I Heart the Breast Cancer Research Stamp

By Anne Krueger

I like bumper stickers and yard signs and stuff that tells people who I am and what I support: “End Gun Violence.” “I ♥ Bruce Springsteen.” “Give Peace a Chance.” “Jon Stewart for President ‘08.”
Unfortunately, I share my cars and home with a curmudgeon who thinks bumpers should never be sullied with slogans and the only sign that should ever grace the front yard is “For Sale.”

No fun!

That’s why I turned to stamps as a form of expression. I’ve always loved the breast cancer research stamp, with its mythical goddess-of-the-hunt (presumably hunting for a cure) artwork. For a decade I haven’t minded paying extra for the stamp (it’s now 55 cents per stamp vs. 42 cents for a regular one), because it’s been an easy way to let everybody know about a cause I support. Read More

Gaps Persist in Use of Less Invasive Breast Cancer Procedure

(HealthDay News) -- The use of a less invasive form of sentinel lymph node biopsy (SLNB) during breast cancer surgery increased substantially in the United States from 1998 to 2005, researchers say. However, there are still disparities in terms of which women receive the therapy.

The study by the American Cancer Society found that non-white women, women aged 72 and older, and women living in poor areas of the country were less likely to receive the SLNB staging test than those who were white, younger, or live in more affluent areas.

In women diagnosed with breast cancer, doctors check to see if the cancer has spread from the breast tissue into neighboring lymph nodes. This can be done by removing many lymph nodes in a procedure called axillary lymph node dissection (ALND) or by removing a few lymph nodes (SLNB), which is associated with easier recovery and fewer long-term problems, according to background information in the study.

In this study, researchers analyzed national data on women who had breast cancer surgery between 1998 and 2005. Clinical care guidelines were changed in 1998 to allow surgeons to use SLNB in certain patients.

The proportion of patients who had SLNB increased from 26.8 percent in 1998 to 65.5 percent in 2005, the study found.

But the researchers also found that disparities in the use of SLNB persisted during those years. For example, in 1998, 29 percent of white women received SLNB, compared with 26 percent of black women, and 35 percent of Hispanic women. By 2005, the rates were 70 percent, 64 percent, and 67 percent, respectively.

According to clinical guidelines, SNLB should only be done in centers that have experienced teams. This study didn't examine whether the disparities in access to SLNB may be related to lack of experience at certain facilities.

"The disparities that were related to receipt of SLNB in this study are particularly important in light of the clinical advantages associated with this technique. Better outcomes have been reported for patients receiving SLNB than for patients receiving ALND," the researchers wrote.

The study was published online March 25 in the Journal of the National Cancer Institute.

"Given America's track record of disparate care, I suppose we should not be surprised that racial and ethnic minorities were disproportionately deprived of another medial advance," Dr. Stephen B. Edge, of Roswell Park Cancer Institute in Buffalo, wrote in an accompanying editorial. "However, this observation is profoundly disappointing and sobering. It is yet another call for us to redouble efforts to identify and correct the root cause of disparities."

More information
The U.S. National Cancer Institute has more about SLNB.

Cancer Death Rates Still Declining

(HealthDay News) -- Good news continues to come forth from the cancer front: U.S. death rates from the disease have declined by 18.4 percent among men and by 10.5 percent among women since mortality rates first started going down in the early 1990s.

In 2008, an estimated 1,437,180 new cancers will be diagnosed, and 565,650 people will die of the disease, according to a report released Wednesday from the American Cancer Society (ACS). Death rates were at their highest for men in 1990, and for women in 1991.

Although the rate of cancer deaths decreased from 2004 to 2005, there was an increase in number of actual deaths (5,424) in 2005 compared to 2004, the report showed.

"We do not know why the declines in death rate from 2004 to 2005 slowed, compared to the previous two years," said Ahmedin Jemal, strategic director for cancer surveillance at the ACS. "But we can say that this occurred for almost all of the major cancer sites for men and women, which include colon and rectum in both men and women, breast cancer in women, and prostate cancer in men."

"Death rates from cancer continue to decrease because of prevention, early detection and treatment," Jemal added. "These have been decreasing from the early '90s and, really, because of this decrease, over half a million deaths from cancer have been avoided."

Jemal is first author of Cancer Statistics 2008, which is published in the March/April issue of CA: A Cancer Journal for Clinicians. The report has been an annual fixture since 1952.

"This is both good news and bad news," said Dr. Louis Weiner, director of the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, D.C. "The good news is that cancer rates continue to decline, and that the lives of hundreds of thousands of Americans have been saved over past 15 or 16 years as a result of this improvement in cancer death rates."

"The bad news is that more than a half a million Americans can be anticipated to die of cancer this year," Weiner continued. "That's equivalent to nearly the entire population of Washington, D.C., and losing more than the entire population of New Orleans in 2003. Viewed from that perspective, we have a long way to go."

According to Jemal, "smoking is a big part [of the decline.] Smoking rates have been decreasing for the last 30 to 40 years, when the Surgeon General came out with his report."

Screening for colorectal, breast and cervical cancer have also contributed to the decrease, he added.

Today, about one-quarter of deaths in the United States today are due to cancer, killing more people under 85 than heart disease.

Some specifics from this year's report:

• In men, cancers of the prostate, lung, colon and rectum represented about half of all newly diagnosed cancers. Prostate cancer alone accounted for one-quarter of the total cancer cases in men.
• In women, the three most commonly diagnosed cancers in 2008 will be breast, lung and colorectal. These account for about half of all cancer cases in women. Breast cancer alone accounts for 26 percent of new cancer cases among women (although the incidence decreased by 3.5 percent per year from 2001 to 2004, part of which may be due to declines in the use of postmenopausal hormone replacement therapy). About one-quarter of all deaths from cancer in women in 2008 will be from lung cancer.
• In men aged 40 and younger, leukemia is the most common cause of cancer death, while lung cancer is the leading killer in men over the age of 40.
• Leukemia is also the leading cause of cancer death among females under 20, while breast cancer takes the greatest toll in women aged 20 to 59. Lung cancer is the biggest cancer killer in women over 60.
• The incidence of cancer is 19 percent higher and the death rate 37 percent higher among black men compared with white men. For black women, the incidence rate is 6 percent lower, but the death rate is 17 percent higher than for white women.
• The five-year survival rate for children with cancer has improved from 58 percent for those diagnosed between 1975 and 1977 to 80 percent for those diagnosed between 1996 and 2003.

