Taco Bell removes green onions (AP)

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Taco Bell removes green onions (AP)

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Taco Bell to Reopen Restaurants After - Washington...

Jamba Juice issues warning in Southwest (AP)

New York first city to oust evil oils - The Age

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Friday, March 31, 2006

News Flash

Work Stress Cause of 'Sick Building Syndrome': Study
A new study, published in the journal Occupational and Environmental Medicine, found that high job demands and perception of poor support were more closely related to sick-building symptoms than were the physical conditions of the workplace. Researchers say this suggests that "sick building syndrome" may in fact be a misnomer.
Teens Not Getting Enough Sleep
Many of America's teenagers are going through life sleep-deprived, according to a poll by the National Sleep Foundation. In a survey that interviewed 1,602 adults caregivers and their children, only 20% of kids between the ages of 11 and 17 were getting the recommended 9 hours of sleep on school nights; more than 1 in 4 reported sleeping in class.
Immune Boosters Could Block Flu Spread
Growing concern that the world is becoming increasingly vulnerable to flu pandemic has spurred new approaches in biotech to develop innovative weapons to fight influenza viruses. Drug companies are working on technologies that attack flu from several directions that include preventing viral growth by shutting down the proteins that allow flu viruses to replicate; tuning up the immune system with new drugs that activate immune system genes, and through a new monoclonal antibody that targets infected cells, to keep ahead of drug-resistant viral strains.
Benzene Levels in Soda OK: FDA
The Food and Drug Administration says the cancer-causing chemical benzene was either not found or was present at levels below the federal limit for drinking water in the vast majority of soft drinks sampled. "Although the results to date are preliminary, they do not suggest a safety concern," wrote Robert E. Brackett, director of the Center for Food Safety and Applied Nutrition, in a letter released Tuesday.


Weight Training May Improve Quality of Life in Breast Cancer Survivors

Weight training improves quality of life (QOL) in breast cancer survivors, according to the results of a randomized trial reported in the March 27 Early View issue of Cancer.

"Aerobic exercise training has been shown to have beneficial effects on QOL in breast cancer survivors," write Tetsuya Ohira, MD, from the University of Minnesota in Minneapolis, and colleagues from the Weight Training for Breast Cancer Survivors (WTBS) Study. "However, the effects of weight training on psychological benefits are unknown.... There is the potential that for breast cancer survivors, weight training might increase a sense of control over their lives during the 'watchful waiting' time frame between the end of active treatment and the 5-year mark post-diagnosis (e.g., psychological empowerment via physical strength increases)."

In the WTBS Study, 86 breast cancer survivors 4 to 36 months' posttreatment were randomized into a treatment group receiving twice-weekly weight training and a control group. The main endpoints were changes in QOL measured by the cancer rehabilitation evaluation system (CARES) short form, and change in depressive symptoms on the Center for Epidemiologic Studies–Depression Scale (CES-D) from baseline to month 6.

Compared with the control group, the treatment group had improvements for 6 months in the physical global QOL score (standardized difference, 0.62; P = .006) and in the psychosocial global score (standardized difference, 0.52; P = .02). There were no changes in CES-D scores. Increases in upper body strength were correlated with improvements in physical global score (r = 0.32; P <.01) and in psychosocial global score (r = 0.30; P < .01). Increases in lean mass had similar associations with improvements in physical global score (r = 0.23; P <.05) and in psychosocial global score (r = 0.24; P <.05).

"Twice-weekly weight training for recent breast cancer survivors may result in improved QOL, in part via changes in body composition and strength," the authors write. "The mechanism by which weight training may improve QOL in breast cancer survivors may be a sense of return to feeling in control of their bodies that may translate into feeling greater efficacy in other areas of life."

Naltrexone May Augment the Effects of the Nicotine Patch for Smoking Cessation

Naltrexone may augment the effects of the nicotine patch for smoking cessation, according to the results of a double-blind, dose-ranging study reported in the March 27 issue of the Archives of Internal Medicine. As an added benefit in some patients, low-dose naltrexone therapy may also lead to weight reduction.

"Many smokers remain refractory to current therapies, which only partially address weight gain after smoking cessation," write Stephanie S. O'Malley, PhD, from Yale University School of Medicine in New Haven, Conn, and colleagues. "This study evaluated whether naltrexone hydrochloride augmentation of nicotine patch therapy improves smoking abstinence and reduces postcessation weight gain more than nicotine patch therapy alone and at what dose."

At an outpatient research center, 400 individuals who smoked 20 or more cigarettes daily were randomized to treatment for 6 weeks with a 21-mg nicotine patch and oral naltrexone (0, 25, 50, or 100 mg/day) Follow-up was for 1 year after randomization. The a priori specified main outcomes were prolonged 4-week cigarette abstinence after a 2-week grace period in the intent-to-treat sample, and weight gain in these abstainers.

In the intent-to-treat analysis, there were no significant differences in prolonged 4-week abstinence (P = .49) or 6-week continuous abstinence after the quit date (P = .12) during treatment. In 295 participants who completed treatment, the 100-mg dose was associated with higher continuous abstinence rates (71.6%) than was placebo (48%; odds ratio, 2.73; 95% confidence interval, 1.39 - 5.39; P < .01).

In the group of continuous abstainers, those receiving 25 mg of naltrexone gained significantly less weight (mean, 0.7 ± 0.31 kg) than did the placebo group (1.9 ± 0.33 kg; P < .01). Participants with prolonged abstinence and treatment completers had similar naltrexone dose effects on weight.

"The 100-mg dose of naltrexone hydrochloride appears the most promising for augmenting the efficacy of the nicotine patch on smoking cessation outcomes but requires further study," the authors write. "The significant weight reduction with low-dose naltrexone therapy suggests that it may be useful as a second-line treatment for weight-concerned smokers."

Study limitations are that the results of the treatment completer analysis must be interpreted cautiously, given the lack of significant effects in the intent-to-treat sample; possible inflation of smoking abstinence rates due to undetected smoking lapses; limited generalizability because of recruitment via advertisements and press releases, and predominantly white sample; insufficient power to detect effects on posttreatment outcomes; short duration of treatment; and type I error.

"The results of this dose-ranging study provide support for further testing of the efficacy of the 100-mg dose for smoking cessation," the authors conclude. "In the meantime, the benefit of low-dose naltrexone therapy on reducing weight gain may have immediate clinical utility for the subset of weight-concerned smokers."

The National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcohol Dependence, National Institutes of Health, the Robert Wood Johnson Foundation, and the Department of Veterans Affairs, Newington, Conn, supported this study. GlaxoSmithKline Inc, donated nicotine patches. Three authors have disclosed they are coinventors on a patent held by Yale University for smoking cessation treatments using naltrexone and related compounds. Several authors have disclosed relevant financial relationships with Alkermes Inc, the maker of an investigational injectable naltrexone; DuPont, the maker of naltrexone; GlaxoSmithKline Inc; Forest Laboratories; Lipha Pharmaceuticals; Ortho-McNeil, Inc; Bristol-Myers Squibb; Pfizer Inc; Sanofi-Aventis; Mallinckrodt Pharmaceuticals; and Johnson & Johnson.


Higher Magnesium Intake May Lower Risk for Metabolic Syndrome


Magnesium Lowers Heart, Diabetes Risks

New research may help explain why eating fruits, vegetables, whole grains, and nuts helps protect the heart and prevent diabetes.

The key may be the mineral magnesium.

People in the study who ate magnesium-rich diets seemed to be protected against developing metabolic syndrome, a cluster of risk factors linked to cardiovascular disease and diabetes.

These risk factors include elevated blood pressure, low levels of HDL "good" cholesterol, elevated triglycerides (blood fats), elevated fasting-glucose (blood sugar) levels, and abdominal obesity as determined by waistline measurement.

Low-Magnesium Diets

Study participants who ate diets low in magnesium were more likely to develop the heart disease and diabetes risk factors.

Whole grains, nuts, and many fruits and vegetables are excellent dietary sources of magnesium.

"These foods have long been recognized as being healthy foods that may protect people from disease," researcher Ka He, MD, ScD, tells WebMD. "Magnesium could play an important role in this, but it is just one component of diet -- and diet is just one component of a healthy lifestyle."

The study group consisted of 4,637 young adults between the ages of 18 and 30 when enrolled in the mid-1980s. Fifteen years after entering the study, just over 600 had developed metabolic syndrome.

The researchers divided all the participants into four equal-sized groups based on their reported magnesium intake.

Daily Recommendations

The National Academy of Sciences recommends a daily magnesium intake of 400 milligrams and 310 milligrams, respectively, for adult males and nonpregnant females age 19 to 30. The recommended levels are 420 milligrams for adult males over 30 and 320 milligrams for adult nonpregnant females over 30.

He and colleagues concluded that people in the study who consumed the most magnesium had a 31% lower risk of developing metabolic syndrome, compared with people who ate the least.

Higher magnesium intake was associated with reduced risk of the individual risk factors that make up metabolic syndrome compared with those with the lowest intake.

The findings are reported in the April 4 issue of the American Heart Association journal Circulation.

Foods, Not Supplements

The researchers noted that the findings need to be confirmed in clinical studies. These studies are also necessary, He says, for determining the optimal daily dosage of the nutrient for people at risk for heart disease or diabetes.

He adds that foods, not dietary supplements, are the best sources of magnesium. Almonds, cashews, soybeans, spinach, avocados, whole grains, beans, and some fish are good food sources of the nutrient.

"Magnesium-rich foods are also rich in other nutrients, which may also be important for reducing risk," he says.

Cardiologist Nieca Goldberg, MD, worries that that message may be lost on many people who think they can take the easy way out with dietary supplements. Too much magnesium from supplement sources (outside of food) can cause problems ranging from weakness and nausea to toxic effects on the heart and nervous system.

"Certainly it is easier to go out and buy a bottle of pills than make the commitment to eating a healthier diet," she says. "But I can tell you from experience that when people make that commitment it really does pay off."

Goldberg is chief of the Women's Cardiac Care center at New York's Lenox Hill Hospital.

In addition to eating a diet rich in vegetables, fruits, whole grains and nuts, she recommends limiting simple carbohydrates, like those found in pasta and other white-flour based foods.

And both Goldberg and He agree that diet is just one factor in reducing heart disease and diabetes risk.

"People should eat healthy foods that are rich in magnesium to reduce their risk," He says. "But exercising regularly, not smoking, and maintaining a healthy body weight are also very important


Does Cannabis Hold the Key to Treating Cardiometabolic Disease?

