HRT Ups Breast Cancer Risk Equally for All Races

September 16, 2005 08:40:47 PM PST
The increased risk of breast cancer known to be associated with the use of hormone replacement therapy (HRT) applies to all ethnicities, a new study finds.

Ever since the Women's Health Initiative (WHI) study was halted in 2002, after investigators found that the women taking HRT had a higher incidence of heart attacks, strokes, blood clots and breast cancer, experts have known about the increased health risks.

But one of the unresolved issues has been whether women of all races were equally affected, since the majority of the WHI participants were white, explained study co-author Malcolm Pike, a professor of preventive medicine at the University of Southern California's Keck School of Medicine. His report appears in the Sept. 16 online issue of the International Journal of Cancer.

However, based on the new study, Pike said, the firm conclusion is that "every one of these ethnic groups has the same risk of breast cancer from HRT."

Pike's study evaluated more than 55,000 menopausal American women taking part in the Multiethnic Cohort Study. That study included more than 215,000 men and women, aged 45 to 75 at the start of the study who were living in Hawaii or California in 1993. The women included whites, blacks, Hawaiians, Japanese-Americans and Latin Americans. "The women told us their contraceptive history, their pregnancy history, what hormones they took post-menopause," Pike said.

Current use of the estrogen-progestin therapy was associated with a 29 percent higher risk of breast cancer after five years of use, he found. The association held for women in all ethnic groups. Current use of estrogen-only therapy was associated with a 10 percent higher risk of breast cancer after five years of use, and this was found in all ethnic groups except for blacks.

The researchers also found that leaner women -- those with a body mass index (BMI) below 25, had a slightly higher relative risk of getting breast cancer than the heavier women, although the heavier women were also at increased risk. Although the researchers couldn't pinpoint the reason for the finding, Pike did have a theory.

"The bigger you are postmenopausally, the more estrogen you [continue] to make," he said. That's because the more fat cells a woman has, the more estrogen she produces.

A woman who weighs 180 pounds, for example, is probably making as much estrogen herself as the breast positively reacts to, Pike said. "These women are at a saturation point."

But the woman who weighs, say, 130 pounds or less gets more of an effect from supplementary estrogen, he said, perhaps accounting for their increased risk.

Studies following the halting of the WHI have been plentiful, all evaluating different aspects of risk. A study published last month in the British Medical Journal found that the risk of breast cancer declines with age if a woman is not taking HRT. But if she does take HRT, that risk starts to climb. If therapy is stopped, however, the risk returns to that of a woman of the same age who has never used HRT, the researchers found.

Another expert, Roshan Bastani, associate dean for research at the University of California Los Angeles School of Public Health and Jonsson Comprehensive Cancer Center, praised the new research.

"I think it's a well-done study," she said. "And it is important, particularly because they were able to include data from large numbers of people from many ethnic groups."

For women, the study provides more valuable information, but each woman must still take into account her own symptoms, medical history and family background when deciding whether to take hormones after menopause, Pike and Bastani agreed.

"What they need to do," Bastani said, "it to understand the risks and then assess whether they are willing to take the risk."

For instance, she said, if a particular woman is told taking hormones increases her risk of breast cancer or other disease by, say, 10 percent, she should ask what her "baseline" risk is, which depends on factors such as family background and medical history. If the baseline risk is just 1 percent or 2 percent, an increased risk is not a lot compared to a baseline risk of 50 percent or 80 percent.

"If you want to take HRT to deal with problems at menopause, it's perfectly reasonable," Pike said, as long as the treatment is limited. It's difficult, he said, to put an absolute number of years on that advice.

The best course, said Pike, is to keep the amount of progestin "to an absolute minimum."

"What a woman wants to do is discuss with her physician -- can she use the minimum amount of estrogen to control her hot flashes, and how frequently does she need to take progestin?" he said.

More information

To learn more about breast cancer, visit the American Cancer Society.

Heart Risk Assessments Ignore Poverty

September 16, 2005 08:40:47 PM PST

This failure to include economic deprivation as a standard risk assessment means that many people are not receiving the lifesaving preventive treatment they need, according to the study.

Currently, when estimating a patient's risk for cardiovascular trouble, doctors look at the standard risk factors of blood pressure, smoking, cholesterol, age, sex and diabetes, pulling them together in the internationally used Framingham Risk Score.

But poverty is not included, even though there's a recognized link between economic hardship and poor health. The study authors said that economic deprivation is left out because there is such variation in country-by-country definitions of deprivation. That makes it difficult to develop an international standard, they said.

Reporting in the Sept. 15 online edition of Heart, researchers at the Cardiovascular Epidemiology Unit at the University of Dundee retrospectively analyzed 10 years of data on 13,000 Scottish men and women using a new deprivation score -- the Scottish Index of Multiple Deprivation (SIMD) -- that includes 31 indicators of economic hardship.

They used the SIMD to compare the "observed risk" of death and illness from heart disease to the "expected risk" using the Framingham score.

The Scottish team found a modest difference in expected risk between the most- and least-deprived people in the study. But there was a sharp difference -- fivefold in women -- in the actual, observed risk between the most- and least-deprived people.

Under the Framingham score, the most-deprived 20 percent of people would receive only half as much primary preventive care in proportion to their future level of heart disease, the researchers said, compared with the least-deprived 20 percent of people.

More information

The American Medical Association has more about heart disease risk factors.

Health Highlights: Sept. 17, 2005

September 17, 2005 08:40:25 PM PST

Here are some of the latest health and medical news developments, compiled by the editors of HealthDay:

Medicare Premiums Raised Again

Seniors face yet another increase in their health-care costs, thanks to the federal government.

