Drop in Breast Cancer Among White Women May Have Stalled

Many American women abandoned hormone replacement therapy after a 2002 study found the treatment was tied to higher breast cancer risk. A sharp drop in breast cancer incidence among whites was observed soon after. However, a new study suggests that the 2002-2003 decline in breast cancer incidence among white women did not continue through 2007. The data suggests that the drop in breast cancers linked to women abandoning hormone replacement therapy (HRT) has now bottomed out.

Breast cancer rates among U.S. white women fell by about 7 percent between 2002 and 2003 after the release in 2002 of findings from the Women's Health Initiative study that linked HRT with an increased risk of breast cancer. To examine whether that trend has continued, American Cancer Society and U.S. National Cancer Institute (NCI) researchers reviewed breast cancer data collected from 2000 to 2007 by NCI Surveillance, Epidemiology and End Results (SEER) registries across the country.

The analysis revealed that the sharp decline in breast cancer rates among white women that occurred between 2002 and 2003 did not continue between 2003 and 2007. Instead, breast cancer rates among white women remained relatively stable from 2003 to 2007. "Postmenopausal hormone replacement therapy certainly had accounted for an increase in the incidence of developing a breast cancer. The use of postmenopausal HRT had sharply declined after multiple reports proved this relationship," noted one expert, Dr. Sharon M. Rosenbaum-Smith, a breast cancer specialist and surgeon at the Comprehensive Breast Center at St. Luke's-Roosevelt Medical Center in New York City.

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Weight Loss Surgery May Cut Knee Osteoarthritis Pain

Losing weight can help reduce the amount of pain experienced by obese people with knee osteoarthritis, researchers say. The new study included 24 obese adults, aged 30 to 67, with knee osteoarthritis who underwent weight loss surgery. The patients' knees were assessed before surgery and at six and 12 months after surgery. Patients who lost an average of 57 pounds within six months of having bariatric surgery showed significant improvements in knee pain, stiffness and physical function, the investigators found.

These patients also experienced improvements in quality of life, the ability to perform day-to-day tasks and sports activity. None of the patients received other treatments for their knee osteoarthritis. The findings were scheduled to be presented Saturday at the American Orthopaedic Society for Sports Medicine's Specialty Day program. "Each individual had some kind of improvement in their pain from losing weight, some more than others," lead researcher Christopher Edwards, of the Penn State College of Medicine, said in a society news release.

"There are few studies that have investigated the role of isolated weight loss in the absence of additional arthritis treatment on those individuals with radiographically confirmed osteoarthritis," he added. "Further research still needs to be performed to investigate whether knee arthritis symptom improvement continues over time and applicable to those individuals who are simply overweight, but our research suggests a strong possibility of improvement."

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Smoking During Head & Neck Cancer Therapy Tied to Poor Outcome

Patients with head and neck cancer who continue to smoke while undergoing radiation treatments have a much lower long-term survival rate than those who kick the addiction, researchers have found. In the study of patients with squamous cell carcinoma of the head and neck, 23 percent of 101 patients who continued to smoke were still alive five years after treatment, compared with 55 percent of matched patients in a control group who quit smoking before they began radiation therapy.

In addition, 53 of the patients who continued to smoke suffered cancer recurrence, compared with 40 patients in the control group. The patients who kept smoking also had more treatment-related complications such as the development of scar tissue, hoarseness and difficulty eating. The poorer outcomes for persistent smokers were found both in patients who had radiation alone and in those who had surgery prior to radiation, the study authors noted in the report published in the February issue of the International Journal of Radiation Oncology/Biology/Physics.

"I've always told patients, 'You should really stop smoking,' but I had no tangible evidence to use to convince them that they would be worse off if they continued to smoke," lead author Dr. Allen Chen, residency training program director at the University of California, Davis, School of Medicine, said in a news release from the American Society for Radiation Oncology. "I wanted concrete data to see if smoking was detrimental in terms of curability, overall survival and tolerability of treatment. We showed continued smoking contributed to negative outcomes with regard to all of those," he added.

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Few Stroke Patients Given Clot-Buster Quickly Enough: Study

Few eligible stroke patients get an injectable clot-busting drug within the recommended 60-minute window after their hospital arrival, new research finds. "It has been widely recommended that the 'door-to-needle' time should be 60 minutes," said study author Dr. Gregg C. Fonarow, a professor of cardiovascular medicine at the University of California Los Angeles David Geffen School of Medicine. The phrase refers to the timeframe between when the patient arrives at the hospital and when that patient is given the clot-buster, known as tissue plasminogen activator (tPA).