Obesity, particularly visceral adiposity, and its related metabolic and cardiovascular disorders, is a worldwide pandemic. The biological properties of one of the most widespread illicit drugs of abuse, marijuana, have been recruited for obesity management. By uncovering the cellular interactions of the cannabinoid Δ9-tetrahydrocannabinol (Δ9-THC)—the major active component of marijuana—researchers have identified new molecular pathways for treating cardiometabolic disease. Studies have demonstrated that modulation of the endocannabinoid system holds great therapeutic promise for the treatment of obesity, dyslipidemia, insulin resistance and atherosclerosis.[1,2]

The endocannabinoid system contributes to the regulation of food intake, energy balance, inflammation, and lipid and glucose metabolism, and might therefore play a fundamental role in the development of obesity and atherosclerosis.[3] To date, two G-protein-coupled cannabinoid receptors that bind Δ9-THC with equal affinity have been identified: CB1 and CB2. The CB1 receptor, believed to mediate the psychotropic effects of cannabis and to participate in the modulation of food intake and adipogenesis, is expressed at high levels by brain cells and by several peripheral tissues including the gastrointestinal tract, the adrenal gland, the heart and adipose tissue. CB1 knockout mice exhibit a lean phenotype and appear to be resistant to diet-induced obesity and insulin resistance.[4] By contrast, CB2 receptors are located primarily on blood cells and immune tissues, and stimulation of these receptors with Δ9-THC results in an immunosuppressive phenotype via the modulation of immune-cell cytokine production.[5] This molecular system might have a role in the development of obesity, the metabolic syndrome and atherosclerosis, and its modulation might form the basis of new therapeutic strategies for these pathophysiologically linked conditions.

Using apolipoprotein E knockout mice Steffens et al. demonstrated that Δ9-THC can protect against the development of atherosclerosis.[1] CB2 receptors were expressed in both human and mouse atherosclerotic lesions, but were absent in nondiseased arteries. Apolipoprotein E knockout mice fed a high cholesterol diet developed extensive atherosclerotic lesions in the aortic root; however, when 1 mg/kg Δ9-THC daily was added to the diet—a dose not associated with CB1 activation and psychotropic effects—a significant reduction in the progression of atherosclerotic lesions was observed. Concomitant CB2 receptor antagonist treatment abolished this observed anti-atherosclerotic effect. Even though Δ9-THC-fed mice continued to have elevated serum lipid levels, fewer inflammatory cells were recruited into atherosclerotic lesions, suggesting that Δ9-THC treatment had a beneficial effect on the inflammatory milieu. Indeed, Steffens and co-workers demonstrated that the immunosuppressive properties of Δ9-THC interfered with the adhesion, migration, proliferation and function of immune cells involved in atherosclerotic plaque formation.

These promising results do not imply that smoking marijuana is the key to a healthy heart.[6] Too often there is failure to translate promising results observed in murine models to human patients. The effects of Δ9-THC on atherogenesis in man have not been studied, so whether this cannabinoid does more cardiovascular harm than good remains to be seen. The beneficial effects of Δ9-THC observed by Steffens et al. followed a U-shaped distribution with a very narrow therapeutic window, suggesting that the blood concentrations of Δ9-THC obtained from smoking marijuana would be too variable to provide sustained clinical benefit.[1] Furthermore, it is unlikely that purified Δ9-THC extract or marijuana would be legalized for use as an adjunctive treatment of cardiovascular disease, since both compounds could serve as drugs of abuse. In addition, smoking marijuana increases carboxyhemoglobin levels, and Δ9-THC activation of CB1 receptors induces a cardiovascular stress response; raising heart rate and blood pressure, decreasing the anginal threshold, and promoting acute coronary syndromes. Overall, smoking marijuana probably has a negative effect on the cardiovascular system. For these reasons, therapeutic strategies using the apparent anti-inflammatory properties of Δ9-THC will probably depend upon developing specific CB2-receptor agonists, to prevent the onset of psychotropic effects. Once thoroughly tested in animal models, translation to human trials could see the positive effects reported by Steffens et al. clinically realized.

Activation of the endocannabinoid system through the CB1 receptor plays an important role in central and peripheral regulation of energy balance, body weight and food intake. Blockade of the CB1 receptor appears to offer great promise in cardiometabolic risk reduction, and 1-year results from the RIO program are very encouraging.[2] In this trial, 1,507 patients with a BMI of at least 30 kg/m2, or at least 27 kg/m2 or more with treated or untreated dyslipidemia, hypertension or both, received double-blind treatment with 5 mg rimonabant—a selective CB1 receptor blocker—daily, 20 mg rimonabant daily, or placebo, in addition to a hypocaloric diet. Treatment with 20 mg rimonabant for 1 year significantly decreased total body weight and waist circumference, and produced a significant weight-independent effect on lipid parameters and several other cardiovascular risk factors. The beneficial changes to the lipid profile remained significant after adjusting for weight loss. Furthermore, treatment resulted in a significant reduction in fasting plasma glucose, fasting plasma insulin, insulin resistance and the proportion of patients who fulfilled the criteria for the metabolic syndrome compared with placebo. To explain the observed weight-independent effect on both lipid and glycemic variables, Van Gaal et al. hypothesized that enhanced rimonabant-induced expression of adiponectin—a cytokine that has a role in the regulation of hyperglycemia, hyperinsulinemia and fatty acid oxidation and is reduced in obese individuals—could be responsible.[2] Thus, by improving adipocyte function, rimonabant might contribute to beneficial changes in other adipokines, such as C-reactive protein, reinforcing the link between obesity and atherosclerosis.[7] Further investigation of in vivo effects of rimonabant are required to fully elucidate this mechanism, especially given the concern that CB1 antagonists might raise blood pressure.[8] Furthermore, rimonabant appears to be a useful agent for smoking cessation, yet another cardiac risk factor.[9] Thus, pharmacologic manipulation of cannabinoid-receptor signaling might combat the development of atherosclerosis through the treatment of obesity, the metabolic syndrome, vascular inflammation and smoking. The beneficial effects with rimonobant appear to be consistent in over 6,600 patients enrolled in the RIO program. Patients administered this drug enjoy sustained reductions in weight, BMI and visceral adiposity, and improvements in insulin sensitivity and dyslipidemia. More importantly, the beneficial effects to counter insulin resistance, improve dyslipidemia and increase adiponectin, are only partly explained by the reduction in weight, indicating a potential direct role for CB1 in adipogenesis and lipid derangement.

The results of the RIO program and the study by Steffens et al. indicate that modulating the activity of the endocannabinoid system holds promise as an approach to treating obesity, dyslipidemia and atherogenesis.[1,2] The CB1 and CB2 receptors might have opposing effects on atherogenesis: whereas central CB1-receptor blockade offers hope for atherogenic risk reduction, peripheral CB2-receptor stimulation in animals has powerful anti-atherosclerotic effects. It is possible that a strategy of CB1-receptor antagonism and CB2-receptor agonism might emerge as the most effective treatment across the spectrum of insulin resistance and vascular disease. It is paradoxical that studying the effects of cannabis, an illicit drug that provides society with numerous social problems, could serve as the basis for novel therapeutic strategies to reduce cardiometabolic risk.


Thursday, March 30, 2006

New Guidelines Issued for Beverage Classification and Consumption

The Beverage Guidance Panel has developed guidelines for beverage classification and consumption, according to a report in the March issue of the American Journal of Clinical Nutrition.

"Over the past several decades, levels of overweight and obesity have increased across all population groups in the United States," write Barry M. Popkin, from the University of North Carolina, Chapel Hill, and colleagues. "Concurrently, an increased daily intake of 150-300 kcal (for different age-sex groups) has occurred, with approximately 50% of the increased calories coming from the consumption of calorically sweetened beverages."

To provide guidance on the relative health and nutritional benefits and risks of various beverage categories, the Beverage Guidance Panel systematically reviewed the available literature on beverages and health. The panel also hoped to develop a deeper dialogue within the scientific community on overall beverage consumption patterns in the United States, and on the great potential to improve health by changing this pattern.

On the basis of caloric and nutrient contents and related health benefits and risks, the panel ranked beverages from the lowest to the highest value. To fulfill daily water needs, drinking water was ranked as the preferred beverage, followed in decreasing value by tea and coffee, low-fat (1.5% or 1.0%) and skim (nonfat) milk and soy beverages, noncalorically sweetened beverages, beverages with some nutritional benefits (fruit and vegetable juices, whole milk, alcohol, and sports drinks), and calorically sweetened, nutrient-poor beverages.

"The Panel recommends that the consumption of beverages with no or few calories should take precedence over the consumption of beverages with more calories," the authors write. "Potable water could be used to fulfill almost all the fluid needs of healthy individuals. However, to allow for variety and individual preferences, healthful diets may include several other types of beverages."

A healthy diet does not rely on fluids to provide energy or nutrient needs, according to the panel report. Because fluids are less satiating than are solid foods, their consumption is associated with a lack of dietary compensation. In other words, fluid calories are not readily "registered" for appetite regulation.

The Panel on Water and Electrolytes of the Institute of Medicine (IOM) has recognized that fluid requirements vary widely among individuals and populations. Therefore, they defined an adequate intake (AI) for water rather than an estimated average requirement (EAR). The AI was set at 125 fl oz (3.7 L)/day for men and 91 fl oz (2.7 L)/day for women. About 80% of the AI is contributed by beverages, including water, and the rest by solid foods. Conversely, except for milk and fruit juices, the contribution of fluids to meeting the recommended dietary allowance (RDA) for essential nutrients is minimal. In a healthy diet, the balance between energy and nutrient content is a critical factor defining the role of beverages.

The proposed guidance system ranks water at the bottom (level 1), to be consumed frequently, and calorically sweetened beverages at the top (level 6), to be consumed sparingly. These recommendations are aimed at the population older than 6 years.

"Below that age, there are many additional factors, such as development of taste preferences and early imprinting of food choices, that may affect beverage choice and intake," the authors write.

For individuals older than 6 years, the Panel recommends the following ranges of intake for beverages:

  • Level 1 (water), 20 to 50 fl oz/day.
  • Level 2: (unsweetened tea and coffee), 0 to 40 fl oz/day (may replace water, but caffeine is a limiting factor, up to 400 mg/day, or ~32 fl oz coffee/day).
  • Level 3: (low-fat and skim milk and soy beverages), 0 to 16 fl oz/day.
  • Level 4: (noncalorically sweetened beverages), 0 to 32 fl oz/day (may substitute for tea and coffee with the same limitations as for caffeine).
  • Level 5: (caloric beverages with some nutrients), 0 to 8 fl oz of 100% fruit juices/day, 0 to 1 alcoholic drink/day for women and 0 to 2 alcoholic drinks/day for men (one drink is ~12 fl oz of beer, 5 fl oz of wine, or 1.5 fl oz of distilled spirits), and 0 fl oz of whole milk/day.
  • Level 6: (calorically sweetened beverages), 0 to 8 fl oz/day.

