Dialysis patients with metabolic syndrome

St. Louis, Mo. – March 07, 2007 - A study of kidney dialysis patients found that nearly 70 percent had metabolic syndrome, a set of symptoms that is a predictor of cardiovascular disease, at the time they initiated maintenance dialysis. This information further illuminates the relationship between heart and kidney disease, as dialysis patients are already known to have an elevated risk of cardiovascular problems.

“Metabolic syndrome is a term we apply to anyone having three of the following five criteria: abdominal obesity, elevated triglyceride levels, low HDL cholesterol (also known as “good cholesterol”) levels, high blood pressure, or high blood glucose after fasting,” says study author Dr. Daniel Young. The study also showed that white, female and diabetic dialysis patients showed the highest incidence of metabolic syndrome.

Dr. Young sees potential to use metabolic syndrome as a medical diagnostic tool. “Checking new dialysis patients for these criteria may assist us in identifying the patients most vulnerable to cardiovascular disease in this population.” In addition, he suggests that additional research involving metabolic syndrome and the earlier stages of kidney disease may yield important insights into the diagnosis of kidney disease itself.

Mammography, Ultrasound Finds More Breast

TUESDAY, May 13 (HealthDay News) -- While undoubtedly lifesaving for many women, mammography is far from perfect. But, undergoing breast ultrasound in addition to standard mammography can find more cancers in high-risk women, particularly those with dense breast tissue, a new study found.

But, the study authors noted, ultrasound also significantly increases the rate of false-positive readings.

"In our study participants, half of the breast cancers were found using mammography alone. By adding ultrasound, we found 78 percent of the cancers," said the study's lead author, Dr. Wendie Berg, a radiologist at an outpatient center in Lutherville, Md., affiliated with Johns Hopkins Medical Center.

However, identifying those extra cancers came with a cost of significantly more false-positive readings.

"With mammography, a woman has about a one in 40 chance that a biopsy will turn out not to be cancer. With the addition of ultrasound, it's one in 10," Berg said.

Results of the study, which was funded by the Avon Foundation and the U.S. National Cancer Institute, were published in the May 14 issue of the Journal of the American Medical Association.

Each year, more than 180,000 American women are diagnosed with breast cancer, and almost 41,000 will lose their lives to the disease. Death rates from breast cancer have been declining, possible due to earlier detection and diagnosis, according to the American Cancer Society.

The new study included almost 3,000 women recruited from 21 centers. The average age was 55 years old, and all of the women had a higher-than-normal risk of breast cancer.

The women were randomly assigned to receive either mammography alone or mammography plus ultrasound performed by a physician.

Forty women were diagnosed with breast cancer within a year of their initial screening. Mammography alone uncovered 20 cancers, 50 percent, while the combination screening technique found 31 of the cancers, or about 78 percent, according to the study.

That means for every woman screened, mammography alone will find 7.6 cancers, mammography plus ultrasound will detect 11.8 cancers, and three cancers will be missed altogether, the researchers said.

The study found that ultrasound was a good complementary screening tool for mammography, because it found cancers that mammography might miss.

"Ultrasound performs best in cases for which mammography performs weakest, i.e., in breast areas with dense fibroglandular tissue," Dr. Christiane Kuhl, with the Department of Radiology at the University of Bonn in Germany, wrote in an accompanying editorial in the journal. Kuhl also noted that the drawbacks to ultrasound include the frequency of false-positives, the cost of the test, and a lack of evidence that the test affects mortality.

Berg noted that there aren't currently enough physicians or ultrasound technicians trained for ultrasound to be a viable, widely used screening tool right now, even just for high-risk women.

"On average, physicians can only perform three to five ultrasounds per hour," said Berg, compared to as many as 50 mammograms in an hour, according to the editorial.

Dr. Julia Smith, director of the Lynne Cohen Breast Cancer Preventative Care Program at the New York University Cancer Institute and Bellevue Hospital in New York City, said, "I already do ultrasounds on women at risk. As a complementary test, ultrasound can be a very useful test. Also, we know it's relatively inexpensive and safe."

