The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated.

It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

Prostate cancer screening has long been problematic. The cancer society, which with more than two million volunteers is one of the nation’s largest voluntary health agencies, does not advocate testing for all men. And many researchers point out that the PSA prostate cancer screening test has not been shown to prevent prostate cancer deaths.

There has been much less public debate about mammograms. Studies from the 1960s to the 1980s found that they reduced the death rate from breast cancer by up to 20 percent.

The cancer society’s decision to reconsider its message about the risks as well as potential benefits of screening was spurred in part by an analysis published Wednesday in The Journal of the American Medical Association, Dr. Brawley said.

In it, researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. With prostate cancer, the situation is similar, the researchers report.

If breast and prostate cancer screening really fulfilled their promise, the researchers note, cancers that once were found late, when they were often incurable, would now be found early, when they could be cured. A large increase in early cancers would be balanced by a commensurate decline in late-stage cancers. That is what happened with screening for colon and cervical cancers. But not with breast and prostate cancer.

Still, the researchers and others say, they do not think all screening will — or should — go away. Instead, they say that when people make a decision about being screened, they should understand what is known about the risks and benefits.

For now, those risks are not emphasized in the cancer society’s mammogram message which states that a mammogram is “one of the best things a woman can do to protect her health.”

Dr. Brawley says mammograms can prevent some cancer deaths. However, he says, “If a woman says, ‘I don’t want it,’ I would not think badly of her but I would like her to get it.”

But some, like Colin Begg, a biostatistician at Memorial Sloan-Kettering Cancer Center in New York, worry that the increased discussion of screening’s risks is going to confuse the public and make people turn away from screening, mammography in particular.

“I am concerned that the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline,” Dr. Begg said. “The fact that population screening is no panacea does not mean that it is useless,” he added.

The new analysis — by Dr. Laura Esserman, a professor of surgery and radiology at the University of California, San Francisco, and director of the Carol Frank Buck Breast Care Center there, and Dr. Ian Thompson, professor and chairman of the department of urology at The University of Texas Health Science Center, San Antonio — finds that prostate cancer screening and breast cancer screening are not so different.

Both have a problem that runs counter to everything people have been told about cancer: They are finding cancers that do not need to be found because they would never spread and kill or even be noticed if left alone. That has led to a huge increase in cancer diagnoses because, without screening, those innocuous cancers would go undetected.

At the same time, both screening tests are not making much of a dent in the number of cancers that are deadly. That may be because many lethal breast cancers grow so fast they spring up between mammograms. And the deadly prostate ones have already spread at the time of cancer screening. The dilemma for breast and prostate screening is that it is not usually clear which tumors need aggressive treatment and which can be left alone. And one reason that is not clear, some say, is that studying it has not been much of a priority.

“The issue here is, as we look at cancer medicine over the last 35 or 40 years, we have always worked to treat cancer or to find cancer early,” Dr. Brawley said. “And we never sat back and actually thought, ‘Are we treating the cancers that need to be treated?’ ”

The very idea that some cancers are not dangerous and some might actually go away on their own can be hard to swallow, researchers say.

“It is so counterintuitive that it raises debate every time it comes up and every time it has been observed,” said Dr. Barnett Kramer, associate director for disease prevention at the National Institutes of Health.

It was first raised as a theoretical possibility in the 1970s, Dr. Kramer said. Then it was documented in a rare pediatric cancer, but was dismissed as something peculiar to that cancer. Then it was discovered in common cancers as well, but it is still not always accepted or appreciated, he said.

But finding those insignificant cancers is the reason the breast and prostate cancer rates soared when screening was introduced, Dr. Kramer said. And those cancers, he said, are the reason screening has the problem called overdiagnosis — labeling innocuous tumors cancer and treating them as though they could be lethal when in fact they are not dangerous.

“Overdiagnosis is pure, unadulterated harm,” he said.

