If parents smoke, chances are their adolescents will too. The study, “Parental Smoking and Adolescent Smoking Initiation: An Intergenerational Perspective on Tobacco Control,” looked at 564 adolescents enrolled in the New England Family Study.
The authors found that there is a direct link between parental smoking and initiation of smoking by adolescents.
The factors impacting the initiation of smoking by teens were parents who were active regular smokers and parents who smoked around their children before age 13. Fathers who smoke are more likely to influence teen boys than girls.
The authors conclude that this study can be used to encourage parents to quit smoking as part of an effort to curb the initiation of smoking among teens.
statements appearing in the February ssue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).
January 26, 2009, 12:01 am (ET)
Wednesday, April 28, 2010
Saturday, April 24, 2010
Codependency Flip
By: Drawk Kwast
I found myself on Wikipedia, researching the patterns for codependency, when I made a most interesting discovery. As an Alpha Male Life Coach, I basically teach the opposite of codependency. I teach inner-dependency (better known as independence). Here's where I took an interesting leap in logic. If a codependent person meets everyone else's needs at the exclusion of their own, wouldn't the opposite of this be a person who meets their needs to the exclusion of everyone else's? I had a huge problem with that conclusion because I don't consider being independent to go hand in hand with being a narcissist, a sociopath, or simply just not caring about others.
So let's start at the beginning. If I read the patterns for codependency, as listed in Wikipedia, and reverse them to reflect what I teach, I come up with the following list:
I easily identify how I am feeling and have no issue letting others know exactly how I feel.
I do not think it is selfish to take care of my needs. I know that my basic needs must be met before I will have the resources to help others.
I make quick decisions based on the best information I have available to me in that moment. I live without regret, because I know I made the best decision I could have at the time, even though new information after the fact may show my errors. I accept and value my failures as learning experiences.
I have no problem accepting praise for a job well done, but I don't let my ego distract me from getting back to work and making future advances.
I have no problem asking others for help. Only an idiot would drown rather than admit he doesn't know how to swim by asking for a life raft.
I have a list of people whose opinions I value based on past experience with them. I welcome their advice and criticism as a path to better my work and myself. The opinions of those whom I have not preselected are irrelevant and do not affect my mood or decisions. The things the average person will say about me reflect more on them than on me.
I am worthy of love, friendship, and enjoyable social interaction. My true value is in my ability to manage my emotional state and positively affect the emotional states of others.
I am open to explore the possibility that I may be wrong. I have no problem quickly letting go of incorrect concepts that I had previously been using to guide my actions. At the same time, I never compromise my integrity. I believe that those who don't have the balls to be hated don't deserve to be loved.
I place everything second to my life mission. A person aimlessly wandering around is not attractive to women or worthy of high-value male friends.
I know when to hold on to value that others don't see and when to let go of something that isn't enjoyable or moving me towards my goal. I am very loyal, but only to those who have shown themselves to deserve it.
I believe that no one cares about my goals as much as I do, nor should they, but I know when to call a specialist who will do a better job than I can.
It is easier to find people I resonate with rather than trying to convince others to see things my way. I understand the huge difference between letting go and giving up.
The best relationships are when neither person needs the other for anything. They are both completely independent. This leaves both people sure that the other person is with them just because they enjoy spending time together. The perfect romantic relationship is defined as two people accomplishing separate goals, together.
This list is interesting to me, because I have never categorized the results of what I teach in this way before. As I go though this little exercise, I am reminded what I think about the question if the human population is inherently good or inherently evil. I think that answer changes based on whether a person's self-perceived needs are being met or not. This is the outdated "moral" question of, "Is it ok for a man to steal bread to feed his family?" I remember back in my psychology 101 class answering that question with another question, "Is his family fat?"
I think that in general the human population will help its fellow man in a time of need. I think in times of crisis, we see those with resources helping those who truly need it. Hearing these stories makes us feel good to be part of the human race. I also think that if a man has to choose between letting his family suffer or hurting someone else to alleviate the suffering of his family, you will be amazed at what he will do. Nietzsche once said that the character of a man is not built out of the experiences he has had, but rather because of the experiences he has not had. He may be completely correct.
I think what it comes down to is simply this. When I travel by airplane, they always tell me to "secure my oxygen mask before helping secure the oxygen masks of others." I have never bothered to ask them why they say this. As an alpha male, I understand that if I pass out from lack of oxygen, I'm not going to be able to help very many people.
I'm honest with myself. I know that self preservation will always be top of the list. After that, though, life is a party, and a party without any guests is very boring. Treat your guests the same way you would want to be treated if you were at their party. True happiness is nothing more than your happiness reflected back to you through others. Click on the link below to get my free eBook as you find yourself ready to learn more.
Free eBook Here! Drawk Kwast is a life coach. His methods are unconventional, and he makes no apologies as he tells you how to dominate the competition at work, attract the most desirable women on the planet, and ultimately achieve a fulfilling life.
Smart Articles @ http://www.articlebrain.com
I found myself on Wikipedia, researching the patterns for codependency, when I made a most interesting discovery. As an Alpha Male Life Coach, I basically teach the opposite of codependency. I teach inner-dependency (better known as independence). Here's where I took an interesting leap in logic. If a codependent person meets everyone else's needs at the exclusion of their own, wouldn't the opposite of this be a person who meets their needs to the exclusion of everyone else's? I had a huge problem with that conclusion because I don't consider being independent to go hand in hand with being a narcissist, a sociopath, or simply just not caring about others.
So let's start at the beginning. If I read the patterns for codependency, as listed in Wikipedia, and reverse them to reflect what I teach, I come up with the following list:
I easily identify how I am feeling and have no issue letting others know exactly how I feel.
I do not think it is selfish to take care of my needs. I know that my basic needs must be met before I will have the resources to help others.
I make quick decisions based on the best information I have available to me in that moment. I live without regret, because I know I made the best decision I could have at the time, even though new information after the fact may show my errors. I accept and value my failures as learning experiences.
I have no problem accepting praise for a job well done, but I don't let my ego distract me from getting back to work and making future advances.
I have no problem asking others for help. Only an idiot would drown rather than admit he doesn't know how to swim by asking for a life raft.
I have a list of people whose opinions I value based on past experience with them. I welcome their advice and criticism as a path to better my work and myself. The opinions of those whom I have not preselected are irrelevant and do not affect my mood or decisions. The things the average person will say about me reflect more on them than on me.
I am worthy of love, friendship, and enjoyable social interaction. My true value is in my ability to manage my emotional state and positively affect the emotional states of others.
I am open to explore the possibility that I may be wrong. I have no problem quickly letting go of incorrect concepts that I had previously been using to guide my actions. At the same time, I never compromise my integrity. I believe that those who don't have the balls to be hated don't deserve to be loved.
I place everything second to my life mission. A person aimlessly wandering around is not attractive to women or worthy of high-value male friends.
I know when to hold on to value that others don't see and when to let go of something that isn't enjoyable or moving me towards my goal. I am very loyal, but only to those who have shown themselves to deserve it.
I believe that no one cares about my goals as much as I do, nor should they, but I know when to call a specialist who will do a better job than I can.