This year's report also includes a special section that discusses the impact of health insurance status on cancer prevention, diagnosis, treatment and outcomes. Earlier this week, researchers from the American Cancer Society reported that people who either have no health insurance or rely on Medicaid are more likely to be diagnosed with advanced cancers.

More information
Visit the American Cancer Society for more on this report and on different types of cancer.

Genetic Breast Cancer Test Approved

(HealthDay News) -- A new genetic test that helps assess the risk of tumor recurrence and long-term survival for patients with relatively high-risk breast cancer has been approved by the U.S. Food and Drug Administration.

The TOP2A/FISH pharmDx is the first approved device to test for the TOP2A (topoisomerase 2 alpha) gene in cancer patients. The gene plays a role in DNA replication. Changes in the TOP2A gene in breast cancer cells indicate increased risk that a tumor will recur or decreased survival.

The new test, made by Dako Denmark A/S, uses fluorescently-labeled DNA probes to detect or confirm gene or chromosome abnormalities, a process called fluorescent in situ hybridization (FISH).

The FDA approval was based on a study of 767 high-risk patients in Denmark who had been treated with chemotherapy after removal of a breast tumor. The findings indicated the test was useful in estimating cancer recurrence and overall survival.

"When used with other clinical information and laboratory tests, this test can provide health care professionals with additional insights on the likely clinical course for breast cancer patients," Dr. Daniel Schultz, director of the FDA's Center for Clinical Devices and Radiological Health, said in a prepared statement.

More information
This FDA announcement has more about the approval.

Breast Cancer Surgeons Don't Discuss Reconstruction Options

(HealthDay News) -- Only a third of breast cancer patients get to discuss their breast reconstruction options with their general cancer surgeon before the tumor is removed, new research finds.

In the study, more than 70 percent of general surgeons who removed the cancer did not talk over options for reconstruction -- which is typically done by a plastic surgeon -- before the woman underwent cancer surgery.

"It's disappointing," said lead researcher Dr. Amy K. Alderman, assistant professor of plastic surgery at the University of Michigan Medical School, Ann Arbor.

These discussions do matter: Women who discussed their options for reconstructing the breast beforehand with their physician were four times more likely to have a mastectomy (versus lumpectomy) compared to those who did not talk about the option, the researchers noted.
Th findings were published online Dec. 21 in Cancer and were expected to be published in the journal's Feb. 1 print edition.

Alderman and others contend it's crucial for a woman to understand all surgical options, and that includes reconstruction, so they can better choose the best treatment for them. About 180,000 women will be diagnosed with breast cancer this year, according to the American Cancer Society.

Long-term outcomes are equal, Alderman said, regardless of whether a woman is treated with lumpectomy or mastectomy. Knowing initially about the option to reconstruct definitely affects a woman's decision, as the study showed.

Alderman and her colleagues looked at almost 1,200 women, average age 59. The women were diagnosed with breast cancer and lived in the Detroit and Los Angeles areas. All were candidates for either mastectomy or breast-conserving surgery. They had all undergone breast cancer surgery and were contacted about three months after their diagnosis.

Alderman's team asked them: Did you discuss reconstruction with your surgeon before the cancer surgery?

Just one-third of patients did, with younger, more educated women more likely to hear about the options from their general surgeon. Those with larger tumors were also more likely to hear about reconstruction options.

The operation to reconstruct a breast can be done right after mastectomy, in which the entire breast is removed, or it can be delayed. Immediate reconstruction offers a better cosmetic outcome and is psychologically better, Alderman said.

"It's helpful if they know all their options at that initial decision-making process," Alderman said. "There's no right or wrong answer."

Women will choose their course, she said, based on a number of factors, including their fear of cancer recurrence, their body image, and other factors.

"What we need to get across to consumers is, they need to be educated consumers of their own health care," Alderman said. If the surgeon doesn't bring up the topic of reconstruction, a woman should, she said, and the sooner the better.

The study didn't delve into why the surgeons didn't talk about the reconstruction option or refer the women to plastic surgeons. But Alderman suspected the "hassle" factor may play a role. The general surgeon must make sure, she said, that the women get in to see the surgeon who will do the reconstruction in a timely manner. "And then the general surgeon and the plastic surgeon have to coordinate their operating room schedules," she said.

Women themselves may be so focused on eliminating the cancer that they don't even broach the topic of reconstruction, Alderman said.

Another expert agreed that the small number of surgeons who initially discussed the reconstruction option was surprising.

"It's very sad that that so few surgeons are sending women for reconstructive appointments," said Dr. Mehra Golshan, director of Breast Surgical Services at the Dana-Farber/Brigham and Women's Cancer Center, Boston, who reviewed the study.

An initial meeting with a surgeon who does reconstruction will provide a woman with information on all options, "even if they decide to do [reconstruction] down the road," he said.

Like Alderman, Golshan couldn't say for sure why such a low number of surgeons referred their breast cancer patients to plastic surgeons for reconstruction discussions, but he speculated on a few possible reasons. "They may think complication rates are too high with immediate reconstruction," he said.

In truth, Golshan said, complications can be higher with immediate reconstruction if post-mastectomy radiation is required. "But not always," he said. And, "when there is no post-mastectomy radiation, the complications rates are equal between immediate reconstruction and delayed."

It's also possible that surgeons may be so focused on cancer elimination that they may not think about referring the patients for reconstruction information, Golshan added.

More information
To learn more about breast reconstruction, visit the American Society of Plastic Surgeons.

Common Household Chemical Could Raise Breast Cancer Risk

(HealthDay News) -- A chemical found in many plastic products used in households caused accelerated breast development and genetic changes in newborn female lab rats, a condition that might predispose the animals to breast cancer later in life, a new study says.

Butyl benzyl phthalate (BBP) is commonly used to soften polymers and plastics. It's found in everything from plastic pipes, vinyl floor tiles and carpet backing to lipstick. BBP has also been found to be an endocrine disruptor, which mimics the effect of hormones. Endocrine disruptors are known to damage wildlife and have also been implicated in reduced sperm counts and neurological problems in humans, the researchers said.

"Our study is the first one demonstrating that exposure to this compound (BBP) soon after birth results in alterations in the expression of genes present in the mammary gland," said lead researcher Dr. Jose Russo, a breast cancer expert at the Fox Chase Cancer Center, in Philadelphia.

The findings are important, Russo said, because the researchers are studying the lifetime effect of BBP on the mammary gland, long before it starts developing under the influence of the hormones of puberty, and the potential implications on humans.