Dr. Peter Albertsen, chief and program director of the urology division at the University of Connecticut Health Center, said that had not been an easy message to get across. “Politically, it’s almost unacceptable,” Dr. Albertsen said. “If you question overdiagnosis in breast cancer, you are against women. If you question overdiagnosis in prostate cancer, you are against men.”

Dr. Esserman hopes that as research continues on how to advance beyond screening, distinguishing innocuous tumors from dangerous ones, people will be more realistic about what screening can do.

“Someone may say, ‘I don’t want to be screened’ ” she said. “Another person may say, ‘Of course I want to be screened.’ Just like everything in medicine, there is no free lunch. For every intervention, there are complications and problems.”

* Drug abuse chief eyes vaccines as new treatment option

* Nicotine vaccines could reach $2 billion market by 2016

By Julie Steenhuysen

CHICAGO, Oct 20 (Reuters) - Hooked on cocaine or cigarettes? The U.S. government wants drug companies to make a vaccine for that.

Convinced of the need for new and better treatments for addiction, the government is focusing its efforts on vaccine development as a new way to treat and possibly prevent addiction to a range of addictive substances.

"It's a perspective that is very different from what we've operated on in the past," Dr. Nora Volkow, director of the National Institute on Drug Abuse told reporters this week at the Society for Neuroscience meeting in Chicago.

Volkow said the agency intends to piggyback on the frenetic investment by drug companies in vaccine development, spurred by the need for new products and the runaway success of products like Merck's (MRK.N) Gardasil vaccine to prevent the virus that causes cervical cancer.

"There is an enormous amount of research and development in vaccines for cancers and a wide variety of disorders," she said. "We can take advantage of those developments."

But first Volkow has to tempt drug companies to develop the vaccines by funding costly clinical trials.

Earlier this month, her agency, part of the National Institutes of Health, awarded Nabi Biopharmaceuticals (NABI.O) a $10 million grant -- the agency's largest ever -- for a late-stage clinical trial of Nabi's vaccine for nicotine addiction called NicVAX.

Volkow said she did her homework before backing the Nabi vaccine to ensure it was significantly different from other products. "Nonetheless, when you are investing in something at this level, it can be very risky," she said.

The vaccine is meant to stimulate the immune system to make antibodies against nicotine, blocking its rewarding effects and helping to prevent relapse in smokers trying to quit.

TOUGH MARKET

A similar anti-smoking vaccine by Cytos Biotechnology (CYTN.S) and Swiss drugmaker Novartis (NOVN.VX) last week missed its main goal in a midstage study, leading some analysts to question whether it can make it to market.

"They are still looking at it but it has been very problematic," said Robert Wasserman, director of investment research at the investment banking firm Dawson James in Florida.

"Vaccines are really tough," he said. "It's not for the faint of heart." 

Still, if it works, a nicotine vaccine could have a huge impact, Volkow said. "It's an international problem that kills 5 million individuals every year across the world," she said.

The global market for smoking cessation is expected to reach $4.6 billion by 2016, and vaccines could account for $2 billion in sales, according to independent market research firm Datamonitor.

Volkow said the same methods for making a nicotine vaccine could be used for other illicit substances.

Her agency backed a study released this month of an anti-cocaine vaccine that helped block the high felt by 38 percent of addicts who took it.

The vaccine was developed by Dr. Thomas Kosten of Baylor College of Medicine in Houston, who used a similar approach to make a nicotine vaccine now being tested in Europe by private equity firm Celtic Pharma.

Volkow said drumming up drug company interest in vaccines for illicit drugs is a harder sell because of liability concerns, and the fact that drug abusers are stigmatized.

"Unfortunately, when it comes to treatments for drug addiction ... most of the investment goes to the government," she said. (Editing by Mohammad Zargham)

LONDON, Oct 19 (Reuters) - Some treatments for inflammatory bowel disease increase the risk of infection-related cancers, French scientists said on Monday, but the benefits of the drugs still outweigh the risks.

