Wednesday, October 09, 2013

Women who have their breasts removed over cancer fears may NOT improve their survival rate, study warns

Women who have a healthy breast removed over fears they might later develop breast cancer may not improve their survival rate, according to new research.

Earlier this year Hollywood star Angelina Jolie underwent surgery to remove her breasts after being told she had an 87 per cent risk of developing breast cancer due to a defective BRCA1 gene and her family history.

Jolie's mother, maternal grandmother and aunt all died from breast or ovarian cancer in their late 40s or in their 50s.

The double mastectomy lowered her chances of developing breast cancer to under five per cent.

But previous research has found most women undergoing this procedure do so out of fear, rather than an understanding of their actual risk.  As much as four out of five preventative mastectomies are ‘misguided,’ campaigners claim.

The new University of Minnesota study set out to look at the decision-making processes that lead women to choose preventative mastectomy.

The research found women with early-stage breast cancer in one breast are increasingly opting to undergo a more aggressive operation to remove both breasts.

This comes just a week after eminent British surgeon, Professor Kefah Mokbel of the London Breast Institute, warned that would be pointless for women who are not in the same category as Jolie.

Scientists claim the risk of developing cancer in the other breast is very low.

Those at high risk include those with a family history of breast or ovarian cancer and women who test positive for the BRCA1 and BRCA2 gene mutations.

Dr Todd Tuttle, chief of surgical oncology, said: ‘There have been several studies in the last couple of years indicating that there may be a survival benefit for selected patients by having their healthy breast removed.’

To evaluate the effect of double mastectomies on life expectancy, the researchers conducted an study among women without a BRCA gene mutation.

Within this group, the researchers compared women who underwent a double mastectomy with women had an operation to remove early-stage breast cancer in one breast and no operation to remove the second breast.

It primarily analysed data from the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) and the Surveillance, Epidemiology, and End Results (SEER) programme to determine how risks were reduced by each operation.

The two databases include information on the treatment and survival of early breast cancer and include more than 100,000 women who have participated in randomised trials over the last 30 years across the United States.

For the study, the researchers estimated the life expectancy gain of those who had double mastectomies among sub-groups of women newly diagnosed with cancer in one breast by age 40 to 60 years, oestrogen receptor status as positive or negative, and stage of cancer I or II.

They found that the maximum life expectancy gain for women who underwent the double mastectomies was six months for all scenarios including age, oestrogen receptor status, and cancer stage groups.

This procedure is a bigger operation associated with a longer recovery period and potentially more complications.

Dr Tuttle said: ‘I think this decision model study will provide women who are considering these extensive operations with more accurate information about whether or not contralateral prophylactic mastectomy (CPM) is going to improve their survival.

‘This information may ultimately help them answer an important question – “If I have that opposite breast removed, is that procedure really going to improve the likelihood that I will be alive 10 to 20 years from now?”’

The study was published at the 2013 Clinical Congress of the American College of Surgeons.


How your parents can break your heart: Children starved of warmth and affection suffer lifelong health problems

This is pretty rubbishy stuff.  Retrospective self-report is very weak data and unloved children probably suffer from other harms than merely being unloved

The effects of childhood abuse and lack of parental affection can last a lifetime, taking a toll both emotionally and physically, reveals a new study.

A new UCLA-led study for the first time examines the effects of abuse and lack of parental affection across the body's entire regulatory system.

The study, published online by the Proceedings of the National Academy of Sciences, found a strong biological link for how negative early life experiences affect physical health and can even lead to cardiovascular disease.

However, it's not all bad news. 'Our findings suggest that there may be a way to reduce the impact abuse has, at least in terms of physical health," said Judith E. Carroll, a research scientist at the Cousins Center for Psychoneuroimmunology at UCLA, and the study's lead author.

The researchers studied 756 adults who had participated in a study called Coronary Artery Risk Development in Young Adults (CARDIA).

They measured 18 biological markers of health risk, such as blood pressure, heart rate, stress hormone, cholesterol, waist circumference, inflammation, and blood sugar regulation, and analysed if they were at higher biological risk for disease.

To determine the study subjects' childhood stress the researchers used a self-report scale called the Risky Families Questionnaire.

They found a significant link between reports of childhood abuse and multisystem health risks, but those who reported higher amounts of parental warmth and affection in their childhood had lower multisystem health risks.

The researchers also found a significant interaction of abuse and warmth, so that individuals reporting low levels of love and affection and high levels of abuse in childhood had the highest multisystem risk in adulthood.

'Our findings highlight the extent to which these early childhood experiences are associated with evidence of increased biological risks across nearly all of the body's major regulatory systems,' said Teresa Seeman, professor of medicine in the division of geriatrics at the David Geffen School of Medicine and of epidemiology at the Fielding School of Public Health at UCLA, and the paper's senior author.

'If we only look at individual biological parameters such as blood pressure or cholesterol, we would miss the fact that the early childhood experiences are related to a much broader set of biological risk indicators - suggesting the range of health risks that may result from such adverse childhood exposures.'

The authors note that the findings used information provided by the participants, so there may be some recall bias.

Also, the analysis may not have captured other factors affecting regulatory systems, such as poor nutrition or environmental pollution.

But the findings suggest that parental warmth and affection protect one against the harmful effects of toxic childhood stress.

Also, the lingering effects of childhood abuse can be linked to age-related diseases such as cardiovascular disease. Among other things, this could have an effect on long-term health care costs.

'It is our hope that this will encourage public policy support for early interventions,' Carroll said.

'If we intervene early in risky families and at places that provide care for children by educating and training parents, teachers, and other caregivers in how to provide a loving and nurturing environment, we may also improve the long term health trajectories of those kids.'


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