It is easier to find people I resonate with rather than trying to convince others to see things my way. I understand the huge difference between letting go and giving up.
The best relationships are when neither person needs the other for anything. They are both completely independent. This leaves both people sure that the other person is with them just because they enjoy spending time together. The perfect romantic relationship is defined as two people accomplishing separate goals, together.
This list is interesting to me, because I have never categorized the results of what I teach in this way before. As I go though this little exercise, I am reminded what I think about the question if the human population is inherently good or inherently evil. I think that answer changes based on whether a person's self-perceived needs are being met or not. This is the outdated "moral" question of, "Is it ok for a man to steal bread to feed his family?" I remember back in my psychology 101 class answering that question with another question, "Is his family fat?"
I think that in general the human population will help its fellow man in a time of need. I think in times of crisis, we see those with resources helping those who truly need it. Hearing these stories makes us feel good to be part of the human race. I also think that if a man has to choose between letting his family suffer or hurting someone else to alleviate the suffering of his family, you will be amazed at what he will do. Nietzsche once said that the character of a man is not built out of the experiences he has had, but rather because of the experiences he has not had. He may be completely correct.
I think what it comes down to is simply this. When I travel by airplane, they always tell me to "secure my oxygen mask before helping secure the oxygen masks of others." I have never bothered to ask them why they say this. As an alpha male, I understand that if I pass out from lack of oxygen, I'm not going to be able to help very many people.
I'm honest with myself. I know that self preservation will always be top of the list. After that, though, life is a party, and a party without any guests is very boring. Treat your guests the same way you would want to be treated if you were at their party. True happiness is nothing more than your happiness reflected back to you through others. Click on the link below to get my free eBook as you find yourself ready to learn more.
Free eBook Here! Drawk Kwast is a life coach. His methods are unconventional, and he makes no apologies as he tells you how to dominate the competition at work, attract the most desirable women on the planet, and ultimately achieve a fulfilling life.
Smart Articles @ http://www.articlebrain.com
Are you prepared for an Earthquake?
By: disasterstore Due to recent events in Haiti and the California coast, more and more people are becoming aware of the devastation a high magnitude earthquake can cause. Disasterrecoverystore.com has items for your home, automobile, and business to prepare for such a devastating event.
Earthquakes can happen anywhere in the world and no state is exempt from a possible earthquake. There are fault lines everywhere. In the last few weeks, beside Haiti, Illinios, California and Oklahoma felt earthquakes higher then a 3.0 magnitude earthquake. The days of feeling safe if you didn’t live in California, Alaska or another state that is known for earthquakes are long gone. It can happen anywhere. Disasterrecoverystore.com is here to make sure that you are well prepared for when the unthinkable happens...
It is important that you have several items on hand incase of an earthquake or any other disaster. Many government and safety agencies agree that there several items you should do prior to an earthquake.
• Strapping down water heater to wall studs, to prevent it from falling over.
• Bolting heavy and tall items that can fall during an earthquake (bookcases, china cabinets)
• Latches on cabinets, to avoid them opening and contents falling out or on people.
Besides securing heavy items in your house, every house should have certain essential items in some instances; you may not be able to leave where you were at the time of the earthquake. Disasterrecoverystore.com recommends that you have the following items, for that time.
• First Aid Kit (also include essential medication)
• Food and Water for all members of the household, including pets.(Ideally you should have a minimum of 3 days of food; this will include about 3 gallons worth of water per person / animal per day).
• Extra set of clothing for all members of the household
• Battery powered radio and flashlight with extra batteries.
• Instructions on how to turn off the water, gas and electricity should you be instructed to do so
• Any special items for members of the household (infants, elderly, disabled)
• Camping supplies in case your home is uninhabitable (camp stove, tent, sleeping bags etc…)
In this article we talked about what to have incase of that earthquake but what do you need to know when that earthquake strikes. The important things to remember is:
• DROP, COVER AND HOLD ON! The best thing to remember is to get under something sturdy, a desk, a table or a door jam (if you know it is a sturdy doorway). Do not stand near any heavy objects, a window, wires or anything that that if falls could injure you.
• If you are outside and can go inside do so, if you are inside do not go outside until the shaking has stopped.
• If you are in a vehicle, pull over away from any large trees, walls, bridges and utility lines.
Michael Gutkin at Disaster Recovery Store is the leading U.S. provider of Fire Safety kits, Emergency Kits, Survival Solutions and equipment offering customized first aid kits to the home, office, automobiles and your family.
Smart Articles @ http://www.articlebrain.com
Earthquakes can happen anywhere in the world and no state is exempt from a possible earthquake. There are fault lines everywhere. In the last few weeks, beside Haiti, Illinios, California and Oklahoma felt earthquakes higher then a 3.0 magnitude earthquake. The days of feeling safe if you didn’t live in California, Alaska or another state that is known for earthquakes are long gone. It can happen anywhere. Disasterrecoverystore.com is here to make sure that you are well prepared for when the unthinkable happens...
It is important that you have several items on hand incase of an earthquake or any other disaster. Many government and safety agencies agree that there several items you should do prior to an earthquake.
• Strapping down water heater to wall studs, to prevent it from falling over.
• Bolting heavy and tall items that can fall during an earthquake (bookcases, china cabinets)
• Latches on cabinets, to avoid them opening and contents falling out or on people.
Besides securing heavy items in your house, every house should have certain essential items in some instances; you may not be able to leave where you were at the time of the earthquake. Disasterrecoverystore.com recommends that you have the following items, for that time.
• First Aid Kit (also include essential medication)
• Food and Water for all members of the household, including pets.(Ideally you should have a minimum of 3 days of food; this will include about 3 gallons worth of water per person / animal per day).
• Extra set of clothing for all members of the household
• Battery powered radio and flashlight with extra batteries.
• Instructions on how to turn off the water, gas and electricity should you be instructed to do so
• Any special items for members of the household (infants, elderly, disabled)
• Camping supplies in case your home is uninhabitable (camp stove, tent, sleeping bags etc…)
In this article we talked about what to have incase of that earthquake but what do you need to know when that earthquake strikes. The important things to remember is:
• DROP, COVER AND HOLD ON! The best thing to remember is to get under something sturdy, a desk, a table or a door jam (if you know it is a sturdy doorway). Do not stand near any heavy objects, a window, wires or anything that that if falls could injure you.
• If you are outside and can go inside do so, if you are inside do not go outside until the shaking has stopped.
• If you are in a vehicle, pull over away from any large trees, walls, bridges and utility lines.
Michael Gutkin at Disaster Recovery Store is the leading U.S. provider of Fire Safety kits, Emergency Kits, Survival Solutions and equipment offering customized first aid kits to the home, office, automobiles and your family.
Smart Articles @ http://www.articlebrain.com
Statins Do Not Protect Against and May Increase Risk for Colorectal Adenomas
From Medscape Medical News
Nick Mulcahy
April 22, 2010 (Washington, DC) — Statins do not protect patients against colorectal adenomas, the benign precursors of colorectal cancer, and might increase the risk of developing them when used for 3 years or more, according to new research.
