in a blinded fashion, to one of four laboratories that perform CMA – NewYork-Presbyterian Hospital/Columbia University Medical Center, Emory University, Baylor College of Medicine or Signature Genetics. The other portion of the sample was sent to Genzyme Genetics for standard karyotyping.

Results show that CMA and karyotyping were equally effective at identifying chromosomal abnormalities such as the duplicate chromosomes that cause Down syndrome and Trisomy 18. But CMA provided significantly more clinically relevant information in two situations.

“In 6 percent of the cases where there’s a structural abnormality of the fetus but karyotyping is normal, CMA will provide additional significant information,” Dr. Wapner says. “And in about 1.7 percent of cases where the procedure was done because of the mother’s age or similar concerns and the chromosomes were normal, CMA reveals additional information of concern.”

Both tests offer information on conditions that can be life-threatening to a newborn baby or that can signal a possible health threat that might be treatable. “We are looking for the same thing in both tests,” Dr. Wapner says. “But we find more abnormalities with CMA.”

CMA can identify at least 150 known conditions and tell us exactly what the problem is and what it means for a child. Although karyotyping provides the same kind of information, CMA will likely provide more information on other potential disorders that might not otherwise be picked up such as intellectual disability or autism.

“It does not always mean that a child will necessarily develop these disorders, because many are due to multiple influences,” Dr. Wapner says. “But it will help parents because they can be on the lookout for a particular disorder and have a treatment plan in place. I believe it is important to give parents as much information as they need about their child.”

However, they both affect a person’s skin, can be quite difficult to treat or remove and, now, dermatologists are discovering new laser therapies which enhance treatment for both conditions.

“Dermatologists are now finding that new laser therapies can significantly improve melasma and even remove tattoos more safely and effectively than laser procedures we have used in the past.” – Arielle N.B. Kauvar Clinical Professor Dermatology  New York University School of Medicine

Combination Laser Therapy Targets Melasma

Melasma is caused by an overproduction of melanin, a natural substance in the body that gives skin its color and can lead to dark patches on the face. While melasma may occur in anyone, the condition most commonly affects women with darker Mediterranean skin, Asians and Hispanics. Dr. Kauvar explained that melasma is typically controlled with topical medications that contain ingredients to lighten the skin, such as hydroquinone or retinoids.

However, this therapy may only provide temporary improvement in more difficult cases – particularly in patients with mixed-type melasma. In this type of melasma, excess pigment is produced in both the epidermis and dermis – the upper and lower levels of the skin. While high-energy lasers for pigment removal and laser resurfacing have been investigated to treat this type of melasma, Dr. Kauvar explained that the procedures were too harsh and could wound the skin, leading to increased pigment production and worsening of melasma. More recently, fractional lasers – which are less aggressive lasers – have been used, but there have been reports of an increased incidence of melasma recurring as well.

“Effective treatment of mixed-type melasma requires a very low-energy and low-impact procedure because irritation and inflammation can worsen melasma,” said Dr. Kauvar.

With the new combination therapy, the dermatologist performs a microdermabrasion immediately followed by a low-energy laser treatment with a Q-switched YAG laser. Patients then begin a topical regimen using hydroquinone and sunscreen.

In Dr. Kauvar’s study of 27 women with mixed-type melasma, 22 subjects (81 percent) experienced greater than 75 percent improvement of their melasma after an average of 2.6 laser treatments. Of those, 11 subjects (40 percent) achieved over 95 percent improvement of their melasma. In addition, she found that clearance of melasma was maintained for at least six months.

Tattoos Getting the Boot with New Laser Therapies

While lasers have been used to remove tattoos for several years, the procedure requires multiple treatment sessions (typically six to 10 treatments or more) and treatments are painful, requiring a few weeks of healing time between procedures. Dr. Kauvar noted that the process of tattoo ink removal is inefficient since every color of ink absorbs different wavelengths of light, requiring the use of multiple lasers. Some colors – such as yellow, orange, turquoise or fluorescent ones – remain more difficult to treat.

“Unfortunately, there is no ideal laser to remove all tattoo colors, but new approaches have recently been introduced that appear to produce better results with fewer treatment sessions,” said Dr. Kauvar.

These four separate treatments are administered at 20-minute intervals and have demonstrated much faster clearance of tattoo inks. Other research involves the use of the fractional ablative laser in conjunction with traditional tattoo-removal lasers to speed up clearance – resulting in as much as 50 percent tattoo ink removal in just one treatment session. In another new study, Dr. Kauvar is investigating the effectiveness of administering two treatments in one day using a combination of laser wavelengths to target different ink colors.