Magnetic resonance imaging (MRI) may be more effective than either mammography or ultrasound, and it's fast becoming a popular tool for breast cancer screening, but, Smith said, the cost of MRI is prohibitive.

Given limited health-care resources, Kuhl wrote that "mammography will probably remain the basis for breast cancer screening for the foreseeable future."

Smith said what's most important is for women to talk with their doctors about their individual risk of breast cancer, and then decide which screening tests would be most appropriate.

cervical cancer

The results, published today in the prestigious international journal Lancet, show that while the vaccine provides effective protection against high grade cervical pre-cancerous lesions caused by human papillomavirus (HPV) types 16 and 18, it also demonstrated additional protection against infections from other strains of HPV that account for another 10 percent of cervical cancers.

The Perth component of the international study was conducted by the Vaccine Trials Group at the Telethon Institute for Child Health Research in collaboration with Princess Margaret Hospital and King Edward Memorial Hospital.

Report co-author Dr Rachel Skinner, who headed the Perth trial, said the results were very encouraging.

“We have found through this study that this vaccine is extremely effective in the prevention of pre-cancerous disease of the cervix due to infection with HPV types 16 and 18,” Dr Rachel Skinner said.

“However we now have evidence that Cervarix offers women broader protection by providing some protection against infections caused by HPV types 45 and 31. These types together with HPV types 16 and 18 account for 80 per cent of cases of cervical cancer worldwide.

“Not only will vaccinated women potentially benefit from a high level of protection against cervical cancer, they will also benefit from a reduction in abnormal Pap smears. However it is crucial that women who choose vaccination continue with regular Paps as the vaccine does not provide complete protection against cervical cancer.”

The international study is the single largest cervical cancer vaccine efficacy study with over 18,000 women aged 15-25 years involved from all corners of the globe, including Europe, Asia Pacific, Latin and North America and women from six centres throughout Australia.

The Therapeutic Goods Adminstration has now approved Cervarix for women aged 10-45 years, making it the first vaccine in Australia available for women over the age of 26 years.

Cellular atypia of the breast predictive of cancer

Several previous studies have shown that atypical hyperplasia (also called atypia) in breast tissue is a major risk factor for breast cancer. Women who have a breast biopsy and are diagnosed with atypia are considered at high risk. Many are counseled to consider preventive medications such as tamoxifen or other risk-reducing approaches. However, questions remained from prior research on whether a positive family history further increases risk in women with atypia and for how long the increased risk in women with atypia lasts.

“The most commonly used tool for risk prediction in women with atypia is the Gail model, which may predict inaccurately because our study shows that family history does not change risk significantly in women with atypia,” says Amy Degnim, M.D., a Mayo Clinic surgeon and study author. “Our findings indicate that women with atypia have a higher absolute risk for breast cancer than previously estimated. This risk is 25 percent over 25 years and is much higher in women with multiple areas of atypia and calcification.” The Gail model predicts risk by using age at onset of menses, age at birth of first child, number of previous breast biopsies, presence of atypia, and number of close relatives with breast cancer.

While the Mayo Clinic study found that family history did not further increase risk, age at diagnosis of atypia did affect risk, with younger women (under age 45) more than twice as likely to develop breast cancer compared to women diagnosed with atypia after 55. The number of areas of atypical hyperplasia was significant as well. With one area of atypia, breast cancer risk was 2.3-fold compared to the general population; this risk more than doubled when two sites were found and increased to nearly eightfold as sites increased to three or more. The group of women with the highest risk had three or more areas of atypia and calcification -- with a 10.4-fold risk over the general population.

“With the ability to stratify the risk of breast cancer in women with atypia, we can have more informed discussions with our patients regarding their personal risk,” says Dr. Degnim. “This will help us to have individualized discussions regarding how aggressively to pursue risk-reduction treatments.”