However, the increased risk is in need of further study, and not cause for patients to stop taking statins for cardiovascular benefit, said lead researcher Monica Bertagnolli, MD, who presented study results here at the American Association for Cancer Research (AACR) 101st Annual Meeting.
I would hate to take away a life-saving drug for a theoretical risk.
"The clear message is that statins save lives in patients with cardiovascular disease. I would hate to take away a life-saving drug for a theoretical risk," said Dr. Bertagnolli, chief of the Division of Surgical Oncology at Brigham and Women's Hospital and professor of surgery at Harvard Medical School in Boston, Massachusetts. She spoke to Medscape Oncology in the press room at AACR.
The new results come from the Adenoma Prevention with Celecoxib (APC) trial, which was primarily designed to evaluate whether the arthritis drug celecoxib (Celebrex, Pfizer) could be used to prevent colon cancer (N Engl J Med. 2006;355:873-884).
However, about a third of the 2035 patients in the study also took cholesterol-lowering statins.
The new statin results are from a planned secondary analysis of the ACP trial and were published online April 19 in Cancer Prevention Research to coincide with the presentation at the meeting.
The randomized placebo-controlled APC trial was designed to assess the effect of concomitant medications on the development of adenomas and other study end points, Dr. Bertagnolli explained.
To make this assessment, the investigators separated out the 679 placebo users, 221 of whom used statins.
Like the rest of the participants in the trial, the patients on placebo were at high risk for adenomas, and underwent colonoscopic surveillance for 5 years after study enrollment.
After adjustment for covariates, including cardioprotective aspirin use, age, and sex, participants in the placebo group who used statins at any time had no benefit over 5 years, compared with participants who had never used statins (risk ratio, 1.24; 95% confidence interval [CI], 0.99 - 1.56; P = .065)
"Statins definitely did not prevent adenomas," said Dr. Bertagnolli.
However, an increased risk for adenomas over the 5-year study period was found in a subset analysis of patients taking statins for more than 3 years (risk ratio, 1.39; 95% CI, 1.04 - 1.86; P = .024).
"We found more adenomas in this group," said Dr. Bertagnolli about the subset analysis. However, the finding was "intriguing only" and was in need of follow-up study, she said.
"We ought to study what happens to patients who take statins for more than 3 years," she said.
Accumulating Evidence or Final Word?
The results add to a literature that has mostly found statins not to be protective against colorectal neoplasia, according to an editorial that accompanies the study.
"The negative data that Bertagnolli et al provide add to the accumulating evidence that, at least overall, statins probably do not prevent colorectal neoplasia," writes John Baron, MD, of the Departments of Medicine and Community and Family Medicine at Dartmouth Medical School in Hanover, New Hampshire.
It is conceivable that there are benefits.
However, Dr. Baron did not entirely close the door on a chemoprotective effect of statins. "It is conceivable that there are benefits with high cumulative doses or in genetically defined subgroups," he writes.
Dr. Baron's reference to genetically defined subgroups is related to another paper, also published online April 19 in Cancer Prevention Research.
In that study, an international group of researchers looked at 40 genes "important to cholesterol synthesis and metabolism." It was an effort to explain the mixed results found in different observational studies of colorectal cancer risk and statin use.
The researchers found that the colorectal cancer–statin association varied according to genotype of the HMG-CoA reductase (HMGCR) gene, with relative risks varying from 0.30 to 0.60.
"It is theoretically possible that the variants might differ from population to population, and so explain the varying observational findings," summarized Dr. Baron about the study.
However, at the AACR meeting, Dr. Bertagnolli spoke very differently about any possible connection between statin use and adenomas. "We feel very confident that stains don't prevent adenomas," she said.
Also, in a press statement, Dr. Bertagnolli closed the door on the possibility of any chemoprotective effect. "Given our results, we do not think that it is reasonable to further study statins for chemoprevention of colorectal cancer, as the chance that they have this activity is very small."
Dr. Bertagnolli reports receiving research funding from Pfizer and from the National Cancer Institute for this study. Dr. Baron reports being either a consultant to or on the advisory board of Merck and Bayer.
American Association for Cancer Research 101st Annual Meeting. Abstract 1136. Presented April 19, 2010.
Cancer Prev Res. Published online April 19, 2010.
Nick Mulcahy
April 22, 2010 (Washington, DC) — Statins do not protect patients against colorectal adenomas, the benign precursors of colorectal cancer, and might increase the risk of developing them when used for 3 years or more, according to new research.
However, the increased risk is in need of further study, and not cause for patients to stop taking statins for cardiovascular benefit, said lead researcher Monica Bertagnolli, MD, who presented study results here at the American Association for Cancer Research (AACR) 101st Annual Meeting.
I would hate to take away a life-saving drug for a theoretical risk.
"The clear message is that statins save lives in patients with cardiovascular disease. I would hate to take away a life-saving drug for a theoretical risk," said Dr. Bertagnolli, chief of the Division of Surgical Oncology at Brigham and Women's Hospital and professor of surgery at Harvard Medical School in Boston, Massachusetts. She spoke to Medscape Oncology in the press room at AACR.
The new results come from the Adenoma Prevention with Celecoxib (APC) trial, which was primarily designed to evaluate whether the arthritis drug celecoxib (Celebrex, Pfizer) could be used to prevent colon cancer (N Engl J Med. 2006;355:873-884).
However, about a third of the 2035 patients in the study also took cholesterol-lowering statins.
The new statin results are from a planned secondary analysis of the ACP trial and were published online April 19 in Cancer Prevention Research to coincide with the presentation at the meeting.
The randomized placebo-controlled APC trial was designed to assess the effect of concomitant medications on the development of adenomas and other study end points, Dr. Bertagnolli explained.
To make this assessment, the investigators separated out the 679 placebo users, 221 of whom used statins.
Like the rest of the participants in the trial, the patients on placebo were at high risk for adenomas, and underwent colonoscopic surveillance for 5 years after study enrollment.
After adjustment for covariates, including cardioprotective aspirin use, age, and sex, participants in the placebo group who used statins at any time had no benefit over 5 years, compared with participants who had never used statins (risk ratio, 1.24; 95% confidence interval [CI], 0.99 - 1.56; P = .065)
"Statins definitely did not prevent adenomas," said Dr. Bertagnolli.
However, an increased risk for adenomas over the 5-year study period was found in a subset analysis of patients taking statins for more than 3 years (risk ratio, 1.39; 95% CI, 1.04 - 1.86; P = .024).
"We found more adenomas in this group," said Dr. Bertagnolli about the subset analysis. However, the finding was "intriguing only" and was in need of follow-up study, she said.
"We ought to study what happens to patients who take statins for more than 3 years," she said.
Accumulating Evidence or Final Word?
The results add to a literature that has mostly found statins not to be protective against colorectal neoplasia, according to an editorial that accompanies the study.
"The negative data that Bertagnolli et al provide add to the accumulating evidence that, at least overall, statins probably do not prevent colorectal neoplasia," writes John Baron, MD, of the Departments of Medicine and Community and Family Medicine at Dartmouth Medical School in Hanover, New Hampshire.
It is conceivable that there are benefits.
