Recent studies confirm previous findings that estrogen-alone therapy may actually reduce the incidence of breast cancer in certain women.  Theses finding seems confusing because estrogen is recognized to stimulate breast cancer growth in some patients.

The confusion stems for previous findings of the Women’s Health Initiative, when their trial of combination estrogen plus progesterone was stopped in July 2002 because of an increase risk of breast cancer and stroke.  Two years later, the Estrogen-Alone segment was stopped.

Evaluation of the Women’s Health Initiative data looking at Estrogen-Alone use in postmenopausal women with prior hysterectomy found breast cancer was reduced in women who were receiving estrogen therapy alone compared to those that were not using estrogen.

It appears that Long-Term Estrogen Deprivation may be the Key.  Dr. Jordan, considered the father of tamoxifen therapy explains: “We know that if breast cancer cells are deprived of estrogen, the majority of the cells die off, and then cells come back that can grow with a minimum of estrogen.  The same is true for when we treat with antihormone therapy,” he continued. “The cells stop growing, and after a long time become resistant. What we know is, if you put estrogen back after you stop the therapy, the cells die. The estrogen kills the cells.”

The onset of menopause “switches” off the ovary and starves the breast of hormones, and in turn, the lack of circulating estrogen now produces an estrogen-withdrawal-like effect. “So the occult breast cancer cells that are already in the breast now start to learn to grow very slowly, with very little available estrogen,” said Dr. Jordan. “When the woman then uses estrogen replacement therapy, say at about age 60 or older, it does the exactly the same as we see with the cells in the laboratory — it causes those microcells in the breast to die off.

“And that is why we saw fewer breast cancers in that trial,” he noted.

The findings suggest that women that have been off estrogen for sometime may benefit from the addition of estrogen in the prevention of breast cancer.  Further studies are needed.

J. Kyle Mathews, MD

Plano OBGyn Associates

Plano Urogynecology Associates

One third of all cancers are caused by 4 common lifestyle factors — tobacco, diet, alcohol, and obesity.

This finding comes from a detailed review of lifestyle and environmental factors. Researchers calculated the fraction of cancers that can be attributed to each of these factors. The huge study was published as a supplement to the December issue of the British Journal of Cancer.

“This is the most comprehensive review of cancer and lifestyle undertaken to date,” said lead author Max Parkin, MD, professor of epidemiology at Queen Mary University, London, United Kingdom. He was speaking at a press conference held by Cancer Research UK, which sponsored the review.

The review was based on the most recent data available; researchers based their 2010 estimates on British incidence figures from 1993 to 2007. The team then calculated the proportion of cancers that could be attributed to 1 of 14 factors: smoking tobacco, drinking alcohol, lack of fruit and vegetables, lack of fiber, eating red and processed meat, too much salt, being overweight or obese, lack of physical exercise, ionizing radiation, ultraviolet radiation, occupational exposure (e.g., asbestos), infections (e.g., human papillomavirus [HPV]), and — specifically for women — postmenopausal hormone replacement therapy and lack of breast-feeding.

“Many people believe that cancer is down to fate or is ‘in the genes,’ and that it is the luck of the draw whether they get it,” Dr. Parkin said. However, he added, “looking at the evidence, it’s clear that about 40% of all cancers are caused by things we mostly have the power to change.”

The figure is 45% in men and 40% in women; that difference was mostly accounted for by breast cancer in women, Dr. Parkin noted.

In the United Kingdom, this means that around 134,000 cancers annually could be prevented — just over 100,000 of these cases were attributed to tobacco, unhealthy diets, alcohol, and excess weight. Smoking was by far the most important factor, accounting on its own for 60,000 cancers in the United Kingdom each year, or 1 in 5 of all cancers diagnosed, Dr. Parkin emphasized.

Several findings in the review were rather surprising, he said.

“We didn’t expect to find that eating fruit and vegetables would prove to be so important in protecting men against cancer,” he said. “And for women, we didn’t expect being overweight to have a greater effect than alcohol.”

Cancers in Men

Cancers in Women

The measure used in this review was the population-attributable fraction. Some of the lifestyle factors studied overlap one another, so the percentages add up to more than 100%, Dr. Parkin noted. In lung cancer, for example, the population-attributable fraction for tobacco was 85%, for occupation factors was 13.2%, for lack of fruit and vegetables was 9%, and for ionizing radiation was 4.7%.

