Weekly curry 'may fight dementia

Eating a curry once or twice a week could help prevent the onset of Alzheimer's disease and dementia, a US researcher suggests.

The key ingredient is curcumin, a component of the spice turmeric.

Curcumin appears to prevent the spread of amyloid protein plaques - thought to cause dementia - in the brain.

But the theory, presented at the Royal College of Psychiatrists' annual meeting, has been given a lukewarm reception by UK experts.

“ If you have a good diet and take plenty of exercise, eating curry regularly could help prevent dementia ”
Professor Murali Doraiswamy Duke University
Amyloid plaques, along with tangles of nerve fibres, are thought to contribute to the degradation of the wiring in brain cells, eventually leading to symptoms of dementia.

Professor Murali Doraiswamy, of Duke University in North Carolina, said there was evidence that people who eat a curry meal two or three times a week have a lower risk of dementia.

He said researchers were testing the impact of higher doses - the equivalent of going on a curry spree for a week - to see if they could maximise the effect.

Animal studies

Professor Doraiswamy told the meeting: "There is very solid evidence that curcumin binds to plaques, and basic research on animals engineered to produce human amyloid plaques has shown benefits."

"You can modify a mouse so that at about 12 months its brain is riddled with plaques.

"If you feed this rat a curcumin-rich diet it dissolves these plaques. The same diet prevented younger mice from forming new plaques.

"The next step is to test curcumin on human amyloid plaque formation using newer brain scans and there are plans for that."

Professor Doraiswamy said a clinical trial was now underway at the University of California, Los Angeles, to test curcumin's effects in Alzheimer's patients.

He said research had also examined turmeric's therapeutic potential for treating conditions such as cancer and arthritis.

Good diet

He stressed that eating a curry could not counter-balance the increased risk of dementia associated with a poor diet.

“ Indian communities that regularly eat curcumin have a surprisingly low incidence of Alzheimer's disease but we don't yet know why ”
Dr Susanne Sorensen Alzheimer's Society
However, he said: "If you have a good diet and take plenty of exercise, eating curry regularly could help prevent dementia."

Professor Doraiswamy predicted it might be possible to develop a curry pill which had the same therapeutic effect.

However, Rebecca Wood, of the Alzheimer's Research Trust, stressed that people would need to eat a lot of curry - over 100g of turmeric curry powder - to get a clinical dose of curcumin.

She said: "Professor Doraiswamy's unpublished research applies only to animal models; his hypothesis has not been confirmed in human clinical trials.

"We look forward to the results of the human curcumin trial at UCLA."

Dr Susanne Sorensen, of the Alzheimer's Society, said: "Indian communities that regularly eat curcumin have a surprisingly low incidence of Alzheimer's disease but we don't yet know why.

"Alzheimer's Society is keen to explore the potential benefits of curcumin in protecting the brain and we are conducting our own research into this area.

"A cheap, accessible and safe treatment could transform the quality of life of thousands of people with the condition."

How soup can help you lose weight

By Jack Challoner

In the battle to lose weight, hunger is the dieter's worst enemy. But research has revealed a simple aid to taming the appetite: soup. It's dieting's best kept secret says one science writer.

Imagine a typical lunchtime meal - say, chicken and vegetables with a glass of water. If you eat the food and drink the water, you will feel full for a couple of hours before hunger kicks in. But if you blend the food with the water - to make soup - you will stay hunger-free for much longer, and less likely to snack through the afternoon.

How can blending the food into soup make such a difference? The answer lies in the stomach. Scientists have used ultrasound and MRI scans of people's stomachs to investigate what happens after eating solid-food-plus-water meals compared with the same food made into soup.

After you eat a meal, the pyloric sphincter valve at the bottom of your stomach holds food back so that the digestive juices can get to work. Water, however, passes straight through the sphincter to your intestines, so drinking water does not contribute to "filling you up".

When you eat the same meal as a soup, the whole mixture remains in the stomach, because the water and food are blended together. The scientists' scans confirm that the stomach stays fuller for longer, staving off those hunger pangs.
The key to this low-tech weapon against hunger is a hormone called ghrelin. It is one of the major players in the body's appetite system.

Discovered as recently as 1999, ghrelin is released by specialised cells in the stomach wall.