However, Dr. Baron did not entirely close the door on a chemoprotective effect of statins. "It is conceivable that there are benefits with high cumulative doses or in genetically defined subgroups," he writes.
Dr. Baron's reference to genetically defined subgroups is related to another paper, also published online April 19 in Cancer Prevention Research.
In that study, an international group of researchers looked at 40 genes "important to cholesterol synthesis and metabolism." It was an effort to explain the mixed results found in different observational studies of colorectal cancer risk and statin use.
The researchers found that the colorectal cancer–statin association varied according to genotype of the HMG-CoA reductase (HMGCR) gene, with relative risks varying from 0.30 to 0.60.
"It is theoretically possible that the variants might differ from population to population, and so explain the varying observational findings," summarized Dr. Baron about the study.
However, at the AACR meeting, Dr. Bertagnolli spoke very differently about any possible connection between statin use and adenomas. "We feel very confident that stains don't prevent adenomas," she said.
Also, in a press statement, Dr. Bertagnolli closed the door on the possibility of any chemoprotective effect. "Given our results, we do not think that it is reasonable to further study statins for chemoprevention of colorectal cancer, as the chance that they have this activity is very small."
Dr. Bertagnolli reports receiving research funding from Pfizer and from the National Cancer Institute for this study. Dr. Baron reports being either a consultant to or on the advisory board of Merck and Bayer.
American Association for Cancer Research 101st Annual Meeting. Abstract 1136. Presented April 19, 2010.
Cancer Prev Res. Published online April 19, 2010.
Folate and Vitamin B6 Lower Cardiovascular Risk
From Medscape Medical News
Emma Hitt, PhD
April 22, 2010 — Dietary intakes of folate and vitamin B6 reduce the risk for mortality from stroke and any cardiovascular disease in women and may reduce the risk for heart failure in men, according to a study conducted in Japan.
The findings were reported online April 15 in Stroke by Renzhe Cui, MD, from the Graduate School of Medicine at Osaka University, in Osaka, Japan, and colleagues.
"This study is the first to show that high dietary intakes of folate and vitamin B6 were associated with a reduced risk of heart failure mortality for men," the authors note.
Data from 23,119 men and 35,611 women (aged 40 - 79 years) who completed food frequency questionnaires as part of the Japan Collaborative Cohort study were analyzed. At a median 14 years of follow-up, 986 participants died from stroke, 424 died from coronary heart disease, and 2087 died from any cardiovascular disease.
Participants' intake of folate, vitamin B6, and vitamin B12 were classified into quintiles. Comparing the lowest vs the highest quintiles for each nutrient, the researchers found that higher consumption of folate and vitamin B6 was associated with significantly fewer deaths from heart failure in men, and significantly fewer deaths from stroke, heart disease, and any cardiovascular diseases in women. By contrast, vitamin B12 intake was not associated with reduced mortality risk.
The protective effects of folate and vitamin B6 remained significant after adjustment for the presence of cardiovascular risk factors and also after exclusion of supplement users (n = 7334) from the analysis.
The hazard ratios (HRs) of coronary heart disease for the highest vs the lowest quintiles were 0.62 (95% confidence interval [CI], 0.42 - 0.89) for folate, 0.51 (95% CI, 0.29 - 0.91) for vitamin B6, and 1.35 (95% CI, 0.80 - 2.27) for vitamin B12. The HRs of heart failure for the highest vs the lowest quintiles were 0.76 (95% CI, 0.51 - 1.13) for folate, 0.60 (95% CI, 0.32 - 1.13) for vitamin B6, and 1.57 (95% CI, 0.90 - 2.73) for vitamin B12.
"Mechanisms for these observed associations may involve the effects of these vitamin intakes on reduction of blood homocysteine concentrations," the researchers suggest.
This study has received grant funding from the Ministry of Education, Science, Sports and Culture of, Japan (Monbusho), Japanese Ministry of Education, Culture, Sports, Science, and Technology. The study authors have disclosed no relevant financial relationships.
Stroke. Published online April 15, 2010.
Emma Hitt, PhD
April 22, 2010 — Dietary intakes of folate and vitamin B6 reduce the risk for mortality from stroke and any cardiovascular disease in women and may reduce the risk for heart failure in men, according to a study conducted in Japan.
The findings were reported online April 15 in Stroke by Renzhe Cui, MD, from the Graduate School of Medicine at Osaka University, in Osaka, Japan, and colleagues.
"This study is the first to show that high dietary intakes of folate and vitamin B6 were associated with a reduced risk of heart failure mortality for men," the authors note.
Data from 23,119 men and 35,611 women (aged 40 - 79 years) who completed food frequency questionnaires as part of the Japan Collaborative Cohort study were analyzed. At a median 14 years of follow-up, 986 participants died from stroke, 424 died from coronary heart disease, and 2087 died from any cardiovascular disease.
Participants' intake of folate, vitamin B6, and vitamin B12 were classified into quintiles. Comparing the lowest vs the highest quintiles for each nutrient, the researchers found that higher consumption of folate and vitamin B6 was associated with significantly fewer deaths from heart failure in men, and significantly fewer deaths from stroke, heart disease, and any cardiovascular diseases in women. By contrast, vitamin B12 intake was not associated with reduced mortality risk.
The protective effects of folate and vitamin B6 remained significant after adjustment for the presence of cardiovascular risk factors and also after exclusion of supplement users (n = 7334) from the analysis.
The hazard ratios (HRs) of coronary heart disease for the highest vs the lowest quintiles were 0.62 (95% confidence interval [CI], 0.42 - 0.89) for folate, 0.51 (95% CI, 0.29 - 0.91) for vitamin B6, and 1.35 (95% CI, 0.80 - 2.27) for vitamin B12. The HRs of heart failure for the highest vs the lowest quintiles were 0.76 (95% CI, 0.51 - 1.13) for folate, 0.60 (95% CI, 0.32 - 1.13) for vitamin B6, and 1.57 (95% CI, 0.90 - 2.73) for vitamin B12.
"Mechanisms for these observed associations may involve the effects of these vitamin intakes on reduction of blood homocysteine concentrations," the researchers suggest.
This study has received grant funding from the Ministry of Education, Science, Sports and Culture of, Japan (Monbusho), Japanese Ministry of Education, Culture, Sports, Science, and Technology. The study authors have disclosed no relevant financial relationships.
Stroke. Published online April 15, 2010.
Folate and Vitamin B6 Lower Cardiovascular Risk
From Medscape Medical News
Emma Hitt, PhD
April 22, 2010 — Dietary intakes of folate and vitamin B6 reduce the risk for mortality from stroke and any cardiovascular disease in women and may reduce the risk for heart failure in men, according to a study conducted in Japan.
The findings were reported online April 15 in Stroke by Renzhe Cui, MD, from the Graduate School of Medicine at Osaka University, in Osaka, Japan, and colleagues.
"This study is the first to show that high dietary intakes of folate and vitamin B6 were associated with a reduced risk of heart failure mortality for men," the authors note.
Data from 23,119 men and 35,611 women (aged 40 - 79 years) who completed food frequency questionnaires as part of the Japan Collaborative Cohort study were analyzed. At a median 14 years of follow-up, 986 participants died from stroke, 424 died from coronary heart disease, and 2087 died from any cardiovascular disease.
