Sunday, December 14, 2008

New study firmly ties hormone use to breast cancer



By MARILYNN MARCHIONE

SAN ANTONIO (AP) — Taking menopause hormones for five years doubles the risk for breast cancer, according to a new analysis of a big federal study that reveals the most dramatic evidence yet of the dangers of these still-popular pills.
Even women who took estrogen and progestin pills for as little as a couple of years had a greater chance of getting cancer. And when they stopped taking them, their odds quickly improved, returning to a normal risk level roughly two years after quitting.

Collectively, these new findings are likely to end any doubt that the risks outweigh the benefits for most women.
It is clear that breast cancer rates plunged in recent years mainly because millions of women quit hormone therapy and fewer newly menopausal women started on it, said the study's leader, Dr. Rowan Chlebowski of Harbor-UCLA Medical Center in Los Angeles.

"It's an excellent message for women: You can still diminish risk (by quitting), even if you've been on hormones for a long time," said Dr. Claudine Isaacs of Georgetown University's Lombardi Comprehensive Cancer Center. "It's not like smoking where you have to wait 10 or 15 years for the risk to come down."

Study results were given Saturday at the San Antonio Breast Cancer Symposium.
They are from the Women's Health Initiative, which tested estrogen and progestin pills that doctors long believed would prevent heart disease, bone loss and many other problems in women after menopause. The main part of the study was stopped in 2002 when researchers saw surprisingly higher risks of heart problems and breast cancer in hormone users.
Since then, experts have debated whether these risks apply to women who start on hormones when they enter menopause, usually in their 50s, and take them for shorter periods of time. Most of the women in the federal study were in their 60s and well past menopause.

So the advice has been to use hormones only if symptoms like hot flashes are severe, and at the lowest dose and shortest time possible. The new study sharpens that message, Chlebowski said.

"It does change the balance" on whether to start on treatment at all, he said.

Even so, most women will not get breast cancer by taking the pills short-term. The increased cancer risk from a couple of years of hormone use translates to a few extra cases of breast cancer a year for every 1,000 women on hormones. This risk accumulates with each year of use, though.

The Women's Health Initiative study had two parts. In one, 16,608 women closely matched for age, weight and other health factors were randomly assigned to take either Wyeth Pharmaceuticals' Prempro — estrogen and progestin — or dummy pills.
This part was halted when researchers saw a 26 percent higher risk of breast cancer in those on Prempro.

But that was an average over the 5 1/2 years women were on the pills. For the new study, researchers tracked 15,387 of these women through July 2005, and plotted breast cancer cases as they occurred over time.

They saw a clear trend: Risk rose with the start of use, peaked when the study ended and fell as nearly all hormone users stopped taking their pills. At the peak, the breast cancer risk for pill takers was twice that of the others.

Think of it as President Bush's public approval rating, said another study leader, Dr. Peter Ravdin of the University of Texas M.D. Anderson Cancer Center in Houston. "Bush's popularity may be 50 percent on average, but it might have been descending the whole time he was president," Ravdin said.

In the second part of the federal study, researchers observed just 16,121 women who had already been on hormones for an average of seven years and another group of 25,328 women who had never used them. No results on breast cancer risk in these women have been given until now.

Plotting cases over time, researchers saw in retrospect that hormone users had started out with twice the risk of breast cancer as the others, and it fell as use declined. Among those taking hormones at the start of the study, use dropped to 41 percent in 2003, the year after the main results made news.

In the general population, use of hormone products has dropped 70 percent since the study, said another of its leaders, Dr. JoAnn Manson, preventive medicine chief at Harvard's Brigham and Women's Hospital in Boston.
That corresponds with big drops in breast cancer cases, but some scientists have said this could be due to a fall-off in mammograms, which would mean fewer cancers were being detected, not necessarily that fewer were occurring.
The new study puts that theory to rest. Mammography rates were virtually the same among those taking hormones and those not.

"It is clear that changing mammography patterns cannot explain the dramatic reductions in breast cancer risk," Manson said.
"The data are getting stronger," said Dr. C. Kent Osborne, a breast cancer specialist at Baylor College of Medicine in Houston.
Women who do need the pills should not panic, though the doubling of risk — a 100 percent increase — for long-term users is quite worrisome, cancer specialists say. Although the new study does not calculate risks in terms of actual cases, previous research showed that the average increased risk of 26 percent meant a difference of a few extra cases a year for every 1,000 women on hormone pills, compared with nonusers.

"Hormone therapy remains a good health care choice to relieve moderate to severe menopausal symptoms," says a statement from Wyeth, which made the pills used in the study.