Because of lasting genetic changes in the breast, exposure to BBP could increase the risk for developing breast cancer later in life, Russo said.

"To prevent breast cancer in adulthood, it is necessary to protect both the newborn child and the mother from exposure to this compound that has an estrogenic effect and could act as an endocrine disruptor," he added.

For the study, Russo's team fed lactating rats BBP, which their offspring absorbed through breast milk. The rat pups received levels of the chemical equivalent to the U.S. Environmental Protection Agency's safe dose limit for humans, according to the report in the Dec. 5 online issue of BMC Genomics.

The researchers found that BBP affected characteristics of the female offspring of the rats, such as more rapid breast development and changes in the genetic profile of the mammary glands.

While these effects wore off after exposure to BBP was stopped, the changes caused by the chemical might have an effect later in life, the researchers said.

"Our original observations are that the genomic changes induced by BBP occur very early in life, and they could result in significant modifications in the risk of the mammary gland to develop cancer later on in life," Russo said.

Russo said he and his colleagues are currently evaluating how changes in gene expression caused by BBP respond to cancer-causing chemicals given to adult rats.

"We are also studying the effects of exposure to BBP before birth. In addition, we are following a cohort of girls entering puberty for determining the tempo of breast development and their first menstrual period and associating these events with exposure to environmental agents such as BBP," Russo said.

One expert said scientists are only beginning to learn how many genes are affected by exposure to chemicals early in life.

"The early exposure to BBP altered breast development and may therefore alter the susceptibility to breast cancer," said Dr. Ted Schettler, science director at the Science and Environmental Health Network, in Ames, Iowa.

Schettler thinks people need to be aware of the possible effects of chemicals on genes during early life, and how these changes can influence susceptibility to disease in adulthood.

"People are finally getting the idea that early life events can matter later in life," Schettler said.

"When people see that commonly encountered environmental agents like BBP can cause genetic changes, it's of public health interest."

However, Dr. Jonathan Borak, a clinical professor of environmental medicine at Yale University School of Public Health, said there's no evidence that exposure to BBP increases the risk of breast cancer.

"To date, studies have failed to find an association between BBP and breast cancer," Borak said. "This study doesn't add specific information on breast cancer and environmental interactions."

Efforts to reach the American Chemistry Council, a chemical industry group, for comment on the study were unsuccessful.

In October, California adopted a law that will ban trace amounts of BBP in toys and baby products such as teething rings, according to published reports.

And in March, a study published in the journal Environmental Health Perspectives suggested that exposure to phthalates could be fueling the obesity epidemic by contributing to abdominal obesity and insulin resistance in men.

More information
For more on breast cancer, visit the American Cancer Society.

New Guidelines Should Improve Ovarian Cancer Detection

(HealthDay News) -- Ovarian cancer has long had a reputation as a silent killer, because many people believed it gave no warning signs until far advanced.

But women suffering from the disease knew differently. They knew they had certain symptoms that were common from patient to patient.

"Survivors for years have said there are symptoms for the disease, but no one listened to them," said Jane Langridge, chief executive officer for the National Ovarian Cancer Coalition.
Now, doctors have agreed with them.

A screening test has been developed that, in one study, accurately detected early stage ovarian cancer 57 percent of the time.

Based on that and similar studies, experts from the American Cancer Society, the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists have agreed on a set of symptoms that can be signs of early ovarian cancer.

"We want people to know it's not the silent killer. There are symptoms women can bring to their doctors that are important to pay attention to," said Dr. Linda Duska, a member of the National Ovarian Cancer Coalition's medical advisory board and a gynecologic oncologist at Massachusetts General Hospital Cancer Center, in Boston.

"This agreement is significant in the fact that, maybe if we pay more attention to symptoms, we can catch them sooner and have more success in treating them," she continued.

Early detection of ovarian cancer is crucial.

More than 22,000 U.S. women will be diagnosed with the disease this year, and three-fourths of them -- more than 15,000 -- will die from it, according to the National Cancer Institute.

If caught in the early stages, the five-year survival rate for ovarian cancer is 90 percent. But 75 percent of women are still diagnosed in the advanced stages, when the prognosis is poor.

Ovarian cancer is the eighth most common cancer among American women, not including skin cancer, according to the American Cancer Society. An estimated two-thirds of women with ovarian cancer are 55 or older.

"It is a disease that is detected in stage 3 and above, and that is unacceptable," said Sherry Salway Black, executive director of the Ovarian Cancer National Alliance and a survivor of the disease. "Our mortality figures are unacceptable."

The symptoms of ovarian cancer can be subtle and hard to assess, because they often mimic common digestive and gastrointestinal disorders. They include persistent swelling, bloating, pressure or pain in the abdomen, gastrointestinal upset, difficulty eating or feeling full quickly, and the frequent or urgent need to urinate.

Because these symptoms are so common, women should be careful not to assume the worst, Duska said.

"The goal of this is not to make everyone think they have ovarian cancer," she said. "If women have these symptoms, and they persist over time, they should have them investigated.

Everyone with bloating does not have ovarian cancer."

Typically, two or more symptoms occur simultaneously and increase in severity over time, according to the National Ovarian Cancer Coalition.

The screening test developed late last year involves an extensive checklist of symptoms and their frequency. It picked up early stage ovarian cancer 56.7 percent of the time, and late stage ovarian cancer 80 percent of the time. The test also produced "false-positive" findings 10 percent to 13 percent of the time.

The test searches for many of the symptoms agreed upon by cancer experts as indicative of ovarian cancer.

"When women go to their doctors and have had some of these symptoms, and they are new and have persisted for two or more weeks, perhaps a doctor now would be willing to perform some pretty simple tests to rule out ovarian cancer," Langridge said.

Women who have a family history of breast or ovarian cancer are at increased risk and should pay particular attention to the symptoms, Duska said.

Treatment of ovarian cancer usually involves a combination of surgery and chemotherapy.

Advances in chemotherapy have made the late-stage disease more survivable, Duska said.

In a more intensive regimen recently shown to improve survival, standard intravenous chemotherapy is combined with chemotherapy injected directly into the abdominal cavity. The abdominal injection exposes hard-to-reach cancer cells to higher levels of chemotherapy than can be reached intravenously.

"That was a breakthrough, I think," Duska said.

Other treatments being explored include new chemotherapy drugs, vaccines, gene therapy and immunotherapy, which boosts the body's own immune system to help combat cancer, according to the Mayo Clinic.