Participants' intake of folate, vitamin B6, and vitamin B12 were classified into quintiles. Comparing the lowest vs the highest quintiles for each nutrient, the researchers found that higher consumption of folate and vitamin B6 was associated with significantly fewer deaths from heart failure in men, and significantly fewer deaths from stroke, heart disease, and any cardiovascular diseases in women. By contrast, vitamin B12 intake was not associated with reduced mortality risk.
The protective effects of folate and vitamin B6 remained significant after adjustment for the presence of cardiovascular risk factors and also after exclusion of supplement users (n = 7334) from the analysis.
The hazard ratios (HRs) of coronary heart disease for the highest vs the lowest quintiles were 0.62 (95% confidence interval [CI], 0.42 - 0.89) for folate, 0.51 (95% CI, 0.29 - 0.91) for vitamin B6, and 1.35 (95% CI, 0.80 - 2.27) for vitamin B12. The HRs of heart failure for the highest vs the lowest quintiles were 0.76 (95% CI, 0.51 - 1.13) for folate, 0.60 (95% CI, 0.32 - 1.13) for vitamin B6, and 1.57 (95% CI, 0.90 - 2.73) for vitamin B12.
"Mechanisms for these observed associations may involve the effects of these vitamin intakes on reduction of blood homocysteine concentrations," the researchers suggest.
This study has received grant funding from the Ministry of Education, Science, Sports and Culture of, Japan (Monbusho), Japanese Ministry of Education, Culture, Sports, Science, and Technology. The study authors have disclosed no relevant financial relationships.
Stroke. Published online April 15, 2010.
Emma Hitt, PhD
April 22, 2010 — Dietary intakes of folate and vitamin B6 reduce the risk for mortality from stroke and any cardiovascular disease in women and may reduce the risk for heart failure in men, according to a study conducted in Japan.
The findings were reported online April 15 in Stroke by Renzhe Cui, MD, from the Graduate School of Medicine at Osaka University, in Osaka, Japan, and colleagues.
"This study is the first to show that high dietary intakes of folate and vitamin B6 were associated with a reduced risk of heart failure mortality for men," the authors note.
Data from 23,119 men and 35,611 women (aged 40 - 79 years) who completed food frequency questionnaires as part of the Japan Collaborative Cohort study were analyzed. At a median 14 years of follow-up, 986 participants died from stroke, 424 died from coronary heart disease, and 2087 died from any cardiovascular disease.
Participants' intake of folate, vitamin B6, and vitamin B12 were classified into quintiles. Comparing the lowest vs the highest quintiles for each nutrient, the researchers found that higher consumption of folate and vitamin B6 was associated with significantly fewer deaths from heart failure in men, and significantly fewer deaths from stroke, heart disease, and any cardiovascular diseases in women. By contrast, vitamin B12 intake was not associated with reduced mortality risk.
The protective effects of folate and vitamin B6 remained significant after adjustment for the presence of cardiovascular risk factors and also after exclusion of supplement users (n = 7334) from the analysis.
The hazard ratios (HRs) of coronary heart disease for the highest vs the lowest quintiles were 0.62 (95% confidence interval [CI], 0.42 - 0.89) for folate, 0.51 (95% CI, 0.29 - 0.91) for vitamin B6, and 1.35 (95% CI, 0.80 - 2.27) for vitamin B12. The HRs of heart failure for the highest vs the lowest quintiles were 0.76 (95% CI, 0.51 - 1.13) for folate, 0.60 (95% CI, 0.32 - 1.13) for vitamin B6, and 1.57 (95% CI, 0.90 - 2.73) for vitamin B12.
"Mechanisms for these observed associations may involve the effects of these vitamin intakes on reduction of blood homocysteine concentrations," the researchers suggest.
This study has received grant funding from the Ministry of Education, Science, Sports and Culture of, Japan (Monbusho), Japanese Ministry of Education, Culture, Sports, Science, and Technology. The study authors have disclosed no relevant financial relationships.
Stroke. Published online April 15, 2010.
Secondhand Smoke Exposure Linked to Chronic Rhinosinusitis
From Medscape Medical News
Laurie Barclay, MD
April 21, 2010 — Secondhand smoke exposure is linked to chronic rhinosinusitis, according to the results of a matched case-control study reported in the April issue of Archives of Otolaryngology–Head & Neck Surgery.
"Most studies of the associations between SHS [secondhand smoke] exposure and respiratory disease in adults have investigated odor and irritation, respiratory symptoms, lung function, asthma, chronic obstructive pulmonary disease, and lung cancer," write C. Martin Tammemagi, DVM, MSc, PhD, from Brock University in St. Catharines, Ontario, Canada, and colleagues. "Few studies have focused on chronic rhinosinusitis (CRS), although evidence suggests that such a relationship may exist."
The goal of this study was to evaluate the association of secondhand smoke with chronic rhinosinusitis using conditional logistic regression odds ratios (ORs). At the Henry Ford Health System in Detroit, Michigan, 306 nonsmoking patients diagnosed with an incident case of chronic rhinosinusitis were matched by age, sex, and race/ethnicity to 306 nonsmoking control subjects. The primary endpoints were exposure to secondhand smoke for the 5 years before diagnosis of chronic rhinosinusitis in case patients and before study entry in control subjects, in the home, work place, public places, and private social functions outside the home.
There was a strong, independent dose-response relationship between chronic rhinosinusitis and the number of venues where secondhand smoke exposure occurred (OR per 1 of 4 levels, 2.03; 95% CI, 1.55 - 2.66). Secondhand smoke appeared to account for approximately 40.0% of chronic rhinosinusitis.
"Exposure to SHS is common and significantly independently associated with CRS," the study authors write. "These findings have important clinical and public health implications."
Limitations of this study include retrospective design, possible recall bias, inability to determine whether the associations between secondhand smoke and chronic rhinosinusitis differed by causal subtype, and lack of biologic measurements of secondhand smoke exposure.
"On the basis of our findings, physicians should recommend that patients who are susceptible to CRS or who have CRS avoid exposure to SHS," the study authors conclude. "The dose-response relationship between SHS and CRS indicates that even modest levels of exposure carry some risk."
A grant from the Flight Attendant Medical Research Institute to study coauthor Ronald M. Davis, MD, supported this study. The other study authors have disclosed no relevant financial relationships.
Arch Otolaryngol Head Neck Surg. 2010;136:327-334. Abstract
Laurie Barclay, MD
April 21, 2010 — Secondhand smoke exposure is linked to chronic rhinosinusitis, according to the results of a matched case-control study reported in the April issue of Archives of Otolaryngology–Head & Neck Surgery.
"Most studies of the associations between SHS [secondhand smoke] exposure and respiratory disease in adults have investigated odor and irritation, respiratory symptoms, lung function, asthma, chronic obstructive pulmonary disease, and lung cancer," write C. Martin Tammemagi, DVM, MSc, PhD, from Brock University in St. Catharines, Ontario, Canada, and colleagues. "Few studies have focused on chronic rhinosinusitis (CRS), although evidence suggests that such a relationship may exist."