In combination, these lifestyle factors account for 89.2% of cases of lung cancer, and just over 10% of lung cancers are not linked to any of these factors, he explained. However, a healthy lifestyle is still no guarantee that you can reduce the risk of getting cancer, he said. “There is always a chance element. While we can modify the probabilities, we can’t remove that chance element,” he said.

“The vast majority of lung cancer can be prevented,” said Sara Hiom, information officer for Cancer Research UK. Although nationwide antismoking campaigns have been very effective at reducing the number of people who smoke, the decline has leveled off and is now at a constant 22% of the population. “We must try to drive this down further, and especially prevent young people from taking up the habit,” she said. Cancer Research UK is considering how to publicize the fact that other cancers, in addition to lung cancer, can be caused by smoking; the charity is also working with the British government on an initiative for plain packaging of tobacco.

Cancer Research UK is also working on ways to emphasize messages about diet, excess weight, and the importance of physical activity, she told journalists. About one quarter of the population in the United Kingdom is now overweight, she noted. The charity has been running a major “sun smart” campaign to tackle the increase in malignant melanoma seen in recent years, emphasizing the risk for cancer from sudden extreme sun exposure among pale Caucasians, the so-called holiday “sunshine binge.”

Dr. Parkin noted that any prevention strategies must be “reasonable.” For example, the review considered no alcohol intake as the optimum, but it is not realistic to encourage everyone to stop drinking; in any case, there is some evidence to suggest that a small amount of alcohol has cardiovascular benefits. Overall, however, following healthy lifestyle options will reduce the risk for other diseases in addition to cancer, he said.

In an introduction to the supplement, Sir Richard Peto, FRS, from Oxford University, United Kingdom, points out that controlling the 4 lifestyle factors that contribute most to cancers — tobacco, alcohol, diet, and obesity — would also substantially reduce the burden of other noncommunicable diseases, particularly cardiovascular, diabetic, renal, and hepatic disease.

By Zosia Chustecka, for original article, click here.

J. Kyle Mathews, MD

Plano OBGyn Associates

Plano Urogynecology Associates

The first large study to examine fish consumption among young women has shown that even moderate intake of fish, just once a week, can be helpful for the Heart.  The findings are important for a number of reasons, says lead author Dr Marin Ström (Statens Serum Institut, Copenhagen, Denmark), who reports the results together with colleagues online December 5, 2011 in Hypertension.

First of all, they illustrate that the benefits of a healthy lifestyle can be obtained at a relatively young age. “We saw quite strong associations with cardiovascular diseases occurring in the study participants when they were in their late 30s,” Ström told heartwire . “The biggest challenge in getting health messages like this across to younger populations is that usually the benefits may not be evident for 30 or 40 years, but our study shows that this is not the case.” By demonstrating that the benefits of eating fish are immediate, she and her colleagues believe it will be easier to convince people to make healthy choices.”This is one of the things that makes our study stand out from most of the previous work in the field,” she observes.

The research is also among the first to be conducted in women of childbearing age and examines primary prevention, she says. Most prior studies of this nature have been conducted in men, in the context of secondary prevention after a cardiovascular event. Studying women separately is important, Ström says, because there is evidence that certain risk factors that can be influenced by fish consumption, such as triglyceride levels, “may have a more negative influence on cardiovascular risk in women than in men.”

The women in this study mainly ate cod, plaice, salmon, herring, and mackerel, says Ström.

The results, she says, are in line with previous observational studies based on older women that suggest that the potential heart benefits of fish can be obtained with relatively moderate intake of even just a couple of times a month.

However, she stresses that to obtain the greatest gain from fish, it should be consumed as a main meal at least twice a week.

Lisa Nainggolan, for original article, click here.

J. Kyle Mathews, MD

Plano OB Gyn Associates

Plano Urogynecology Associates

Women in their 40s with no family history of breast cancer are just as likely to develop invasive breast cancer as women with a family history, according to research presented here at the Radiological Society of North America 97th Scientific Assembly and Annual Meeting.

The finding offers conclusive evidence that women 40 to 49 years of age should be screened yearly with mammography, Stamatia V. Destounis, MD, from Elizabeth Wende Breast Care, Rochester, New York, told reporters at a press briefing.

This flies in the face of the 2009 recommendation by the US Preventive Services Task Force that came out against screening for women in their 40s.

