Decrease In Breast Cancer Rates Began Before HRT Was Linked To Higher Breast Cancer Rates, Report Says

A decline in breast cancer incidence began in 1998, before hormone replacement therapy use was linked to breast cancer, according to an American Cancer Society report published in the May 3 edition of Breast Cancer Research, the Wall Street Journal reports. According to the Journal, the recent decline in breast cancer incidence often is attributed to a drop in HRT use after the release of a 2002 Women's Health Initiative study (Parker-Pope, Wall Street Journal, 5/3).

Peter Ravdin, a research professor in the Department of Biostatistics at M.D. Anderson Cancer Center, and colleagues in December 2006 at the 29th Annual San Antonio Breast Cancer Symposium presented data showing that breast cancer incidence among U.S. women dropped by 7% from 2002 to 2003. Ravdin and colleagues in a study published last month in the New England Journal of Medicine found that the decline in breast cancer incidence observed from 2002 to 2003 continued in 2004 (Kaiser Daily Women's Health Policy Report, 4/20). For the ACS report, Ahmedin Jemal, an epidemiologist at ACS, and colleagues examined the pattern of breast cancer rates since 1975. The researchers found a 10.6% overall decline in breast cancer rates between 1999 and 2003, according to the study. In addition, the study found a 5% decrease in breast cancer rates in the years leading up to the WHI 2002 study. According to Jemal, the decrease in incidence was seen across several age groups and was greatest for small tumors and early-stage cancers that often are detected through mammography.

Reasons for Decline
The ACS report found that some of the decline in breast cancer incidence likely is the result of decreased HRT use after the release of the WHI study and another factor in the decline might be that fewer women are being screened for breast cancer (Wall Street Journal, 5/3). Ravdin and colleagues also found that the decrease in breast cancer rates is most likely associated with a drop in both HRT use and mammography rates. HRT use decreased by about 30% in 2002 after the WHI study found that breast cancer risk increased for women who used the treatment for an extended period of time (Kaiser Daily Women's Health Policy Report, 12/18/06). According to the Journal, the ACS report's findings suggest that thousands of early stage cancers could be undetected but might show up later at a more advanced stage.

Reaction
Ravdin said whether a decrease in HRT use will have a "long-term effect" on decreasing breast cancer incidence or "whether eventually there will be an increase in incidence again, we don't know that." Marisa Weiss, a Philadelphia-based oncologist and founder of the Web site breastcancer, said that women saw their doctors less after HRT use declined and began receiving mammograms less regularly. "There are few reasons to see your doctor because he's no longer prescribing HRT, and the absolutely required mammogram doctors must have prior to prescribing HRT drops out." Len Lichtenfeld, ACS deputy chief medical officer, said the new repot is important because many women have been confused about breast cancer, HRT use and screening. He said the "message a woman is hearing is, 'I don't have to worry about breast cancer any more because I'm not taking hormones,'" adding that he is concerned that women will stop seeking mammograms (Wall Street Journal, 5/3).


The ACS report is available online.

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Kaiser Daily Women's Health Policy Report Highlights Recently Released Journal Articles

The following highlights recently released journal articles on women's health issues.

Pregnancy & Childbirth
"Cigarette Smoking Affects Uterine Receptiveness," Human Reproduction: Sergio Soares of IVI-Lisboa and colleagues compared in vitro fertilization outcomes of 44 women who smoked more than 10 cigarettes per day with 785 nonsmokers and women who smoked fewer than 10 cigarettes per day. About 34.1% of women who smoked more than 10 cigarettes daily became pregnant through IVF, compared with 52.2% of women who smoked less than 10 cigarettes per day. The study found that 60% of the heavy smokers had multiple births, compared with 31% of the nonheavy smokers. Soares said that more studies are needed to determine if tobacco affects the uterus differently in some women (Reaney, Reuters, 11/8).

Public Health
"Ovarian Cancer in Younger vs Older Women: A Population-Based Analysis," British Journal of Cancer: John Chan of the Stanford University's Division of Gynecologic Oncology and colleagues examined the medical records of 28,165 U.S. women who were diagnosed with ovarian cancer between 1988 and 2001, including 400 under age 30, 11,601 women ages 30 to 60 and 16,164 women older than age 60. The study found that 65.3% of the women under age 30 had stage I-II ovarian cancer, compared with 40.2% of women ages 30 to 60 and 22.5% of women older than age 60. The five-year survival rate for the women under age 30 was 78.8%, compared with 58.8% for the ages 30 to 60 group and 35.2% for the over age 60 groups (Chan et al., British Journal of Cancer, November 2006). Researchers called for further research to be conducted into the biological and molecular differences that could account for the disparities in survival rates among the age groups, Reuters reports (Reuters, 11/7).