The goal of this study was to evaluate the association of secondhand smoke with chronic rhinosinusitis using conditional logistic regression odds ratios (ORs). At the Henry Ford Health System in Detroit, Michigan, 306 nonsmoking patients diagnosed with an incident case of chronic rhinosinusitis were matched by age, sex, and race/ethnicity to 306 nonsmoking control subjects. The primary endpoints were exposure to secondhand smoke for the 5 years before diagnosis of chronic rhinosinusitis in case patients and before study entry in control subjects, in the home, work place, public places, and private social functions outside the home.
There was a strong, independent dose-response relationship between chronic rhinosinusitis and the number of venues where secondhand smoke exposure occurred (OR per 1 of 4 levels, 2.03; 95% CI, 1.55 - 2.66). Secondhand smoke appeared to account for approximately 40.0% of chronic rhinosinusitis.
"Exposure to SHS is common and significantly independently associated with CRS," the study authors write. "These findings have important clinical and public health implications."
Limitations of this study include retrospective design, possible recall bias, inability to determine whether the associations between secondhand smoke and chronic rhinosinusitis differed by causal subtype, and lack of biologic measurements of secondhand smoke exposure.
"On the basis of our findings, physicians should recommend that patients who are susceptible to CRS or who have CRS avoid exposure to SHS," the study authors conclude. "The dose-response relationship between SHS and CRS indicates that even modest levels of exposure carry some risk."
A grant from the Flight Attendant Medical Research Institute to study coauthor Ronald M. Davis, MD, supported this study. The other study authors have disclosed no relevant financial relationships.
Arch Otolaryngol Head Neck Surg. 2010;136:327-334. Abstract
Friday, April 16, 2010
Despite Progress, Half a Million Women Still Die in Childbirth Annually
From Medscape Medical News
Megan Brooks
April 15, 2010 — A report released this week provides some sobering statistics on global maternal and infant mortality rates: an estimated 350,000 to 500,000 women still die in childbirth each year, 3.6 million newborns die in the first month of life, and an additional 5.2 million children die before the age of 5 years.
It will take an infusion of cash — about $20 billion annually — and widespread adoption of known and proven therapies and preventive measures to substantially reduce maternal and child deaths worldwide, according to the report, released ahead of a June meeting in Canada of world leaders at which maternal and child health problems will take center stage.
The new report, discussed Wednesday at the United Nations, comes from members of Countdown to 2015, a global scientific and advocacy group formed in 2005 to track global progress in reducing maternal, newborn, and child deaths — 2 of the Millennium Development Goals set by 189 member nations of the UN General Assembly in 2000.
Although considerable progress has been made toward meeting other Millennium Development Goals, the 2 goals on maternal and child survival have lagged behind, the report states. Progress on curbing maternal and infant mortality has been particularly slow in sub-Saharan Africa and South Asia.
According to the United Nations Children's Fund, 135 countries have child mortality rates of less than 40 per 1000 live births or have a rate reduction sufficient to meet the goal of two-thirds reduction by 2015. However, at this time, 39 countries show insufficient progress, and 18 show no progress or worsening child mortality rates.
Countdown to 2015 focuses on 68 countries, most in Africa, which together account for 92% of maternal, newborn, and child deaths. Members of the group held discussions with world leaders at the United Nations in New York April 14 to focus attention on the toll of maternal and child mortality and to advance an action plan.
At the meeting, US Department of Health and Human Services Secretary Kathleen Sebelius said: "This is one of the greatest human rights issues of our times. The hundreds of thousands of deaths each year among women due to complications of pregnancy and childbirth, the devastating lifelong consequences among millions more, and the millions of children who will die from preventable causes, are among our greatest moral and development challenges, and they highlight the world's lingering inequity."
"Because we know what causes these deaths and what would prevent them, major progress is possible," Jennifer Bryce, EdD, MEd, a child health researcher at Johns Hopkins University, Baltimore, Maryland, and a member of Countdown to 2015, noted in a prepared statement. "The Countdown analysis provides a road map, helping countries focus on their own data and take action to meet their specific needs."
"This is a multi-layered problem that can be addressed with a combination of many, very simple interventions," stated Flavia Bustreo, MD, director of the World Health Organization's Partnership for Maternal, Newborn & Child Health, a group of more than 300 organizations, foundations, institutions, and countries that is one of the leaders in the effort to cut maternal and infant mortality rates.
"No single intervention is sufficient," added Zulfiqar Bhutta, MD, PhD, from Pakistan's Aga Khan University and cochair of Countdown to 2015. "What is required is a seamless continuum of care including family planning, breastfeeding, hand washing, skilled attendance at delivery, and childhood immunizations. There are multiple therapies and practices that have been proven to save lives, and the use of national data can prioritize which ones will make the biggest difference in the shortest time."
Although donor countries have increased their funding for maternal, newborn, and child health by almost 100%, to $4 billion a year from 2003 to 2007, the funding gap will be about $20 billion per year between 2011 and 2015, which includes both maternal and child health programs and the cost of improving health systems. A financing task force created in 2008 is working to increase funding to help close the gap, the report notes.
A related report published in The Lancet this week found accelerated decreases in maternal mortality in China, Egypt, Ecuador, and Bolivia. Secretary Sebelius commented at the April 14 UN meeting: "This week's Lancet article suggests that in many parts of the world, we are making some progress in saving women's lives. It is up to us in this room to escalate our efforts and accelerate sustainable progress toward Millennium Development Goals 4 and 5."
In a letter posted on the Partnership for Maternal, Newborn & Child Health Web site, Dr. Bustreo echoed these sentiments: "The Lancet has published an important article...reporting significant progress in reducing the unacceptably high number of maternal deaths in many low income countries. Although debate may continue about the numbers, it is clear that the new estimates offer hope at last that the lives of women are finally being counted and that our collective actions are starting to reduce this tragedy in the new millennium. These encouraging results are no reason for complacency. Now is the time to redouble our efforts."
However, The Lancet study also found surprising increases in maternal mortality in the United States, Canada, and Denmark, which may be partially explained by changes in documentation of pregnancy-related deaths in at least one of these countries.
In a telephone interview with Medscape Ob/Gyn & Women's Health, Renee Brown-Bryant, MSW, associate director of heath communications in the Division of Reproductive Health at the Centers for Disease Control and Prevention, Atlanta, Georgia, said caution is needed in interpreting these new US data.
"One thing to consider," she said, "is that states are required to put a checkbox on death certificates to see if a woman was pregnant at the time of her death. You're going to have a check in the box, in some states, if, for example, the coroner says the woman was pregnant when there was a fatal accident and that may or may not be pregnancy related."
In the United States, Ms. Brown-Bryant noted, "we've seen a drop (in maternal mortality) near the end of the twentieth century but we didn't see a continued drop. We have not had the decline that we would want to have, but some people would say where we are is a far cry from where we were 100 years ago, and even 35 years ago."
Megan Brooks
April 15, 2010 — A report released this week provides some sobering statistics on global maternal and infant mortality rates: an estimated 350,000 to 500,000 women still die in childbirth each year, 3.6 million newborns die in the first month of life, and an additional 5.2 million children die before the age of 5 years.