More information
To learn more about ovarian cancer, visit the U.S. National Library of Medicine.

Education Linked to Cancer Death Rates

(HealthDay News) -- If you have a college degree, you have up to a 76 percent reduced risk of dying from cancer, a new study found.

Higher education lowers the risk for black and white women and men, according to the report in the Sept. 11 online edition of the Journal of the National Cancer Institute.

"Cancer mortality varies a great deal for all cancers by individual level of education," said study co-author Elizabeth Ward, the American Cancer Society's director of cancer surveillance. "If we could get everyone's cancer mortality to the level we see among the best educated, it would make a huge impact on cancer in the United States."

Education is tied to socioeconomic status and access to medical care, Ward noted. The new study finding makes it clear that many of the factors that influence cancer mortality are preventable, she said.

"They are preventable by social policies -- things we can change, such as smoking prevention, access to cancer screening and opportunities to good nutrition and physical activity," Ward said.

In the study, Ward and her colleagues used data from death certificates and the U.S. Census Bureau to look at the associations between education level and death rates from lung, breast, prostate and colorectal cancer. The researchers collected data on 137,708 cancer deaths from 2001 involving black and white men and women between the ages of 25 and 64.

The researchers found that more education was associated with lower death rates from cancer among all race and gender groups. The greatest difference was found between people with 12 or fewer years of education and those with more than 12 years of schooling, Ward's team found.

Compared with those with the lowest levels of education, those with the highest levels of education cut their risk of dying from cancer. For the highest educated white men, the risk was cut by 48 percent, for white women it was cut by 76 percent as it was for black men, and the most educated black women had a 43 percent lower risk of dying from cancer, the researchers reported.

This difference in cancer deaths is most likely due to a relationship between education and other factors directly associated with risks of developing and dying from cancer, such as smoking, cancer screening, and access to health care, the researchers speculated.

Although cancer death rates were higher among blacks than whites with the same level of education, they were almost the same for black and white men with zero to eight years of education, the researchers said.

"The difference between blacks and whites is most certainly due to socioeconomic conditions and access to care," Ward said.

Sholom Wacholder, an epidemiologist with the National Cancer Institute and author of an accompanying editorial in the journal, thinks the study findings account for some -- but not all -- cancer disparity rates between blacks and whites.

"I asked myself if I could use this data to figure out the difference between blacks and whites in cancer mortality," said Wacholder. "And the answer is that it is probably not possible."

The problem is that there are too many unanswered questions, Wacholder said. "We can't answer the question whether additional education by itself is the explanation or whether people with access to education have lower cancer mortality beyond the effect of education," he said.

More information
For more on cancer, visit the American Cancer Society.

Reevaluating Hormone Replacement Therapy

(HealthDay News) -- Five years after the results of the Women's Health Initiative sounded the supposed death knell for hormone replacement therapy, experts gathered Wednesday to reassess those results and discuss the fine-tuning and evaluation that has taken place since.

"The science has evolved substantially in the past five years," Dr. JoAnn Manson, chief of the division of preventive medicine at Brigham and Women's Hospital in Boston, said at a press conference sponsored by the Society for Women's Health Research. "There's been mounting evidence that a woman's age and amount of time since onset of menopause may influence the effect of hormone therapy."

The Society for Women's Health Research is a nonprofit organization but has received funds from companies such as Amgen, Cytyc, Eli Lilly, Ethicon and Wyeth.

The original Women's Health Initiative (WHI) was halted when U.S. researchers found an increased risk of adverse events which, depending on whether the woman was taking estrogen alone or estrogen plus progestin, included heart attack, stroke, breast cancer and blood clots.

Manson was one of the principal investigators on the WHI trial.

The average age of women enrolled in the WHI was 63, or about 12 years past menopause.
And the trial was designed not to look at how well hormone therapy combated menopausal symptoms such as hot flashes, but whether it could play a role in chronic disease prevention.

"The WHI was designed to evaluate the balance of benefits and risks of hormone therapy in generally healthy postmenopausal women when used for chronic disease prevention," Manson said. "At the time WHI was started in the early 1990s, it was becoming increasingly common in clinical practice to use hormone therapy in older women who were at high risk of cardiovascular disease, or who already had a diagnosis of cardiovascular disease, in order to prevent future cardiovascular events."

Since then, it has become increasingly clear that hormone therapy has different benefits and risks, depending on the age of the woman.

Just last week, Manson and her colleagues reported in the New England Journal of Medicine that women in their 50s who take estrogen therapy have lower levels of dangerous calcium deposits in their arteries, suggesting they're at reduced risk for heart disease.

But in older women, hormone therapy appears to increase the risk of cardiovascular problems and blood clots, a phenomenon confirmed by a study in this week's British Medical Journal.

And researchers have speculated that a decline in the incidence of breast cancer in recent years is due to a decline in the use of hormone therapy after the WHI results were announced. But a cause-and-effect link is not at all clear.

"I think it's possible that declining use of hormone therapy has contributed at least a little to a decreased incidence rate, but there could be other explanations," Manson said. "There's some suggestion that the decline in breast cancer may have begun as early as 1999, which was well before there was decreasing use of hormone therapy. And there is also some evidence that mammogram screening has decreased over the past several years and that this could contribute to lower rates of detection and diagnosis of breast cancer."

That being said, combined estrogen and progestin has been linked to a risk of breast cancer after four to five years of use. It's not clear if estrogen has a similar risk.

There was some evidence in the WHI study that combination hormone therapy reduced the risk of colon cancer, but the evidence isn't enough to recommend hormones as a preventive strategy, Manson said.

Similarly, while estrogen reduces the risk of fracture and enhances bone density, this benefit would require long-term treatment. Other medications are available and should be tried first, Manson said.

Overall, the bulk of the research today, five years after the WHI, should serve to reassure younger women who may need hormone therapy to alleviate menopausal symptoms.

"The most important reason to go on hormone therapy is for menopausal symptoms," said Dr. Nieca Goldberg, medical director of the Women's Health Program at New York University Medical Center and associate professor of medicine at New York University School of Medicine.

"Younger women who need to go on hormone therapy for this reason can relax. But hormone therapy should never be given to women with cardiovascular disease."

Manson added: "I don't think that hormone therapy should be started or continued for the express purpose of preventing cardiac disease or other chronic diseases, because there are known risks. However, this is very different from the situation in a recently menopausal woman who has moderate to severe hot flashes and night sweats which interfere with sleep and quality of life. Hormone therapy is known to be the most effective treatment for menopausal symptoms.