Thiopurine drugs -- immunosuppressive medicines that inhibit the body's immune system -- are regularly used to treat inflammatory bowel disease, the researchers said, but can increase the risk of cancers linked to viral infections.

Laurent Beaugerie and colleagues at the Saint-Antoine hospital in Paris looked at more than 19,000 patients with inflammatory bowel disease. Around 30 percent of the patients were taking thiopurines, 14 percent had stopped taking them and 56 percent had never taken them.

Following up after almost 3 years, the researchers found 23 new cases of cancers -- one of Hodgkin's lymphoma and 22 of non-Hodgkin lymphoma.

Statistical analysis showed that patients receiving thiopurines -- like azathioprine produced by several generic drugmakers and by GlaxoSmithKline (GSK.L) as Imuran -- had a more than five-fold increased risk of lymphoma compared with those who had never received the drugs, the researchers said in a study published in The Lancet journal.

Older male patients with a longer history of inflammatory bowel disease also had increased lymphoma cancer risk.

"The absolute cumulative risk...in young patients receiving a 10-year course of thiopurines remains low -- (less than 1 percent) -- and does not undermine the positive risk-benefit ratio of these drugs," the researchers wrote.

But for elderly patients and for unlimited treatment periods, more studies were needed to assess the risk, they said.

Commenting on the study, Geert D'Haens of the Imelda GI Clinical Research Centre and Paul Rutgeerts University Hospital Gasthuisberg, both in Belgium, said doctors should be cautious in prescribing thiopurines for prolonged periods.

But they said that despite the slightly increased risk of lymphoma, the drugs would "probably remain one of the cornerstones of treatment." (Reporting by Kate Kelland; Editing by Charles Dick)

MASONTOWN, Pa. — For years, residents here complained about the yellow smoke pouring from the tall chimneys of the nearby coal-fired power plant, which left a film on their cars and pebbles of coal waste in their yards. Five states — including New York and New Jersey — sued the plant’s owner, Allegheny Energy, claiming the air pollution was causing respiratory diseases and acid rain.

So three years ago, when Allegheny Energy decided to install scrubbers to clean the plant’s air emissions, environmentalists were overjoyed. The technology would spray water and chemicals through the plant’s chimneys, trapping more than 150,000 tons of pollutants each year before they escaped into the sky.

But the cleaner air has come at a cost. Each day since the equipment was switched on in June, the company has dumped tens of thousands of gallons of wastewater containing chemicals from the scrubbing process into the Monongahela River, which provides drinking water to 350,000 people and flows into Pittsburgh, 40 miles to the north.

“It’s like they decided to spare us having to breathe in these poisons, but now we have to drink them instead,” said Philip Coleman, who lives about 15 miles from the plant and has asked a state judge to toughen the facility’s pollution regulations. “We can’t escape.”

Even as a growing number of coal-burning power plants around the nation have moved to reduce their air emissions, many of them are creating another problem: water pollution. Power plants are the nation’s biggest producer of toxic waste, surpassing industries like plastic and paint manufacturing and chemical plants, according to a New York Times analysis of Environmental Protection Agency data.

Much power plant waste once went into the sky, but because of toughened air pollution laws, it now often goes into lakes and rivers, or into landfills that have leaked into nearby groundwater, say regulators and environmentalists.

Officials at the plant here in southwest Pennsylvania — named Hatfield’s Ferry — say it does not pose any health or environmental risks because they have installed equipment to limit the toxins the facility releases into the Monongahela River and elsewhere.

But as the number of scrubbers around the nation increases, environmentalists — including those in Pennsylvania — have become worried. The Environmental Protection Agency projects that by next year, roughly 50 percent of coal-generated electricity in the United States will come from plants that use scrubbers or similar technologies, creating vast new sources of wastewater.

Yet no federal regulations specifically govern the disposal of power plant discharges into waterways or landfills. Some regulators have used laws like the Clean Water Act to combat such pollution. But those laws can prove inadequate, say regulators, because they do not mandate limits on the most dangerous chemicals in power plant waste, like arsenic and lead.