With this procedure, Dr. Kauvar first uses a Q-switched YAG laser on the tattoo, followed by a Q-switched alexandrite laser (which is better at treating blues and greens) 20 minutes after the first laser. Dr. Kauvar noted that initial results of this procedure have shown significant improvement in removing blue, green and black inks.

Patients use a remote control to gradually create a space within their chest wall for a breast implant.

Breast cancer patients, who wish to have reconstructive surgery after mastectomy, used to undergo a process involving injections of saline to gradually expand skin and muscle of their chest. The process can be painful and may require frequent doctor’s visits over the course of four to six months or longer.

“Unfortunately, less than half of all women who have mastectomies in the United States undergo reconstructive surgery. One major factor in this decision may be limitations of the traditional approaches.” – Dr Jeffrey Ascherman Site Chief Division Plastic Surgery Columbia University Medical Center

The new approach is designed to promote a higher quality of life for patients dealing with cancer recovery. Once a small expander device is implanted in the patient’s chest, she can control the process in the comfort of her home – without any injections and with fewer doctor’s visits. At a moment of the patient’s choosing, a remote control is used to activate the device and release a small amount of compressed carbon dioxide.

“The whole process is also a lot quicker,” says Ascherman.

The procedure is offered as part of an ongoing clinical trial designed to compare the outcomes of the traditional saline expansion method with the investigational, remote-controlled tissue expander. NewYork-Presbyterian/Columbia was the first center in the U.S. to receive Institutional Review Board (IRB) approval for a trial of the new technique, the first center in the U.S. to begin using the device, and it is currently the only hospital in the Eastern U.S. to be actively participating in the trial.

Study funding is provided by AirXpanders Inc. of Palo Alto, Calif.

Eligible patients include non-obese women from 18 to 65 years of age who do not smoke, have not had previous tissue expansion or radiation therapy, and who are opting for breast reconstruction with tissue expansion after mastectomy. For more information about the trial, patients can contact Dr. Ascherman at jaa7@columbia.edu or (212) 305-9612.
Columbia University Medical Center

Research conducted by NewYork-Presbyterian Hospital/Weill Cornell Medical Center global health investigators and cancer specialists in New York, Qatar and Haiti suggests that aspirin should be evaluated for its ability to prevent development of cervical cancer in HIV-infected women.

The report, published in the current issue of journal Cancer Prevention Research, says this simple and inexpensive solution has the potential to provide enormous benefit for women in the Caribbean, Latin America and Africa, who suffer from a disproportionately high rate of cervical cancer death.

Preventive aspirin use could be especially useful in Haiti, where invasive cervical cancer is a common cause of death in HIV-infected women. The country also has the highest reported incidence of cervical cancer in the world and one of the highest HIV infection rates in the Western Hemisphere.

“These young patients — many of whom were mothers and the sole support for their families — had worked hard to have their HIV controlled with antiretroviral therapy, only to develop and die from cervical cancer,” says the study’s lead researcher, Dr. Daniel Fitzgerald, an associate professor of medicine at Weill Cornell Medical College who lived in Haiti for seven years and continues to treat HIV patients there.

Dr. Fitzgerald is a key member of the Weill Cornell Medical College Center for Global Health and directs the College’s collaboration with GHESKIO, a Haitian non-governmental organization dedicated to providing clinical service, research and training in HIV/AIDS since 1980.

“The results of this collaborative effort will make a real difference for women living in one of the poorest nations in the world,” he says. “It is wonderful that clinicians and scientists from different parts of the world were able to come together to address such a critical issue of care.”

The researchers discovered that HIV induces expression of the COX-2/prostaglandin E2 (PGE2) inflammatory pathway in cervical tissue samples from Haitian women who were infected with HIV. The findings tie two known facts together: that HIV causes chronic inflammation; and that PGE2, which is elevated during inflammation, is linked to cancer development in a number of tumor types, including cervical cancer.

The fact that HIV ramps up production of PGE2 in cervical tissue was not known before this study, the researchers say.

This may help explain why HIV-positive women are five times more likely to develop invasive cervical cancer than HIV-negative women. It also suggests that inhibitors of the COX-2 molecule (which contributes to the production of PGE2) might break the link between HIV and cervical cancer. Aspirin is one of the cheapest and most effective COX inhibitors.

“The findings in this study provide new insights into the link between viral infection and inflammation, two known drivers of cancer development,” says senior author Dr. Andrew Dannenberg, director of the Weill Cornell Cancer Center at NewYork-Presbyterian/Weill Cornell and the Henry R. Erle, M.D. – Roberts Family Professor of Medicine at Weill Cornell Medical College.