"Oral Contraceptive Use as a Risk Factor for Premenopausal Breast Cancer: A Meta-Analysis," Mayo Clinic Proceedings: Chris Kahlenborn of Altoona Hospital and colleagues analyzed data from 34 studies about breast cancer and oral contraceptive use published after 1980 to determine the risk associated with premenopausal breast cancer and oral contraceptive use, Reuters Health reports. Study participants were all ages 50 or younger or premenopausal. The study found that women who used oral contraceptives were 1.19 times more likely to develop breast cancer than women who did not use oral contraceptives. For women who had given birth, oral contraceptive use was associated with a 1.29 times greater likelihood of developing breast cancer, and the risk for women who had never given birth was 1.24 times greater than for women not using oral contraceptives, the study found. The risk of developing breast cancer was 1.15 times greater for women who used oral contraceptives prior to their first full-term pregnancy and 1.52 times greater if oral contraceptives were used four years prior to their first full-term pregnancy. In a related Mayo Clinic Proceedings editorial, James Cerhan of the Mayo Clinic College of Medicine writes that the "absolute risk" of developing premenopausal breast cancer after oral contraceptive use "is very small," adding that benefits of oral contraceptive use also should be considered when analyzing the risks (Reuters Health, 11/7).
















"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

What Are The Signs And Symptoms Of Breast Lumps?

The signs and symptoms of breast lumps vary, and depend mainly on what is causing them (it). A symptom is sensed by the patient, while a sign is detected by others, including the doctor or nurse. An example of a symptom might be pain, while dilated pupils could be a sign.


Fibroadenosis (fibrocystic breast disease) - also known as benign breast disease, fibrocystic breast changes, and mammary dysplasia. Benign (non-cancerous) changes occur in breast tissue, resulting in:

Breast discomfort and general tenderness
Irregular lumps, cysts or swellings
Itching
Sensitive nipples


What Are Breast Lumps?


What Are The Signs And Symptoms Of Breast Lumps


What Are The Causes Of Breast Lumps?


How Is A Breast Lump Diagnosed?


What Are The Treatment Options For A Breast Lump?

Symptoms may alter during the menstrual cycle - tending to become more pronounced just before or during menses (menstrual bleeding). After the menopause women do not generally have symptoms any more.


Women may have very different symptoms, and the same woman may experience varying symptoms on different occasions. For some patients fibroadenosis is a slight nuisance, while for others it is extremely painful. Doctors say fibroadenosis is the female body's normal reaction to changes in hormone levels.


Fibroadenoma - these are small, solid, rubbery, benign (non-cancerous) lumps, consisting of fibrous and glandular tissue. They sometimes develop outside the milk duct. Doctors often recommend a tissue sample (biopsy) to rule out cancer because they appear as a lump. Signs and symptoms include:

A well-rounded, smooth, solid lump
May get larger during pregnancy
Occur in women of childbearing years
They are painless
They may disappear on their own, but can often persist and slowly grow
When touched they move easily
They have a rubber-like texture

Breast cyst - a cyst is a closed sac-like structure - an abnormal pocket of fluid, like a blister - that contains either liquid, gaseous, or semi-solid substances. A cyst is located within a tissue, and can occur anywhere in the body and can vary in size - some are so small they can only be viewed through a microscope, while others may become so big that they displace normal organs.















A breast cyst is a fluid-filled sac within the breast; there may be many or just one. They are typically:

Round
With distinct edges
With a soft grape like or water-filled balloon texture
The cyst may feel firm
More common in woman in their 30s and 40s.
They normally go away after the menopause, unless the woman is taking HRT (hormone replacement therapy)
They may be tiny or several centimeters in diameter
Pain is unusual, unless the cyst is a large one and grows during the menstrual cycle

Experts believe breast cysts develop when milk ducts become blocked.


Unless the cyst is large and causing discomfort, in which case it may be drained, it does not normally require treatment.