For instance, only one in 43 power plants and other electric utilities across the nation must limit how much barium they dump into nearby waterways, according to a Times analysis of E.P.A. records. Barium, which is commonly found in power plant waste and scrubber wastewater, has been linked to heart problems and diseases in other organs.

Even when power plant emissions are regulated by the Clean Water Act, plants have often violated that law without paying fines or facing other penalties. Ninety percent of 313 coal-fired power plants that have violated the Clean Water Act since 2004 were not fined or otherwise sanctioned by federal or state regulators, according to a Times analysis of Environmental Protection Agency records. (An interactive database of power plant violations around the nation is available at www.nytimes.com/coalplants.)

Fines for Plants Modest

Other plants have paid only modest fines. For instance, Hatfield’s Ferry has violated the Clean Water Act 33 times since 2006. For those violations, the company paid less than $26,000. During that same period, the plant’s parent company earned $1.1 billion.

“We know that coal waste is so dangerous that we don’t want it in the air, and that’s why we’ve told power plants they have to install scrubbers,” said Senator Barbara Boxer, the California Democrat who is chairwoman of the Senate Committee on Environment and Public Works. “So why are they dumping the same waste into people’s water?”

Though the Environmental Protection Agency promised earlier this decade to consider new regulations on power plant waste — and reiterated that pledge after a Tennessee dam break sent 1.1 billion gallons of coal waste into farms and homes last year — federal regulators have yet to issue any major new rules.

One reason is that some state governments have long fought new federal regulations, often at the behest of energy executives, say environmentalists and regulators.

The counties surrounding Hatfield’s Ferry, which are home to multiple universities, are an example of what hangs in the balance as this debate plays out.

Last year, when Hatfield’s Ferry asked the state for permission to dump scrubber wastewater into the Monongahela River, the Pennsylvania Department of Environmental Protection approved the request with proposed limits on some chemicals.

But state officials placed no limits on water discharges of arsenic, aluminum, boron, chromium, manganese, nickel or other chemicals that have been linked to health risks, all of which have been detected in the plant’s wastewater samples, according to state documents.

Records show, and company officials concede, that Hatfield’s Ferry is already dumping scrubber wastewater into the Monongahela that violates the state’s few proposed pollution rules. Moreover, those rules have been suspended until a judge decides on the plant’s appeal of the proposed limits.

“You can get used to the plant, and the noise and soot on your cars,” said Father Rodney Torbic, the priest at the St. George Serbian Orthodox Church, across the road from Hatfield’s Ferry. “But I see people suffering every day because of this pollution.”

Officials at Hatfield’s Ferry say there is no reason for residents to be concerned. They say that lawsuits against the plant are without merit, and that they have installed a $25 million water treatment plant that removes many of the toxic particles and solids from scrubber wastewater. The solids are put into a 106-acre landfill that contains a synthetic liner to prevent leaks.

Officials say that the plant’s pollution does not pose any risk. Limits on arsenic, aluminum, barium, boron, cadmium, chromium, manganese and nickel are not appropriate, the company wrote in a statement, because the plant’s wastewater is not likely to cause the Monongahela River to exceed safety levels for those contaminants.

“Allegheny has installed state-of-the-art scrubbers, state-of-the-art wastewater treatment, and state-of-the-art synthetic liners,” the company wrote in a statement. “We operate to be in compliance with all environmental laws and will continue to do so.”

The plant’s water treatment facility, however, does not remove all dissolved metals and chemicals, many of which go into the river, executives concede. An analysis of records from other plants with scrubbers indicates that such wastewater often contains high concentrations of dissolved arsenic, barium, boron, iron, manganese, cadmium, magnesium and other heavy metals that have been shown to contribute to cancer, organ failures and other diseases. Company officials say the emissions by the plant will not pose health risks, because they will be diluted in the river.