'Cupcake circuit'
These cells produce a constant stream of ghrelin whenever the stomach is empty. The ghrelin travels via the blood stream to the brain's appetite centre, an organ called the hypothalamus. As a result, the hypothalamus screams "You are hungry - find food."

But whenever the stomach wall is stretched - when the stomach is full - the cells stop producing ghrelin, and the hypothalamus responds accordingly, turning off the appetite signal. The longer the stomach remains full, the longer you feel satisfied and the less you are likely to eat.

WHICH VARIETY IS BEST?
Vegetable soup is best
It produces a more consistent blend
And it generally has fewer calories than chicken or fish soup

The stomach gradually empties, more slowly for the soup than the solid meal plus water. The BBC staged an experiment for the programme 10 Things You Need to Know About Losing Weight to test this theory. In this experiment, and in previous experiments, participants reported feeling full for up to an hour-and-a-half longer than their solid meal counterparts.
Although some researchers refer to appetite as "the cupcake circuit", the mechanism behind human appetite evolved long before cupcakes were invented - at a time when food was scarce.

As a result, we are hardwired to eat high-calorie foods, which are unfortunately so abundant in the modern world.
Finding ways to control the appetite signal is crucial if we are to stave off the meteoric rise in obesity. Food scientists and pharmaceutical companies alike are on a major quest to find ways to do just that.

Could soup help address obesity?
Appetite is one of the most researched areas of weight-loss science. Unfortunately, the appetite system is complex, and still poorly understood.

There are probably dozens of hormones that play a role in regulating appetite. Of those that have already been discovered, there is one that is released after eating protein-rich meals (called PYY), one that is released by fat cells (leptin) and several that respond to the presence of any kind of food.

But of all the hormones that make up the appetite system, it is ghrelin that has caused the most interest. In addition to its role in sending the "stomach empty" signal to the brain, ghrelin also promotes fat storage. Even worse, it inhibits the breakdown of stored fat during times of weight loss. Inject ghrelin into the bloodstream of a rat and the animal eats insatiably - and quickly becomes obese.

In 2006, scientists at the Scripps Research Centre in the US developed a vaccine to counteract the influence of ghrelin, in an attempt to control appetite. It is still undergoing clinical trials - so for now, the best and simplest way to keep hunger at bay is to reduce your stomach's release of ghrelin: blend your food into a healthy, voluminous soup. The best sort? Vegetable soup, as it produces a more consistent blend and is generally lower calorie than chicken or fish soup.
Jack Challoner is a science writer and author of the website explaining-science.co.uk.

When Unhealthy Foods Hijack Overeaters' Brains

Food hijacked Dr. David Kessler's brain. Not apples or carrots. The scientist who once led the government's attack on addictive cigarettes can't wander through part of San Francisco without craving a local shop's chocolate-covered pretzels. Stop at one cookie? Rarely. It's not an addiction but it's similar, and he's far from alone.

Kessler's research suggests millions share what he calls "conditioned hypereating" — a willpower-sapping drive to eat high-fat, high-sugar foods even when they're not hungry. In a book being published next week, the former Food and Drug Administration chief brings to consumers the disturbing conclusion of numerous brain studies: Some people really do have a harder time resisting bad foods. It's a new way of looking at the obesity epidemic that could help spur fledgling movements to reveal calories on restaurant menus or rein in portion sizes.

"The food industry has figured out what works. They know what drives people to keep on eating," Kessler tells The Associated Press. "It's the next great public health campaign, of changing how we view food, and the food industry has to be part of it." He calls the culprits foods "layered and loaded" with combinations of fat, sugar and salt — and often so processed that you don't even have to chew much. Overeaters must take responsibility, too, and basically retrain their brains to resist the lure, he cautions. "I have suits in every size," Kessler writes in "The End of Overeating." But, "once you know what's driving your behavior, you can put steps into place" to change it.

At issue is how the brain becomes primed by different stimuli. Neuroscientists increasingly report that fat-and-sugar combinations in particular light up the brain's dopamine pathway — its pleasure-sensing spot — the same pathway that conditions people to alcohol or drugs. Where did you experience the yum factor? That's the cue, sparking the brain to say, "I want that again!" as you drive by a restaurant or plop before the TV. "You're not even aware you've learned this," says Dr. Nora Volkow, chief of the National Institute on Drug Abuse and a dopamine authority who has long studied similarities between drug addiction and obesity.