It's still a very appropriate short-term treatment, but we still recommend using the lowest effective dose for the shortest duration of time necessary."

More information
Visit the U.S. National Library of Medicine for more on hormone replacement therapy.

No Evidence Tomatoes, Lycopene Cut Cancer: FDA

(HealthDay News) -- There's little hard evidence that a diet rich in tomatoes and the tomato antioxidant lycopene can ward off cancer, according to research from the U.S. Food and Drug Administration.

Reporting in the July 10 issue of the Journal of the American Cancer Institute, FDA experts lay out in great detail the evidence -- or mostly lack of it -- behind their November 2005 statement that tomato consumption is not linked to any reduction risk of tumors of the prostate, ovary, stomach and pancreas.

The agency had previously found no evidence that tomatoes could cut risks for lung, colorectal, breast, cervical or endometrial tumors, either.

The November 2005 statement contended that, "there is no credible evidence to support qualified health claims for lycopene, as a food ingredient, component or food, or as a dietary supplement, and reduced risk of any of the cancers in the petition."

The petition for approval of the claims was submitted by a supplement maker, American Longevity.

The FDA has now put the evidence behind its decision in print, said Paul Coates, director of the office of dietary supplements at the U.S. National Institutes of Health and the author of a related journal editorial.

The new data review "gives people some idea of what the process is," Coates said. That's important, he said, because "one of the things that people are concerned about is how are these decisions arrived at. Making the process transparent and open will be helpful."

As part of its review, the FDA pored over data from 107 observational studies comparing the level of consumption of either tomatoes or lycopene with people's general cancer risk.

They also looked at 23 studies that focused on blood levels of lycopene, although most of those trials were deemed unreliable, either because there were too many confounding factors or because most focused on cancer patients, not healthy people.

The agency also included dozens of studies comparing lycopene or tomato intake against the risk of individual cancers such as prostate, colon and breast malignancies.

The bottom line, according to the FDA: There's just not enough evidence to recommend that Americans boost their tomato intake to ward off cancer.

However, the new report is certainly not the last word on cancer-preventing claims for lycopene, Coates added.
"It just codifies the fact that the information about lycopene and cancer is not very robust," he said. "It may well be that if more studies are done, a greater effect might be found. But now, when you look at similar studies done by different people, they come to the same conclusion."

For its part, the American Cancer Society prefers to stay away from recommending any one food as a cancer preventive agent, said Marji McCullough, director of nutritional epidemiology for the organization.

"In our guidelines, we encourage people to eat a variety of foods, especially fruits and vegetables," she said. "Several studies have suggested a lower risk of cancer with some kinds of foods, including tomatoes, but we encourage variety."

The society encourages consumption of "dark deep-colored vegetables, because some studies have found an association between them and lower cancer risk," McCullough said.

The society also encourages fruit and vegetable consumption, because it helps prevent weight gain, she said.

But endorsement of specific foods won't come until research shows that they clearly are associated with lower cancer risk, McCullough said. As for supplements, "most of the evidence comes from studies of foods," she said.

More information
There's more on lycopene at the American Cancer Society.

Sex Drive Need a Tune-Up?

Q: Sex Drive Need a Tune-Up?
What is female sexual dysfunction? Is it a medical term for low sex drive? If so, what can be done about it?

A: You ask a provocative question. In its January 4, 2003 issue, the British Medical Journal published an article arguing that pharmaceutical companies are trying to create a medical diagnosis called "female sexual dysfunction," a condition that may not exist. And yet, according to some estimates, 43 percent of women suffer from it. One source for that figure was an article in the February 10, 1999 Journal of the American Medical Association, which reported on responses from more than 1,700 women to questions on whether they had experienced sex-related problems such as lack of desire or lack of lubrication that had lasted for at least two months. The authors did note, however, that some of the problems were related to non-medical issues, such as a drop in income, having young children at home, or stress.

A study from the University of Pennsylvania published in October, 2002, found that women who reported declining libido had fluctuating levels of testosterone, the hormone that governs sex drive in both men and women. Those who had the most variability in testosterone levels were two to three times more likely to report decreased libido than those who had the most stable levels. In the past, researchers believed that decreased levels of testosterone, particularly after menopause, were to blame for declining sex drive among women. Apart from fluctuations in testosterone levels, the only other factors affecting female sex drive discovered in this study were depression and the presence of children in the house.

Testosterone replacement can restore a flagging sex drive, but new evidence suggests that it may be a risky strategy. In July 24, 2006, a study published in the Archives of Internal Medicine found that taking estrogen and testosterone together appears to more than double the risk of breast cancer. The findings came from the long-running Nurses Health Study, which includes more than 120,000 women.

Over 24 years of follow-up the researchers found that the risk of breast cancer among women taking the combination of estrogen and testosterone (most often in the form of the prescription drug Estratest) was 2.5 times higher than it was among women who never took hormones. Even after researchers accounted for other breast cancer risk factors, such as family history, age, and weight at menopause, they still noted an increased risk associated with taking the combination. Given these findings, testosterone replacement may not be the best option for women, at least not until we know more about the risks it presents.

Unfortunately, there are no other proven remedies for low sex drive in women. Damiana (Turnera diffusa), a plant native to Mexico with a reputation as a female aphrodisiac, may be worth a try, although it hasn’t been well studied. Look for it in health food stores and follow the dosage recommendations on the label. If vaginal dryness, a menopausal symptom, is the source of the problem, the over-the-counter lubricant Replens vaginal lotion can help. Topical estrogen, available by prescription, can also relieve vaginal dryness.

Andrew Weil, M.D.

Preventing Breast Cancer Recurrence?