Though synthetic liners are generally considered effective at preventing leaks, environmentalists note that the Hatfield’s Ferry landfill is less than a mile uphill from the river, and that over time, other types of liners have proven less reliable than initially hoped.

The Environmental Protection Agency, in a statement last month, said it planned to revise standards for water discharges from coal-fired power plants like Hatfield’s Ferry. Agency studies have concluded that “current regulations, which were issued in 1982, have not kept pace with changes that have occurred in the electric power industry,” officials wrote.

But some environmentalists and lawmakers say that such rules will not be enough, and that new laws are needed that force plants to use more expensive technologies that essentially eliminate toxic discharges.

Cleaning Up Pollution

“It’s really important to set a precedent that tells power plants that they need to genuinely clean up pollution, rather than just shift it from the air to the water,” said Abigail Dillen, a lawyer with the law firm Earthjustice, which represents two advocacy organizations, the Environmental Integrity Project and the Citizens Coal Council, in asking a Pennsylvania court to toughen regulations on Hatfield’s Ferry.

Ms. Dillen, like other environmentalists, has urged courts and lawmakers to force plants to adopt “zero discharge” treatment facilities, which are more expensive but can eliminate most pollution.

State officials say they have established appropriate water pollution limits for Hatfield’s Ferry, and have strict standards for landfill disposal.

“We asked the plant for estimates on how much of various pollutants they are likely to emit, and based on those estimates, we set limits that are protective of the Monongahela,” said Ron Schwartz, a state environmental official. “We have asked them to monitor some chemicals, including arsenic, and if levels grow too high, we may intervene.”

However, environmental groups have argued in court documents and interviews that Hatfield’s Ferry probably will emit dangerous chemicals, and that they fear the state is unlikely to intervene.

Similar problems have emerged elsewhere. Twenty-one power plants in 10 states, including Alabama, Kentucky, North Carolina and Ohio, have dumped arsenic into rivers or other waters at concentrations as much as 18 times the federal drinking water standard, according to a Times analysis of E.P.A. data.

In Florida, Georgia, Illinois, Indiana, Maryland, North Carolina, Ohio, Wisconsin and elsewhere, power plants have dumped other chemicals at dangerous concentrations. Few of those plants have ever been sanctioned for those emissions, nor were their discharge permits altered to prevent future pollution.

Records indicate that power plant landfills and other disposal practices have polluted groundwater in more than a dozen states, contaminating the water in some towns with toxic chemicals. A 2007 report published by the E.P.A. suggested that people living near some power plant landfills faced a cancer risk 2,000 times higher than federal health standards.

Lobbyists Block Controls

In 2000, Environmental Protection Agency officials tried to issue stricter controls on power plant waste. But a lobbying campaign by the coal and power industries, as well as public officials in 13 states, blocked the effort. In 2008 alone, according to campaign finance reports, power companies donated $20 million to the political campaigns of federal lawmakers, almost evenly divided between Democrats and Republicans.

In interviews, E.P.A. officials said that toughening pollution rules for power plants was among their top priorities. Last month, the agency announced it was moving forward on new rules regulating greenhouse gas emissions from hundreds of power plants and other large industrial facilities. Lisa P. Jackson, who was confirmed to head the agency in January, has said she would determine by the end of the year whether certain power plant byproducts should be treated as hazardous waste, which would subject them to tougher regulations.

But for now, there are no new rules on power plant waste. And many states are trying to dissuade Ms. Jackson from creating new regulations, according to state and federal regulators, because they worry that new rules will burden overworked regulators, and because power plants have pressured local politicians to fight greater regulation.

For instance, Pennsylvania has opposed designating the waste from Hatfield’s Ferry and other power plants as hazardous. In a statement, the Department of Environmental Protection said the state had “sufficient state and federal laws and regulations at our disposal to control wastewater discharges at levels protective of the environment and public health.”

But residents living near power plants disagree.