Volkow is a confessed chocoholic who salivates just walking past her laboratory's vending machine. "You have to fight it and fight it," she said. Conditioning isn't always to blame. Numerous factors, including physical activity, metabolism and hormones, play a role in obesity. And the food industry points out that increasingly stores and restaurants are giving consumers healthier choices, from allowing substitutions of fruit for french fries to selling packaged foods with less fat and salt. But Kessler, now at the University of California, San Francisco, gathered colleagues to help build on that science and learn why some people have such a hard time choosing healthier:
First, the team found that even well-fed rats will work increasingly hard for sips of a vanilla milkshake with the right fat-sugar combo but that adding sugar steadily increases consumption. Many low-fat foods substitute sugar for the removed fat, doing nothing to help dieters eat less, Kessler and University of Washington researchers concluded.
Then Kessler culled data from a major study on food habits and health. Conditioned hypereaters reported feeling loss of control over food, a lack of satiety, and were preoccupied by food. Some 42 percent of them were obese compared to 18 percent without those behaviors, says Kessler, who estimates that up to 70 million people have some degree of conditioned hypereating.
Finally, Yale University neuroscientist Dana Small had hypereaters smell chocolate and taste a chocolate milkshake inside a brain-scanning MRI machine. Rather than getting used to the aroma, as is normal, hypereaters found the smell more tantalizing with time. And drinking the milkshake didn't satisfy. The reward-anticipating region of their brains stayed switched on, so that another brain area couldn't say, "Enough!"

People who aren't overweight can be conditioned hypereaters, too, Kessler found — so it's possible to control. Take Volkow, the chocolate-loving neuroscientist. She's lean, and a self-described compulsive exerciser. Physical activity targets the dopamine pathway, too, a healthy distraction. Smoking didn't start to drop until society's view of it as glamorous and sexy started changing, to view the habit as deadly, Kessler notes. Unhealthy food has changed in the other direction. Foods high in fat, sugar and salt tend to be cheap; they're widely sold; and advertising links them to good friends and good times, even as social norms changed to make snacking anytime, anywhere acceptable. Retrain the brain to think, "I'll hate myself if I eat that," Kessler advises. Lay down new neural reward circuits by substituting something else you enjoy, like a bike ride or a healthier food. Make rules to resist temptation: "I'm going to the mall but bypassing the food court." And avoid cues for bad eating whenever possible. Always go for the nachos at your friends' weekend gathering spot? Start fresh at another restaurant. "I've learned to eat things I like but things I can control," Kessler says. But he knows the old circuitry dies hard: "You stress me enough and I'll go pick up that bagel."

What is the failure rate after lumbar disc replacement surgery?

Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM, Goldfarb N, Vaccaro AR, Hilibrand AS. Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine 2008;33:1701-7.

Hypothetically, lumbar disc arthroplasty should serve to preserve motion and thereby ultimately avoid stress and degeneration of the adjacent segment. It is expected that disc replacement would be better than fusion.

Recent research, however, suggests serious shortfalls with disc replacement.

A 3-year follow-up period found that patients who received lumbar disc replacement experienced a high failure rate (33% experienced serious postoperative pain). In another recent study, Shim reported a high progression rate of facet joint osteoarthritis for prosthesis in more than 32% of all patients. This high incidence of facet degeneration after an average follow-up of less than 4 years was too short to be explained by the natural course of degeneration.

In a study examining surgical disc replacement after 17 years, there was a 60% rate of spontaneous ankylosis and a reoperation rate of 11%.

The extremely high rate of spontaneous ankylosis (unintended surgical fusion of sorts) is opposite from the result this surgical scheme is attempting to produce. Moreover, a systematic review by an international medical team suggests that the data on disc replacement argue for caution by patients and surgeons.

Enzyme behind cancer spread found

Scientists say they have identified an enzyme that helps cancer spread around the body.
Cancer metastasis, where the cancer spreads from its original location, is known to be responsible for 90% of cancer-related deaths.
Institute of Cancer Research scientists have found that an enzyme called LOX is crucial in promoting metastasis, Cancer Cell journal reports.