"Most women should be able to discontinue hormones in three to four years," or at least reduce their dose, Manson said.
A future analysis will look at other women in the study who took only estrogen, generally women who have had hysterectomies.

On the Net:
Cancer conference: http://www.sabcs.org
Hormone study: http://www.nhlbi.nih.gov/whi/estro_pro.htm

Saturday, December 6, 2008

Stress hits even before pregnancy


Premature birth can cause long-term health problems

Stress in the six months before conception increases the risk of giving birth prematurely, research suggests.
Mothers who experience a death or serious illness in the family before falling pregnant are more likely to have a preterm baby, a study found.

The link was particularly strong in mothers who had experienced "severe life events" in older children, the Human Reproduction journal reported.

Effects of stress hormones in the womb, may explain the findings, experts said.
Records from 1.35m mothers in Denmark were analysed in the study, which comes on the back of earlier research suggesting stress during pregnancy is a risk factor for premature birth.

Serious illness or death in older children in the six months prior to conception, increased the risk of birth before 37 weeks by 23% and the risk of birth before 33 weeks by 59%.

Death or illness in close relatives, such as parents, siblings or a partner in the last six months before becoming pregnant increased the risk of birth before 37 weeks by 16%.

Mothers who had experience stress and were also missing a parent or who did not have a partner were significantly more likely to have a premature birth, the study showed.

Hormones
The researchers suggested several possible explanations for the findings including increased levels of stress hormones or lifestyle changes in response to stress, such as increased consumption of tobacco or alcohol.

Study leader, Professor Philip Baker, from the Maternal and Fetal Health Research Group at the University of Manchester said most research to date had focused on stress during pregnancy.
"Yet these results suggest that the impact could be greater in the period preceding conception.
"Although relatively subtle its still a real effect."
He added they had chosen to look at death and serious illness in close relatives as they were undoubtedly very stressful events for anyone.

"This should help our understanding of the causes of premature birth," he added.
Tommy's, the baby charity, who funded the research said around 50,000 babies are born prematurely each year in the UK, putting them at risk of long-term health problems such as chronic lung disease, learning difficulties and blindness.
Ronald Lamont, consultant obstetrician at North West London Hospitals NHS Trust and spokesman for the Royal College of Obstetricians and Gynaecologists, said the results were a "little surprising".

"It's quite interesting and fits with what we knew about stress during pregnancy.
"The fact that the risk of pre-term birth was increased if pregnant women were missing a parent or partner shows the importance of close support."

Friday, December 5, 2008

Stem cell cure hope for back pain



Millions suffer debilitating back pain

A patient's own stem cells could soon be used to cure chronic back pain, say researchers.
The team from the University of Manchester hope their treatment will be available within three years.

They are perfecting a way to rebuild the soft shock-absorbing discs which separate the vertebrae in the spine.

Damage to these intervertebral discs (IVDs) is a common cause of debilitating low back pain which affects around 12 million in the UK.

BackCare
A treatment which effectively cured the problem could potentially save the UK economy as much as £5 billion a year.

The new therapy, developed by Dr Stephen Richardson, uses mesenchymal stem cells (MSCs) from adult bone marrow to regenerate spinal discs.

MSCs are a class of stem cell which can grow into many different cell types, including bone, cartilage, fat and muscle.

Dr Richardson has succeeded in turning MSCs into the cells which make up the gel-like nucleus pulposus (NP) tissue separating the vertebrae.

He plans to begin pre-clinical trials next year, with full patient trials to follow on.

Dr Richardson said: "Once we have extracted the bone marrow from the patient and have purified the MSCs, they will be grown in culture and our patented method of differentiation will be applied.

"They will then be embedded within a gel which can be implanted back into the patient."

No rejection

Since the stem cells are taken from the patient's own body, there is no chance of them being rejected by the immune system.

The gel is based on a natural collagen similar to one already used for the treatment of cartilage defects.

It is implanted using an arthroscope, a thin tube device slipped through a small incision in the back.

Dr Richardson said there was no reason why a patient should not return home on the same day as the procedure, or the day after.

He said: "Once implanted, the differentiated MSCs would produce a new NP tissue with the same properties as the original and would both treat the underlying cause of the disease and remove the painful symptoms."

Currently, low back pain is treated with a combination of painkillers, physiotherapy or surgery.

In severe cases tissue is removed to relieve the pain, or vertebrae fused together.

However, success is limited, and these techniques do not solve the root cause of the problem.

Dries Hettinga, research and information manager at the charity BackCare, said: "This is a really exciting area of research and although it is still early days, the initial results look very promising."