"The obesity epidemic provides the rationale for developing the Beverage Guidance System," the authors write. "Because some beverages provide primarily energy and can contribute significantly to a positive energy balance, reducing their consumption is an important component of a broader strategy to reduce energy intake."

Research and development issues identified for the food industry include reducing the calorie content of sweetened beverages by 75% to 80% from current levels and developing low-calorie alternatives; reversing the trend among children and adolescents to replace milk in their diet with calorically sweetened beverages; and studying potentially negative effects of fortifying noncaloric beverages, such as flavored bottled water, with essential nutrients.

"The Panel also notes the need for further research regarding the health effects of dairy products and reduced or noncalorically sweetened beverages," the authors conclude. "In our view and in agreement with the IOM, it is important that >60%, if not 100%, of fluid needs are provided by calorie-free beverages. This is important because, as we recognize, fluid needs vary widely among people, and persons with higher-than-average needs should increase their fluid intake from calorie-free beverages, preferably water."

Dr. Popkin initiated the Beverage Guidance Panel. According to the study's disclosure statement, the Unilever Health Institute in the Netherlands assisted by providing funding for the group's meeting in Boston and for the publication of its deliberations. Unilever had no power to influence or veto panel decisions and did not attempt to make changes. The manuscript was initially drafted by Dr. Popkin with major additions for all sections coming from each coauthor until full agreement was reached. All authors participated in all sections of manuscript preparation and review. One of the authors is a member of a scientific advisory board of Unilever.


Bed Bugs

What are bed bugs?

Bed bugs are small, oval, wingless insects that reach about 1/5” in length. They belong to the insect family Cimicidae, which includes three species that bite people. Bed bugs have flat bodies and are reddish-brown in color. They may sometimes be mistaken for ticks or small cockroaches. Bed bugs feed by sucking blood from humans or animals.

Bed Bug on Hand


Where are bed bugs found?

Bed bugs were common in the U.S. before World War II and became rare after widespread use of the pesticide DDT began in the 1940s and 1950s. They remained prevalent in other areas of the world and, in recent years, have been increasingly observed again in the U.S. Bed bugs are most likely to be found when sanitation conditions are poor or when birds or mammals are nesting on or near a home. Crowded living quarters also facilitate the spread of bed bugs.


Can bed bugs harm humans?

Bed bugs are not believed to carry diseases; however, they do bite and suck blood from humans. In the act of feeding on human blood, they may inject their own saliva into the bite area, leading to a localized area of itching and swelling. If scratched, the bite areas can become infected. Bed bugs are most active at night and bite any exposed areas of skin while an individual is sleeping. Bed bug bites may go unnoticed or be mistaken for flea or mosquito bites. Bed bugs also have glands whose secretions may leave odors, and they also leave dark fecal spots on bed sheets and around their hiding places (in crevices or protected areas around the bed or anywhere in the room).

How do I know if my home is infested with bed bugs?

You can look to see if you can identify the fecal stains, egg cases, and exuviae (shed skins) in crevices and cracks on or near beds. You should also look at other areas such as under wallpaper, behind picture frames, in couches and other furniture, in bed springs, and even in articles of clothing. Observing the bed bugs themselves is definitively confirmation that your home is infested. You may require professional assistance in determining whether your home contains bed bugs.

Bed Bugs


How are bed bugs eradicated in the home?

Most cases of bed bug infestation will require treatment by a pest control expert. A variety of low-odor sprays, dusts, and aerosol insecticides can be used to eradicate bed bugs. These must be applied to all areas where the bugs are observed as well as spaces where they may crawl or hide. The pest control company can help you determine if the mattress can be disinfected or must be discarded. Since beds cannot readily be treated with insecticides, it’s often necessary to discard infested mattresses and beds.

Alcohol, Tobacco, and Male Gender up Risk of Earlier Onset Colorectal Cancer

Alcohol use, tobacco use, and male gender are all risk factors for earlier onset of colorectal cancer and may one day be used to individualize screening recommendations, according to a new report.

"Most medical groups recommend colon cancer screening at age 50 because that's when the risk really goes up," senior author Dr. Hemant K. Roy, from Northwestern University in Evanston, Illinois, told Reuters Health. "Aside from considering a person's family history of colon cancer, screening really isn't individualized."

Our results support the notion that a "one-size-fits-all" approach is not the best way to screen for colorectal cancer, Dr. Roy said. In particular, "screening should possibly start earlier than 50 years of age in alcohol and tobacco users."

The new findings, which appear in the Archives of Internal Medicine for March 27, are based on analysis of data for 161,172 patients who were diagnosed with colorectal cancer between June 1, 1993 and December 31, 2003.

Current drinkers or smokers developed cancer, on average, 5.2 years earlier than their counterparts who did not drink or smoke. Current drinking and smoking hastened the onset of disease by 7.8 years. Current drinkers and smokers were also slightly more likely to have distal location for their malignancy.

Cancer onset in men was 1.9 years earlier than in women (p < 0.001). Distal disease sites were also more common in men.

The effect of smoking on disease onset was stronger in women than in men. Women smokers developed cancer 6.3 years earlier than their peers who did not drink or smoke compared with 3.7 years in men.

"Smoking and alcohol use are generally accepted risk factors for colorectal cancer, but I was somewhat surprised at the magnitude of the effect they had on disease onset," Dr. Roy said.

Although confirmation in other studies is needed, "our findings are very intriguing and may lead to tailored recommendations for colorectal cancer screening," Dr. Roy noted.


Preschool Diet Linked to Later Breast Cancer Risk

Diet during preschool may be associated with the risk of breast cancer in adulthood, according to findings published in the February issue of the International Journal of Cancer.

Dr. Karin B. Michels, of Harvard Medical School, Boston, conducted a case-control study including 582 breast cancer patients and 1569 healthy controls who had been enrolled in the Nurses' Health Study and the Nurses' Health Study II. They used a 30-item food frequency questionnaire to obtain data on the childhood diets of the nurses at ages 3 to 5 years from the participants' mothers.

Women who had frequently consumed French fries at preschool age had an increased risk of breast cancer. The odds ratio (OR) for breast cancer for one additional serving of French fries per week was 1.27. Consumption of whole milk was linked to a slightly decreased breast cancer risk (OR per additional glass of whole milk/day = 0.90). No association was found between intake of any of the nutrients calculated and the risk of breast cancer.

"For us breast cancer researchers this indicates that we are on the right track to research earlier periods of a woman's life than we previously have done in the search for breast cancer risk factors," Dr. Michels told Reuters Health. "It seems that childhood diet may be important and maybe even more important than an adult woman's diet with respect to later life risk of breast cancer."

Dr. Michels cautioned against overinterpreting the current findings. "First of all, we would like to see these findings confirmed in other studies," she said. "Secondly, this was a case-control study and the mothers of the nurses knew whether their daughters had developed breast cancer or not, which may or may not have influenced their reporting, but we must not lose sight of this fact."

What Causes Ulcers?

A peptic ulcer is an area of damage to the tissues lining the stomach, esophagus, or duodenum (the first part of the small intestine). Over 25 million Americans will have a peptic ulcer at some point in their lifetime. People of all ages can suffer from ulcers. Men and women are equally affected.

Peptic ulcers were formerly thought to be caused by lifestyle stress, coffee consumption, or spicy foods. Now it is clear that about 90% of peptic ulcers are caused by a bacterial infection that can usually be cured.

The bacterium Helicobacter pylori (H. pylori) was established as the leading cause of peptic ulcers in the early 1980s. It was also found to cause gastritis (inflammation of the stomach lining)

H. pylori is a spiral-shaped bacterium that can live and grow on the lining tissues of the stomach. Some people can be infected with H. pylori and never develop an ulcer or show any symptoms of the infection. In other people, the organism may persist for years before any symptoms develop.

It remains unclear why some people develop symptoms of the infection and others do not. It is also not clear exactly how H. pylori is transmitted from person to person. In the United States, H. pylori infection is more common among the elderly, African-Americans, Hispanics, and in those living under lower socioeconomic conditions.

Ulcers related to H. pylori infection are commonly treated now with a one- to two-week course of an antibiotic. The antibiotic is usually given along with a bismuth preparation (such as Pepto-Bismol) or one of the proton pump inhibitors that decrease acid output by the stomach. Omeprazole (Prilosec) and lansoprazole (Prevacid) are common proton pump inhibitors. If antibiotics are not administered, up to 80% of ulcers recur, in contrast to about 6% when the H. pylori infection is treated with an antibiotic.

Tests for H. pylori infection include upper endoscopy, in which a lighted optical scope is used to examine the esophagus, stomach, and duodenum. With endoscopy, the diagnosis of an ulcer can be confirmed and biopsy material removed and examined for the presence of H. pylori.

Noninvasive tests cannot determine if an ulcer is present but may be used to diagnose H. pylori infection. These include blood tests to identify antibodies to H. pylori and a the urea breath test (UTB). For the urea breath test, an oral preparation of urea containing radiolabeled carbon is given. H. pylori in the stomach metabolize the urea, and the resulting radioactive carbon is absorbed into the blood stream and ultimately exhaled. The exhaled breath is tested for radioactive carbon, indicating the H. pylori infection.

There are other causes of peptic ulcer that are unrelated to H. pylori infection, but these are less common. In particular, the chronic use of non steroidal antiinflammatory drugs (NSAIDs) and cigarette smoking can be causes of both ulcer formation and failure of treatment.


Healthy Food for Living Longer

If you want to eat foods for living longer, consider a plant-based diet.

We all know about the kinds of foods that may contribute to shortened, less healthy lives. Pork rinds, charred meat and lard, these kinds of things. But are there foods for living longer?

There is no shortage of people who will be happy to sell you a specific supplement or food that they claim will help you live a longer and healthier life. The science behind many of these products, however, is not always convincing to some public health scientists, or epidemiologists.

"What we know is that diets rich in fruits and vegetables appear to be much healthier, leading to less chronic disease and lower healthcare costs, but it's less clear how any specific dietary items affect longevity," says Hubert Warner, PhD, associate director of the biology of aging program at the National Institute of Aging.

