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More women having a healthy breast removed

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More women having a healthy breast removed

A small but growing number of women with breast cancer are choosing to have the unaffected breast removed in an effort to prevent a recurrence, researchers reported Monday.

Using data from New York State hospitals, the researchers found that between 1995 and 2005, the prevalence of preventive mastectomy among women with a history of cancer in one breast more than doubled.

The procedure was performed in about 2 percent of all women diagnosed with breast cancer in 1995 and 1996 — rising to just over 4 percent by 2005.

In contrast, there was only a small increase in preventive mastectomies among women who had no personal history of breast cancer but were considered at risk because of a strong family history of the disease.

The findings suggest that while the number of preventive mastectomies performed each year in New York was small, the procedure is becoming more common, the researchers report in the journal Cancer.

The more marked increase among women with a history of breast cancer raises some concerns, senior researcher Dr. Stephen B. Edge, of the Roswell Park Cancer Institute in Buffalo, told Reuters Health.

The central issue, he explained, is that there is no evidence that removing the unaffected breast improves long-term survival.

While preventive mastectomy likely cuts the chances of cancer developing in the second breast, the ultimate impact on survival is a more complicated matter.

Edge noted that among women who are not at high genetic risk of breast cancer — about 95 percent of all breast cancer patients — the odds of developing cancer in the second breast are between 10 percent and 20 percent over 20 to 30 years.

So in deciding whether to have a preventive mastectomy, women need to consider the uncertain long-term benefits and the risk of complications — which include bleeding, infection and nerve damage.

“Women need to be carefully counseled on the issues of the risks of developing a second cancer, and the largely minimal or no impact this may have on their survival,” Edge said.

The study findings are based on data from hospital discharge records and the New York State cancer registry. Of the nearly 70,000 women who underwent mastectomies between 1995 and 2005, 9 percent — 6,275 women — had one for preventive reasons.

Of women having a preventive mastectomy, 81 percent had a history of breast cancer. The number of these procedures rose from 295 in 1995 to 683 in 2005.

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Over 65? Take lots of vitamin D to prevent a fall

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Over 65? Take lots of vitamin D to prevent a fall

Important news for seniors: A daily dose of vitamin D cuts your risk of falling substantially, researchers reported today.

But not just any dose will do. “It takes 700 to 1000 international units (IU) of vitamin D per day and nothing less will work,” Dr. Heike A. Bischoff-Ferrari, who directs the Center on Aging and Mobility at the University of Zurich, Switzerland, noted in an email to Reuters Health.

Those recommendations – which are higher than those by the U.S. Institute of Medicine — are based on the results of eight studies that looked at vitamin D supplements for fall prevention among more than 2,400 adults aged 65 and older. Falls were not notably reduced with daily doses of vitamin D lower than 700 IU.

An analysis of all eight studies, posted online today in the British Medical Journal, add weight to several others which have shown that vitamin D improves strength and balance, and bone health in the elderly, the researchers note.

Each year, 1 in 3 people aged 65 and older, and 1 in 2 aged 50 and older, fall at least once. Nine percent of these mishaps require a trip to the emergency room and around 6 percent result in a fracture. Many elderly people who fall end up in nursing homes.

“Falls are important events to prevent,” Bischoff-Ferrari said, “and 700 to 1000 IU of vitamin D per day is safe and inexpensive,” but it’s higher than the currently recommended by the Institute of Medicine for older adults. (The Institute recommends 400 IU per day for adults between age 51 and 70, and 600 IU per day for those aged 70 years and over.)

The current findings, Bischoff-Ferrari said, provide an argument to revise the recommendations. They looked at two forms of the vitamin: Vitamin D3, or cholecalciferol, which is more readily absorbed by the body and more potent than vitamin D2, or ergocalciferol, the form often found in multivitamins.

“At the higher dose of 700 to 1000 IU vitamin D, the benefit on fall prevention is significant — at least 19 percent, 26 percent with vitamin D3,” Bischoff-Ferrari said.

While vitamin D3 seemed more potent than D2, forms of vitamin D marketed as “active,” such as calcitriol, did not seem to be more effective than standard vitamin D supplements, the researchers found. Such active forms are more expensive and carry a higher risk of elevated calcium levels, which have been linked to hormone problems and cancer.

Moreover, the effect of 700 to 1000 IU vitamin D daily is kicks in “in a few months and is sustained over years, and the benefit is independent of age and present in those living at home and those living in nursing homes,” Bischoff-Ferrari noted.

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Is swimming pool chlorine fueling the allergy epidemic?

Is swimming pool chlorine fueling the allergy epidemic?

Swimming in a chlorinated pool may boost the odds that a child susceptible to asthma and allergies will develop these problems, a study released today indicates.

“These new data clearly show that by irritating the airways of swimmers chlorination products in water and air of swimming pools exert a strong additive effect on the development of asthma and respiratory allergies such as hay fever and allergic rhinitis,” Dr. Alfred Bernard, a toxicologist at the Catholic University of Louvain in Brussels, Belgium, noted in an email to Reuters Health.

“The impact of these chemicals on the respiratory health of children and adolescents appears to be much more important — at least by a factor of five — than that associated with secondhand smoke,” Bernard noted.

Taken together with his team’s prior studies, he added, “There is little doubt that pool chlorine is an important factor implicated in the epidemic of allergic diseases affecting the westernized world.”

In the current study, Bernard and colleagues compared the health of 733 adolescents, 13 to 18 years old, who swam in chlorinated outdoor and indoor pools for various amounts of time with that of 114 “control” adolescents who swam mostly in pools sanitized with a concentration of copper and silver.

In children with allergic sensitivities, swimming in chlorinated pools significantly increased the likelihood of asthma and respiratory allergies, the researchers report in the journal Pediatrics.

Among “sensitive” adolescents, the odds for hay fever were between 3.3- and 6.6-fold higher in those who swam in chlorinated pools for greater than 100 hours and the odds of allergic rhinitis were increased 2.2- to 3.5-fold among those who logged more than 1000 hours of chlorinated pool time.

For example, among children and teens who swam in chlorinated pools for 100-500 lifetime hours, 22 children out of 369 (6.0%) had current asthma, compared with those who had spent less than 100 hours (2 of 144, 1.8%). The proportions with asthma rose with longer exposure, to 14 out of 221 (6.4%) who had been swimming for 500-1000 hours, and 17 out of 143 (11.9%) who swam for more than 1000 hours.

The risk of asthma and allergy was not influenced by swimming in copper-silver sanitized pools and children without allergic tendencies were not at increased risk of developing allergies.

“The only plausible explanation” for these observations, the researchers argue, is that the chlorine-based toxic chemicals in the water or hovering in the air at the pool surface cause changes in the airway and promote the development of allergic diseases.

“It is probably not by chance,” Bernard told Reuters Health, “that countries with the highest prevalence of asthma and respiratory allergies are also those where swimming pools are the most popular.”

The current findings, he and colleagues conclude, “reinforce” the need for further study on the issue and to enforce regulations concerning the levels of these chemicals in water and air of swimming pools.

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