Preventing Breast Cancer Recurrence?Is it safe to take turmeric after a lumpectomy and radiation treatments? Would it be helpful to ward off any cancer cells that may still be in my body?
Turmeric (Curcuma longa) is the yellow spice most familiar in Indian cooking and American-prepared mustard. Not only do I think that it is safe to take after breast cancer treatment, I think it would be helpful. The reason is that turmeric affects hormones that promote inflammation and cell proliferation, processes that seem to underlie most cancers.
Turmeric is being studied widely for its powerful anti-cancer effects. However, women being treated for breast cancer may be advised to avoid it during chemotherapy because of evidence from laboratory and animal studies suggesting that it may inhibit the action of certain chemotherapy drugs.
The potential benefits of taking an anti-inflammatory for cancer prevention emerged from analysis of data from the Women's Health Initiative, a large National Institutes of Health study, which recently showed that long term use of non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or aspirin reduced the risk of breast cancer, in some cases by as much as half. Although results of a smaller study have not confirmed those findings, the results were intriguing enough to spur scientists to call for more research. In the meantime, I wouldn't recommend taking NSAIDS regularly for breast cancer protection because they can cause gastrointestinal problems and blood thinning as well as damage to the liver and kidneys. However, I would suggest taking a natural anti-inflammatory. I often recommend New Chapter's Turmericforce; take one capsule twice a day. You can also safely add ginger, another natural anti-inflammatory, to your diet by eating crystallized ginger or the pickled ginger that comes with sushi.
Andrew Weil, M.D.

Walking Away from Breast Cancer?

Walking Away from Breast Cancer?I heard that exercise and weight loss can protect against breast cancer. If this is true, how much exercise is necessary? What kind? What about weight loss?
Exercise can protect against breast cancer, but until recently, we thought that it mostly helped lower the risk of the disease among women who did strenuous physical activities when they were young. In September of 2003 the Journal of the American Medical Association published results of a study involving more than 74,000 women followed for nearly five years showing that even those who don't begin exercising until later in life can lower their risk by 20 percent, and that a brisk, half hour walk five days a week will do the trick. The exercise effect was seen among women at all levels of risk, even those with a strong family history of breast cancer, those who hadn't had children (a long-recognized risk factor), and those who had taken hormone replacement therapy.
The same study found that the more you exercise and the slimmer you are, the greater the risk reduction. For example, the researchers found that women of low to normal weight and even those who were slightly overweight were able to cut their risk by more than 30 percent if they devoted 10 hours a week to exercise.
The researchers suggested that exercise influences breast cancer susceptibility by lowering body fat, which in turn reduces levels of circulating sex hormones. Another study, published in the August 20, 2003 issue of the Journal of the National Cancer Institute, found that obese, postmenopausal women were at higher-than-normal risk of breast cancer because their fat cells release too much estrogen. The more the women in the study weighed, the higher their risk of breast cancer and the higher their levels of the hormone estradiol, a potent form of estrogen.
Some breast cancer risks can't be controlled: about 10 percent of all cases are hereditary, and getting older also increases the risk. But these studies show women what they can do to improve the odds.
Andrew Weil, M.D.

Finding Breast Cancer Early?

Finding Breast Cancer Early?
With all the controversy about mammograms and breast self-exams, I'm very confused about what women are supposed to do these days. Have mammograms or not? Do self-examinations or not? Can you clarify?
It's easy to get confused when studies cast doubt on the usefulness of self-examination and on whether or not regular mammograms really do save lives. In 2003, in an attempt to address some of the questions women had, the American Cancer Society (ACS) updated its recommendations and, for the first time, included special suggestions for women at high risk and older women.
In a big change, the ACS no longer recommends monthly breast self-examination (BSE) for all women starting at the age of 20. Instead, the recommendations state that all women should be told about the benefits and limitations of BSE when they're in their twenties so they can decide whether or not to do it. Two large studies, one in China and one in Russia, found that breast self-exams don't reduce breast cancer deaths. In addition, women participating in both studies who examined their breasts had higher rates of biopsies for benign disorders than those who didn't do BSE.
While it may be acceptable to skip BSE, I believe that all women should be familiar with the way their breasts normally feel so that they can recognize any changes that may develop. The ACS did not change its recommendation that women ages 20 to 39 should have a breast exam by a physician every three years or that women age 40 and older have an annual breast exam by a physician.
As for mammograms, the ACS continues to recommend that beginning at age 40 all women have them annually. In the past, however, no specific recommendation was included for older women. However, evidence from a study reported in the November
19, 2002 issue of the Annals of Internal Medicine showed for the first time that mammograms benefit women over the age of 75. The ACS now recommends that older women continue having annual mammograms, as long as they don't have any serious, chronic health problems.
As for women at high risk (because of family or personal history of breast cancer), the ACS recommended discussing beginning mammograms earlier, having more frequent clinical exams by one's physician, or having additional tests such as breast ultrasound or magnetic resonance imaging (MRI). Noninvasive imaging technologies are beginning to become available with the hope of detecting cancers earlier; however, this research is in its infancy and mammography remains our best screening tool for now.
Andrew Weil, M.D.

Banishing Breast Cancer?

Banishing Breast Cancer?
I was treated for breast cancer five years ago and have been taking Tamoxifen ever since. I'm supposed to stop now. What can I do to prevent a recurrence?

Tamoxifen is an oral drug that blocks the effects of estrogen, the hormone that promotes growth of some breast cancer cells. It can help prevent recurrences of estrogen-receptor-positive breast tumors and is usually prescribed for five years after the primary treatment. Oncologists see no benefit to taking Tamoxifen for more than five years, both because patients are then past the time of highest risk for recurrence and because Tamoxifen can become less effective after an extended period of use, and yet half of breast cancer recurrences occur five or more years after diagnosis.

Results of a clinical trial involving 5,187 women in the United States, Canada and Europe show that another drug, letrozole (trade name FemaraTM), can nearly halve the risk of breast cancer recurrence among postmenopausal women with estrogen-receptor-positive tumors. The results were so dramatic that investigators halted the trial so that they could offer letrozole to women taking a placebo. The study results were announced on October 9, 2003 and published in the November 6, 2003 issue of The New England Journal of Medicine.

Letrozole works by blocking an enzyme (aromatase) that converts hormones from the adrenal gland to estrogen. The effect is to reduce blood levels of estrogen by more than 95 percent. Side effects include hot flashes, night sweats, sore muscles and an increased risk of osteoporosis. A separate sub-study is trying to determine the exact long-term effects of Femara on bone density. There is also concern that this drug might raise cholesterol levels over time.

Cancer experts still don't know how long women should take letrozole and whether doctors should recommend it to all women who have been on Tamoxifen. The current consensus seems to be that women just finishing their five years on Tamoxifen should consider taking letrozole.
You also can try to lower your estrogen levels, and thus your risk of breast cancer recurrence, by losing excess fat if you're overweight, getting regular exercise, reducing or eliminating consumption of alcohol, and eating only hormone-free beef and dairy products (if you eat those foods). Adding soy foods to your diet can also help. Make sure you eat plenty of fresh fruits and vegetables and fish or flaxseed to get omega-3 fatty acids, and consider supplementing with CoQ10, which may be beneficial.

