Preliminary research suggests that higher consumption of fatty fish in women is linked with a lower risk of renal cell carcinoma, a common form of kidney cancer, according to a study in the September 20 issue of JAMA.
Renal cell carcinoma (RCC) involving the renal parenchyma (the functional tissue of the kidney) accounts for more than 80 percent of all kidney cancers. Renal cell carcinoma incidence rates in the United States had been increasing in 1970-1990s, especially among black women and men; more recent data suggest a leveling off in this trend for most racial groups. The evidence that fish consumption, especially fatty fish, may be associated with lower risk of several cancers has not been consistent, according to background information in the article.
Previous studies have analyzed total fish consumption and have not taken into account that there are large differences between fatty fish and lean fish in the content of omega-3 fatty acids and vitamin D. Marine omega-3 polyunsaturated fatty acids, eicosapentaenoic acid and docosahexaneoic acid, which are present in significant amounts in fatty cold-water fish (up to 20-30 times higher content than in lean fish), have been reported to slow the development of cancer. Fatty fish has 3 to 5 times higher content of vitamin D than lean fish, and lower serum vitamin D levels have been associated with development and progression of RCC.
Alicja Wolk, D.M.Sc., of the Karolinska Institutet, Stockholm, Sweden and colleagues investigated the association between fatty fish and lean fish consumption and the risk for development of RCC in a population with a relatively high consumption of fatty fish. The participants, from the Swedish Mammography Cohort, included 61,433 women age 40 to 76 years without previous diagnosis of cancer at baseline (March 1987 to December 1990). Participants filled in a food frequency questionnaire at baseline and in September 1997. The researchers considered fatty fish to include salmon, herring, sardines, and mackerel; lean fish included cod, tuna, and sweet water fish; and other seafood included shrimp, lobster, and crayfish.
During an average of 15.3 years of follow-up between 1987 and 2004, 150 RCC cases were diagnosed. After adjustment for potential confounders, an inverse association of fatty fish consumption with the risk of RCC was found, while no association was found with the consumption of lean fish or other seafood.
"In this large population-based cohort with data on long-term diet, we found that women who consumed one or more servings of fatty fish per week had a statistically significant 44 percent decreased risk of RCC compared with women who did not consume any fish. Women who reported consistent long-term consumption of fatty fish at baseline and 10 years later had a statistically significant 74 percent lower risk," the authors write.
"Our results support the hypothesis that frequent consumption of fatty fish may lower the risk of RCC possibly due to increased intake of fish oil rich in eicosapentaenoic acid and docosahexaneoic acid as well as vitamin D," they write. "Our results, however, require confirmation because this is the first epidemiological study addressing this issue."
Editor's Note: This study was supported by grants from the Swedish Cancer Foundation, the Swedish Research Council/Longitudinal Studies, and V?stmanland County Research Fund Against Cancer. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
American Medical Association (AMA)
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суббота, 29 октября 2011 г.
суббота, 22 октября 2011 г.
Trust For America's Health Releases Report On Connection Between Women's Health And Stalled Infant Mortality Rates
Trust for America's Health (TFAH) released a report, Healthy Women, Healthy Babies, in conjunction with the release of the Annie E. Casey Foundation's KIDS COUNT DATABOOK 2008. The report explains why after 40 years of progress, infant mortality rates in the U.S. have stalled since 2000. TFAH finds that the deteriorating health of American women, due in part to wide-spread chronic disease epidemics like obesity and diabetes, is taking a toll on American infants, resulting in stagnated improvement when it comes to infant health. TFAH's report offers recommendations for Congress and the American health system to aggressively improve the health of new-born infants.
"In the wake of all the great medical breakthroughs over the last 40 years, one would assume that infant mortality rates would plummet. Instead, medical progress has been cancelled out in the delivery room by the deteriorating health of childbearing-aged women and their lack of health care access; and infant mortality rates have stalled as a result," said Jeff Levi, Executive Director of Trust for America's Health. "American women, children and families simply deserve better."
Levi added, "We know now that an infant's chances of sickness, disability and survival often hinge on the health of the mother, before she even becomes pregnant. Therefore, the way to reduce risks to new born babies is to invest in a woman's health throughout her childbearing years. If we concentrate our efforts most on those hit hardest by the biggest health problems - low-income and minority women - we will once again see healthier babies and dropping infant mortality rates."
"Two of the most disturbing trends in our 2008 KIDS COUNT Data Book that we are releasing today are the increase in the rate of low-birthweight babies and the lack of progress in infant mortality," said Laura Beavers, coordinator of the national KIDS COUNT project at the Annie E. Casey Foundation. "The Trust for America's Heath's report, Healthy Women, Healthy Babies provides us with the information we need to turn this around and to begin to once again see steady progress on both of these critical indicators."
