Fitness Club

October is National Breast Cancer Awareness Month, but what some people want people to become more aware of is how little progress has been made in defeating this disease over the last quarter century. Since 1990, when National Breast Cancer Awareness Month was first launched, the rate of decline of breast cancer deaths has been a disappointing 2 percent per year. On average, 117 people -- mostly women -- died each day from breast cancer in 1991. Today that figure stands at 110.

In an article published in the Los Angeles Times, Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, NH, notes that breast cancer is many different diseases. Some tumors -- called "indolent" -- are basically harmless, while others grow slowly and may eventually cause trouble. However, the most dangerous forms of breast cancer are those characterized by aggressive tumors that grow fast and metastasize before they're detected.

The Detection Conundrum

Women have been encouraged for years to examine their own breasts and, after they reach a certain age -- the recommendations on age have become controversial -- to have annual mammogram screenings. The problem, according to Welch, is that these measures are best at finding the least-threatening tumors.

Treatments tend to be the same for all breast cancers, so what's happening is that many women whose tumors might never cause them any problem are being subjected to unnecessary surgeries, radiation and chemotherapy.

For every life a mammogram has saved, five to 15 lives may have been irreparably altered by mammogram findings that led to unwarranted treatments, suggested Welch in an editorial published in the New England Journal of Medicine accompanying a study on the role of mammograms in reducing the breast cancer death rate.

What Welch and others are proposing is that more attention be paid to preventing breast cancers, rather than putting all the eggs, so to speak, in the detection-and-treatment basket. That approach is complicated by the fact that a high-profile campaign such as National Breast Cancer Awareness Month is sponsored by AstraZeneca, which markets the breast cancer drugs Arimidex, Faslodex, Nolvadex and Zoladex. Welch has called the pharma's sponsorship a "huge conflict of interest."

10 Steps for Prevention

Following are some ways to reduce the risk factors for breast cancer, based on current research:

1. Consume a healthy diet that emphasizes vegetables, fruits, lean protein (chicken, fish), whole grains and vegetable oils. Avoid sugar, refined carbohydrates and foods high in animal fat.

2. Exercise at least 30 minutes a day.

3. Strive to maintain a normal weight (body mass index under 25). Obesity is linked to breast cancer.

4. Limit alcohol consumption to one drink per day or less.

5. Don't smoke.

6. Breastfeed your babies for as long as possible. Women who breastfeed for one or more years have significantly lower risk.

7. Avoid menopausal hormone replacement therapy. If you have severe symptoms, ask about other options.

8. Limit use of antibiotics.

1.9. Avoid exposure potentially carcinogenic chemicals in pesticides, cleaning supplies and other household products. 2.

3.10. Choose cosmetics and beauty supplies with natural ingredients. Choose products that are fragrance-free or are scented with essential oils over those containing synthetic "fragrance."

A new study of the cardiovascular benefit from using omega-3 enriched margarine in patients who previously suffered heart attacks turned up disappointing results, but its design may have been flawed.

The study, conducted over a period of 3 1/2 years by researchers in the Netherlands, concluded that the rate of cardiovascular problems, including resulting deaths, was substantially the same, whether the participants were consuming additional low doses of omega-3 fatty acids in their diet or not.

The 4,800 participants were mostly men, aged 60 to 80. All were taking medications during the study period to regulate blood pressure and cholesterol levels, as well as guard against clotting.

Daan Kromhout of the division of human nutrition at Wageningen University presented the findings Sunday at the European Society of Cardiology Congress in Stockholm.

Although at face value the study may seem to suggest that omega-3 supplementation provides no heart-health advantage, that conclusion might not be warranted, for several reasons. The amount of supplementation provided may have been too little. The patients consumed an average of 18.8 grams of margarine per day, which gave them an average of 226 milligrams of eicosapentaenoic acid (EPA) combined with 150 milligrams of docosahexaenoic acid (DHA), both derived from fish; and/or 1.9 grams of alpha-linolenic acid (ALA), found in plants. These amounts are considered "low dose." Heart patients are often advised to take 1,000 milligrams of omega-3 daily.The supplementation may have been provided too late for most of the study participants. Several years had intervened between the time many of them experienced their heart attacks and the beginning of the study. However, it is the period immediately following a cardiac event when a patient is most vulnerable.Some of the patients did seem to benefit from the supplementation. There was a "borderline significant reduction" in major heart events among women who consumed ALA, as well as among diabetics in the study. The supplementation appeared to protect against ventricular arrhythmia-related events, the researchers said. Unlike taking an omega-3 supplement in pill form, the study required patients to consume margarine, so a secondary food was required -- and that typically was bread. The study did not account for the possible negative effects of weight gain or increased blood pressure from eating extra bread, critics have noted. The strength of the patients' heart-protective medications may have overshadowed any potential benefit from the low-dose supplementation.The study was conducted among a population that typically consumes a lot of fish, which naturally provides omega-3. Supplementation might be of greater benefit to people who eat more meat and less fish (typical in the US).The study was not designed to consider the potential heart benefits of omega-3 supplementation among a general population of individuals who had never had a heart attack or other serious cardiovascular problems.

It's likely that more research is warranted to provide a clearer picture of the relationship between supplementation with omega-3 fatty acids and heart health.

Once again, a research study has turned up damning evidence against the hormone replacement therapy that millions of women continue to use to ease the symptoms of menopause. In brief, women who took estrogen plus progesterone for five years or more were more likely to get breast cancer; they were also more likely to get other, more serious, cancers; and they were at greater risk of dying from them.

These were the main findings of a study published this week in the Journal of the American Medical Association.

The conclusions are based on 11 years of follow-up with more than 12,000 participants in the Women's Health Initiative study, which found in 2002 that prolonged use of HRT increased the incidence of ovarian cancer, breast cancer and strokes, among other ill effects.

The study was halted when those findings came to light, and all participants stopped taking hormones; however, researchers continued to monitor the participants.

The most recent study contradicts earlier studies that concluded the increased risk connected with HRT applied only to less aggressive, more treatable tumors that some doctors considered no more than minor problems. For the first time, researchers found a link between hormone therapy and increased risk of death.

Guessing Game

All categories of breast cancer were increased among women who used HRT, and as a group, their cancers were more advanced. Twice as many of them died versus WHI participants who took a placebo instead of HRT.

Rowan Chlebowski, MD, of the Los Angeles Biomedical Research Institute, who authored the most recent analysis, has said that even though the risk of death is low -- 2.6 per 10,000 per year -- it is real.

HRT sales plummeted following the 2002 report, but doctors continue to prescribe it to millions of women, betting that lower doses taken for shorter periods of time won't be harmful to their patients. However, there is no research to support the validity of that approach.

To Die For?

Hormone replacement therapy for the treatment of menopausal symptoms seemed like one of the wonders of the modern world when it first became available. For some women, those symptoms can be severe -- even disabling.

Yet no woman has ever died from menopause. OPINION Doctors need to free themselves from the influence of big pharma and the pressures applied by patients who want a pill to cure whatever ails them -- even if it means rolling the dice.

The percentage of women who die as a consequence of seeking relief from menopausal symptoms may be tiny, but for those who represent that small slice of humanity, the consequences are significant indeed.

No drug should be prescribed merely to relieve pain or discomfort if death could be the result -- except to patients who are already terminally ill or whose lives really aren't worth living without it.

Few cases of menopausal distress would meet that standard.