These findings resulted from reviewing the records of 331 women with atypia identified within the Mayo cohort of 9,376 women who had benign breast biopsies surgically obtained between 1967 and 1991. More than half (55.9 percent) of the women were over age 55 when diagnosed with atypia, and 42.9 percent had a family history of breast cancer. The majority (68.6 percent) of women showed calcification in the biopsy tissue, and 40 percent had multiple sites of atypical hyperplasia.

The American Cancer Society reports that more than 240,000 women will be diagnosed in the United States this year with breast cancer, and more than 40,000 will die from it. Dr. Degnim and her fellow researchers have been working to better understand the steps that precede breast cancer and which of them can be recognized in benign breast tissue. The current study contributes to Mayo’s emerging model that seeks to define every woman’s risk more precisely and to tailor screening and risk-reduction measures to women depending on their individual risks.

Health Tip: Treating an Ulcer

(HealthDay News) -- Ulcers are sores that occur in the lining of the digestive tract. They can be triggered by factors such as bacteria, medication or excess production of stomach acid.

If you have an ulcer, here are things you should discuss with your doctor to promote healing, courtesy of the American Academy of Family Physicians:

• Medications can help ulcers heal. Antibiotics are prescribed to thwart bacteria, and other medications may be taken to help reduce stomach acid.
• Avoid smoking.
• Don't take anti-inflammatory medications such as aspirin or ibuprofen.
• Avoid caffeine and alcohol in your diet. If you do have some, try to make sure it's after you've eaten a meal or snack.
• Don't eat foods that seem to aggravate your ulcer. Examples may include chocolate, coffee, certain herbs and spices, and some spicy foods.
• Eat several small meals throughout the day, rather than one big meal.

Physical Impairment Elderly

SATURDAY, May 3 (HealthDay News) -- Two new studies show that anticholinergics, a commonly prescribed group of drugs, may cause elderly people to "slow down" in their daily physical activities.

The two reports from researchers at Wake Forest University School of Medicine support findings released a few weeks ago that anticholinergic drugs -- which treat a variety of diseases and conditions, including acid reflux, Parkinson's disease and urinary incontinence -- may cause older people to lose their thinking skills more quickly than those who don't take the medicines.

Anticholinergic drugs work by stopping acetylcholine, a chemical that enhances communication between nerve cells in the brain, from binding to its receptors in nerve cells.

In the first Wake Forest study, older adults taking anticholinergics became more likely to walk more slowly and to need help in other daily activities.

"These results were true even in older adults who have normal memory and thinking abilities," study author Dr. Kaycee M. Sink said in a prepared statement. "For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function was similar to that of someone three to four years older."

Common anticholinergic medicines cited in the study included the blood pressure medication nifedipine (Adalat or Procardia), the stomach antacid ranitidine (Zantac) and the incontinence medication tolterodine (Detrol).

The findings, which involved more than 3,000 people, average age 78, were scheduled to be presented Saturday at the American Geriatrics Society annual meeting, in Washington, D.C.

In a separate Wake Forest study, published online in April in the Journal of the American Geriatrics Society, Sink found that older nursing home residents who took medicines for dementia along with anticholingerics for incontinence declined in function 50 percent faster than those only treated only for dementia.

"Over a year's time, the decline we observed would represent a resident going from requiring only limited assistance in an activity to being completely dependent, or from requiring only supervision to requiring extensive assistance in an activity," said Sink, an assistant professor of internal medicine-gerontology at Wake Forest.

The seniors in the second study had completed at least two consecutive prescriptions for cholinesterase inhibitors, a family of drugs used to treat dementia by increasing levels of acetylcholine. These include donepezil (brand name Aricept), galantamine (Razadyne), rivastigmine (Exelon) and tacrine (Cognex).

About 10 percent of those studied were also taking either oxybutynin or tolterodine, the two most commonly prescribed drugs for urinary incontinence.