Healthy Women, Healthy Babies reports that approximately 30 percent of women who give birth have some form of pregnancy complication, which cost the U.S. at least $26.2 billion in 2005. Prematurity and low birth weights are often associated with health issues in the mother, such as diabetes, high blood pressure, or obesity. Many experts now believe that because the early weeks after conception are critical to a baby's development, traditional prenatal care, which usually begins in the first three months of a pregnancy, comes too late to prevent many serious maternal and child health problems. The way to ensure infant mortality rates resume their fall is to assure that all women are insured and have access to primary care. If we improve the health of all women aged 15-44 and execute earlier interventions for those with chronic health conditions and risks, we will also see better birth outcomes.
KEY RECOMMENDATIONS OF Healthy Women, Healthy Babies, which were drawn from interviews and comments from 10 leading experts in maternal and child health, include:
-- Fully Implement and Enhance Medicaid Policies.
- Assuring better health coverage for poor women through state expansion of Medicaid coverage. States should have the authority to cover women without a federal waiver and allow Medicaid benefits to follow women after the birth for 24 months. Both changes would significantly reduce infant mortality.
-- Expand Other Programs that Provide Primary Care and Other Services to Women of Childbearing Age.
- Federal programs like the Healthy Start Infant Mortality Reduction Program, Community Health Centers, Title X Family Planning and Title V Maternal and Child Health Block Grant need better funding to reach all those at risk.
-- Make Research on Preconception Health and Health Care a Priority.
- Research needs to be jump-started through increased funding at organizations like the Centers for Disease Control's National Center on Birth Defects and Developmental Disabilities, the National Center for Chronic Disease Prevention and Health Promotion, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Healthy Women, Healthy Babies was supported by a grant from the Annie E. Casey Foundation.
Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. healthyamericans.
The Annie E. Casey Foundation is a private charitable organization, whose primary mission is to foster public policies, human-resource reforms, and community supports that more effectively meet the needs of today's vulnerable children and families. For more information, visit aecf.
America's Health
"In the wake of all the great medical breakthroughs over the last 40 years, one would assume that infant mortality rates would plummet. Instead, medical progress has been cancelled out in the delivery room by the deteriorating health of childbearing-aged women and their lack of health care access; and infant mortality rates have stalled as a result," said Jeff Levi, Executive Director of Trust for America's Health. "American women, children and families simply deserve better."
Levi added, "We know now that an infant's chances of sickness, disability and survival often hinge on the health of the mother, before she even becomes pregnant. Therefore, the way to reduce risks to new born babies is to invest in a woman's health throughout her childbearing years. If we concentrate our efforts most on those hit hardest by the biggest health problems - low-income and minority women - we will once again see healthier babies and dropping infant mortality rates."
"Two of the most disturbing trends in our 2008 KIDS COUNT Data Book that we are releasing today are the increase in the rate of low-birthweight babies and the lack of progress in infant mortality," said Laura Beavers, coordinator of the national KIDS COUNT project at the Annie E. Casey Foundation. "The Trust for America's Heath's report, Healthy Women, Healthy Babies provides us with the information we need to turn this around and to begin to once again see steady progress on both of these critical indicators."
Healthy Women, Healthy Babies reports that approximately 30 percent of women who give birth have some form of pregnancy complication, which cost the U.S. at least $26.2 billion in 2005. Prematurity and low birth weights are often associated with health issues in the mother, such as diabetes, high blood pressure, or obesity. Many experts now believe that because the early weeks after conception are critical to a baby's development, traditional prenatal care, which usually begins in the first three months of a pregnancy, comes too late to prevent many serious maternal and child health problems. The way to ensure infant mortality rates resume their fall is to assure that all women are insured and have access to primary care. If we improve the health of all women aged 15-44 and execute earlier interventions for those with chronic health conditions and risks, we will also see better birth outcomes.
KEY RECOMMENDATIONS OF Healthy Women, Healthy Babies, which were drawn from interviews and comments from 10 leading experts in maternal and child health, include:
-- Fully Implement and Enhance Medicaid Policies.
- Assuring better health coverage for poor women through state expansion of Medicaid coverage. States should have the authority to cover women without a federal waiver and allow Medicaid benefits to follow women after the birth for 24 months. Both changes would significantly reduce infant mortality.
-- Expand Other Programs that Provide Primary Care and Other Services to Women of Childbearing Age.
- Federal programs like the Healthy Start Infant Mortality Reduction Program, Community Health Centers, Title X Family Planning and Title V Maternal and Child Health Block Grant need better funding to reach all those at risk.
-- Make Research on Preconception Health and Health Care a Priority.
- Research needs to be jump-started through increased funding at organizations like the Centers for Disease Control's National Center on Birth Defects and Developmental Disabilities, the National Center for Chronic Disease Prevention and Health Promotion, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Healthy Women, Healthy Babies was supported by a grant from the Annie E. Casey Foundation.
Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. healthyamericans.
The Annie E. Casey Foundation is a private charitable organization, whose primary mission is to foster public policies, human-resource reforms, and community supports that more effectively meet the needs of today's vulnerable children and families. For more information, visit aecf.
America's Health
суббота, 15 октября 2011 г.
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.
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.
суббота, 8 октября 2011 г.
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.
суббота, 1 октября 2011 г.
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?
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?
суббота, 24 сентября 2011 г.
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
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
суббота, 17 сентября 2011 г.
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
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
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