Drugs to block this enzyme's action could keep cancer at bay, they hope.
The researchers studied breast cancer in mice, but are confident that their findings will apply to humans with other cancer types too.

LOX (lysyl oxidase) works by sending out signals to prepare a new area of the body for the cancer to set up a camp. Without this preparation process the new environment would be too hostile for the cancer to grow.
Lead researcher Dr Janine Erler described the discovery as "the crucial missing piece in the jigsaw that scientists have been searching for."

She said it was the first time one key enzyme has been identified as responsible for effectively allowing the cancer to spread.
"If we can interrupt the body's ability to prepare new locations for the cancer to spread to, we can effectively prevent cancer metastasis.

"Cancer metastasis is very difficult to treat and this new discovery provides real hope that we can develop a drug which will fight the spreading of cancer," she said.

Dr Julie Sharp, Cancer Research UK's science information manager, said: "A better understanding of how cancer spreads is crucial to improving the treatment of the disease. This research takes scientists a step closer to understanding this major problem - the next stage will be to find out if the LOX protein can be switched off to stop cancer spreading."

Scans 'no aid for back pain care'

Check this out! The National Institute for Clinical Excellence (NICE) recommends "Manual Therapy" first in their guidelines for Low Back Pain. Study after study has shown that chiropractic is the gold standard for manual therapy. Nice of them to do that!

Scans should be reserved for 'serious conditions', the study says
The routine use of scans in patients with lower back pain does not improve their outcomes, US scientists say.
They looked at six trials including more than 1,800 patients and found no benefit from the scans when patients were followed for up to a year.
Previous studies in the UK have shown similar results.
The National Institute for Clinical Excellence (NICE) is expected to publish guidelines on the treatment of lower back pain in May.
The researchers said the results were most applicable to the type of acute lower back pain assessed by a GP.
They looked at pain, function, quality of life, mental health, overall patient-reported improvement and patient satisfaction in the care they received for up to a year after their initial treatment.
All the patients were randomised to receive either immediate scans or standard clinical care.
Some of the standard care group were offered scans if they had not improved within three weeks.
They did not find significant differences between immediate imaging with X-ray or MRI scans and usual clinical care either in the short-term - up to three months later, or the long-term - six to 12 months.
Existing guidelines
Imaging in the first month of low back pain is not recommended in the US or in draft guidelines from NICE that were published in October.

DRAFT NICE GUIDELINES ON BACK PAIN
Consider course of manual therapy
Consider course of acupuncture
Consider structured exercise programme
Do not offer an X-ray
MRI only for suspected spinal fusion or other serious underlying condition

Dr Roger Chou, lead researcher from the Oregon Health and Science University said some doctors still do it routinely, "possibly because they aim to reassure their patients and themselves, to meet patient expectations about tests or because reimbursement structures provide financial incentives to image".
He added: "Clinicians should refrain from routine, immediate lumbar imaging in patients with acute or sub-acute low back pain and without features suggesting a serious underlying condition."
In the paper published in the Lancet, the researchers say rates of MRI scans for back pain are rising according to figures from US medical programme Medicare.
They think patient expectations and preferences for imaging should be addressed, because in one trial 80% of patients with low back pain would undergo radiography if given the choice.
"Educational interventions could be effective for reducing the proportion of patients with low back pain who believe that routine imaging should be done."
UK experience
It is estimated that 40% to 50% of the population in the UK experience back pain in any given year.
With normal clinical care 80% of them will recover within six weeks.
The remaining five million go on to have back pain that needs some sort of help and investigation.
Dr Dries Hettinga, head of research at the UK charity Backcare, said: "While back pain is very common, we still have a very poor understanding of this condition and its causes.
"Health professionals play a vital role in reassuring patients.
"While it may seem that sending patients for an X-ray or MRI can provide this reassurance, the scans often reveal very little.
"With the right information and support, most people are able to manage their pain and find that it gets better within days or weeks."
The draft guidelines from NICE say X-ray and MRI investigations of the spine should be limited to when tumours, breaks, fusions or serious inflammation and infection is suspected.
It advises all people with lower back pain to exercise, if necessary in supervised groups, and that doctors should be able to offer a course of manual therapy or acupuncture.