“Future studies will be needed to determine whether aspirin-like agents, known inhibitors of prostaglandin production, can reduce the risk of cervical cancer in this high-risk population,” he adds.

The researchers examined levels of COX-2 and PGE-M (a stable metabolite of PGE2) in three groups of women and found increased levels of both molecules in 13 women who were co-infected with HIV and HPV. COX-2 and PGE-M were also elevated in 18 HIV-infected women with a negative HPV test and lowest in 17 HIV-negative women who also were not infected with HPV.

The findings thus demonstrate that HIV infection is associated with increased cervical COX-2 and elevated systemic PGE2 levels, says Dr. Fitzgerald. Co-infection with HPV adds to the cervical cancer risk. Future studies will seek to define the population of women that may benefit from daily use of aspirin or related inhibitors.

Dr. Fitzgerald, along with GHESKIO physician and study co-author Dr. Cynthia Riviere, initiated the clinical research program to care for and prevent cervical cancer in HIV-positive women in Haiti after they began noticing an increasing report of cases.

“The goal is to give patients in Haiti the same standard of treatment found in any cancer center,” says Dr. Jeremie Arash Rafii Tabrizi, assistant professor of genetic medicine at Weill Cornell Medical College in Qatar who has treated women at the GHESKIO clinic. “We are focusing on procedures that will allow for a reduction of morbidity — as this is a major concern in this population — as well as a reduction of risk of recurrence.”

The research was funded by the National Cancer Institute, the Fogarty International Center, and the Flight Attendant Medical Research Institute.

Other co-authors include Karl Bezak, Oksana Ocheretina, Xi Kathy Zhou, Baoheng Du, Kotha Subbaramaiah, Erin Byrt and Matthew L. Goodwin, all from Weill Cornell; Thomas C. Wright from Columbia University College of Physicians and Surgeons; and Ginger L. Milne from Vanderbilt University School of Medicine.

Dr. Dannenberg is the senior editor for Cancer Prevention Research.

The authors declare the following potential conflicts of interest: Dr. Dannenberg is a member of the Scientific Advisory Board and holds an equity interest in Tragara Pharmaceuticals Inc., a company that is developing a selective COX-2 inhibitor. Dr. Fitzgerald supervises a scholarship program for Tanzanian medical students sponsored by Pfizer Inc.

According to this new study, published in the Jan. 19, 2012, issue of Cell Host & Microbe, α-hemolysin, a toxin secreted by many strains of Escherichia coli (E. coli), may play an important, unexpected role during both the establishment and persistence of urinary tract infections.

Urinary tract infections (UTIs) are among the most common infectious diseases worldwide. Each year, 15 million U.S. women have a UTI and nearly 50 percent of women will have at least one UTI in their lifetime. Bacteria known as uropathogenic E. coli (UPEC) are the leading cause of both acute and chronic urinary tract infections. UPEC invade cells on the surface of the bladder, where it can stimulate exfoliation, or shedding, of bladder cells.

“Exfoliation of bladder cells can be viewed as a double-edged sword since it may benefit both the host and the invading bacteria.” –  Matthew Mulvey Associate Professor Pathology University of Utah.

“While shedding helps to get rid of infected cells, it can also promote spread of the bacteria both within and outside of the urinary tract. The goal of our investigation was to uncover possible mechanisms by which UPEC might prime bladder cells for shedding,” he explained.

Mulvey and Bijaya Dhakal, Ph.D., U of U postdoctoral fellow in pathology, found that infection of bladder cells with UPEC led to degradation of a protein called paxillin, which helps to regulate cell adhesion. They discovered that paxillin degradation was stimulated by α-hemolysin (HlyA), a toxin secreted by UPEC, which inserts into bladder cell membranes.

HlyA itself does not act to break down paxillin, but Mulvey and Dhakal found that HlyA caused increased activation of a protein-degrading enzyme called mesotrypsin.

“Our data indicate that mesotrypsin is at least partially responsible for paxillin degradation in the UPEC-infected bladder cells,” says Mulvey. “This finding is unexpected and intriguing because, although mesotrypsin has been implicated in bladder and other cancers, as well as the shedding of skin cells, its function is still largely undefined,” he added.

When UPEC infect bladder cells, the bacteria either multiply or persist in an inactive state for days or even weeks. This persistence creates intracellular reservoirs of bacteria, which are thought contribute to chronic or recurrent infections. Mulvey and Dhakal found that HlyA triggers not only paxillin degeneration, but also breakdown of key proteins involved in cellular responses to infection.