Breast cancer - during the early stages breast cancer does not have any palpable symptoms (symptoms the patient can notice). However, as the tumor grows, the way the breast looks and feels can change. The following changes may occur:

A thickening in the breast, or near it (in the underarm area)
A lump in the breast or near it (in the underarm area)
The lump feels firm, usually has an irregular shape, and seems anchored (stuck) to either deep tissue within the breast or the skin of the breast or nearby area.
The size and/or shape of the breast may change
There may be puckering or dimpling in the skin of the affected breast
The nipple of the affected breast may turn inward
There may be a discharge from the nipple; the discharge may be bloody
The skin on the breast and/or nipple may be scaly, red or swollen


What Are Breast Lumps?
What Are The Signs And Symptoms Of Breast Lumps
What Are The Causes Of Breast Lumps?
How Is A Breast Lump Diagnosed?
What Are The Treatment Options For A Breast Lump?

Hereditary Breast Cancer - A High Cost To Patient And Healthcare Provider Alike

Some women who carry the BRCA gene mutation, which predisposes to breast cancer, may choose to have a prophylactic mastectomy rather than undertake lifetime surveillance, a Dutch scientist will tell the 6th European Breast Cancer Conference (EBCC-6) today (Wednesday 16 April). The mastectomy option appears to give an excellent result in avoiding breast cancer, with a remaining risk of less than 1%, Dr. Reinie Kaas, from the Surgical Department of the Netherlands Cancer Institute, Amsterdam, The Netherlands, will say.



Dr. Kaas set out to study the effects of prophylactic mastectomy in 250 patients who were BRCA carriers. "It was thought that after such a mastectomy the risk of being diagnosed with breast cancer was about 5%," she says "and therefore there was debate about whether continued surveillance was necessary or not. We decided to try to answer this question in order that women at high risk should be able to make an informed choice."



Women with mutations in the BRCA1 or BRCA2 genes have an estimated lifetime risk of developing breast cancer of about 85%. Currently strategies to deal with this risk are surveillance with monthly breast self-examination, bi-annual clinical breast examination by a physician and annual mammography plus breast MRI, or prophylactic mastectomy, where the entire breast is removed. About half of the carriers choose the latter strategy. The surveillance strategy does not prevent breast cancer, and especially in BRCA1 carriers, who mostly have fast growing tumours, 25-30% of carriers are diagnosed when the tumour is already more than 2cm in diameter.



Dr. Kaas and her team found that only one out of the 250 carriers studied was diagnosed with a breast cancer, and this was likely to be because the axillary tail (a small part of the breast that extends towards the armpit) had not been completely removed. "Our epidemiologists are investigating how many breast cancers are avoided up to the age of 80 in these women," she says. "But on current evidence we can safely state that continued follow-up, which can be costly as well as stressful for the patient, is not warranted in patients who have had a prophylactic mastectomy. Surveillance in those BRCA carriers who do not opt for mastectomy has to start at an early age, and the frequent visits to the doctor and the many examinations which need to be undertaken regularly can be a source of great stress for many women.



"However, the decision to remove healthy breasts is solely the decision of the woman, and healthcare services should not press women to make this choice simply to reduce costs."



In another presentation to the conference tomorrow (Wednesday) Dr. Yvonne Kamm, a medical oncologist from the Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, will say that the costs of screening for BRCA carriers are very high, and even more so because the MRI that is used can have a high false positive rate, leading to further investigations.
















"The MRI is expensive in itself, but useful because it can detect very small tumours which might not be picked up otherwise. But it also detects many other abnormalities that are not cancer, and this implies not just extra cost but also considerably anxiety for the women concerned," she says.



Between September 1999 and 2005, Dr. Kamm and her team screened 196 women at risk of hereditary breast cancer. When an abnormality was found, the women underwent further investigations. The women were screened for a median period of 2 years; this included 1149 breast examinations, 494 mammograms, and 436 MRI scans. Abnormalities led to further investigations; 32 breast examinations, 17 mammograms, 64 MRI scans, 114 ultrasound examinations, and 48 biopsies.



The cost of the first screening programme was ?‚¬254 per woman year, and the extra costs of further investigations ?‚¬61 per woman year. During the 6 year period 13 cancers were found.