In fact, just last week, a Canadian task force issued new guidelines recommending against screening women in this age group, and extending the interval between mammography screening in women 50 to 74 years to as much as 3 years.

“All these task forces are coming out saying don’t screen, don’t do breast self-exam, don’t do clinical breast exam. It’s just ridiculous,” Dr. Destounis told Medscape Medical News.

She and her team performed a retrospective review of all patients who underwent screening mammography at their center from 2000 to 2010. During that period, 6154 cancers were found in 5813 women.

Of these cancers, 1116 (18.1%) were found in women 40 to 49 years of age, and 373 were diagnosed as a result of mammography screening. The remainder were diagnosed because the women presented with symptoms such as pain, a lump, nipple discharge, and skin changes.

When the researchers focused on the women who had their cancers detected on screening mammography, they found that 144 (39%) had a family history of breast cancer and 228 (61%) did not; in the case of 1 woman, family history was unknown.

All but 1 of the patients went on to have surgery. In the women with no family history, the percentage of invasive breast cancer was 64%; in the women with a family history, the percentage was 63.2%.

The researchers also found that 31% of the women with a family history and 29% without a family history had positive lymph nodes.

“Our conclusion is that family history really doesn’t seem to impact the rate of invasive disease or metastatic rate in this patient cohort,” Dr. Destounis noted.

“Obviously, we know that the risk of getting breast cancer increases per decade. We get that. But 40- to 49-year-old women get breast cancer, too. They get diagnosed with screening mammography, and a considerable number of these are invasive cancers. The groups against screening say we do not have to screen them, but we do have to screen them. These women have a considerable percentage of cancers that are invasive and a considerable number of lymph nodes that are positive,” she said.

Breast Cancer Risk in Younger Women Higher Than Previously Thought

Nina A. Mayr, MD, a radiation oncologist from Ohio State University, Columbus, told Medscape Medical News that the study confirms what many people have suspected.

“Many of us believe that the breast cancer risk of younger women in their 40s is much higher than we probably thought, and the recurrence rate is also higher,” she said.

“I see these young women. They didn’t have a mammogram and then they come in with a cancer that is very large. Many of these women still have children at home, so the socioeconomic cost of breast cancer is very high,…much higher than for in a woman in her 70s. I think these aspects are very important and they tend to be overlooked,” Dr. Mayr said.

Critics who oppose screening mammography say that those who are in favor of it have a vested interest in doing mammograms, but Dr. Mayr denied that this is the case.

“If we were talking about a very expensive nuclear medicine test or an expensive surgical procedure that makes a lot of money, they might have a point. But mammograms do not make much money,” she said.

In fact, academic centers and private practices find it extremely difficult to find people who want to do mammography, she noted.

“The cost of a mammogram is about $75. It is a procedure that incurs a lot of liability, so the financial yield is low and the liability is high…. If you want to derive a lot of financial benefit, you do not want to do mammography.”

By Fran Lowry.  For original article, click here.

J. Kyle Mathews, MD

Plano OB Gyn Associates

Plano Urogynecology Associates

Women on long-term Osteoporosis medications called bisphosphonates might benefit from screening X-Rays, radiographs, to detect a type of fracture in the upper leg called incomplete atypical femoral fractures (AFF).

Two studies were presented recently at the Radiological Society of North America annual meeting discussing the possible risks of long-term use of medications for Osteoporosis. Bisphosphonates such as Fosamax, Boniva, Actonel, and Reclast are often prescribed for the treatment of Osteoporosis and the studies showed that long-term use of this class of medication was associated with an increase risk of developing this type of fracture.

The authors suggest routine screening radiographs on patients that have been on these medications for more than 3 years.  Further study is also suggested.

J. Kyle Mathews, MD

Plano OBGyn Associates

Plano Urogynecology Associates

A recent study published in November 2011 of Menopause has found that women who discontinue postmenopausal hormone replacement had a significant increase in hip fractures.  The protective affect of hormone replacement therapy on bones is well document and the study showed that this protective effect disappeared within 2 years after stopping hormone therapy.

J. Kyle Mathews, MD

Plano OB Gyn Associates

Plano Urogyn

The time of day you eat a snack may affect how easy it is to lose weight, new research suggests.

A study published in the December edition of the Journal of the American Dietetic Association finds midmorning snacking was associated with less weight loss than snacking at other times of day. The study suggest that appropriate snacking can help with weight loss but morning snackers loss less weight than those who snack later in the day.