The investigators also discovered that the effects of HlyA are not limited to bladder cells. HlyA stimulated protein degradation in macrophages, key immune cells responsible for destroying bacteria, as well. These disruptions of the normal immune response to bacterial invasion may help to explain why UTIs can persist or recur, even in otherwise healthy individuals and in the presence of antibiotics.

In many cases, the cars or trains are sounding horns that the pedestrians cannot hear, leading to fatalities in nearly three-quarters of cases.

“Everybody is aware of the risk of cell phones and texting in automobiles, but I see more and more teens distracted with the latest devices and headphones in their ears.” – Richard Lichenstein MD Associate Professor University of Maryland School of Medicine

“Unfortunately as we make more and more enticing devices, the risk of injury from distraction and blocking out other sounds increases,” he explained.

Dr. Lichenstein and his colleagues studied retrospective case reports from the National Electronic Injury Surveillance System, the U.S. Consumer Product Safety Commission, Google News Archives, and Westlaw Campus Research databases for reports published between 2004 and 2011 of pedestrian injuries or fatalities from crashes involving trains or motor vehicles. Cases involving headphone use were extracted and summarized.

The research is published online today in the journal Injury Prevention.

Researchers reviewed 116 accident cases from 2004 to 2011 in which injured pedestrians were documented to be using headphones. Seventy percent of the 116 accidents resulted in death to the pedestrian. More than two-thirds of victims were male (68 percent) and under the age of 30 (67 percent). More than half of the moving vehicles involved in the accidents were trains (55 percent), and nearly a third (29 percent) of the vehicles reported sounding some type of warning horn prior to the crash. The increased incidence of accidents over the years closely corresponds to documented rising popularity of auditory technologies with headphones.

“This research is a wonderful example of taking what our physicians see every day in the hospital and applying a broader scientific view to uncover a troubling societal problem that needs greater awareness.” - Albert Reece MD Vice President Medical Affairs University of Maryland, John Z. and Akiko K. Bowers Distinguished Professor Dean University of Maryland School of Medicine

Dr. Lichenstein and his colleagues noted two likely phenomena associated with these injuries and deaths: distraction and sensory deprivation. The distraction caused by the use of electronic devices has been coined “inattentional blindness,” in which multiple stimuli divide the brain’s mental resource allocation. In cases of headphone-wearing pedestrian collisions with vehicles, the distraction is intensified by sensory deprivation, in which the pedestrian’s ability to hear a train or car warning signal is masked by the sounds produced by the portable electronic device and headphones.

Dr. Lichenstein says the study was initiated after reviewing a tragic pediatric death where a local teen died crossing railroad tracks. The teen was noted to be wearing headphones and did not avoid the oncoming train despite auditory alarms. Further review revealed other cases not only in Maryland but in other states too.

Dr. Holly Andersen of the Ronald O. Perelman Heart Institute Offers Women Tips on Recognizing a Heart Attack and Reducing Their Risk of Heart Disease

The risk for heart-related death is increasing in young adults ages 35 to 54, and the numbers are even more alarming for younger women. It is the number-one cause of death for both men and women in the United States, yet every year since 1984 more women have died of cardiovascular health problems than men, according to the American Heart Association.

“Although there has been a general decline in deaths caused by heart disease, the last decade has seen a steady increase among younger women ages 35 to 44. Women account for more than 50 percent of deaths due to heart disease and 60 percent of stroke deaths in this country.” – Dr. Holly Andersen Director of Education and Outreach Ronald O. Perelman Heart Institute NewYork-Presbyterian Hospital/Weill Cornell Medical Center

Dr. Andersen offers the following advice to women on how to stay healthy, know their risk factors, and get the best medical treatments to take better care of their hearts.

Enjoy yourself. Eat right, be active, attempt to get a good night’s sleep, practice stress reduction, and enjoy fun times with friends. Women who regularly spend time with close friends have less heart disease.

Know the warning signs of an attack. Women oftentimes do not experience the crushing chest pain that is so often associated with a heart attack. Women are more likely to experience atypical symptoms, which may include neck, shoulder or abdominal pain. Others may have nausea, vomiting, fatigue or shortness of breath, Most women experiencing a heart attack know that something is wrong.

Test for the silent attack. Some women, however, feel no pain at all and experience what is known as a silent heart attack. Silent heart attacks lead to long-term shortage of blood and oxygen flow to the heart. If you are a post-menopausal woman and have at least three risk factors for heart disease, you should discuss with your doctor the tests available to determine if you have coronary artery disease.

Know your risk factors. Your risk of having a heart attack greatly increases if you are obese/overweight, a smoker, or have high cholesterol and/or diabetes.

According to the American Heart Association, low-levels of good cholesterol (HDL) are a stronger predictor of heart disease death in women than in men over 65.