In his analysis of stroke patients from 1,083 hospitals, he found the 60-minute window was not the typical reality. "That occurs only in 26.6 percent of patients," he said. Fonarow was slated to present the findings Thursday at the American Stroke Association's International Stroke Conference in Los Angeles; the research is being published simultaneously in the journal Circulation. Perhaps even more surprising, the hospitals in the study were all participating in the American Heart Association/American Stroke Association's Get with The Guidelines-Stroke quality improvement program, which recommends early tPA administration.

"It involved some of the largest, best-known hospitals for stroke care," Fonarow said. The study looked at more than 25,500 patients who had suffered ischemic stroke in which a blood clot obstructs blood flow and had been treated with tPA within three hours of the start of symptoms. Just 6,790 got the intravenous drug within 60 minutes. During the course of the study, there was only modest improvement in the hospitals' track records.

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Stroke Hospitalizations Up in Teens, Young Adults

Older Americans are suffering fewer strokes, but new government research shows that stroke hospitalizations are sharply rising among children and younger adults, especially for men under 35. Although the study doesn't explore the reasons for the trend, experts point to the obesity epidemic, increasing rates of diabetes and high blood pressure as likely culprits. Recreational drugs may play a role as well, they added. "Young people should see their doctor for regular checkups," said Dr. Brett Kissela, a professor of neurology at the University of Cincinnati Neuroscience Institute, who has conducted previous research on strokes but was not involved with this study.

Routine check-ups can help control risk factors for stroke, such as high blood pressure, he explained. Dr. Mary George, a researcher with the U.S. Centers for Disease Control and Prevention, is scheduled to report the findings Wednesday at the International Stroke Conference in Los Angeles. Experts note that research presented at meetings typically has not been subjected to the same scrutiny as studies published in peer-reviewed medical journals. For the study, CDC researchers examined hospitalization data for the period from 1994 to 2007 from the Nationwide Inpatient Sample, identifying patients with a primary diagnosis of ischemic stroke.

Ischemic stroke, which occurs when a blood clot or clogged artery blocks the blood supply to the brain, is more common than hemorrhagic stroke, the result of a ruptured blood vessel. The increases and decreases in stroke rates varied by gender and age group, the researchers found. Among males aged 15 to 34, the rate surged by nearly 53 percent. Among females in that age group, it increased 17 percent. Strokes soared 36 percent in boys aged 5 to 14 and 31 percent in girls of the same age. Men between 35 and 44 years old had a 47 percent increase in stroke incidence. For women in that age range, stroke incidence rose 36 percent.

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Lead Exposure May Raise Blood Pressure in Pregnancy

In pregnant women, even small amounts of lead in the blood may cause significantly higher blood pressure, new research suggests. The study of 285 pregnant women found that about one in four had a lead level higher than about 1 microgram per deciliter (1 mcg/dL) of umbilical cord blood. That's significantly lower than the safety thresholds set by the U.S Centers for Disease Control and Prevention, which recommends taking action to reduce lead exposure when pregnant women or children have a blood lead level of 5 mcg/dL.

Even so, women in the study with lead levels greater than 1 mcg/dL had higher systolic and diastolic blood pressure readings than those with lower lead levels. The average increase was 6.9 mm Hg and 4.4 mm Hg, respectively. Though further research is needed, the findings suggest that pregnant women may be as sensitive to lead toxicity as young children, said the researchers. Prolonged high blood pressure during pregnancy can lead to complications such as preeclampsia or eclampsia, potentially deadly seizures that also can increase a woman's future risk of heart attack.

"We didn't expect to see effects at such low levels of lead exposure, but in fact we found a strong effect," Dr. Lynn Goldman, dean of the George Washington University School of Public Health and Health Services, said in a university news release. The study did not find an association, however, between lead exposure and pregnancy-induced hypertension or preeclampsia.

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New Heart Failure Therapy Proves Most Effective in Women

A therapy to prevent heart failure is twice as effective in women as in men, a new study finds. It's the first time that a heart treatment has been shown to offer greater benefit to women, the researchers added. The finding was "unexpected, but extremely important," study author Dr. Arthur J. Moss, a professor of medicine at the University of Rochester Medical Center, said in a news release. He and his colleagues looked at the effectiveness of cardiac resynchronization therapy with defibrillator (CRT-D) in 1,820 patients in Canada, Europe and the United States.

