Drop in Breast Cancer Among White Women May Have Stalled

Many American women abandoned hormone replacement therapy after a 2002 study found the treatment was tied to higher breast cancer risk. A sharp drop in breast cancer incidence among whites was observed soon after. However, a new study suggests that the 2002-2003 decline in breast cancer incidence among white women did not continue through 2007. The data suggests that the drop in breast cancers linked to women abandoning hormone replacement therapy (HRT) has now bottomed out.

Breast cancer rates among U.S. white women fell by about 7 percent between 2002 and 2003 after the release in 2002 of findings from the Women's Health Initiative study that linked HRT with an increased risk of breast cancer. To examine whether that trend has continued, American Cancer Society and U.S. National Cancer Institute (NCI) researchers reviewed breast cancer data collected from 2000 to 2007 by NCI Surveillance, Epidemiology and End Results (SEER) registries across the country.

The analysis revealed that the sharp decline in breast cancer rates among white women that occurred between 2002 and 2003 did not continue between 2003 and 2007. Instead, breast cancer rates among white women remained relatively stable from 2003 to 2007. "Postmenopausal hormone replacement therapy certainly had accounted for an increase in the incidence of developing a breast cancer. The use of postmenopausal HRT had sharply declined after multiple reports proved this relationship," noted one expert, Dr. Sharon M. Rosenbaum-Smith, a breast cancer specialist and surgeon at the Comprehensive Breast Center at St. Luke's-Roosevelt Medical Center in New York City.

Lead Exposure May Raise Blood Pressure in Pregnancy

In pregnant women, even small amounts of lead in the blood may cause significantly higher blood pressure, new research suggests. The study of 285 pregnant women found that about one in four had a lead level higher than about 1 microgram per deciliter (1 mcg/dL) of umbilical cord blood. That's significantly lower than the safety thresholds set by the U.S Centers for Disease Control and Prevention, which recommends taking action to reduce lead exposure when pregnant women or children have a blood lead level of 5 mcg/dL.

Even so, women in the study with lead levels greater than 1 mcg/dL had higher systolic and diastolic blood pressure readings than those with lower lead levels. The average increase was 6.9 mm Hg and 4.4 mm Hg, respectively. Though further research is needed, the findings suggest that pregnant women may be as sensitive to lead toxicity as young children, said the researchers. Prolonged high blood pressure during pregnancy can lead to complications such as preeclampsia or eclampsia, potentially deadly seizures that also can increase a woman's future risk of heart attack.

"We didn't expect to see effects at such low levels of lead exposure, but in fact we found a strong effect," Dr. Lynn Goldman, dean of the George Washington University School of Public Health and Health Services, said in a university news release. The study did not find an association, however, between lead exposure and pregnancy-induced hypertension or preeclampsia.

Breast Cancer Treatment May Lead to Hip Fracture

Middle-aged breast cancer survivors face an increased risk for hip fractures, a condition normally uncommon in women younger than 70, a new study has found. Researchers at Northwestern University in Chicago say that this may be because early menopause caused by breast cancer treatment and the effects of breast cancer drugs could weaken the bones by the time women reach middle age. The finding came from a study of six women who had survived breast cancer and, in their early 50s, were being treated for hip fractures.

Most of the women did not have osteoporosis, but they did have lower-than-normal bone mineral density (osteopenia). This suggests that rapid changes in bone architecture caused by chemotherapy, early menopause and adjuvant breast cancer therapy may not be detected on a bone mineral density test, said Dr. Beatrice Edwards, an associate professor of medicine and orthopedic surgery and director of the bone health and osteoporosis program Northwestern University's Feinberg School of Medicine, who led the research.

The women had been diagnosed with early-stage breast cancer, and their treatments had included lumpectomy, radiation therapy and chemotherapy with cytoxan and adriamycin for one to four years before they broke a hip. All of the women were perimenopausal at the time of the fracture. In four of the women, their breast cancer had grown in response to estrogen, and their cancer therapy had included aromatase inhibitors to prevent their bodies from making estrogen. Recent research has linked aromatase inhibitors with possible bone loss in women.

Narrowed Leg Arteries Disable Women Faster Than Men: Study

Women coping with peripheral arterial disease (PAD) in the legs appear to lose mobility faster than men, new research reveals. PAD is marked by narrowing and blockages of the peripheral arteries, usually those in the legs and pelvis. The most common symptoms are pain, cramping and tiredness in the leg or hip muscles when walking or climbing stairs symptoms that go away during rest. "The bottom line is that among those with lower extremity PAD, women have faster declines in mobility and functional performance compared to men," said study author Mary M. McDermott, a professor of medicine.

"This may be related to gender differences in calf muscle, as women tend to have less calf muscle compared to men," McDermott added. She and her colleagues report their findinsg in the Feb. 8 issue of the Journal of the American College of Cardiology. Both the researchers and the American Heart Association note that an estimated 8 million American men and women are affected by lower extremity PAD, with disease prevalence being split about equally across genders. To examine whether disease progression differs among men and women, between 2002 and 2009 McDermott and her team tracked the progress of 380 male and female patients with PAD of the legs in the Chicago area.

All the participants were 59 and older. Over a four-year period, annual mobility assessments were conducted during which each patient was asked to complete a quarter mile, six-minute walk, as well as a four-minute speed test, to observe the development of disability. Changes in calf muscle measurements and characteristics were also noted, alongside knee extension strength. Overall, the research team determined that after adjusting for age, women fared more poorly than men over the course of the study. As the study period unfolded, they noted that women ended up walking less per week and had more difficulty walking the quarter-mile.