Warner also says that not eating much food at all, ever, may promote living longer, while also making life decidedly less enjoyable.

"Many animal studies show that calorie restriction, meaning a permanent, low-calorie diet, can lengthen life in the laboratory," says Eugenia Wang, PhD, professor of biochemistry at the University of Kentucky in Louisville, who studies the genetics of aging. Several monkey studies on calorie restriction are under way at the University of Wisconsin, according to Warner, but no human studies have been done.

So if you're looking for foods for living longer, a plant-based diet -- something very similar to what most of us would consider a vegetarian diet -- seems to be the ticket, these experts say.

"There are thousands of small, short-term studies of foods or supplements that may show a particular effect, but when you look at large, long-term studies of how diet affects longevity and healthcare costs in the real world, it is plant-based diets that actually appear to be healthier," says Neal Barnard, MD, president of the Physicians' Committee for Responsible Medicine and author of Eat Right, Live Longer: Using the Natural Power of Foods to Age-Proof Your Body and other books.

Barnard cites a study, "Ten Years of Life. Is It a Matter of Choice?" as an example of this evidence. In the study, researchers looked at 34,192 non-Hispanic, white Seventh Day Adventists over age 30.

"Researchers like to study the Adventists because they are nearly all nonsmokers, they avoid alcohol, and are mostly vegetarians," says Barnard. Roughly 30% of the study subjects were vegetarians; about 20% were semi-vegetarians, eating meat less than once per week. The research showed that vegetarian men and women had "an expected age of death at 83.3 and 85.7 years, respectively." Men lived 7.28 years longer than the average American man, and women lived 4.42 years longer than the average American woman. 

"This gives Adventists a higher life expectancy than any other formally described population," the study authors' wrote. 

Ten extra years, without resorting to calorie restriction. What's more, this plant-based diet may offer protection from disease, according to the landmark China Project study, the largest study of diet and disease ever.

"In the '80s, China was like a huge living lab," says Banoo Parpia, PhD, an associate researcher at Cornell University in Ithaca, N.Y., who is involved with the China Project. "People didn't travel, and they ate locally." The thousands of people studied were largely without refrigeration or processed foods. They ate essentially a pre-modern diet, often growing their own food.

In more than 65 rural Chinese counties, researchers took blood and urine samples, weighed food, gave questionnaires, and filled out subject histories on everything from smoking history to age of onset of puberty.

Chinese diets were low in total fat (about 6% to 24%) and much higher in dietary fiber (about 10 to 77 grams per day). These diets contained less than 20% animal-based foods. The average American diet contains about 60% or more animal-based foods.

"At that time, China had higher rates of communicable diseases so their average life span was shorter than in the U.S., but the rate of heart disease and diabetes was very low, and breast cancer was almost nonexistent," says Parpia.

When the researchers correlated this information with the reported incidence of cancer for the areas, they were able to attribute the low levels of chronic disease and some cancers to the Chinese plant-based diet.

"The China Project study and others like it allow us to actually assess how diet affects incidence of disease and longevity in the real world," says Barnard. "What we see over and over again is that vegetarian or near-vegetarian diets over a lifetime yield a five- to 10-year lengthening of life."

How Good Is Soy?

Awakening to the sound of a whirring blender and the sharp scent of fresh soybeans on Saturday mornings meant only one thing: a breakfast of Grandma's warm, sweet soy milk. I loved to sit and watch as she squeezed the milk out of ground soybeans wrapped in a cheesecloth.

Countless glasses later, I discovered that soy milk has a lot more to offer than fond childhood memories. Packed in every yellow bean are estrogen-like molecules, called isoflavones, which may help fight heart disease, osteoporosis, cancer, and other diseases. Based on just some of the latest findings, the Food and Drug Administration last year gave food makers permission to extol soy's cholesterol-lowering prowess on package labels.

That's great, if you happen to believe soy is a healthy choice for everyone. But with soy showing up in everything from breakfast cereal and pasta to energy bars and smoothies, some researchers now worry that too much of a good thing could be harmful.

"People ought to know that there ain't no free lunch," says Lon White, MD, MPH, senior neuroepidemiologist at the University of Hawaii. "At some point -- if these molecules are as potent as [we think] they are -- there will be potent [adverse] effects."

White, for one, worries that soy may speed the aging of brain cells. He recently found evidence that the brains of elderly people who ate tofu at least twice a week for 30 years were aging faster than normal. Tests designed to assess memory and analytical ability showed that their brains functioned as if they were four years older than their actual age, White says of his study published in the April 2000 issue of the Journal of the American College of Nutrition.

Another fear is that the estrogen-like substances in soy may dampen the function of the thyroid. Consuming 40 milligrams of isoflavones a day can slow the production of thyroid hormone, says Larrian Gillespie, MD, author of The Menopause Diet and The Goddess Diet. (One tablespoon of soy powder contains about 25 milligrams of isoflavones, while most isoflavone supplements come in 40-milligram pills.)

According to Gillespie, within a few weeks of regularly consuming 40 milligrams of isoflavones, some women feel fatigued, constipated, and achy all over. Some also gain weight and have heavier menstrual periods. Menopausal women are at particular risk, since they're already prone to hypothyroidism. "Women think it's because of hormones and don't realize they're symptoms of hypothyroidism," Gillespie says. "Once they stop the soy, they say, 'I'm feeling fine again.' "

Soy's Not All Bad

But if some studies point to dangers from soy, others suggest important benefits. For instance, isoflavones may prevent the growth of estrogen-dependent breast cancer cells, according to findings published in the March 2000 issue of the journal Cancer Research. That's because isoflavones appear to encourage the body to break down estrogen more quickly -- before it can stimulate cancer cells to grow. Instead of lingering in the blood, bits and pieces of estrogen molecules wind up in the urine.

Isoflavones can also slow prostate cancer cells from growing, according to a study published in the June 2000 issue of the International Journal of Oncology. Other studies hint that eating soy may help prevent heart disease, endometriosis, and even osteoporosis in women, Gillespie says. However, if you think you may have any of these conditions, see your doctor before making any substantive changes to your diet.

Soy's biggest impact is on cholesterol levels, according to a mound of studies. One published in the December 1998 issue of the American Journal of Clinical Nutrition found that men who ate a low-fat diet and relied on soy as their main protein source for five weeks saw their "bad" (LDL) cholesterol levels decrease by as much as 14% and their "good" (HDL) levels increase by as much as 8%. Men who ate a low-fat diet but instead relied on meat as protein also saw their cholesterol levels significantly improve, though not as much as the soy-eaters.

And eating soy helps to replace animal products, which are loaded with saturated fats and cholesterol, says nutritionist Mark Messina, PhD, author of The Simple Soybean and Your Health.

In the Kitchen

So what's the verdict on soy? Health experts say that although there's no need to give up your favorite frosty shake made with soft tofu, frozen strawberries, and a dab of honey, you may not want to eat soy for breakfast, lunch, and dinner. Yet there's nothing wrong with incorporating soy into a healthy diet of fruits, vegetables, and whole grains.

Messina, for instance, recommends a daily serving of soy: perhaps 1 cup of soy milk or 3 to 4 ounces of tofu. "If 20 years from now researchers don't find any benefits to soy, then you've lost nothing," Messina says. "If they do find some benefits, then you've got a great trade-off."

As for my grandma, she successfully fought off breast cancer at the age of 80, and she couldn't be healthier now at 93. She still memorizes Bible passages and spends afternoons sweating to the beat of an exercise video. Researchers can't tell her what role, if any, soy has played in her life and health. It doesn't, however, seem to have done her any harm.

Diet, Lifestyle May Affect Eye Health

Use of the AF SuppressionTM algorithm over a 15-month period was associated with a progressive decrease in incidence of AF. Is this case consistent with current theories on the potential effects of cardiac remodeling?

March 24, 2006 -- Your eyes may be a window to your body's health, a new study shows.

The report, published in Nutrition, shows that diet and lifestyle might sway the odds -- for better or worse -- of developing age-related macular degeneration (AMD).

AMD is America's leading cause of vision loss. More than 13 million people in the U.S. show some signs of AMD, which is uncommon in people younger than 55. A new study shows that diet, smoking, and BMI (body mass index) may affect the chances of getting AMD.

Eating healthfully, not smoking, and not being overweight could help keep age-related macular degeneration at bay, according to the new study. The reverse also appears to be true, write the researchers. They included Johanna Seddon, MD, of Harvard Medical School and the Harvard School of Public Health.

Tracking AMD

Seddon and colleagues studied 934 people who were 67 to 71 years old, on average. Half of the participants were screened at a Boston eye and ear clinic. The others were screened at an eye clinic in Portland, Ore.

A total of 184 participants didn't have AMD. The rest had mild AMD (201 patients), moderate AMD (326 patients), or advanced AMD (223 patients).

Participants completed surveys about their diet and lifestyle. They also gave blood samples, which Seddon's team checked for levels of C-reactive protein (CRP) and homocysteine, which have been linked to increased risk of heart disease.

The researchers had previously reported that CRP and homocysteine are associated with age-related macular degeneration. This time, they checked how diet and lifestyle affected levels of CRP and homocysteine, as well as AMD risk.

None of the participants were asked to change their diets or lifestyles. The researchers just looked for patterns among the participants' habits, blood chemicals, and AMD diagnosis.

Eye-Opening Data

The researchers found that people who smoked, were overweight, and consumed fewer antioxidants (natural chemicals found in many fruits and vegetables) tended to have higher levels of CRP and homocysteine.

For instance, people who reported eating fish more than twice per week had lower CRP levels. This was also true for people who consumed higher levels of vitamin C, beta-carotene, and the antioxidants lutein and zeaxanthin.

CRP levels were higher for people who smoked or had higher BMI, the study also shows.

Lower homocysteine levels were seen in people with more vitamin E in their blood and those who consumed more antioxidants and vitamin B-6. But higher blood levels of vitamin E were also tied to higher CRP levels. That contradiction should be studied further, note Seddon and colleagues.

"Overall, these findings suggest that sick eyes may occur in sick bodies related to smoking, being overweight, and other unhealthy behaviors," they write.

"AMD is associated with immune, inflammatory, and other cardiovascular mechanisms, and these results emphasize the need to adhere to healthy lifestyles for your eyes and your body overall," Seddon says in a news release.