It will take an infusion of cash — about $20 billion annually — and widespread adoption of known and proven therapies and preventive measures to substantially reduce maternal and child deaths worldwide, according to the report, released ahead of a June meeting in Canada of world leaders at which maternal and child health problems will take center stage.
The new report, discussed Wednesday at the United Nations, comes from members of Countdown to 2015, a global scientific and advocacy group formed in 2005 to track global progress in reducing maternal, newborn, and child deaths — 2 of the Millennium Development Goals set by 189 member nations of the UN General Assembly in 2000.
Although considerable progress has been made toward meeting other Millennium Development Goals, the 2 goals on maternal and child survival have lagged behind, the report states. Progress on curbing maternal and infant mortality has been particularly slow in sub-Saharan Africa and South Asia.
According to the United Nations Children's Fund, 135 countries have child mortality rates of less than 40 per 1000 live births or have a rate reduction sufficient to meet the goal of two-thirds reduction by 2015. However, at this time, 39 countries show insufficient progress, and 18 show no progress or worsening child mortality rates.
Countdown to 2015 focuses on 68 countries, most in Africa, which together account for 92% of maternal, newborn, and child deaths. Members of the group held discussions with world leaders at the United Nations in New York April 14 to focus attention on the toll of maternal and child mortality and to advance an action plan.
At the meeting, US Department of Health and Human Services Secretary Kathleen Sebelius said: "This is one of the greatest human rights issues of our times. The hundreds of thousands of deaths each year among women due to complications of pregnancy and childbirth, the devastating lifelong consequences among millions more, and the millions of children who will die from preventable causes, are among our greatest moral and development challenges, and they highlight the world's lingering inequity."
"Because we know what causes these deaths and what would prevent them, major progress is possible," Jennifer Bryce, EdD, MEd, a child health researcher at Johns Hopkins University, Baltimore, Maryland, and a member of Countdown to 2015, noted in a prepared statement. "The Countdown analysis provides a road map, helping countries focus on their own data and take action to meet their specific needs."
"This is a multi-layered problem that can be addressed with a combination of many, very simple interventions," stated Flavia Bustreo, MD, director of the World Health Organization's Partnership for Maternal, Newborn & Child Health, a group of more than 300 organizations, foundations, institutions, and countries that is one of the leaders in the effort to cut maternal and infant mortality rates.
"No single intervention is sufficient," added Zulfiqar Bhutta, MD, PhD, from Pakistan's Aga Khan University and cochair of Countdown to 2015. "What is required is a seamless continuum of care including family planning, breastfeeding, hand washing, skilled attendance at delivery, and childhood immunizations. There are multiple therapies and practices that have been proven to save lives, and the use of national data can prioritize which ones will make the biggest difference in the shortest time."
Although donor countries have increased their funding for maternal, newborn, and child health by almost 100%, to $4 billion a year from 2003 to 2007, the funding gap will be about $20 billion per year between 2011 and 2015, which includes both maternal and child health programs and the cost of improving health systems. A financing task force created in 2008 is working to increase funding to help close the gap, the report notes.
A related report published in The Lancet this week found accelerated decreases in maternal mortality in China, Egypt, Ecuador, and Bolivia. Secretary Sebelius commented at the April 14 UN meeting: "This week's Lancet article suggests that in many parts of the world, we are making some progress in saving women's lives. It is up to us in this room to escalate our efforts and accelerate sustainable progress toward Millennium Development Goals 4 and 5."
In a letter posted on the Partnership for Maternal, Newborn & Child Health Web site, Dr. Bustreo echoed these sentiments: "The Lancet has published an important article...reporting significant progress in reducing the unacceptably high number of maternal deaths in many low income countries. Although debate may continue about the numbers, it is clear that the new estimates offer hope at last that the lives of women are finally being counted and that our collective actions are starting to reduce this tragedy in the new millennium. These encouraging results are no reason for complacency. Now is the time to redouble our efforts."
However, The Lancet study also found surprising increases in maternal mortality in the United States, Canada, and Denmark, which may be partially explained by changes in documentation of pregnancy-related deaths in at least one of these countries.
In a telephone interview with Medscape Ob/Gyn & Women's Health, Renee Brown-Bryant, MSW, associate director of heath communications in the Division of Reproductive Health at the Centers for Disease Control and Prevention, Atlanta, Georgia, said caution is needed in interpreting these new US data.
"One thing to consider," she said, "is that states are required to put a checkbox on death certificates to see if a woman was pregnant at the time of her death. You're going to have a check in the box, in some states, if, for example, the coroner says the woman was pregnant when there was a fatal accident and that may or may not be pregnancy related."
In the United States, Ms. Brown-Bryant noted, "we've seen a drop (in maternal mortality) near the end of the twentieth century but we didn't see a continued drop. We have not had the decline that we would want to have, but some people would say where we are is a far cry from where we were 100 years ago, and even 35 years ago."
Wednesday, April 7, 2010
Breast Cancer Surveillance Recommended When Chest Irradiated for Cancer Early in Life
From Medscape Medical News
Nick Mulcahy
April 6, 2010 — Women treated with chest radiation for cancer during childhood, adolescence, or young adulthood have a substantially elevated risk for breast cancer at a relatively young adult age, according to a new systematic review on the subject.
The increased risk is found as early as 8 years after chest radiation and does "not plateau with increasing length of follow-up," according to the review authors, led by Kevin C. Oeffinger, MD, director of the Adult Long-Term Follow-Up Program in the Departments of Pediatrics and Medicine at the Memorial Sloan-Kettering Cancer Center in New York City.
The cumulative incidence of breast cancer by 40 to 45 years in these women ranged from 13% to 20%.
This incidence is similar to that in women with a BRCA gene mutation.
"This incidence is similar to that in women with a BRCA gene mutation," write Dr. Oeffinger and his colleagues from the Children's Oncology Group (COG).
The review, which is published in the April 6 issue of the Annals of Internal Medicine, noted that about two thirds of these women were initially treated for Hodgkin's lymphoma. Their breast cancer risk increased linearly with the dose of the earlier chest radiation.
The COG reports that "there seems to be a benefit from early detection" in these patients. Thus, when there is radiation of 20 Gy or more early in life, the COG recommends annual surveillance mammography and magnetic resonance imaging (MRI) starting either at the age of 25 years or 8 years after completion of radiation therapy, whichever occurred last.
Nevertheless, this approach to annual surveillance is a recommendation with caveats.
"Too little is understood about the potential harms," write the COG authors about screening-related false-positives, additional unnecessary testing and biopsies, and the emotional and economic costs.
And there is also the matter of giving more radiation to these women via mammograms.
"Another potential harm is the additional risk for radiation-induced breast cancer," write the authors.
A standard 2-view mammogram exposes a woman to about 3.85 mGy.
"A standard 2-view mammogram exposes a woman to about 3.85 mGy," Dr. Oeffinger told Medscape Oncology.
Women who start receiving surveillance at the age of 25 would have at least 15 more mammographies than women who undergo usual screening, which begins at the age of 40, note the authors.