"The total costs to find one breast cancer were high - ?‚¬13168," says Dr. Kamm. We know that such intensive screening works, and that it can find breast cancer at an early stage. Therefore, we have made the choice to screen intensively women at very high risk from breast cancer."




Catalogue nos: 109, Wednesday 14.30 hrs CEST (Hall 15.2)

18, Wednesday Poster Session (Hall 11)



European Breast Cancer Conference

Lost That Lovin' Feeling? Don't Blame The Pill

When your sex drive is sputtering, you may want to take a closer look at several factors in your life.


In fact, it's natural for people to ask: Is the loss of sexual desire due directly to taking the birth control pill? The answer to this question which has been asked for more than 40 years, since the oral contraceptive was introduced may now be less murky, according to researchers at the Ohio State University Medical Center.


Dr. Jonathan Schaffir, an obstetrician and gynecologist with the medical center, reviewed more than 25 years' worth of studies, examining the relationship between oral contraceptives and libido, and concluded that the pill has little, if any, effect on a woman's sex drive. His study was published in a recent issue of the Journal of Sex & Marital Therapy.


The issue has roots in the early forms of the pill, developed in the 1960s, which often contained high levels of estrogens and progestins many times as much as 80 to 150 micrograms in single doses. The makeup of birth control pills caused many women to become bloated, feel breast tenderness or experience nausea.


"These side effects could easily have caused women to feel extremely uncomfortable, translating into decreased libido," noted Schaffir. "Also much less was known about the human sexual response at that time, which could have led to information based on opinion and not on fact."


Schaffir made a critical assessment of the published information, to see if there is a way to predict whether certain types of hormonal contraception or certain segments of the population are more prone to changes in libido.


Schaffir noted that some women, indeed, experience a change in libido while taking oral contraceptives, but he could find no predictable patterns for this in the literature.


When looking for a consistent biological effect of hormonal contraception on sexual desire, androgens would probably be the factor most suspected to play a role, said Schaffir. "It was shown that the birth control pill decreased the concentration of free androgens, including testosterone, but that doesn't necessarily translate to a loss of libido. Chemical changes occurred, but they did not apparently impact sexual behavior for the vast majority of women," he said.


Similarly, the effect of progestin on women's sexual desire was not dramatic. "A small minority of all the users of progestin were actually bothered by a low libido," said Schaffir.


Based on his review of studies dating from 1975 to 2004, Schaffir found that only a small minority of oral contraceptive users experienced a negative effect on sexuality. Furthermore, he found no reliable predictor of a negative effect in those who experienced such side effects.


"Studies showed that it was a problem for a small number of women using birth control pills to experience decreased libido, but it didn't happen predictably in any specific sub-population, or with any particular type of hormonal contraception," said Schaffir. "In fact, changes in sexual desire could as likely represent a combination of biological, psychological and social phenomena as any hormonal effect.















"The available literature illustrated that decreased libido is an idiosyncratic, unpredictable reaction in a small minority of women," stated Schaffir.


Schaffir reassured patients and clinicians that women should continue to use oral contraceptives without fear of an adverse effect on libido. "Don't let such fear factor into your decision of whether to take hormonal birth control pills," said Schaffir.


If you are experiencing a diminishing sex drive, you may want to ask yourself:


Have you recently started taking a medication?


There are some medications that are known to interfere with libido, and antidepressants are probably the most notorious group, said Schaffir. You may want to consult your physician, because stopping or changing the medication could be effective, he said. Schaffir and other researchers at Ohio State are part of ongoing FDA phase II and phase III trials, involving hormonal and non-hormonal medications that some day may directly improve sexual drive, noted Schaffir. But currently there is no one pill that you can take for a lack of libido.


Have you recently had increased tensions or stresses in your sexual relationship?


The only thing that to this point has been consistently effective in treating low libido is sex therapy, or couples therapy, in which you talk with a counselor about a relationship or discuss sexual goals, noted Schaffir. This emphasizes the fact that such a difficulty is probably many times psychological, and not just biological, he said.