Wednesday, March 29, 2006

News Flash

AIDS Drug Shows Promise
Scientists now believe they may soon have a pill that could keep people from contracting the AIDS virus. A combination of 2 drugs already used to treat HIV infection have shown promise at preventing the virus in monkeys, and officials plan to expand early tests on healthy high-risk men and women. "If it works, it could be distributed quickly and could blunt the epidemic," said Thomas Folks, a federal scientist.
Loneliness Linked to High Blood Pressure
A study published in the journal Psychology and Aging found that the loneliest people over the age of 50 had blood pressure readings as much as 30 points higher than those who weren't lonely, suggesting that loneliness can be as bad for the heart as being overweight or inactive. "The research says something about the importance of social connection in our everyday lives," said John Cacioppo, a psychology professor at the University of Chicago.
Red Bull Doesn't Tame Alcohol
Men reported feeling less drunk when they drank vodka mixed with the energy drink Red Bull, according to a new study. But researchers say those impressions were misleading, as men who rated themselves as less drunk preformed just as poorly on coordination tests and scored the same on breath alcohol levels as those who drank vodka alone. "People need to understand that the 'sensation' of well-being does not necessarily mean that they are unaffected by alcohol," says researcher Maria Lucia Souza-Formigoni at Brazil's Federal University of Sao Paolo.
Bird Flu: How Serious Is the Risk?
While it is impossible to watch television or read a newspaper without encountering dire reports about the possibility of a worldwide bird flu epidemic, researchers believe a human pandemic caused by the A (H5N1) virus is by no means inevitable, and many doubt it will ever happen.
Heavy Periods Could Signal Disease
Though rare, women with heavy periods could be affected by an undiagnosed bleeding disorder, according to The Hemophilia Society. Von Willebrand's disease is an inherited condition which leads to heavy or prolonged menstrual flow. Because issues of menstruation remain "taboo," and because the condition is hereditary, women often think that the heavy periods they share with other members of their family are normal.


Exercise Eases Menopause Symptoms

Study Shows Regular Exercise Improves Mental and Physical Health of Menopausal Women

 It's never too late for women to reap the benefits from starting a regular exercise program, according to a new study that shows exercise can relieve the symptoms of menopause and improve quality of life.

Researchers found menopausal women aged 55-72 who started a yearlong exercise program experienced significant improvement in both mental and physical health while those who didn't exercise got worse.

"The group that improved took part in three hours of fully supervised exercise a week for 12 months," says researcher Carmen Villaverde-Gutierrez, professor of nursing at the University of Granada in Spain, in a news release. "As well as monitoring severe symptoms, we also looked at the women's quality of life and found that the average scores for the exercise group improved while those for the control group decreased."

The results appear in the Journal of Advanced Nursing.

Exercise Relieves Symptoms

In the study, researchers examined the effects of an exercise program consisting of cardiovascular, stretching, muscle strengthening, and relaxation exercises in 48 menopausal women. Half of the women participated in the 12-month exercise program and the other half did not.

At the start of the study, 50% of the women in the exercise group and about 58% of nonexercisers had severe menopausal symptoms. By the end of the study, the percentage of women with severe menopausal symptoms dropped to 37% among the exercise group and rose to over 66% among the others.

The exercise group also improved on measures of physical and psychological functioning and positive state of mind, while the nonexercisers declined in these areas.

"Joining the regular exercise programme improved the women's health and also gave them the chance to join a sociable group activity and reduce feelings of loneliness," says Villaverde-Gutierrez in a news release. "Our findings suggest that regular exercise programmes can help to alleviate some of the physical symptoms associated with the menopause and improve women's health and quality of life."

"We would like to see exercise programmes offered as an integral part of primary healthcare for menopausal women. At the very least, women going through the menopause should be encouraged to join a local exercise group suitable for their age and health so that they can share the benefits experienced by the women in our study," says Villaverde-Gutierrez.


Confusion Reigns in How Men Decide Treatment for Prostate Cancer

NEW YORK (Reuters Health) Mar 27 - When it comes to treating localized prostate cancer, treatment decisions frequently do not appear to reflect patient preferences, investigators report in an upcoming issue of Cancer.

There is no gold standard for optimal treatment of localized prostate cancer, choices of which include radical prostatectomy, external beam radiation therapy, brachytherapy, and watchful waiting, the authors of the study note. Despite a plethora of studies examining how men decide on a treatment plan when they are diagnosed with localized prostate cancer, there is no consensus on what issues actually guide their decisions.

Dr. Scott D. Ramsey, from Fred Hutchinson Cancer Center in Seattle, and his associates conducted a literature search and identified 69 peer-reviewed studies concerning the treatment decision-making process for localized prostate cancer. The findings will appear in Cancer on May 1.

Initially, cancer eradication is the primary concern of most patients. The investigators report that the advice men are given varies according to physician specialty, and usually does not include all pertinent information required to make an informed decision as to survival and quality of life, nor does it always take into account the seriousness of the patient's cancer.

Nevertheless, physician recommendation is a major influencing factor for more than half of patients interviewed. Study results suggest that physicians' advice varies, with blacks and men with lower income or education levels receiving less aggressive treatment.

Patients also are concerned to varying degrees about side effects, such as incontinence and impotence. However, fear of side effects only rarely affects treatment decisions, and the authors suggest that many patients don't understand side effect issues and they often do not receive accurate information.

Dr. Ramsey and his associates recommend "future prospective studies aimed at examining how patient values evolve throughout the period of time from their first being diagnosed with prostate cancer until the completion of treatment."

They suggest that researchers explore how patients' personal values affect their decisions, as well as the role of family members, patients' ethnicity and socioeconomic status, and the settings in which men receive treatment.


Risk Factors for Prostate Cancer

Doctors don't know why one man develops prostate cancer and another doesn't.

But there are certain risk factors that make it more likely in some people, the U.S. National Cancer Institute says.

These include:

  • Age. Men under age 45 rarely get this disease, while most men who do are over age 65.
  • Family history. Your risk of contracting prostate cancer is higher if your father or brother had it.
  • Race. Black men have a higher incidence of prostate cancer than white men; Asian and Native American men appear to be at lower risk.
  • A diet high in animal fat.
  • Certain cell changes in the prostate.

It's important to note that most men diagnosed with prostate cancer don't have any risk factors, except growing older, the institute says.



Postpartum Anxiety May Be Common

A cross-sectional study published online March 23 in BMC Psychiatry suggests the importance of evaluating for postpartum anxiety in addition to postpartum depression.

"Postnatal depression has received considerable research and clinical attention, however anxiety and stress in the postpartum has been relatively ignored," write Renée L. Miller, from the Swinburne University of Technology in Hawthorn, Victoria, Australia, and colleagues. "Along with the widespread use of the Edinburgh Postnatal Depression Scale (EPDS), depression has become the marker for postnatal maladjustment. Symptoms of anxiety tend to be subsumed within diagnoses of depression, which can result in anxiety being minimized or overlooked in the absence of depression."

As part of a larger cross-sectional study, 325 primiparous mothers were evaluated with the EPDS and the Depression, Anxiety and Stress Scales (DASS-21). Mothers ranging in age from 18 to 44 years (median, 32 years) whose babies were aged between 6 weeks and 6 months were recruited through mother's groups and health centers in Melbourne, Australia.

Based on a cut-off of more than 9 on the EPDS, 80 women (25%) were possibly depressed. The DASS-21 corroborated depression in 58% of these women. In the total sample, the DASS-21 identified depression in 61 women (19%). When broader criteria for distress were used, the DASS-21 identified an additional 33 women (10%) with symptoms of anxiety and stress without depression, and a total of 41 women (13%) with symptoms of anxiety either alone or combined with depression.

Based on the DASS-21, 7% of the sample was diagnosed with both anxiety and depression. Women in this subgroup had higher mean EPDS and DASS-21 depression scores than did women with depression but without anxiety.

"The prevalence of anxiety and stress in the present study points to the importance of assessing postnatal women for broader indicators of psychological morbidity than that of depression alone," the authors write. "The DASS-21 appears to be a useful instrument for this purpose."

Study limitations include recruitment from mothers' groups and health centers by placing posters rather than by approaching individual women directly; high proportion of tertiary educated women; possible self-selection bias; and lack of formal diagnostic structured interview to provide a "gold standard" against which to validate the DASS-21.

"For as long as the focus of postnatal maladjustment is on depression, failure to identify and treat significant symptoms of anxiety and stress may leave women vulnerable to worsening symptomatology," the authors conclude. "Untreated maternal distress can have a substantial impact on the well-being of the mother, her relationships, and her infant. The DASS-21 is a brief, easy to administer inventory that may assist practitioners (along with clinical interviews) to more effectively assess and treat new mothers who may be depressed, anxious and/or stressed in the postpartum."

An Australian Postgraduate Award supported this study. The authors report no relevant financial relationships.

Allergies Spring Into Action

While budding trees and blooming flowers are among the delights of spring, the season also brings the threat of sneezing, itchy, watery eyes, and other allergy symptoms for more than 20 percent of Americans.

The American Academy of Allergy, Asthma and Immunology offers the following 10 tips on how people with allergies can ease their symptoms:

  • Spring clean. Do a thorough cleaning inside your home. Through the winter, windows, bookshelves, and air conditioning vents can collect dust and mold that can trigger allergy symptoms.
  • Avoid pollen. Close the windows in your home when pollen counts are high. Avoid using window fans that may draw pollen inside. When mowing the lawn or gardening, wear a filter mask. Minimize outdoor activity when pollen counts are high. Peak pollen times are usually between 10 a.m. and 4 p.m. You can get up-to-date pollen information for your area by going to the National Allergy Bureau's Web site at www.aaaai.org/nab.
  • Be prepared.Take allergy medications at least 30 minutes before your go outside. Consult with an allergist/immunologist to ensure medications are helping you or when you suffer reactions to medications.
  • Wash n' dry right. Wash bedding weekly in hot water. Dry laundry indoors -- sheets hanging on outside lines can collect pollen.
  • De-pollinate. Shower and wash your hair before bed in order to wash off pollen that's collected on your skin and hair.
  • Watch pets, too. Keep pets off furniture and out of the bedroom. Pollen can cling to dogs and cats who've been outside.
  • Drive (and breathe) safe. During peak pollen season, keep your car windows closed. Use air conditioning and point the vents away from your face.



Sick Building Syndrome May Be Partly Based on Psychosocial Issues

  Sick building syndrome (SBS) may have more to do with the psychosocial work environment than with the physical attributes of the building, according to the results of a cross-sectional study reported in the March issue of Occupational and Environmental Medicine.