Andrew Weil, M.D.

Dense Breasts Raise Cancer Risk

(HealthDay News) -- Two new studies suggest breast density is nearly as important as age in predicting who is going to develop breast cancer.
The information may help better identify women at high risk for the disease, the researchers noted.
"After age, it's probably the most important factor," said William E. Barlow, lead author of one of the studies and a senior investigator at Group Health Cooperative in Seattle. "If we wanted to identify women who were really at high risk for chemoprevention efforts or more intense screening surveillance, then any model that incorporates breast density is going to be better at picking out those women."
Both studies are in the Sept. 6 issue of the Journal of the National Cancer Institute.
Since the late 1980s, medical professionals have relied on the Gail model to assess breast cancer risk in women undergoing annual mammography. That model uses risk factors known at the time, such as current age, age at first menstrual period, age at birth of first child, number of first-degree relatives with a family history of breast cancer and number of previous breast biopsies. More recently, race and atypical hyperplasia were added to the model.
Experts had speculated that adding newly identified risk factors for breast cancer such as breast density and use of hormone therapy might improve the test's predictive powers.
Barlow and his colleagues looked at 11,638 women who had developed breast cancer, out of a larger group of about 1 million.
Among premenopausal women, age, breast density, family history of breast cancer and a previous breast procedure were significant risk factors for developing breast cancer. Having any type of prior breast procedure was associated with about a 50 percent increased risk. Women with extremely dense breasts had about a fourfold greater risk than women whose breasts were not dense.
For postmenopausal women, factors included age, breast density, race, ethnicity, family history of breast cancer, a prior breast procedure, body-mass index, natural menopause, hormone therapy and a prior false-positive mammogram.
The model may perform better than the Gail model, although the accuracy was far from perfect. This suggests that the major determinants of breast cancer are still unknown.
A second study, conducted at the National Cancer Institute, used an updated version of the Gail model to assess the absolute risk of developing breast cancer. This model also included breast density, along with weight, age at first live birth, number of previous benign biopsies and number of first-degree relatives with breast cancer.
Again, this model predicted that women with high breast density had an increased risk of breast cancer.
It's unclear if breast density can be considered a modifiable risk factor.
"It may be modifiable, but we don't know that for sure," Barlow said. "It is related to hormone use in women. Their breasts can be denser during the time they're on hormone replacement therapy."
It's also not clear exactly how this new information will be incorporated into practice. Breast density generally needs to be measured by a radiologist. "It's not something that a woman can judge for herself," Barlow explained. "There really isn't a feedback mechanism from the radiologist back to the woman to say what the breast density is."
In the future, however, Barlow envisions mammography facilities becoming more like risk-counseling facilities that incorporate breast density along with other risk factors and past mammogram results. "But that would require an evolution of mammography centers," he noted.
Even in the more immediate present, the findings reinforce the notion of taking steps to prevent breast cancer in high-risk and other women.
"We as a medical community still have not accepted the paradigm that we can identify women who are at a high risk for developing breast cancer," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "We could intervene with a treatment to reduce their risk."
"We don't use the tools we already have to identify women at a high risk for breast cancer and offer them potential treatment to reduce their risk like we do for cholesterol and heart disease," he continued. "Now, we're further defining the model that will predict even better who could potentially benefit from these tools."

More information
For more on breast cancer, visit the American Cancer Society.

Gene Test May Improve Breast Cancer Treatment

(HealthDay News) -- A test that checks the expression of 70 genes associated with breast cancer can help doctors determine a patient's risk of cancer recurrence or death, an international study finds.
The study included 307 breast cancer patients assigned to high- and low-risk groups based on their scores from the 70-gene signature test and standard risk-assessment using a software program. The patients were followed for 13.6 years.
The gene-signature test was a more accurate predictor of cancer recurrence and death than the software, the researchers found. The study also concluded that the gene test included most of the prognostic information provided by traditional risk classifiers.
"These results indicate that the gene signature adds independent prognostic information," reported scientists at the Netherlands Cancer Institute in Amsterdam.
The findings were published in the Sept. 6 issue of the Journal of the National Cancer Institute.
The 70-gene signature test will be evaluated in a larger study of 6,000 women with node-negative early-stage breast cancer. The trial will assess whether the test can improve identification of women who can safely be spared adjuvant chemotherapy.

More information
The U.S. National Library of Medicine has more about genetics and breast cancer.