Acupuncture 'works for headaches

Acupuncture is a widely used alternative therapy
Traditional acupuncture is effective at preventing headaches, a scientific review finds - but so is a sham form.
The Cochrane Review reviewed 33 separate trials into acupuncture and its so-called "sham" counterpart.
The latter also involves the insertion of needles - but not into traditional "energy points".
The scientist leading the review said the results showed that putting needles into particular locations might not be that important.

British Medical Accupuncture Society
Acupuncture is still regarded as a "complementary" therapy, but is increasingly being viewed as a potential mainstream treatment for certain conditions, such as chronic pain.
The endorsement by the Cochrane Collaboration is likely to lead to further calls for it to be made more widely available on the NHS.

The traditional explanation of its effects involves tapping into a network of "meridians" around the body to regulate the flow of an energy called "chi". Acupuncture points are located at various positions along these meridians.
However, many modern acupuncture specialists believe that the insertion of needles actually cause subtle changes in the nervous system and brain activity which can be beneficial - and place needles in other parts of the body rather than concentrating solely on traditional acupuncture points.

The Cochrane reviews involved a total of 6,736 patients, who were given acupuncture to prevent either mild to moderate "tension" headaches, or migraine attacks.
Following a course of at least eight weeks, acupuncture patients suffered fewer headaches than those given only painkillers.

'Not a sham'
Acupuncture was also superior to preventative drug treatments in migraine, the reviewers concluded.
However, acupuncture relying on non-traditional needle positions was just as good as the traditional variety in preventing tension headaches, and almost as good in the migraine patients.

Dr Klaus Linde, from the Centre for Complementary Medicine Research at the Technical University of Munich in Germany, said that much of the benefit for both might be due to a "placebo effect", in which the experience itself of being treated can produce results independently of the effects of the treatment.
He said: "Much of the clinical benefit of acupuncture might be due to non-specific needling effects and powerful placebo effects, meaning that the selection of specific needle points may be less important than many practicioners have traditionally argued."

Dr Mike Cummings, medical director of the British Medical Acupuncture Society, welcomed the research.
He said that the differences between so-called "true" and "fake" acupuncture remained controversial within the profession.
"I think that, quite literally, many practioners have missed the point in the past.

"We certainly don't call what we do 'sham' acupuncture, as we believe there is growing evidence for a mechanism behind what we do.

"However, we still don't fully understand what is happening when needles are inserted, although these reviews suggest that for certain conditions, it is effective."

All that "core" muscle strengthening... a waste of time?

This is the second study from a reputaible journal that I've seen that casts doubt on the notion that weak trunk muscle strength is related to lower back pain. Maybe all that core strenghtening is unnecessary. Here's the study.
 
Paalanne N, Korpelainen R, Taimela S, Remes J, Mutanen P, Karppinen J. "Isometric trunk muscle strength and body sway in relation to low back pain in young adults." Spine. 2008 Jun 1;33(13):E435-41.
Department of Sports Medicine, Deaconess Institute of Oulu, Oulu, Finland.
nikopaal@mail.student.oulu.fi

STUDY DESIGN: A cross-sectional study on young adults.

OBJECTIVE: To evaluate the relationships between low back pain (LBP), maximal isometric trunk muscle strength, and body sway among young adults.

SUMMARY OF BACKGROUND DATA: The
results of previous studies evaluating the association between trunk muscle strength and LBP are conflicting and heterogeneous. Furthermore, there are only few studies on the association between body sway and LBP.

METHODS: The subjects
(n = 874) belonged to a subcohort of the Northern Finland Birth Cohort 1986 (mean age 19 years). Trunk muscle strength and body sway were measured from all subjects. LBP symptoms were inquired with a questionnaire, which was completed
concurrently with the examinations. Latent Class Analysis (LCA) was used to cluster the subjects according to their LBP symptoms. RESULTS: LCA analysis produced 6 clusters differing with respect to LBP symptoms. There were no
statistically significant differences between the clusters in trunk muscle strength or body sway.

CONCLUSION: LBP does not seem to be associated with maximal isometric trunk muscle strength or body sway in young adults.