"Although guidelines exist for the investigation and management of SBS, systematic research has failed to identify consistent associations between particular physical properties of buildings and SBS," write A. F. Marmot from the Linton House in London, United Kingdom, and colleagues from the Whitehall II study. "There is increasing evidence that the psychosocial work environment is related to health and that the physical responses to work stress may resemble symptoms that have been attributed to the physical work environment. Work overload, lack of support at work, and conflict at work may exacerbate the effects of the physical work environment."

The investigators used cross-sectional data on the physical environment of a selection of 44 buildings to individual data from the Whitehall II study, an ongoing health survey of office-based civil servants. Ten symptoms of SBS and psychosocial work stress were evaluated with a self-report questionnaire administered to 4052 participants aged 42 to 62 years.

After adjustment for age, sex, and employment grade, no significant relationship was found between most aspects of the physical work environment and symptom prevalence. There was a nonsignificant trend toward a positive relationship between airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. High job demands, low support, and other features of the psychosocial work environment had greater effects on symptom prevalence. Based on multivariate analysis, only psychosocial work characteristics and control over the physical environment were independently associated with symptoms.

"The physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms," the authors write. " 'Sick building syndrome' may be wrongly named."

Study limitations may include high quality of Whitehall buildings above the threshold for affecting symptoms; the potential for misclassification of the environmental characteristics for each building; self-reported nature of the psychosocial work characteristics and symptoms; and questionnaire and fieldwork data collected at different times of the year.

"These findings should not be interpreted as justification for assuming that the quality of the physical environment of the workplace is unimportant," the authors conclude. "The results imply that if SBS is reported in a building, management should consider causes beyond the physical design and operation of the workplace and should widen their investigation to include the organisation of work roles and the autonomy of the workforce.... SBS symptoms are more about the jobs people do, their psychosocial environment, and their ability to control conditions in their office than about the physical environment of the building or workstation where the job is performed."

Financial support for the Whitehall II study came from the UK Medical Research Council; the British Heart Foundation; Health and Safety Executive; the UK Department of Health; the National Heart, Lung, and Blood Institute and the National Institute on Aging of the US National Institutes of Health; the US Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality; and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health.


What to Do With Aging Breast Implants

 For the estimated three million American women with breast implants, one thing remains certain: At some point, they will need to be replaced or removed.

Breast implants do not last forever -- whether they are filled with silicone gel or saline, or whether they were done to reconstruct a breast after a mastectomy or to augment the size or shape of a breast.

Knowing just when that time has come, however, and what to do if you suspect it has, is not always simple.

Sonia Fuentes, 77, of Potomac, Md., a retired attorney and co-founder of the National Organization for Women, encountered that conundrum last year when she suspected problems with the silicone-gel implant she had gotten 15 years earlier after a mastectomy. She thought it had hardened and gotten smaller and feared it was leaking.

She consulted her oncologist, the surgeon who had performed the mastectomy and the plastic surgeon who had performed the implant, and she also scrolled the Internet for background. But opinions and advice were conflicting:

  • Get a mammogram to see if the implant has ruptured, one doctor suggested.
  • Don't get a mammogram, a women's Web site warned, as the compression could cause the implant to break.
  • Have an MRI, the FDA urged on its site, noting that that's the best way to detect a rupture.
  • An MRI wasn't necessary, another doctor told her.

"The quality of advice people get is very spotty," said Dr. Scott Spear, chief of plastic surgery at Georgetown University Hospital in Washington, D.C., and immediate past president of the American Society of Plastic Surgeons.

So what's a woman to do?

Anyone concerned about an implant should "start off by seeing a doctor, a plastic surgeon" preferably, Spear said. If the original surgeon cannot be reached or the woman is uncomfortable with the surgeon's opinion, he recommended going to a clinic that specializes in implants or finding a plastic surgeon associated with a university.

That's when Fuentes' saga really began. First she consulted the doctors who had treated her initially. "All of these doctors are top guys," she said. "I had a lot of respect for them." But, she said, two of them "said to me, 'Your breast hasn't changed,' " which she considered "a little presumptuous."

She also was not comfortable with their nudging her to have a mammogram, given what she had read on the Internet and heard from friends.

"You've got to learn to go with your gut," Fuentes said. "But so many women, if a doctor tells them something -- that's it."

Fuentes insisted on an MRI, her doctor relented, and the MRI revealed a ruptured implant.

She asked a plastic surgeon in Cleveland to remove the implant, replace it with a saline version and reconfigure her breasts to ensure symmetry. But she said the surgeon insisted on an ultrasound of the implant beforehand, an option no one else had proposed. It, too, showed a rupture, and the surgery went on as planned.

Dr. Michele Shermak, chief of plastic surgery at Johns Hopkins Bayview Medical Center in Baltimore, said she also uses ultrasound to evaluate implants.

"A mammogram, like any plain film X-ray, is not good at seeing soft-tissue problems," Shermak explained.

For detecting breast cancer, the American Cancer Society recommends regular mammograms, and Shermak indicated that advice should apply to women with and without implants. "Compression should not be a problem" for women with implants, she said.

But for detecting possible rifts in an implant, "mammograms are really not the best way to go," she said.

"Ultrasound is usually the first test that I'll do," Shermak said. She described it as "easy technology" and a test that most medical offices could perform.

"MRI would be the next step," she said. "The MRI is very good, very specific, very sensitive." She described it as "almost too precise in some cases" as it tends to detect "any little thing that looks a little bit abnormal."

In Fuentes' case, however, the MRI and ultrasound were on target. Her surgery took 4-1/2 hours, in part because "the implant had collapsed and had silicone all over it, so it was difficult to remove," Fuentes said she was told by the surgeon.

Saline leaking from a broken implant appears to pose no danger, but opinions differ on the effect of escaping silicone.

If silicone leaks, "the body walls it off," Shermak explained. "The body normally develops scar tissue to things it doesn't see as itself. The scar tissue effectively becomes a shell around the implant."

However, Spear said that "the risk of it even locally causing mischief is pretty low."

Both surgeons said that for any woman unnerved by those thoughts or having other fears about an implant, removing the implant is usually the appropriate option.

"You only need to treat or remove the implant if the patient is symptomatic," Shermak said. "But I would never say 'don't do it,' if that's what the woman wants."


Infectious Mononucleosis a Risk Factor for Multiple Sclerosis

NEW YORK (Reuters Health) Mar 28 - Infection with Epstein-Barr virus (EBV), manifesting as infectious mononucleosis, in adolescents and young adults, more than doubles the risk of developing multiple sclerosis (MS) later in life, results of a meta-analysis suggest.

"Multiple sclerosis is a complicated disease, probably caused by a combination of factors," lead author Evan L. Thacker from the Harvard School of Public Health, Boston, told Reuters Health. "It is likely that some viral infections, such as infectious mono, play a role in determining whether multiple sclerosis will occur."

Similarities in the epidemiology of infectious mononucleosis and MS have led researchers to consider EBV in the cause of MS, Mr. Thacker and two colleagues from Harvard point out in the Annals of Neurology for March.

"Both infectious mononucleosis and MS occur in young adults, both follow a latitude gradient, and both are rare in populations where infections occur at an early age, suggesting that late infection with EBV, evidenced by occurrence of infectious mononucleosis, is an important causal factor in MS," they explain.

However, studies that have evaluated the relation of infectious mononucleosis and MS risk have produced inconsistent results.

Against this backdrop, the Harvard group systematically identified and statistically combined 14 relevant studies conducted in the US, Europe, and Australia to come up with an overall picture of the connection between infectious mono and MS.

The combined relative risk of MS after infectious mononucleosis was 2.3, they report.

"The most important observation in our study was that people who got infectious mono while growing up were about twice as likely to get multiple sclerosis later, compared to people who never got infectious mono," Thacker told Reuters Health.

"The potential implication of our observation is that some cases of multiple sclerosis could probably be averted through the prevention of infectious mono," he said. "One way to accomplish this might be to develop a safe and effective vaccine against Epstein-Barr virus, the virus that causes infectious mono."


Tuesday, March 28, 2006

Benefits of Omega-3s Fishy

The benefits of omega-3s in fighting heart disease may be only so-so, according to a new review of research on the fatty acids found in fish and some plant and nut oils.

The study doesn't rule out an important effect of omega-3 fatty acids on health, but the results indicate that the evidence behind the fishy fats is less conclusive than previously thought.

Eating foods rich in omega-3 fatty acids, such as fatty fish and some plant and nut oils, such as olive and walnut, is thought to lower the risk of heart disease, and several public health organizations have recommended that people to eat more oily fish, such as salmon and tuna.

But in a review of 89 studies that measured the effect of omega-3 fatty acids on heart attack, death, cancer, and strokes, researchers didn't find any clear benefit of omega-3s in reducing the risk of these health hazards.

Omega-3's Health Benefits Questioned

In the review, which appears in the journal BMJ, researchers analyzed the results of studies that looked at the omega-3 fatty acids on reducing health risks in people who increased their intake of omega-3s through diet or supplementation with fish oil capsules for six months or more.

After taking differences in study quality into account, researchers found the pooled results of the studies showed no strong proof that omega-3 fatty acids had an effect on reducing the risk of death or heart-related events, like heart attack and stroke.

Researchers say other recent reviews of studies on omega-3s have shown that people taking supplements of the fatty acids had a lower risk of death, and they can't explain why this review came up with conflicting results.

Therefore, they recommend that further study is needed to fully understand the benefits and risks of omega-3 fatty acids.

In an editorial that accompanies the study, Eric Brunner of the department of epidemiology and public health at the Royal Free and University College London Medical School writes, "We are faced with a paradox.

"For the general public some omega-3 is good for health," writes Brunner. "Health recommendations advise increased consumption of oily fish and fish oils. However, industrial fishing has depleted the world's fish stocks by some 90% since 1950, and rising fish prices reduce affordability particularly for people with low incomes. Global production trends suggest that, although fish farming is expanding rapidly, we probably do not have a sustainable supply of long-chain omega-3 fats."


