HEALTH NEWS: Study: Breast Cancer Survivors Still At Risk

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/14/2008

New research from a 16-year study indicates that early-stage breast cancer patients who have completed five to 10 years of drug and/or chemotherapy treatment have a one in five - around 20 percent - chance of relapse.

Between 1985 and 2001, oncologists/researchers at the University of Texas' M.D. Anderson Cancer Center examined 2,838 patients with stage I to III breast cancers who had been treated at the center. All were cancer-free five years after initial treatment with surgery or surgery and radiation.

All of the women underwent up to five years of additional treatments with chemotherapy, the anti-estrogen drug tamoxifen or both. After a 28-month follow-up, 215 women developed recurrent cancer.

This incidence rate put the risk at 7 percent for women with stage I breast cancer, 11 percent for stage II, and 13 percent for women with stage III cancer. This relapse rate increased to 20 percent 15 years after first being diagnosed.

"The risk of relapse was still small, but certainly not insignificant," Abenaa M. Brewster, M.D., an oncologist and researcher with M.D. Anderson Cancer Center told WebMD. "I think these numbers are somewhat reassuring, but they also highlight the need for new [therapeutic] options for women who have completed five years of treatment."

Factors associated with the risk of recurrence were tumor grade, hormone receptor status and endocrine therapy.

Forms of treatment available to newly diagnosed patients usually include surgery and radiation therapy (chemotherapy) or surgery and drug therapy.

Up until the year 2000, drug treatment consisted of tamoxifen for both premenopausal and postmenopausal women with estrogen-receptor positive tumors (they respond to hormone treatments). Today, a newer class of drugs called aromatase inhibitors are used.

In the study, 34 ER-negative women had a relapse and 149 ER-positive women did. The study and results were published Tuesday in the online edition of the Journal of the National Cancer Institute.

Estrogen-receptor (ER) negative tumors are considered more deadly than ER-positive ones. However, "women who had ER-positive cancer were more likely to have late recurrences than those with ER-negative," according to Len Lichtenfeld, M.D., the American Cancer Society deputy chief medical officer in healthday.com.

However, what to do about this continued risk is up in the air, Dr. Lichtenfeld said.

A possible treatment alternative is in the works by British and Finnish researchers, who are testing a combination of two inexpensive, commonly used and easily available drugs on killing cancer-cells in tumors.

The first drug is doxorubicin, a common chemotherapy-regimen drug, followed 24 hours later by the osteoporosis medication zoledronic acid. When tested on mice, the drug combo was 99.99 percent effective in killing such cells. Human trials are currently underway with results expected later this year.

This announcement was also made in the Journal of the National Cancer Institute.

Each year in the U.S., around 180,000 women are diagnosed with breast cancer. In the U.K., almost 46,000 new cases are diagnosed every year.


Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008

HEALTH NEWS: Diabetes Before Pregnancy Linked To Birth Risk

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/13/2008

A study from the U.S. Centers for Disease Control and Prevention (CDC) reported that women with diabetes prior to becoming pregnant are eight times more likely to have children with multiple birth defects compared to women without diabetes.

The study found also that women with diabetes are three to four times more likely to give birth to a baby with at least one birth defect.

Women with pregnancy-induced diabetes, or gestational diabetes, were also found more likely to have a child with a birth defect, although usually only if they were overweight or obese at conception. This range would mean a body mass index (BMI) - weight measured in proportion to height - of 25 or higher.

The study expanded on previous research by examining women with type 1 and type 2 diabetes as well as gestational diabetes, and considering both cardiac and non-cardiac defects, nearly 40 in all.

Only 2 percent of babies with single birth defects and 5 percent with multiple defects were born to mothers with pre-pregnancy diabetes, while 93 percent of the birth defects examined were not associated with maternal diabetes.

Overall, diabetes diagnosed before pregnancy was linked with about half of the birth defect categories examined.

Birth defects may include heart problems, brain and spinal defects, oral clefts, limb deficiencies, and kidney and gastrointestinal tract defects. These affect 1-in-33 infants and are a leading cause of infant death, according to the CDC. Most causes are unknown.

The findings were based on data analyzed from over 13,000 infants with birth defects and nearly 5,000 without defects, all born between 1997 and 2003. Of those without defects, 24 mothers had diabetes before diabetes. Of those newborns with defects, 283 mothers had pre-pregnancy diabetes.