However, as the COG authors note, findings from researchers who have looked at the "detected-induced [breast cancer] ratio" from mammography are probably not applicable to the population of women treated with high doses of therapeutic radiation. In short, the ratio is unknown.
"Further research is required to better define the harms and benefits of lifelong surveillance," say the authors about the variety of unknowns, including the effects of mammography-related radiation exposure.
Still, given the COG recommendation for these women to start early surveillance with mammography and MRI, these experts endorse annual screening. "Limited evidence indicates that specialized surveillance will benefit this high-risk population," they write.
Study Findings and the Need to Intervene
Clinicians who want to discuss breast cancer risk and surveillance with these women first need to know the history of chest radiation for cancer during childhood, adolescence, and young adulthood.
The women need to know it too, write the study authors, so "interventions" are needed.
At Memorial Sloan-Kettering, women are provided with a summary of their earlier cancer treatment and risks, and a recommendation for surveillance, according to Dr. Oeffinger. "We give our patients a 1-page summary with this information and discuss it with them. The surveillance rate of our women exceeds 90%," he said.
To assess breast cancer risk in this population, Dr. Oeffinger and his COG colleagues looked at 11 retrospective cohort studies and 3 case–control studies. The cohort studies consisted of more than 14,000 women, 7,000 of whom received chest radiation for some kind of cancer before the year 2000. There were 422 women who subsequently developed breast cancer.
Among the "higher-quality" cohort studies, the standardized incidence ratio ranged from 13.3 to 55.5 per 10,000 person-years, and the absolute excess risk ranged from 18.6 to 79.0 per 10,000 person-years.
One of the case–control studies found that, among women who received a diagnosis of Hodgkin's lymphoma at the age of 15 and were counseled to undergo screening at the age of 25, 9.2% of those who received 20 to 39 Gy and 11.1% of those who received 40 Gy or more would develop breast cancer by the age 45.
Receiving radiation to the chest for cancer in childhood is not protective, compared with receiving radiation in adolescence, observe the authors.
"Risk in women treated before puberty is not lower than that in those treated during adolescence, as suggested by some early studies," they write. Studies with extended years of follow-up have not found a difference in breast cancer risk between women treated with chest radiation before puberty and those treated in adolescence, they note.
With regard to the clinical characteristics of breast cancer in these women and the outcomes after diagnosis, the authors found that "available limited evidence" suggests that they are similar to those of women in the general population."
The study was funded by the National Cancer Institute. Dr. Oeffinger has disclosed no relevant financial relationships.
Ann Intern Med. 2010;152:444-455.
Nick Mulcahy
April 6, 2010 — Women treated with chest radiation for cancer during childhood, adolescence, or young adulthood have a substantially elevated risk for breast cancer at a relatively young adult age, according to a new systematic review on the subject.
The increased risk is found as early as 8 years after chest radiation and does "not plateau with increasing length of follow-up," according to the review authors, led by Kevin C. Oeffinger, MD, director of the Adult Long-Term Follow-Up Program in the Departments of Pediatrics and Medicine at the Memorial Sloan-Kettering Cancer Center in New York City.
The cumulative incidence of breast cancer by 40 to 45 years in these women ranged from 13% to 20%.
This incidence is similar to that in women with a BRCA gene mutation.
"This incidence is similar to that in women with a BRCA gene mutation," write Dr. Oeffinger and his colleagues from the Children's Oncology Group (COG).
The review, which is published in the April 6 issue of the Annals of Internal Medicine, noted that about two thirds of these women were initially treated for Hodgkin's lymphoma. Their breast cancer risk increased linearly with the dose of the earlier chest radiation.
The COG reports that "there seems to be a benefit from early detection" in these patients. Thus, when there is radiation of 20 Gy or more early in life, the COG recommends annual surveillance mammography and magnetic resonance imaging (MRI) starting either at the age of 25 years or 8 years after completion of radiation therapy, whichever occurred last.
Nevertheless, this approach to annual surveillance is a recommendation with caveats.
"Too little is understood about the potential harms," write the COG authors about screening-related false-positives, additional unnecessary testing and biopsies, and the emotional and economic costs.
And there is also the matter of giving more radiation to these women via mammograms.
"Another potential harm is the additional risk for radiation-induced breast cancer," write the authors.
A standard 2-view mammogram exposes a woman to about 3.85 mGy.
"A standard 2-view mammogram exposes a woman to about 3.85 mGy," Dr. Oeffinger told Medscape Oncology.
Women who start receiving surveillance at the age of 25 would have at least 15 more mammographies than women who undergo usual screening, which begins at the age of 40, note the authors.
However, as the COG authors note, findings from researchers who have looked at the "detected-induced [breast cancer] ratio" from mammography are probably not applicable to the population of women treated with high doses of therapeutic radiation. In short, the ratio is unknown.
"Further research is required to better define the harms and benefits of lifelong surveillance," say the authors about the variety of unknowns, including the effects of mammography-related radiation exposure.
Still, given the COG recommendation for these women to start early surveillance with mammography and MRI, these experts endorse annual screening. "Limited evidence indicates that specialized surveillance will benefit this high-risk population," they write.
Study Findings and the Need to Intervene
Clinicians who want to discuss breast cancer risk and surveillance with these women first need to know the history of chest radiation for cancer during childhood, adolescence, and young adulthood.
The women need to know it too, write the study authors, so "interventions" are needed.
At Memorial Sloan-Kettering, women are provided with a summary of their earlier cancer treatment and risks, and a recommendation for surveillance, according to Dr. Oeffinger. "We give our patients a 1-page summary with this information and discuss it with them. The surveillance rate of our women exceeds 90%," he said.
To assess breast cancer risk in this population, Dr. Oeffinger and his COG colleagues looked at 11 retrospective cohort studies and 3 case–control studies. The cohort studies consisted of more than 14,000 women, 7,000 of whom received chest radiation for some kind of cancer before the year 2000. There were 422 women who subsequently developed breast cancer.
Among the "higher-quality" cohort studies, the standardized incidence ratio ranged from 13.3 to 55.5 per 10,000 person-years, and the absolute excess risk ranged from 18.6 to 79.0 per 10,000 person-years.
One of the case–control studies found that, among women who received a diagnosis of Hodgkin's lymphoma at the age of 15 and were counseled to undergo screening at the age of 25, 9.2% of those who received 20 to 39 Gy and 11.1% of those who received 40 Gy or more would develop breast cancer by the age 45.
Receiving radiation to the chest for cancer in childhood is not protective, compared with receiving radiation in adolescence, observe the authors.
"Risk in women treated before puberty is not lower than that in those treated during adolescence, as suggested by some early studies," they write. Studies with extended years of follow-up have not found a difference in breast cancer risk between women treated with chest radiation before puberty and those treated in adolescence, they note.
With regard to the clinical characteristics of breast cancer in these women and the outcomes after diagnosis, the authors found that "available limited evidence" suggests that they are similar to those of women in the general population."
The study was funded by the National Cancer Institute. Dr. Oeffinger has disclosed no relevant financial relationships.
Ann Intern Med. 2010;152:444-455.
Subscribe to:
Posts (Atom)