Fat Facts

In 2006, the surgeon general called obesity "the terror within" and said it could "dwarf 9/11 or any other terrorist attempt."

A recent anti-obesity ad campaign featured a "suicide bomber" with bars of butter strapped to his chest.

A 2002 study found that 13% of men and 17% of women of recruitment age are too fat to serve in the military.

In 1997, the World Health Organization teamed up with the International Obesity Task Force to redefine obesity standards. "Overweight" was defined as a body mass index (BMI) of 25 or more, down from 27.8.

70% of the Obesity Task Force's funding comes from the two drug companies that make the popular weight-loss pills Xenical, Meridia, and Reductil.

In 1998, the US government adopted the new BMI standards, spurring fears of an "obesity epidemic."

That move was hailed by the American Obesity Association, a lobbying group that's received funding from Weight Watchers and Jenny Craig.

Sarah Hartshorne, a "plus size" contestant on America's Next Top Model, has a BMI of 21.5—well within the "normal" range.

Recent studies have attributed obesity to low-fat foods, lack of sleep, ear infections, intestinal bacteria, pollution, plastics, poverty, air conditioners, socializing with obese people, your mom's age when you were born, and your maternal grandmother's diet.

Researchers say obese Americans contribute disproportionately to global warming by consuming 18% more food and 938 million extra gallons of gas every year.

Southwest Airlines requires customers "who compromise any portion of adjacent seating" to buy 2 seats.

People who weigh more than 220 lbs are 150% less likely to survive a car crash than those under 130 lbs.

All 157 West Virginia public middle schools use the video game Dance Dance Revolution in gym classes.

Schools in Pennsylvania, Delaware, South Carolina, and Tennessee send "obesity report cards" to parents.

One Pennsylvania school district that does so serves pizza and churros for breakfast.

The federal government's list of banned foods in school cafeterias doesn't include fries, candy bars, or chocolate chip cookies.

In 2005, Sesame Street changed Cookie Monster's theme song from "C Is for Cookie" to "A Cookie Is a Sometime Food."

In 2005, British doctors said a 15-year-old who'd eaten only jam sandwiches and Pop-Tarts since he was 4 was totally healthy, except for an iron deficiency.

A 2008 study on "brideorexia" found that 70% of brides-to-be try to lose weight. Almost 1/4 try fasting, pills, or laxatives.

First-time users of Alli, a new over-the-counter fat-blocking pill, are advised to "wear dark pants, and bring a change of clothes with you to work."

People consume an average of 28% more calories when eating snacks labeled "low fat," in part because they mistakenly think they're eating fewer calories.

In 2007, T.G.I. Fridays rolled out a "Right Portion" Cajun pasta dish with 4 times more fat than the USDA's daily recommendation.

People served soup in bowls that secretly refilled ate 73% more than those eating from normal bowls. But they felt just as full afterward.

The "Diet Fork" has dull teeth and an uncomfortable grip that force eaters to "scoop less."

"Diet glasses," whose blue tint makes food look less appealing, were big in Japan last year.

Gwyneth Paltrow, Madonna, and Christina Aguilera wear $250 sneakers by Masai Barefoot Technology, which claims they burn cellulite.

The net worths of white women whose BMIs fall 10 points increase by an average of $11,800.

Christian weight-loss books include What Would Jesus Eat? and More of Jesus, Less of Me.

25 minutes of daily Islamic prayers burns 80 calories.

ChastitySF.com, a Catholic site, tells dieters to imagine a "Purgatory where every unnecessary mouthful of food you have ever taken will be purged from you as flaming vomit."

Liquids account for 22% of the average American's daily calories.

After New York City made eateries post nutritional data, a survey found that 80% of diners were surprised that a Big Mac meal had 1,200 calories.

A recent Burger King commercial included the line, "I will eat this meat until my innie turns into an outie."

Last year, a Republican Mississippi state legislator proposed prohibiting restaurants from serving obese people.

Researchers asked 3,000 overweight people how they responded to discrimination; 79% said they ate more.

Active obese people are almost 50% less likely to die of heart disease than sedentary thin people.

Playboy Playmates of the Year selected during tough social and economic times are heavier and have larger waists.

When the Dow lost nearly 778 points in one day last September, every S&P 500 company went down—except Campbell's Soup.

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