News Flash

Fewer Physicians Offer Charity Care: Survey
According to a survey released by the Center for Studying Health System Change, the number of doctors who provide free care to the poor and uninsured has dropped over the past decade, declining across all major specialties. Dr. Peter Cunningham, senior researcher for the center, said he believes the drop reflects several trends: stagnant reimbursement rates from the government, and lower fees negotiated by insurance companies on behalf of their customers. He also cites an increase in the number of physicians joining large group practices that have less control over the type of patients they see.
Exercise may Be Alternate ADHD Treatment
Doctors are studying a variety of non-medical treatments for attention deficit hyperactivity disorder. There hasn't been any definitive studies concerning exercise and ADHD, but David Goodman, an assistant professor at John Hopkins University School of Medicine, says that it makes sense that working out would help people cope with the condition. Studies show that exercise increases levels of 2 key brain chemicals, dopamine and norepinephrine, that help people to focus.
Mice May Provide Embryonic Stem Cells
New research published by the journal Nature says German scientists have identified cells from the testes of mice that can behave like embryonic stem cells. If the same holds true for humans testes, it could provide a controversy-free source of versatile cells for use in treating disease.
New IVF Method Uses Fewer Eggs
A new in vitro fertilization method called minimal stimulation uses low-dose oral drugs in place of a daily regimen of hormone shots. Although the success rate is lower than standard IVF procedures, minimal stimulation uses fewer eggs, making it a simpler option for most women than traditional IVF.


Schizophrenia Linked to Variety of Autoimmune Disorders

NEW YORK (Reuters Health) Mar 24 - Results of a study published in the March issue of the American Journal of Psychiatry suggest an association between schizophrenia and a large range of autoimmune diseases.

"Individuals with schizophrenia and their relatives tend to have either higher or lower than expected prevalences of autoimmune disorders, especially rheumatoid arthritis, celiac disease, autoimmune thyroid diseases, and type 1 diabetes," Dr. William W. Eaton, of the Johns Hopkins University, Baltimore, Maryland, and colleagues write.

In a large epidemiological study, the researchers examined the association between schizophrenia and a range of autoimmune diseases. They used data from the Danish Psychiatric Register, the National Patient Register, and a register containing socioeconomic information. Included were 7704 patients diagnosed with schizophrenia between 1981 and 1998 and their parents, as well as matched control subjects and their parents.

Subjects with one or more autoimmune diseases had a 45% increased risk of schizophrenia, and schizophrenia patients had a higher prevalence of nine autoimmune disorders compared with the controls. The parents of schizophrenic patients had a higher prevalence of 12 autoimmune diseases compared with the parents of the controls.

Thyrotoxicosis, celiac disease, acquired hemolytic anemia, interstitial cystitis, and Sjogren's syndrome occurred more often in schizophrenic patients and their parents compared with the controls and their parents, the researchers report.

"In future clinical studies it may be interesting to search for a family history of autoimmune diseases, and specific autoantibodies, in patients with schizophrenia," Dr. Eaton's team suggests. "Eventually, individual or family disease comorbidity may help to elucidate shared etiologic pathways."


Snoring Linked With Lower Mental Development Scores in Infants

NEW YORK (Reuters Health) Mar 24 - Infants with snoring-related respiratory arousal have lower scores on standardized mental development assessments, the results of a study published in the March issue of Pediatrics suggest. Exposure to secondhand cigarette smoke may contribute to the deleterious effects of infant snoring.

"The link between sleep-disordered breathing and neurocognitive functioning in preschool and school-aged children now has been established clearly," Drs. Hawley E. Montgomery-Downs, of West Virginia University, Morgantown, and David Gozal of the University of Louisville in Kentucky point out.

In their study, the researchers assessed the potential association between snoring and decrements in developmental performance among 35 healthy infants. The possible contribution of exposure to cigarette smoke was also examined. The infants (mean age 8.2 months) underwent full overnight polysomnography recordings, and were administered the Bayley Scales of Infant Development, including the Mental Developmental Index.

Respiratory arousal index was significantly negatively correlated with Mental Development Index and snoring-associated arousals accounted exclusively for this association. No significant correlation was found between Mental Development Index score and spontaneous arousals, arousals associated with episodes of central apnea or oxyhemoglobin desaturation. All infants had an apnea-hypopnea index of 0.

Thirty-three percent of the infants were from a home in which at least one parent smoked. Infants from smoking households were more likely to snore and significantly more likely to have respiratory-related arousals. However, no significant differences on Mental Development Index scores were seen between infants from smoking or non-smoking households.

"This study and others clearly support the need for identification and evaluation of the youngest children with recognizable risk factors for sleep disordered breathing," the authors conclude. "This may pose a formidable challenge when we consider that the symptoms of sleep disordered breathing, such as snoring, are less frequently the presenting complaint in such children when compared with associated comorbidities, such as recurrent upper respiratory tract infections and delays in growth and development."


Aspirin Equally Effective in Reducing Platelet Clumping in Men and Women

NEW YORK (Reuters Health) Mar 24 - Clinical trials have suggested that aspirin prophylaxis is less effective in preventing MI in women than in men, although women do benefit from a similar reduction in risk of ischemic stroke. However, new study results show that the lower efficacy in women is not due to a failure of aspirin to suppress platelet aggregation, as has been proposed.

"Women are clearly benefiting from taking aspirin and should continue to take it to improve their cardiovascular health," Dr. Diane M. Becker states in a Johns Hopkins press release. "Aspirin has been proven by all previous studies to lower the risk of stroke and, as our latest findings show, it also reduces platelet aggregation that can lead to potentially fatal clots in blood vessels."

To explore why aspirin seems to exert different effects in men and women, Dr. Becker, from Johns Hopkins Medical Institutions in Baltimore, and her team studied the effects of 14 days of aspirin therapy on platelet reactivity in unaffected individuals from families with premature coronary disease. They report their findings in the Journal of the American Medical Association for March 22/29.

Included in the study were unaffected healthy siblings of 403 patients with coronary heart disease events before 60 years of age, along with their adult offspring (571 men, 711 women). Platelet function was assessed at baseline and after 14 days of aspirin 81 mg daily, upon exposure to several agonists.

At baseline, platelet aggregation in reaction to all agonists was higher in women than in men, though the differences were "modest," the authors note.

For example, whole blood exposed to arachidonic acid 0.5 mM (which directly measures the cyclooxygenase-1 pathway, considered to be the most protective against MI), aggregation was 94.9% in men and 98.0% in women. Corresponding values after exposure to collagen 1 g/mL were 20.9% and 22.0%.

After aspirin treatment, most men and women demonstrated zero aggregation after exposure to arachidonic acid.

In platelet aggregation assays indirectly related to COX-1 (exposure to collagen, adenosine diphosphate and epinephrine), women demonstrated more inhibition but still had modestly but significantly more residual aggregation.

Closure time was measured in whole blood loaded into cartridges containing collagen and epinephrine. It was similar between men and women at baseline, but after aspirin, 32.4% of men and 50.8% of women had platelet function analyzer closure times of less than 300 seconds.

Multivariable analyses showed that the greatest contribution to the total variance in aggregation outcomes after exposure to agonists was the baseline level of aggregation. In most analyses, sex was not a significant predictor after adjustment for baseline aggregation.

"Although women in our study still retained a modest residual platelet reactivity that exceeds that of men, regardless of age," Dr. Becker's team concludes, "there is virtually total suppression of the COX-1 direct platelet function pathways in most women."


Intake of Dairy and Calcium May Be Inversely Related to Colon Cancer Risk

Intake of dairy foods and calcium is inversely related to risk for colon cancer, according to the results of a large, prospective cohort study reported in the March issue of the American Journal of Clinical Nutrition.

"Recent epidemiologic studies have generally reported a modest inverse association between calcium intake and the risk of colorectal cancer," write Susanna C. Larsson, MD, from Karolinska Institutet in Stockholm, Sweden, and colleagues. "However, findings pertaining to specific subsites in the colorectum have been conflicting."

In the Cohort of Swedish Men, 45 306 men aged 45 to 79 years and without a history of cancer completed a food-frequency questionnaire in 1997 and were followed up through December 31, 2004.

During a mean follow-up of 6.7 years, 449 incident cases of colorectal cancer occurred. After adjustment for age and other risk factors, the multivariate rate ratio (RR) of colorectal cancer for men in the highest quartile of total calcium intake compared with those in the lowest quartile was 0.68 (95% confidence interval [CI], 0.51 - 0.91; P for trend = .01).

High dairy consumption was also associated with a lower risk for colorectal cancer. Colorectal cancer risk for 7 servings/day or more of total dairy foods was about half that for less than 2 servings/day (multivariate RR, 0.46; 85% CI, 0.30 - 0.71; P for trend = .01). Milk was the dairy food that was most strongly inversely associated with the risk for colorectal cancer.

For cancer subsites, RRs were 0.37 for proximal colon (95% CI, 0.16 - 0.88), 0.43 for distal colon (95% CI, 0.20 - 0.93), and 0.48 for rectum (95% CI, 0.23 - 0.99).

"Our findings provide support for inverse associations between intakes of calcium and dairy foods and the risk of colorectal cancer," the authors write. "The associations did not vary significantly by subsite in the colorectum."

Study limitations include possible misclassification of calcium intake, and the possibility of unmeasured confounders accounting for the observed associations.

"Future studies should examine the relation of other components of dairy foods, such as conjugated linoleic acid, sphingolipids, and milk proteins, with the risk of colorectal cancer," the authors conclude.

The Swedish Cancer Foundation, the Swedish Research Council-Longitudinal Studies, the Swedish Foundation for International Cooperation in Research and Higher Education (STINT), Västmanland County Research Fund against Cancer, Örebro County Council Research Committee, and Örebro Medical Center Research Foundation supported this study. The authors have disclosed no relevant financial relationships.

In an accompanying editorial, James C. Fleet, from Purdue University in West Lafayette, Indiana, calls this a powerful study with a large population linked to well-maintained, complete health records.

"Although this study offers some new insight into the dietary modulation of colon cancer, one is still likely to feel that this story has a lot more to reveal and that [this article] only begins to address these gaps," Dr Fleet writes. "Given that the interaction between vitamin D status and calcium metabolism is well established and that vitamin D status appears to modulate the effect of calcium on colon cancer risk, future studies on calcium or dairy intakes and cancer risk should not ignore it."


Oral Contraceptives Increase Insulin Resistance in Adolescent PCOS

NEW YORK (Reuters Health) Mar 24 - Oral contraceptives improved features of polycystic ovary syndrome (PCOS) in adolescent girls but have an unfavorable impact on insulin resistance, according to a report in the February issue of Fertility and Sterility.

Adolescent girls with PCOS often have reduced insulin sensitivity, hepatic insulin resistance, and compensatory hyperinsulinemia, the authors explain. Oral contraceptives may worsen these features.

Dr. George Mastorakos and colleagues from Athens University School of Medicine, investigated the effect on carbohydrate metabolism of two combined oral contraceptives containing cyproterone or desogestrel as progestogenic compounds in 36 adolescent girls with PCOS.