“Americans want cheap electricity, but those of us who live around power plants are the ones who have to pay for it,” Mr. Coleman said. “It’s like being in the third world.”

The Environmental Protection Agency plans to conduct a new study about the potential health risks of atrazine, a widely used weedkiller that recent research suggests may be more dangerous to humans than previously thought.

Atrazine — a herbicide often used on corn fields, golf courses and even lawns — has become one of the most common contaminants in American drinking water.

For years, the E.P.A. has decided against acting on calls to ban the chemical from environmental activists and some scientists who argued that runoff was polluting ecosystems and harming animals.

More recently, new studies have suggested that atrazine in drinking water is associated with birth defects, low birth weights and reproductive problems among humans, even at concentrations that meet current federal standards.

The E.P.A. is expected to announce on Wednesday that it will conduct a new evaluation of the pesticide to assess any possible links between atrazine and cancer, as well as other health problems, such as premature births. The E.P.A. may determine that new restrictions are necessary.

The decision by E.P.A.’s administrator, Lisa P. Jackson, who took over the agency in January, is a significant departure from the policies of the E.P.A. under President George W. Bush.

For years, agency officials said that atrazine in drinking water posed almost no risk to humans or the environment. As recently as this summer, E.P.A. staff members argued that current regulations were adequate.

“We’re going to use our scientific resources in a new and more aggressive way regarding atrazine,” said Stephen A. Owens, who was recently confirmed as E.P.A. assistant administrator for prevention, pesticides and toxic substances.

“There are new scientific findings that deserve attention, and we’re going to engage our scientific panels in actively reviewing the work of this office under previous administrations,” he added. “We have a question: Did the decisions made in previous administrations use all the available science?”

A representative of atrazine’s largest manufacturer, the Swiss company Syngenta, said that she had not been fully briefed on the E.P.A.’s announcement. However, the spokeswoman, Sherry Ford, said, “we expect a positive outcome for atrazine at the end of this process.”

Ms. Ford added that the company “stands behind the safety of atrazine, which has undergone extensive testing. We are a science-based company, and we expect the E.P.A. to make sound decisions based on science, no matter which administration is currently in power.”

Observers say the E.P.A.’s announcement signals a significant shift.

“This is a dramatic change,” said Linda Birnbaum, director of the National Institute of Environmental Health Sciences, part of the Department of Health and Human Services. “There is growing evidence that atrazine could be a hazard to human health. This is a strong signal that the world is changing for some of the most widely used chemicals.”

Atrazine has become a lightning rod in disputes over how the E.P.A. has used scientific findings to regulate chemicals and toxins.

The agency was sued in 2003 by an environmental advocacy organization, the Natural Resources Defense Council, amid claims that regulators had ignored studies showing that atrazine was dangerous to some animals.

In August, The New York Times reported on recent epidemiological studies that suggested small amounts of atrazine in drinking water, including levels considered safe by federal standards, might be associated with birth defects — including skull and facial malformations and misshapen limbs — as well as premature births and low birth weights in newborns.

E.P.A. officials said those studies, as well as recent papers reviewing numerous studies that showed that atrazine interferes with the development and hormone systems of some animals, played a role in their decision to re-evaluate the chemical.

A Times analysis of E.P.A. records also found that in some American towns, atrazine concentrations in drinking water had spiked sharply, sometimes for as long as a month. Though the E.P.A. and Syngenta were aware of those spikes, they often did not promptly warn local water systems, and the reports produced by local regulators and distributed to residents often failed to reflect those higher concentrations. Interviews with local water officials indicated that many of them were unaware that atrazine concentrations sometimes jumped sharply in their communities.

But officials in other communities have grown concerned. Water systems in six states — Illinois, Indiana, Iowa, Kansas, Mississippi and Ohio — recently sued atrazine’s manufacturers to force them to pay for removing the chemical from drinking water.

The E.P.A. is expected to announce on Wednesday four meetings over the coming year of the agency’s independent scientific advisory panel that will focus on atrazine.