Saturday, March 31, 2012

Just one glass of wine a day linked to breast cancer

This appears to be a meta-analysis and while such analyses are important their results can very easily be swung in the direction expected by the researchers.  The data input seems to  have been epidemiological so proves nothing anyhow.  Alcohol drinking may be simply a proxy for how careful people are about their health generally.

Just one good double blind study is needed for firm conclusions.  Given that, all the meta-analyses would be superfluous.  The journal article is "Epidemiology and Pathophysiology of Alcohol and Breast Cancer: Update 2012"

Women should stick to just one glass of wine a day and those with a family history of breast cancer should abstain altogether as researchers find even moderate alcohol consumption increases chances of developing the disease.

A review of research on alcohol and breast cancer has found that just one drink a day can increase the risk of breast cancer by five per cent.  Women drinking 'heavily' by having three or more drinks a day are up to 50 per cent more likely to develop breast cancer than those who abstain, it was found.

It could mean that thousands of cases of breast cancer in Britain each year are caused by alcohol.

The link between breast cancer and alcohol is already known but it has not been clear if there was an the increased risk with low levels of consumption or a 'safe' threshold, below which there was no effect on breast cancer.  There are around 48,000 women diagnosed with breast cancer in Britain each year and just under 12,000 women with the disease die annually.

The analysis of 113 research papers was published in the journal Alcohol and Alcoholism.

The researchers from the University of Heidelberg in Germany and the University of Milan, in Italy, wrote in the journal: "Since several populations show a high prevalence of light drinkers among women, even the small increase in risk we reported — in the order of five per cent — represents a major public health issue in terms of breast cancers attributable to alcohol consumption."

In the research, a drink was defined as 10 to 12 grams of ethanol, the equivalent of up to 1.5 UK units, or around one 125ml glass of average strength red wine or a pint of lager.

The researchers found that the more women drank the higher their risk of breast cancer, and calculated that each 10g of alcohol per day was linked to a ten to 13 per cent increased risk of cancer.

For every 200 women, 20 are expected to develop breast cancer during their lifetime. If they all drank 1.5 units every day, an extra one woman would develop cancer because of alcohol, the research suggests.

Lead author Prof Helmut Seitz wrote: "Since there is no threshold level of ethanol for breast cancer risk, the breast is one of the most sensitive organs for the carcinogenic action of alcohol. Healthy women should not exceed one drink a day (equivalent to 10–12g of ethanol).

"Women at an elevated risk for breast cancer such as those with a positive family history, or conditions associated with an increased breast cancer risk should avoid alcohol or consume alcohol only occasionally."

It is thought alcohol affects the female hormone oestrogen which can fuel certain forms of breast cancer.

Sarah Williams, health information officer at Cancer Research UK, said: “Research has already shown that the risk of breast cancer increases the more alcohol a woman drinks.  "But this new study adds to the evidence that drinking even small amounts of alcohol – about one drink a day – can slightly increase the risk of breast cancer.

"Women can help reduce their risk of breast cancer by reducing the amount of alcohol they drink, keeping a healthy weight, and being physically active.”


One-a-day heart pill to stave off stroke is given the green light

Warfarin (rat poison) is very dangerous so an alternative is good news

The first once-a-day anti-clotting drug for patients with an irregular heartbeat has been given the green light for use on the NHS.  Rivaroxaban works as well as warfarin, a treatment based on rat poison which has been used since the 1950s, but with fewer side effects.

Hundreds of thousands of patients with atrial fibrillation (AF) could be eligible, which may prevent 5,000 strokes a year.

The drug is the second new anti-clotting agent to get the go-ahead from the NHS rationing body, the National Institute for Health and Clinical Excellence (Nice), which recently approved Pradaxa.

AF is the most common heart rhythm disturbance, affecting up to 1.2 million Britons and causing 12,500 strokes a year.  In AF, the upper chambers of the heart are out of rhythm and beat much faster than normal, which allows blood to pool and generate tiny blood clots which can trigger a stroke.

Rivaroxaban is expected to become a blockbuster drug. As a daily pill, it has a key advantage over Pradaxa, which must be taken twice a day.

AF patients have to take anti-clotting agents for life, but Nice says the new drugs offer value for money either as a replacement for warfarin or for patients who cannot take it.

At £2.10 a day, Rivaroxaban is slightly cheaper than Pradaxa (£2.50), but there is still a big price differential with warfarin. The new drug costs £64 for a month’s supply, compared to warfarin’s cost of only £1, plus clinic visits. Some of the clinic costs associated with monitoring warfarin may be recouped, says Nice.

Warfarin, which is still used in large doses to kill vermin, has been given routinely to AF patients for decades, reducing the rate of stroke by up to two-thirds at the cost of increased bleeding.

But it is inconvenient for patients because careful monitoring and regular blood tests are needed to prevent excessive bleeding from cuts or stomach ulcers.

A consensus conference by the Royal College of Physicians in Edinburgh estimated 5,000 strokes and 2,000 premature deaths a year could be avoided through effective detection and treatment of AF, with only half of patients currently receiving drugs.

Trudie Lobban, chief executive and founder of the Atrial Fibrillation Association, said prevention and treatment of strokes should be an NHS priority.

She added: ‘After 60 years when warfarin was the only option for patients we now have a choice of agents that will have a significant impact on strokes and quality of life. They are opening the way for raising awareness and education, and encouraging GPs to check for AF.’

Rivaroxaban was developed by Bayer AG and Johnson & Johnson and is expected to make peak sales worth two billion euros a year in Europe.

Dr Peter Coleman, of The Stroke Association, said: ‘Warfarin is a highly effective treatment for stroke prevention, but it is not suitable for everyone.  ‘We’re pleased to hear that GPs will have another safe medication in their armoury to treat patients with atrial fibrillation.’

Professor Carole Longson, of Nice, added: ‘We know that people taking warfarin can find it difficult to maintain their blood clotting at a proper level and are often not within the target therapeutic range.

‘Rivaroxaban, like dabigatran etexilate, which Nice recently approved as an option for this indication, can benefit people with AF in these circumstances.’


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