Ohio State University Medical Center

450 W. 10th Ave.

Columbus, OH 43210

United States

osumedcenter.edu

Maternal Health Must Become A Priority In Developing Countries

"Mothers are the backbones of communities. When they die, children become orphaned, families are fragmented," said Jean Chamberlain Froese, MD, during the President's Program at The American College of Obstetricians and Gynecologists (ACOG) 57th Annual Clinical Meeting. Although making pregnancy and childbirth safer in countries where maternal mortality is extraordinarily high can seem like a daunting task, employing practical solutions is possible to improve maternal health and pregnancy outcomes, according to Dr. Froese.


In her presentation, "Where Have All the Mothers Gone?," Dr. Chamberlain Froese spoke about her personal experience working in Uganda to make childbirth safer there. The logical first step in improving a community's overall health care is to improve maternal health, she said, because the equipment and systems necessary for a strong maternal health program also benefit the overall community. "The needs in developing countries are so immense and seem overwhelming, but once you've got the basics for a good maternal health program, you've got a good structure that will help the general population as well," Dr. Chamberlain Froese said.


Communities need to be educated about pregnancy risks and common pregnancy complications so that pregnant women become a priority, according to Dr. Chamberlain Froese. Two key components in reaching this goal include grassroots public education and agenda setting.


Governments need to allocate money toward improving the infrastructure, such as roads, because muddy and pothole-laden roads can make an emergency trip slow and dangerous. In some instances, pregnant women may stand on the side of the road, hemorrhaging while trying to flag down a car or public bus, but no one stops.


Agenda setting among political leaders is key to improving maternal health. Four members of the Ugandan Parliament have participated in a master's of public health (MPH) leadership program overseen by Dr. Chamberlain Froese. This program trains Ugandan professionals from many disciplines to make motherhood safer for African women. One member of the Ugandan Parliament has introduced new legislation to improve safe motherhood.


Awareness is increasing little by little. A Uganda journalist from the national daily newspaper has completed the MPH program and has helped bring attention to the issue. "There was nothing on safe motherhood for three months in the national newspapers. And now there are regular features every one to two weeks that cover issues concerning safe motherhood and reproductive health," Dr. Chamberlain Froese said.


Dr. Chamberlain Froese is the executive director of the nonprofit organization Save the Mothers and assistant professor of ob-gyn at McMaster University in Hamilton, Ontario. For the last four years, she has spent eight months of the year in Uganda overseeing the MPH leadership program. Before that, she spent five years in Yemen improving conditions for pregnant women.


The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization, ACOG: strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's health care.

Source
American College of Obstetricians and Gynecologists

Children Of Women Who Smoked During Pregnancy At Increased Risk Of Becoming Smokers

New research has revealed that prenatal exposure to nicotine increases the vulnerability to nicotine self-administration in adolescent mice. The results support the hypothesis that adolescents with prenatal nicotine exposure are more likely to start smoking earlier than their peers and that they are also more susceptible to the addictive effects of nicotine, especially as a result of stress and peer pressure. The study performed with mice is part of a project researching the behavioural and molecular mechanisms of nicotine addiction. The research project was carried out under the Academy of Finland's Research Programme on Substance Abuse and Addictions.


The key observation made by the Finnish and Russian researchers in the project was that adding nicotine to the drinking water of pregnant mice led to differences between the control and nicotine-exposed offspring in terms of nicotine self-administration. Treating the dams with nicotine during the prenatal period increased the frequency of self-administration in the offspring compared to the control group, even at lower doses.


The study also examined the receptor-level combined effects of opioids (morphine and morphine-related compounds) and nicotine. A receptor is a human protein to which endogenous and exogenous compounds bind. Once the receptors are activated, they trigger a number of intracellular signals. The compounds that bind to a receptor may also alter or turn off the receptor signalling. The present study was conducted using cell lines that express different subtypes of nicotinic receptors. Nicotine attaches to these receptors and activates them.


The results of the research project show that morphine and its related compounds, which normally attach to their own receptors, also bind to nicotinic receptors, causing altered nicotine responses. This provides a possible explanation for the common concurrent use of nicotine and other substances. The results may also pave the way for the development of new medication used to treat both smoking and drug addiction.


The study was conducted as a joint Finnish-Russian project between the Division of Pharmacology and Toxicology at the University of Helsinki, the Saint Petersburg Pavlov Medical University and Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry in Moscow. The project was a concrete example of how people, research and knowledge can transcend national and cultural boundaries. The Finnish part of the project received funding from the Academy of Finland.


Sources: Suomen Akatemia, AlphaGalileo Foundation.