CRT-D combines the benefits of both an implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy. ICDs prevent sudden, irregular rhythm-related cardiac death, and resynchronization therapy boosts heart function and reduces the risk of heart failure and related symptoms. CRT-D is approved in the United States to treat patients with severe heart failure and those with mild heart failure to prevent them from progressing to advanced heart failure. The CRT-D device was developed by Boston Scientific, which was a partner in this study.

Among women, CRT-D led to a 70 percent reduction in heart failure and a 72 percent reduction in death. Among men, the treatment led to a 35 percent reduction in heart failure, according to the report published in the Feb. 7 issue of the Journal of the American College of Cardiology. "It's not that men did poorly in the trial, but rather, women had really fantastic results, likely due to the type of heart disease we see more commonly in women," Moss said in the journal news release.

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Breast Cancer Treatment May Lead to Hip Fracture

Middle-aged breast cancer survivors face an increased risk for hip fractures, a condition normally uncommon in women younger than 70, a new study has found. Researchers at Northwestern University in Chicago say that this may be because early menopause caused by breast cancer treatment and the effects of breast cancer drugs could weaken the bones by the time women reach middle age. The finding came from a study of six women who had survived breast cancer and, in their early 50s, were being treated for hip fractures.

Most of the women did not have osteoporosis, but they did have lower-than-normal bone mineral density (osteopenia). This suggests that rapid changes in bone architecture caused by chemotherapy, early menopause and adjuvant breast cancer therapy may not be detected on a bone mineral density test, said Dr. Beatrice Edwards, an associate professor of medicine and orthopedic surgery and director of the bone health and osteoporosis program Northwestern University's Feinberg School of Medicine, who led the research.

The women had been diagnosed with early-stage breast cancer, and their treatments had included lumpectomy, radiation therapy and chemotherapy with cytoxan and adriamycin for one to four years before they broke a hip. All of the women were perimenopausal at the time of the fracture. In four of the women, their breast cancer had grown in response to estrogen, and their cancer therapy had included aromatase inhibitors to prevent their bodies from making estrogen. Recent research has linked aromatase inhibitors with possible bone loss in women.

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Narrowed Leg Arteries Disable Women Faster Than Men: Study

Women coping with peripheral arterial disease (PAD) in the legs appear to lose mobility faster than men, new research reveals. PAD is marked by narrowing and blockages of the peripheral arteries, usually those in the legs and pelvis. The most common symptoms are pain, cramping and tiredness in the leg or hip muscles when walking or climbing stairs symptoms that go away during rest. "The bottom line is that among those with lower extremity PAD, women have faster declines in mobility and functional performance compared to men," said study author Mary M. McDermott, a professor of medicine.

"This may be related to gender differences in calf muscle, as women tend to have less calf muscle compared to men," McDermott added. She and her colleagues report their findinsg in the Feb. 8 issue of the Journal of the American College of Cardiology. Both the researchers and the American Heart Association note that an estimated 8 million American men and women are affected by lower extremity PAD, with disease prevalence being split about equally across genders. To examine whether disease progression differs among men and women, between 2002 and 2009 McDermott and her team tracked the progress of 380 male and female patients with PAD of the legs in the Chicago area.

All the participants were 59 and older. Over a four-year period, annual mobility assessments were conducted during which each patient was asked to complete a quarter mile, six-minute walk, as well as a four-minute speed test, to observe the development of disability. Changes in calf muscle measurements and characteristics were also noted, alongside knee extension strength. Overall, the research team determined that after adjusting for age, women fared more poorly than men over the course of the study. As the study period unfolded, they noted that women ended up walking less per week and had more difficulty walking the quarter-mile.

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Electrical Stimulation of the Brain May Spark Insight

Electrical stimulation of the brain can bring a flash of insight that can help people solve new, difficult problems, research suggests. Investigators in Australia found that volunteers who received electrical stimulation of the brain's anterior temporal lobes were three times more likely to be able to figure out a challenging, unfamiliar problem than participants in a control group.

Many people have difficulty achieving creative leaps needed to solve new problems because they tend to stick to strategies and insights that have been successful before, study authors Richard Chi and Allan Snyder, from the Center for the Mind at the University of Sydney, explained in a news release from the Public Library of Science.The use of "transcranial direct current stimulation" temporarily increases or decreases the activity of populations of brain cells, the study authors said.

This safe, noninvasive technique can be used to manipulate the competition between the left and right hemispheres of the brain by inhibiting and/or activating certain networks, they explained. According to Chi and Snyder, the right anterior temporal lobe is associated with insight or finding new meaning, and the inhibition of activity in the left anterior temporal lobe can lead to thinking that is less likely to be influenced by preconceptions. However, the authors noted that more research is needed.

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