Although body mass index and waist-to-hip ratio remained unchanged during treatment, three patients developed impaired fasting glucose and another three patients developed impaired glucose tolerance after 12 months of treatment, the authors report.

The fasting glucose-to-insulin ratio declined after 12 months of treatment in both groups, the results indicate, although the decline was statistically significant only in the cyproterone group. Similarly, the insulin sensitivity index decreased significantly and insulin secretion increased significantly only in the cyproterone-treated group.

"Both combined oral contraceptive formulations are effective in ensuring normal menstrual cyclicity and in reducing hirsutism in adolescent patients with PCOS," the authors note. "Both treatments have an unfavorable impact on insulin resistance. However, as has been suggested in the past, this effect is not translated into a clinically relevant major impact."

"The positive correlation between insulin values and body mass index in women with PCOS suggests that obese teenage patients, along with psychological support, should also be encouraged to lose weight and exercise in an effort to improve the clinical and metabolic features of the syndrome," the researchers conclude.


Monday, March 27, 2006

Breakthroughs in Breast Cancer Treatments

New findings are showing progress in hormonal and targeted breast cancer therapies.
Advances in hormonal and biological therapies and optimized chemotherapy dosing for breast cancer will help doctors better treat early-stage breast cancer and breast cancer that has spread to other parts of the body.

More than 2 million women living in the U.S. have been treated for or are living with breast cancer, and more than 40,000 women are expected to die from the disease in 2006. Though breast cancer death rates are declining -- mostly due to earlier diagnosis -- the disease remains the second leading cause of cancer death in women (after lung cancer).

Depending on the characteristics of the tumor, treatment for early-stage breast cancer can include surgery or radiation and may also include the use of hormonal therapy, chemotherapy, or biological ("targeted") therapies. For metastatic breast cancer, or cancer that has spread to other parts of the body, therapies that affect the entire body (systemic therapies) are used, such as hormonal therapy, chemotherapy, or biological therapies. Researchers are focusing on the best way to use these treatments to gain the most favorable results with the least amount of side effects and they are making headway. Experts presented their findings at the 2005 San Antonio Breast Cancer Symposium.

Advances in Hormonal Therapy for Postmenopausal Women

Tamoxifen has been available for the treatment of early-stage breast cancer since the 1980s; but, more recently, a new class of drugs called aromatase inhibitors has been found to produce better results when compared directly with tamoxifen. Aromatase inhibitors, indicated for use in postmenopausal women, act by blocking the formation of estrogen, which fuels the growth of "hormone receptor-positive" breast cancers.

The three aromatase inhibitors approved in the U.S. include Femara, Aromasin, and Arimidex.

Several studies are under way to find out the best strategy for using these agents in patients who have already received tamoxifen. One study presented at the breast cancer symposium reported increased disease-free survival when patients received two to four years of Femara instead of a placebo (sugar pill) after receiving five years of tamoxifen. In particular, patients who had disease that had spread to their lymph nodes seemed to show the greatest benefit from continued Femara use.

Likewise, a study comparing Femara to placebo suggested that patients who took a placebo following five years of tamoxifen therapy and then chose to switch to Femara experienced significantly longer survival -- both disease-free and overall -- than did patients who continued taking placebo. In other words, these results suggest that there is still risk of recurrence after finishing a five-year course of tamoxifen, but that benefit may still be gained from taking Femara even when there is a delay between its initiation and ending tamoxifen.

Positive results have also been demonstrated with Arimidex, another aromatase inhibitor, in the treatment of early-stage breast cancer. One study found that switching to Arimidex after two to three years of tamoxifen was linked to better survival without disease recurrence after five years compared with staying on tamoxifen for five years.

Similar findings have been reported for Aromasin.

Together, these findings help to confirm that aromatase inhibitors provide significant benefit to patients with early-stage breast cancer.

"I think that the message that we should get from these and other recent studies is that tamoxifen has prevented thousands of recurrences and has saved thousands of lives," says Henning Mouridsen, MD, with the Copenhagen University Hospital in Denmark. "But the advent of the new aromatase inhibitors is going to further improve the prognosis of postmenopausal patients with estrogen receptor-positive tumors."

Targeted Cancer Treatments

Perhaps the most important breakthrough in cancer treatment over the past few years has been the introduction of so-called "targeted" therapies. Rather than the sledgehammer effect achieved by traditional therapies, the newer targeted therapies are designed to home in on cancer cells like a missile while leaving the healthy cells untouched. As a result, these agents lack many of the severe side effects associated with chemotherapy.

Herceptin, an effective targeted therapy for breast cancer, attaches to a protein on the surface of breast cancer cells called HER2 that transmits growth-stimulating signals to cells. By blocking the actions of HER2, Herceptin slows or stops the growth of tumor cells. Herceptin is effective in tumors that express large amounts of the HER2 protein (described as HER2-positive), which is the case in about 25% of patients.

Results from several trials of Herceptin in early-stage breast cancer have confirmed the striking effectiveness of this agent when used with or after chemotherapy. However, the results are preliminary, and further studies are needed to determine the best way to combine Herceptin with chemotherapy, how long to give it, and which patients might benefit the most.

At the breast cancer meeting, Dennis Slamon, MD, presented results from a large international trial that evaluated three treatment regimens, two of which contained Herceptin. Both of the Herceptin-containing treatments were more effective in reducing disease recurrence than the non-Herceptin-containing regimen. However, an increased risk of heart problems was seen in both Herceptin-containing groups. Adriamycin, a chemotherapy agent used in one of the Herceptin containing treatments, has also been linked to heart-related side effects -- making researchers particularly cautious about combining Adriamycin with Herceptin. Therefore, it was encouraging to see that both of the Herceptin-containing regimens -- one containing Adriamycin and the other not -- were effective.

This study also identified certain genetic changes in breast tumors that may indicate increased susceptibility of the tumor -- meaning a better response -- to Adriamycin treatment. In patients with these types of tumors (about 30% of the patients tested), researchers suggested that the added risk of heart problems from Herceptin and Adriamycin might be worthwhile given the superior treatment effect, although these data need further confirmation.

One question that remains unanswered with regard to Herceptin is how long patients should keep taking the drug. Given the high cost and the potential for rare but serious heart side effects, it is important to know if patients would also benefit from a shorter course of the therapy. An intriguing study presented at the meeting found that Herceptin given for only nine weeks alongside a chemotherapy regimen was also able to decrease breast cancer recurrence. The tentative conclusion of the study indicated that short-term use of Herceptin appears to be effective and may be better tolerated than a longer one-year regimen.

Advances in hormonal and biological therapies and optimized chemotherapy dosing for breast cancer will help doctors better treat early-stage breast cancer and breast cancer that has spread to other parts of the body.

More than 2 million women living in the U.S. have been treated for or are living with breast cancer, and more than 40,000 women are expected to die from the disease in 2006. Though breast cancer death rates are declining -- mostly due to earlier diagnosis -- the disease remains the second leading cause of cancer death in women (after lung cancer).

Depending on the characteristics of the tumor, treatment for early-stage breast cancer can include surgery or radiation and may also include the use of hormonal therapy, chemotherapy, or biological ("targeted") therapies. For metastatic breast cancer, or cancer that has spread to other parts of the body, therapies that affect the entire body (systemic therapies) are used, such as hormonal therapy, chemotherapy, or biological therapies. Researchers are focusing on the best way to use these treatments to gain the most favorable results with the least amount of side effects and they are making headway. Experts presented their findings at the 2005 San Antonio Breast Cancer Symposium.

Advances in Hormonal Therapy for Postmenopausal Women

Tamoxifen has been available for the treatment of early-stage breast cancer since the 1980s; but, more recently, a new class of drugs called aromatase inhibitors has been found to produce better results when compared directly with tamoxifen. Aromatase inhibitors, indicated for use in postmenopausal women, act by blocking the formation of estrogen, which fuels the growth of "hormone receptor-positive" breast cancers.

The three aromatase inhibitors approved in the U.S. include Femara, Aromasin, and Arimidex.

Several studies are under way to find out the best strategy for using these agents in patients who have already received tamoxifen. One study presented at the breast cancer symposium reported increased disease-free survival when patients received two to four years of Femara instead of a placebo (sugar pill) after receiving five years of tamoxifen. In particular, patients who had disease that had spread to their lymph nodes seemed to show the greatest benefit from continued Femara use.

Likewise, a study comparing Femara to placebo suggested that patients who took a placebo following five years of tamoxifen therapy and then chose to switch to Femara experienced significantly longer survival -- both disease-free and overall -- than did patients who continued taking placebo. In other words, these results suggest that there is still risk of recurrence after finishing a five-year course of tamoxifen, but that benefit may still be gained from taking Femara even when there is a delay between its initiation and ending tamoxifen.

Positive results have also been demonstrated with Arimidex, another aromatase inhibitor, in the treatment of early-stage breast cancer. One study found that switching to Arimidex after two to three years of tamoxifen was linked to better survival without disease recurrence after five years compared with staying on tamoxifen for five years.

Similar findings have been reported for Aromasin.

Together, these findings help to confirm that aromatase inhibitors provide significant benefit to patients with early-stage breast cancer.

"I think that the message that we should get from these and other recent studies is that tamoxifen has prevented thousands of recurrences and has saved thousands of lives," says Henning Mouridsen, MD, with the Copenhagen University Hospital in Denmark. "But the advent of the new aromatase inhibitors is going to further improve the prognosis of postmenopausal patients with estrogen receptor-positive tumors."

Oral Chemotherapy Agents

A recently approved drug for kidney and stomach cancer is emerging as a potential treatment for breast cancer. Sutent, like Avastin, also stops the development of the tumor's blood supply but is given orally. This agent has demonstrated its effectiveness when used alone, without additional chemotherapy or hormonal therapy, in patients with previously treated metastatic breast cancer. In one study of 64 patients treated, 16% responded favorably.

Findings about an experimental oral drug, lapatinib, were also presented at the meeting. Like Herceptin, lapatinib targets HER2, but it also targets a related protein called EGFR, meaning that it could have a broader range of effectiveness or could be especially effective when added to Herceptin. One small study evaluated the combination of lapatinib and Herceptin in patients with metastatic breast cancer. The researchers reported no additional or unexpected side effects with the combination. Moreover, a good percentage of this difficult-to-treat population responded to the treatment.

"We are very excited about the results of all of these studies with these new agents, and they clearly demonstrate a role for this type of therapy in the treatment of metastatic breast cancer," Miller says. "We also expect an even greater benefit for these therapies when used for earlier-stage disease as opposed to the metastatic setting."