J. Kyle Mathews, MD

Plano OBGYN Associates

Plano Urogynecology

This report serves as a cautionary tale about the potential risks related to dietary supplements and makes the point that more is not necessarily better. In the United States, about 50% of adults are currently taking 1 or more dietary supplements, and it is a $20-plus billion annual industry. But are consumers really getting value for the money spent?

For a long time, vitamins and minerals had the reputation of being “magic bullets” because they are very effective in treating deficiencies. We know that vitamin C prevents scurvy, vitamin D prevents rickets, and thiamine will prevent beriberi. However, this doesn’t mean that in a well-nourished population, these supplements will prevent the chronic diseases, cardiovascular diseases, cancer, and other chronic diseases of the 20th and 21st centuries, or that more will be better.

In this study, the Iowa Women’s Health Study, more than 38,000 women who were, on average, age 62, were followed for up to 22 years. There were more than 15,000 deaths during the follow-up period. This study showed very few benefits of any of these vitamin or mineral supplements. In fact, there was a suggestion of some risk associated with several of them.

Multivitamins, vitamin B6, folic acid, iron supplements, copper, and zinc were all associated with some increase in risk. In replication analyses in later follow-up periods, excess risks continued to be seen with iron supplements. This risk was dose-dependent and has been found in some other studies as well. On the benefit side was a suggestion of a reduced risk, or a slight reduction in mortality risk, with calcium supplements.

We know from randomized trials that many of the antioxidant vitamins may, in fact, increase risks, especially in well-nourished populations. The randomized trials of beta-carotene and vitamin E have not shown clear health benefits. Studies even suggested a risk. We know that beta-carotene increases lung cancer risk in smokers, and vitamin E was recently linked to an increased risk for prostate cancer in men and was previously linked to an increased risk for hemorrhagic stroke.

Well-nourished populations may derive no benefits from these supplements, and there may, in fact, be a risk. The bottom line of this report is to try to avoid excessive intake of these micronutrients and to let our patients know that more is not necessarily better. As with many nutrients, there appears to be a U-shaped curve where risk is increased with low-intake deficiency states as well as with high intake. It is probably best to encourage a healthy and balanced diet with a high intake of fruits, vegetables, and whole grains.

The Institute of Medicine has recommended up to 600 IUs of vitamin D for women up to age 70 years and 800 IUs above age 70 years and 1200 mg of calcium daily for postmenopausal women. Some women may need to take supplements in order to achieve these levels of intake. For most vitamins and minerals, a balanced diet will provide adequate intake.

By Dr. JoAnn Manson.  For original article, click here.

J. Kyle Mathews, MD

Plano OB GYN Associates

Plano Urogynecology

Medical authorities are witnessing explosive growth in the number of newborn babies hooked on prescription painkillers, innocent victims of their mothers’ addictions.

The trend reflects how deeply rooted abuse of powerful narcotics, such as OxyContin and Vicodin, has become. Prescription drug abuse is the nation’s fastest-growing drug problem, classified as an epidemic by the Centers for Disease Control and Prevention.

National statistics on the number of babies who go through withdrawal are not available, and states with the worst problems have only begun to collect data. Scattered reports show the number of addicted newborns has doubled, tripled or more over the past decade. In Florida, the epicenter of the illicit prescription drug trade, the number of babies with withdrawal syndrome soared from 354 in 2006 to 1,374 in 2010, according to the Florida Agency for Health Care Administration.

In response to the growing severity of the problem, theAmerican Academy of Pediatrics convened a committee this year to revise its treatment guidelines for the babies. The new guidelines are set to be published next year.

Donna Leinwand Leger, to read the entire article, click here.

J. Kyle Mathews, MD

Plano OBGYN Associates

Plano Urogynecology Associates

Screening for cervical cancer is equally effective with conventional Pap testing and liquid-based cytology with human papillomavirus (HPV) testing. So concludes the upcoming update of the 2003 US Preventive Services Task Force (USPSTF) recommendations, based in part on 2 literature reviewspublished online October 17 in the Annals of Internal Medicine. In addition to concluding that liquid-based cytology HPV testing is generally not superior to conventional Pap tests, the reviewers conclude that routine cervical cancer screening is generally not needed in women younger than 20 years and older than 65 years.