All children were part of the National Birth Defects Prevention Study, which drew data from 10 birth-defect surveillance systems in 10 states.

However, according to Janis Biermann, a spokeswoman for the March of Dimes which reviewed the study for WebMD, women shouldnotbe unduly concerned.

"Just because there is an increased risk of a baby having a birth defect if a woman has preconception diabetes doesn't mean it is going to happen," she said, "It just means there is a greater chance than if a woman doesn't have it."

The study is the largest yet done to identify the range of birth defects linked to pre-pregnancy diagnoses of diabetes, but the link itself has been known for almost two decades. Researchers hope that increased awareness will encourage people to seek the best available everyday preconception care.

"Early and effective management of diabetes for pregnant women is critical in helping to not only prevent birth defects, but also to reduce the risk for other health complications for them and their children," said lead author Dr. Adolfo Correa, an epidemiologist at the CDC's National Center on Birth Defects and Developmental Disabilities, in a news release.

According to the March of Dimes, about 1.85 million U.S. women of childbearing age have diabetes.

"The most important thing is that the patient ... get [her diabetes] in control," said Dr. Louis Weinstein, M.D., professor and chairman of OBGYN at Thomas Jefferson University.

In an urban area such as Philadelphia, "we tend to see more diabetes than in other parts of the country because we have lower socioeconomic populations with higher BMI [levels] than elsewhere," Dr. Weinstein added.

"It's important to take care of yourself, exercise, be at an optimal weight, plan your pregnancy, and make sure the diabetes is well controlled before you get pregnant," Ms. Biermann, from the March of Dimes, said to WebMD.

Once pregnant, Ms. Biermann notes the importance of following the same healthy habits and having regular prenatal care, along with regular appointments with a diabetes specialist for those diagnosed.

The report was published this month in the American Journal of Obstetrics & Gynecology.

Heather J. Chin can be reached at hchin@thebulletin.us.

©The Evening Bulletin 2008

HEALTH: Study: Americans Drinking Less Alcohol, More Wine

(previously published here at www.thebulletin.us)

By: Heather J. Chin, The Bulletin

08/12/2008

Americans may drink more in one sitting than some Europeans (who drink steadily in small amounts), but their average overall alcohol intake has decreased across age and gender differences, according to a study published last week in the American Journal of Medicine.

The results from a 55-year study (1948-2003) on 8,600 white adults in Framingham, Mass., found Americans drink less as they get older, and they tend to gravitate away from beer and toward wine in the process. Each successive generation also showed a trend from heavier drinking toward moderate drinking.

All participants were initially at least 28 years old and were born between 1900 and 1959.
The average amount of alcohol intake was highest between ages 30 and 50 for most cohorts, regardless of gender.

Up to their mid-30s, young men relied on beer for at least half of their alcohol consumption. After that, beer consumption dropped to around one-quarter of the average male in his mid-70s.

While both men and women in each generation drank less with age and each generation drank less than the generation before it, the overall incidence rate of an alcohol use disorder among those aged 40 to 79 years was about three times higher among men (12.8 percent) than women (3.8 percent).

Female participants also showed a move from beer to wine over time, although the report's authors noted that they were less partial to beer to begin with. No significant alcohol-related problems were linked with women here, but a report by University of Washington researchers in the May issue of Alcoholism: Clinical and Experimental Research found that women born after 1953 had rising rates of alcoholism.

Lead author Yuqing Zhang, D.Sc., of the Boston University School of Medicine, told WebMD he doesn't know why the rates of alcohol use dropped over generations and this study "did not try to answer these questions."

The long-term health study collected data by asking participants to answer questions about their lifestyle and health, including alcohol consumption over time. Researchers hoped that the data would help determine patterns of alcohol use and disorders according to sex, age and birth cohorts.

The study, supported by a grant from the National Institute on Alcohol Abuse and Alcoholism (part of the National Institutes of Health), is not clearly representative of all U.S. adults, but researchers said the data supports the efficacy of efforts to reduce alcohol use disorders.

Researchers also hope the data may be useful for policy-making groups responsible for drinking and alcohol recommendations, continuing "to support potentially beneficial effects of moderate drinking on cardiovascular disease and other diseases of aging, as well as adverse health and social effects of heavy alcohol use."

Heather J. Chin can be reached at hchin@thebulletin.us

©The Evening Bulletin 2008