Scientists Map Genetic Codes for Breast, Colon Cancers

(HealthDay News) -- In what experts are calling a milestone achievement, U.S. researchers have sequenced the genetic "blueprints" of two major cancer killers -- breast and colon cancer.
Identifying nearly 200 genes thought responsible for these diseases, the work gives researchers new insight into these malignancies and lays the foundation for the gene-targeted therapies that may one day cure them.
"Only by understanding this blueprint of cancer will we be fully able to understand the mechanism of what makes a cancer a cancer and to think about strategies for diagnosis, prevention and therapy," explained Dr. Victor Velculescu, senior researcher on the project and an assistant professor of oncology at Johns Hopkins University's Kimmel Cancer Center.
Experts elsewhere were similarly optimistic. In a statement, Dr. Elias A. Zerhouni, director of the U.S. National Institutes of Health, which funded the project, described the new genetic maps as "groundbreaking work."
"This research approach holds great promise for providing an understanding of the genomic contributions to cancer," he said.
Velculescu's team outlined the findings in the Sept. 8 issue of the journal Science.
Just as the human body has its genetic code, so, too, do cancer cells.
"Work from the past two decades has shown us that cancer is a genetic disease," said Velculescu. He explained that a malignancy occurs when specific genes in healthy cells undergo unhealthy mutations.
"A mutation is really like a typo in a blueprint that's 3 billion letters long," he said, so spotting any one mutation has been like finding the proverbial needle in a haystack.
A new $100 million federal initiative, The Cancer Genome Atlas project, seeks to change all that by mapping the myriad genetic "typos" that cause specific tumor types to form. The project described in Science is the first major step in that effort.
In their research, Velculescu and his colleagues from across the United States focused on cracking the gene codes for breast and colon cancers, which together make up one-fifth of all cancer diagnoses worldwide. Other initiatives, focused on other tumor types, are currently under way.
The team analyzed more than 13,000 genes from tumor tissues taken from 11 patients with breast cancer and 11 patients with colorectal cancer.
What they found surprised them.
"Many of us might have expected that only a few of the 'building blocks' in a cell to be mutated, but we actually found quite a number of them," Velculescu said. "It looks like each cancer has about 100 different genes that are mutated, at least 20 of which are thought to be important for the tumor's progression."
The research also confirmed that there's no one disease called cancer.
"It looks like there are quite a bit of differences between the blueprint of different cancer types," the Johns Hopkins expert noted. "Colon and breast cancers are different, and, in addition, each individual's cancer is different. This, in part, may explain the differences that clinicians for a long time have seen among their cancer patients."
But the team also found "commonalities" between colon and breast cancers as well -- mutations that affected similar cellular pathways. "As we learn more and more about how these genes interact, about pathways and how these genes control processes that occur inside cancer cells, we may be able to find simpler [treatment] targets," Velculescu said.
Another expert agreed. "This achievement is important because, to the degree that those genes are proven now to be related to the cancer process, they provide targets that can be potentially used either for diagnostic or treatment purposes," said Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society.
For example, doctors may someday use sensitive nanotechnology early detection tests to spot tiny amounts of cancer-linked proteins produced by these aberrant genes. "That would be a test that would enable you to diagnose a cancer long before you are actually able to see it," Lichtenfeld said.
In terms of treatments, drug developers can target specific genes and their proteins to create treatments that stop a cancer cold without harming the patient. Gleevec -- the "wonder" drug now used to halt chronic myelogenous leukemia -- is one such targeted therapy, Lichtenfeld said.
"So, this new achievement is a really important step and an important link between where we are today and where we have been talking that we will be in five, 10, 15 years," he said.
Velculescu said he shares that vision.
"We are predicting that cancer is an individualized disease, and there will come a day when people will go into the clinic and their tumor will be analyzed for specific mutations," he said. "Based on the combination of genes that are mutated, they will receive a particular combination of therapies that will treat the disease."
"We're not there yet, and there's still a long way to go," Velculescu said. "But without knowing what's broken inside a cancer cell, we have no hope of fixing it."

More information
For more on gene therapy and cancer, head to the American Cancer Society.

Breastfeeding Medicine

New Rochelle, NY, July 31, 2006—In Recognition of World Breastfeeding Week, Mary Ann Liebert, Inc. (www.liebertpub.com) will provide free online access to Breastfeeding Medicine for the entire month of August.

Breastfeeding Medicine, the official publication of the Academy of Breastfeeding Medicine, is a new international peer-reviewed medical journal that provides physicians with the evidence-based information they need to further educate themselves, their hospital staff, and patients on all aspects of breastfeeding to ensure optimal care for both mother and infant.

All published issues are available free online at www.liebertpub.com/bfm
“A new level of interest in breastfeeding coupled with widespread evidence-based research on the benefits of breastfeeding was the impetus for Breastfeeding Medicine,” said Mary Ann Liebert, President and CEO of Mary Ann Liebert, Inc. “Breastfeeding has a major impact on healthcare outcomes and costs since the baby has fewer medical problems (such as ear infections, allergies and obesity), as does the mother (such as lower incidence of breast and ovarian cancer). It gives me great pleasure to extend online access to everyone for the month of August,” she added.

Breastfeeding Medicine publishes original scientific papers, reviews, and clinical case studies on a wide spectrum of topics in lactation medicine such as: the epidemiology, physiological and psychological benefits of breastfeeding; breastfeeding recommendations and protocols; health consequences of artificial feeding; optimal nutrition for the breastfeeding mother; breastfeeding indications and contraindications; breastfeeding the premature or sick infant; breastfeeding in the chronically ill mother; management of the breastfeeding mother on medication; and much more.

The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection, and support of breastfeeding and human lactation through education, research, and advocacy. The Academy’s 2006 Annual International Meeting, “Current Controversies in Breastfeeding Medicine,” is taking place on September 19-22, 2006 in Niagara Falls, NY. For further details and to register, visit (www.bfmed.org)

Mary Ann Liebert, Inc. is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Journal of Women’s Health, Pediatric Asthma, Allergy, & Immunology, and Obesity Management. Its biotechnology trade magazine, Genetic Engineering News (GEN), was the first in its field and is today the industry’s most widely read publication worldwide. A complete list of the firm’s 60 journals, books, and newsmagazines is available at www.liebertpub.com

Breast implants linked to suicide, but not cancer

NEW YORK (Reuters Health) -- A large Canadian study adds to evidence that women with breast implants do not face a higher risk of cancer or other major diseases, but they may have a higher-than-average rate of suicide.

Among the more than 40,000 women in the study, those who'd received cosmetic breast implants had lower-than-average risks of dying from breast cancer, heart disease and a host of other major diseases.

The findings, published in the American Journal of Epidemiology, are in line with those of several past studies. Despite concerns that implants might be a risk factor for cancer or other major illnesses, researchers have generally found lower risks among breast implant recipients.

"To some extent, what you're seeing is a screening effect," said Dr. Howard Morrison of the Public Health Agency of Canada in Ottawa.

That is, women who undergo elective invasive surgery are necessarily in good health, and may have lower-than-average risks of various diseases.

Together with past studies, the new findings should be generally reassuring to women with implants, according to Morrison, whose colleague at the health agency, Dr. Paul J. Villeneuve, led the study.

But the research also confirmed another finding that several studies have now uncovered: Women with breast implants commit suicide at a higher-than-average rate.

"These findings agree fundamentally with those of past reports," Morrison said. "The one thing that lights up is this increased suicide risk."

Though this study could not dig for the reasons, Morrison noted that other studies have found poorer self-esteem and elevated rates of depression and other psychiatric disorders among women who opt for breast augmentation.

The current findings are based on data from 24,558 women who received breast implants between 1974 and 1989, and 15,893 women who had other types of plastic surgery during the same time period. The researchers tracked deaths through 1997.

Compared with rates for the general population, women in both surgery groups were about one-quarter less likely to die of cancer, and their risks of death from other major diseases were similarly lower.

Women with implants were, however, 73 percent more likely than those in the general population to commit suicide, while women who had other forms of plastic surgery also had an elevated suicide rate.

The risk was not dramatic, Morrison noted, as few women in the study committed suicide -- including 58 of the more than 24,000 breast implant patients.

Still, he said it "seems reasonable" to suggest plastic surgeons refer implant seekers for mental health consultation when they suspect the patients are at high risk of a psychiatric disorder or suicide.

Copyright 2006 Reuters.

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