Common Epilepsy Drug Taken During Pregnancy Might Raise Spina Bifida Risk

Pregnant women with epilepsy who are taking carbamazepine (Tegretol) to control seizures may be at a slightly increased risk of having an infant with spina bifida, a new study finds. Spina bifida is a condition in which the bones of the spine do not close but the spinal cord remains in place, usually with skin covering the defect. Most children will need lifelong treatment for problems arising from damage to the spinal cord and spinal nerves.

"For women with epilepsy, seizure control during pregnancy is very important," said lead researcher Lolkje de Jong van den Berg, from the division of pharmacy at the University of Groningen in the Netherlands. "Our study can help in decisions regarding whether carbamazepine should be the drug of choice in pregnancy." However, the best option regarding treatment can be chosen only on an individual basis by the woman and her neurologist before pregnancy, weighing the benefits of epilepsy control against the risk of birth defects, de Jong-van den Berg said.

The report is published in the Dec. 3 online edition of the BMJ. For the study, de Jong-van den Berg's team reviewed existing research to determine the risk of birth defects among women taking Tegretol. The researchers found that infants of women taking Tegretol were 2.6 times more likely to have spina bifida, compared with women not taking any anti-epileptic medication.

Daily Pill Lowers Odds for Infection With HIV

A pill a day cut the risk of HIV infection by almost 44 percent in those at highest risk for contracting the virus, namely sexually active gay and bisexual men, a new study finds. The reduction in risk climbed to nearly 73 percent among study participants who took the pill, called Truvada, 90 percent of the time, the researchers added. Truvada is already available by prescription in the United States as a treatment for HIV-infected people.

The pill, which was tested in over 2,500 men at 11 sites in six countries worldwide, combines two HIV antiretroviral medications, emtricitabine (Emtriva) and tenofovir (Viread). Experts are hailing the results as a big step in the worldwide effort to combat the spread of the HIV virus, which infected some 2.7 million people worldwide in 2008. And it adds to other efforts to prevent spread, such as a topical gel containing tenofovir that was found last summer to be effective in preventing HIV infection in women in southern Africa.

"These results represent a major advance in HIV prevention research," Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention at the U.S. Centers for Disease Control and Prevention, said in a statement. "For the first time, we have evidence that a daily pill used to treat HIV is partially effective for preventing HIV among gay and bisexual men at high risk for infection, when combined with other prevention strategies. Given the heavy burden of HIV among gay and bisexual men, a new tool with potential additive benefit is exciting and welcome news."

High Cholesterol in Middle Age May Not Raise Dementia Risk for Women

For years, doctors have been saying that keeping your cholesterol levels in check as you age is good for your brain as well as your heart, but a new study suggests the connection between cholesterol and dementia later in life isn't quite so clear-cut. After more than 1,400 Swedish women followed for 32 years, Johns Hopkins researchers found that those with high cholesterol at mid-life were at no greater risk of developing Alzheimer's and other types of dementia than women with lower levels. In addition, the women whose cholesterol levels decreased the most from middle to older age were 2.5 times more likely to develop dementia than those whose levels increased or stayed the same.

Both cell and animal studies have suggested that high cholesterol contributes to Alzheimer's disease, the researchers noted, but they stressed that the relationship between cholesterol and dementia may vary over a lifetime. "Our findings highlight how risk factors can change over the course of a person's life span," said Michelle M. Mielke, an assistant professor of psychiatry at Hopkins and lead author of the study, which was published online Nov. 10 in the journal Neurology. "My biggest worry is that people will look at these results and decide that cholesterol doesn't matter, but that's not what we're saying," Mielke added.

"We know that high cholesterol is a very strong risk factor for cardiovascular disease and still needs to be treated with diet, exercise and possibly medication." Mielke added that it was unclear why a decline in cholesterol levels in old age was linked to a higher risk of dementia, but said it might be an early part of the disease process. "As people start to develop symptoms, they often forget to eat and start losing weight, and that may be why their cholesterol goes down." For the study, Mielke and her colleagues examined data from the Prospective Population Study of Women, which began in 1968 and consisted of 1,462 Swedish women between the ages of 38 and 60.

Eating Peanuts While Pregnant May Raise Child's Allergy Risks

Women who eat peanuts during pregnancy may be putting their babies at increased risk for peanut allergy, a new study suggests. U.S. researchers looked at 503 infants, aged 3 months to 15 months, with suspected egg or milk allergies, or with the skin disorder eczema and positive allergy tests to milk or egg. These factors are associated with increased risk of peanut allergy, but none of the infants in the study had been diagnosed with peanut allergy. Blood tests revealed that 140 of the infants had strong sensitivity to peanuts. Mothers' consumption of peanuts during pregnancy was a strong predictor of peanut sensitivity in the infants, the researchers reported in the Nov. 1 issue of the Journal of Allergy and Clinical Immunology.

"Researchers in recent years have been uncertain about the role of peanut consumption during pregnancy on the risk of peanut allergy in infants. While our study does not definitively indicate that pregnant women should not eat peanut products during pregnancy, it highlights the need for further research in order to make recommendations about dietary restrictions," study leader Dr. Scott H. Sicherer, a professor of pediatrics at Jaffe Food Allergy Institute at the Mount Sinai School of Medicine in New York City, said in a journal news release. Sicherer and his colleagues recommended controlled, interventional studies to further explore their findings. "Peanut allergy is serious, usually persistent, potentially fatal, and appears to be increasing in prevalence," Sicherer said.