The New York Times reported Saturday that basic Medicare premiums will go up again; this time the hike will be 13 percent, to $88.50 a month. Increased use of doctor's services is behind the latest increase, the Times reported.

Many beneficiaries will have to pay an additional premium for the much-touted new prescription drug benefit program, set to start Jan. 1, which should average $32 a month. The combined premiums will now average $120 a month, the Times reported.

Medicare premiums are typically deducted from monthly Social Security checks, which currently average $955 a month for retirees, the Times said. Medicare provides medical coverage to 42 million people who are older or disabled.

The basic Medicare premium has gone up by nearly $30 a month, or 51 percent, from 2003 to 2006, Kirsten A. Sloan, a health policy analyst at AARP, told the Times.

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New Orleans Sludge Still Contaminated With Bacteria, Oil

Initial tests conducted on sediments taken after floodwaters receded in New Orleans show high amounts of E. coli bacteria and oil runoff from fuel and chemical plants, the U.S. Environmental Protection Agency said Friday.

E. coli indicates there is fecal bacteria in the water and exposed sediment, and contact with both should be avoided, Marcus Peacock, the EPA's deputy administrator, told reporters Friday at a news conference, the agency's second this week. He said 18 sediment samples taken on Sept. 10 represented the start of "extensive" testing, the Bloomberg news service reported.

And flooded parts of New Orleans, which was 80 percent under water after Hurricane Katrina, include more than 60 chemical plants, oil refineries, and petroleum storage facilities, Bloomberg said.

The Coast Guard said Thursday that Hurricane Katrina may have spilled more than 7 million gallons of oil, about two-thirds of what was released in the Exxon Valdez accident in 1989, according to the Associated Press.

Contact with fuel oils can lead to skin and eye irritation, increased blood pressure, and headache, Bloomberg said.

Officials told Bloomberg that the full extent of the contamination probably won't be known until the city is completely pumped out, which they say could take until mid-October.

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Defibrillator Problems on the Rise: FDA Study

Malfunctions in implanted heart devices called defibrillators were increasing even before a huge recall this summer by Guidant Corp., according to a joint study released Friday by the U.S. Food and Drug Administration and Harvard University.

Defibrillators shock awkwardly beating hearts back into a normal rhythm. About 20 of every 1,000 devices malfunction, the researchers found. Those defects led to 31 deaths between 1990 and 2002, although that was a fraction of the more than 400,000 devices implanted during the span, the Associated Press reported.

Nonetheless, the study "points out the need for our agency to improve the way it regulates these products, and we're doing just that," Dr. Daniel Schultz, chief of the FDA's medical devices unit, told the AP.

The research was presented Friday at a daylong meeting of the Heart Rhythm Society in Washington, D.C., to discuss recent safety problems with defibrillators and other implanted cardiac devices, including pacemakers.

The study's leader, Dr. William Maisel of Harvard, found that from 1990 to 2002, 2.25 million pacemakers and 416,000 cardiac defibrillators were implanted in the United States. More than 17,000 of the devices had to be removed later due to malfunctions, the AP reported.

Equally troubling, 50 percent of the defibrillator malfunctions between 1990 and 2002 occurred within the last three years of that time period, the researchers said.

Guidant, and two other makers -- Medtronic and St. Jude Medical -- have recalled or issued warnings about more than 200,000 defibrillators since January, the wire service said. Guidant recently conceded that it waited three years before telling doctors and patients about an electrical defect in one of its models. The defect has been linked to two deaths, the AP reported.

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Aspirin at Night May Lower Blood Pressure

Not only may daily aspirin prevent a heart attack, it could also lower blood pressure -- especially if taken at night, researchers have found.

Scientists from Spain, writing in the Sept. 20 issue of the Journal of the American College of Cardiology, said they randomly divided patients with mild hypertension into three groups: those who took aspirin in the morning, those who took it before bed, and those who didn't take aspirin at all.

After three months, blood pressure rose slightly among those who took aspirin in the morning, but fell in the group that took it at night. The group that didn't take aspirin at all saw only a very slight decline in blood pressure that wasn't statistically significant, the researchers at the University of Vigo said.

The authors and other experts said the results would have to be confirmed in future studies.

"Given the widespread use of aspirin, the prevalence of hypertension, and the ease in altering the time of aspirin administration, these results should be widely disseminated," Dr. Joseph Messer, from Rush University Medical Center in Chicago, said in a prepared statement from the American College of Cardiology. Messer wasn't directly connected to the research, the statement said.

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Lipitor, Celebrex Lead Price Increases, U.S. Reports

The cholesterol-lowering medicine Lipitor and the pain drug Celebrex had the most impact on a 25 percent overall increase in U.S. retail drug prices from 2000 to 2004, says a federal government report.

The Government Accountability Office report said that the price of a 30-day supply of 96 drugs used by older people increased by 24.5 percent from January 2000 to December 2004, the Kansas City Star reported.

The study found that 20 of the 96 drugs accounted for nearly two-thirds of that increase. Of those 20 drugs, 19 were name-brand drugs and one was a generic drug.

"The drug with the largest effect on the price index was Lipitor 10 mg, which accounted for 6.6 percent of the total increase," the report noted. Celebrex had the second greatest impact on drug prices. Both are made by Pfizer Inc.

The other drugs in the top five were: blood thinner Plavix, made by Sanofi-Aventis SA and Bristol-Myers Squibb Co.'; the ulcer drug Prevacid, made by Abbott Laboratories and Takeda Pharmaceutical Co. Ltd.; and Pfizer's Lipitor 20 mg.