"The two drugs are pharmacological opposites, which led us to hypothesize that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs, Sink said.

As an estimated 33 percent of people with dementia also take a medicine to control incontinence, this finding is especially alarming.

The two studies suggest that physicians should carefully consider the implications when prescribing anticholingeric medications to older adults.

Familial Breast Cancer Risk Lasts a Lifetime for Sisters

TUESDAY, May 13 (HealthDay News) -- New research has found both bad news and good news on breast cancer risk.

The bad news is a risk factor you can't change: Women whose sisters were diagnosed with breast cancer face an increased risk of breast cancer throughout their lives, regardless of their sister's age at diagnosis, according to a study in the May 13 issue of the Journal of the National Cancer Institute (JNCI).

The good news comes from a risk factor you can do something about: Women who exercise are much less likely to develop breast cancer, according to two new research studies -- one from the same issue of JNCI, and the other from the 2008 online first edition of the British Journal of Sports Medicine.

The first study from JNCI compared the rate of breast cancer in nearly 24,000 sisters of women with breast cancer to the rate of cancer in nearly 1.8 million women with sisters who didn't have breast cancer. All of the women were from Sweden, and the data collection for the study spanned from 1958 to 2001.

The researchers found that women between the ages of 20 and 39 who had a sister who'd been diagnosed with breast cancer faced a sixfold higher risk of breast cancer than did women whose sisters didn't have breast cancer. The excess risk declined as the women aged but didn't disappear. Women who were older than 50 with a sister with breast cancer had about a twofold risk of developing the disease, according to the study. And, it didn't matter what age the sister was when she was diagnosed.

"After the diagnosis of breast cancer in a family, the other sisters -- especially the youngest -- have an increased risk of breast cancer that persists for 20 years," said one of the study's authors, Marie Reilly, a professor of biostatistics at the Karolinska Institute in Stockholm, Sweden. "This suggests that sisters of breast cancer patients, especially the young sisters, should be intensely screened, independent of the screening recommendations for women their age."

Dr. Julia Smith, director of the Lynne Cohen Breast Cancer Preventative Care Program at the New York University Cancer Institute and Bellevue Hospital in New York City, called the findings "interesting and troubling." She added, "Sisters have to worry about increased risk no matter when their sister was diagnosed."

The second study from JNCI relied on data from the Nurse's Health Study II and included information from almost 65,000 women who completed questionnaires about their physical activity from age 12 until age 35. During the six-year follow-up period, 550 women from that group were diagnosed with breast cancer.

Women who walked about 13 hours a week or ran 3.25 hours a week had a 23 percent reduced risk of developing premenopausal breast cancer than women who were less active. The incidence rates of breast cancer were 194 per 100,000 "person-years" for the least active women, compared to 136 cases per 100,000 "person-years" for the most active women.

"These results suggest that consistent physical activity during a woman's lifetime is associated with decreased breast cancer risk. Unlike many risk factors for breast cancer, physical activity is an exposure that can be modified," wrote the study's authors, who were led by Dr. Graham Colditz, of Washington University School of Medicine in St. Louis.

Smith said: "For many reasons, women should continue to exercise and try to be in shape." It makes sense that exercise might reduce breast cancer risk, she said, adding, "Women who are exercising regularly are decreasing body fat and estrogen."

The third study on breast cancer risk was an analysis of 62 other studies that looked at the impact of physical activity and breast cancer risk. This review, published online ahead of the print version of the British Journal of Sports Medicine, found that women who are physically active have a 25 percent decreased risk of breast cancer.

The researchers found that both recreational or on-the-job activity could reduce risk, and that moderate and vigorous exercise caused a similar reduction in risk. This review also found that activity performed after menopause was more effective in reducing risk.

Smith recommends that women exercise at least 20 minutes, three times a week, and preferably more. She said that during those 20 minutes of moderate to vigorous exercise, the heart rate should consistently be above baseline.