Call 911. The most recent survey from the AHA showed that only 53 percent of women who believe they were having a heart attack would call 911. Time is muscle and can mean the difference between life and death. If you think you are having a heart attack, do not wait — call 911. Emergency medical teams can begin to treat patients before they arrive at the hospital and save precious time that is often lost when patients try to drive themselves to the emergency room.

Get an EKG. Once a woman does arrive in the emergency room it is important to ask for an EKG test or an enzyme blood test to check for a heart attack, since medical professionals may attribute a woman’s symptoms to other health conditions such as indigestion.

The report, published in the New England Journal of Medicine today, says that of nearly 2,600 patients without a history of atrial fibrillation but with a recently implanted pacemaker, more than one-third had episodes when the heartbeat would become rapid and irregular for more than six minutes.

In 85 per cent of these patients, the irregular heartbeat did not cause any symptoms and was only detected by the modern pacemakers. Those who had one of these asymptomatic atrial arrhythmias in the first three months had more than twice the risk of stroke or embolism compared to others.

The international research team based at the Population Health Research Institute was led by Dr. Jeff Healey, an associate professor of medicine of the Michael G. DeGroote School of Medicine at McMaster.

“This study suggests that silent atrial fibrillation is very common and may be the cause of many strokes that previously could not be explained. In all, atrial fibrillation may be responsible for nearly 1 in 5 strokes,” said Healey.

“This is an important observation as we have very effective and specific therapies to prevent stroke in patients with atrial fibrillation, once this heart rhythm disturbance is identified,” he added.

The Asymptomatic Stroke and Atrial Fibrillation Evaluation in Pacemaker Patients Trial (ASSERT) was a prospective cohort study conducted in 23 countries with 136 centres, to explore the relationship between device-detected atrial arrhythmias and stroke. The study participants were 65 years old or older, with a history of hypertension but no history of atrial fibrillation. They were followed for approximately 2.5 years.

The study was sponsored by St. Jude’s Medical Inc.

A longer follow-up of more than 76,000 men in a major U.S. study shows that six years of aggressive, annual screening for prostate cancer led to more diagnoses of tumors but not to fewer deaths from the disease.

The updated results of the Prostate, Lung, Cancer, Colorectal and Ovarian (PLCO) Cancer Screening Trial will be published online Jan. 6 in the Journal of the National Cancer Institute.

“The data confirm that for most men, it is not necessary to be screened annually for prostate cancer,” – Gerald Andriole MD chief urologic surgeon Siteman Cancer Center Barnes-Jewish Hospital and Washington University School of Medicine.

The PLCO study involved men ages 55 to 74, who were randomly assigned to receive either annual PSA tests for six years and digital rectal exams for four years or “routine care,” meaning they had the screening tests only if their physicians recommended them.

The new research updates an earlier report of the data published in 2009 in the New England Journal of Medicine. At that time, when nearly all men had been followed for seven years, Andriole and his colleagues did not find a mortality benefit from prostate cancer screening.

But because so few men in the study had died from any causes, the researchers said then that it would be premature to make broad generalizations about whether men should continue to be screened. However, they did recommend against prostate cancer screening for men with a life expectancy of seven to 10 years or less.

The researchers detected 12 percent more prostate tumors among men screened annually compared to those who received routine care (4,250 tumors in the screening arm vs. 3,815 tumors in the control arm).

But deaths from prostate cancer did not differ significantly between the groups. There were 158 deaths from prostate cancer in the screening group and 145 deaths in the routine-care group.

Annual screening tests also did not reduce deaths from prostate cancer among men in their 50s and 60s, as the researchers had hoped.

In addition, men diagnosed with prostate cancer who also had a history of heart attacks, strokes, diabetes, cancer or lung and liver disease were far more likely to die from causes other than prostate cancer – a finding that suggests that screening often finds tumors that are not likely to cause harm.

“Mass screening of all men on the basis of age alone is not the way to go, but screening can still be useful in select men,” says Andriole, who acknowledges that widespread testing has lead many men with slow-growing tumors to be over-diagnosed and over-treated with surgery or radiation therapy, the possible side effects of which include incontinence and impotence.

“We have to take a more nuanced approach to determine which men should be screened with PSA in the first place, how frequently they should be tested, the PSA level at which they should be biopsied and whether their cancer warrants aggressive therapy,” he added.

The study comes just months after a draft recommendation by the U.S. Preventive Services Task Force calling for an end to routine PSA testing for healthy men age 50 and older because of concerns that the test does not save lives and, when positive, often leads to invasive biopsies and aggressive treatments.