Sunday, August 15, 2010

Rediscovered: Fat women get LESS breast cancer

It's been known for years but there are any number of statements to the contrary.

The presentation of the findings below is, however, very misleading, as usual. They only discuss relative risk, not what most people want to know: absolute risk. What they don't tell you (but which any calculator will) is that out of the big group of old ladies studied over a 10 year period, only 5% got cancer, so the risk for ALL groups was small. Most of the variations on HRT use would move you, for instance, from being around 3% at risk to 4% at risk -- which trivial change is in line with what has previously been reported

Journal abstract here

A prospective observational study that began following more than 50,000 California teachers in 1995 has confirmed reports linking hormone replacement therapy to breast cancer, but suggests obesity may offer some protection.

Data from 56,867 women enrolled in the California Teachers Study indicate that women who used estrogen therapy for at least 15 years had a 19% increase in the risk of breast cancer, and women who used combined estrogen-progestin therapy had an 83% increase in breast cancer risk.

The increase in risk was confined to tumors that were positive for both estrogen and progesterone receptors, wrote Tanmei Saxena of the University of Southern California, Los Angeles, and her coauthors. It was also more pronounced in women with low body mass index (BMI).

"These findings, taken in context of the larger literature on this topic, continue to underscore the need to personalize risk-benefit discussions for women contemplating the use of [hormone therapy]," wrote the investigators (Cancer Epidemiol. Biomarkers Prev. 2010;19:OF1-13).

The California Teachers Study is a prospective cohort study of 133,479 women who were enrolled in 1995. For the purposes of this study, the investigators excluded women who were not California residents, who had a previous or unknown history of breast cancer, who were older than 80 years at baseline, who were premenopausal or of unknown menopausal status, or who had an unknown history of hormone therapy.

Of the remaining 56,867 perimenopausal and postmenopausal teachers, 2,857 women (5%) were diagnosed with pathologically confirmed invasive breast cancer through December 2006, after a mean follow-up of 9.8 years. The average age at diagnosis was 67.1 years.

In a multivariate analysis, the investigators adjusted for race/ethnicity, first-degree family history of breast cancer, BMI, smoking history, alcohol consumption during the year prior to baseline, mammographic screening over the prior 2 years, parity and age at first full-term pregnancy, age at menarche, age at menopause, and history of breast biopsy.

Compared with women who never used any hormone therapy, those who did had a statistically significant 40% increase in the risk of breast cancer. The increase in risk was 19% for women who reported at least 15 years of estrogen-alone therapy, and 83% in women who reported at least 15 years of combined estrogen-progestin therapy.

Current use of hormonal therapy was associated with higher risk than past use. The greatest increase in risk - 69% - was among women who were using estrogen-progestin therapy currently and had never used any other formulation. The investigators noted that duration of use tended to be shorter among former users.

The longer the women used hormone therapy, the greater the risk. The increase associated with duration of use was statistically significant for all forms of hormone therapy. For example, women using estrogen-progestin therapy for less than 2 years at baseline had a 12% increase in the risk of breast cancer, compared with women who never used hormone therapy. The increase in risk was 42% for those using estrogen-progestin therapy for 3-5 years, 50% at 6-9 years, 67% at 10-14 years, 79% at 15-19 years, and 92% at 20 years or more.

Among current users of hormonal therapy, the association with breast cancer risk was statistically significant only for tumors that were both estrogen receptor-positive and progesterone receptor-positive, with increased risks of 33% in women who had 15 or more years of estrogen therapy and 84% in those who had been on estrogen and progestin for 15 years or more. The risks were even higher for women whose tumors were also HER2 positive, but the investigators suggested this might be a statistical fluke because of the small numbers involved. No association was seen between long duration of hormone use and triple-negative tumors.

BMI seemed to modify the risk associated with hormonal therapy, the investigators reported. Among women with a BMI of 25 or less, the relative risk of breast cancer was 2.1 in current long-term users of estrogen and progestin, compared with women who had never used hormone therapy (P less than .0001). In women with a BMI of 25-30, the relative risk was 1.9 in current long-term users of estrogen and progestin (P less than .0001). However, the effect was not statistically significant in women with a BMI higher than 30 (RR 1.2, P = .11).

The National Cancer Institute and the California Breast Cancer Research Fund sponsored the study. A coauthor disclosed serving as an expert witness for plaintiffs pursuing Prempro litigation.


Food cravings could be helped with pressure point therapy called Emotional Freedom Technique

Probably a placebo effect

IF YOU'VE ever wished you could stop those pesky chocolate cravings, the solution could be at your fingertips.

A study by Queensland's Griffith University has found that massaging key pressure points can stave off food cravings and even turn people off certain foods for life, leading to weight loss.

The 15-minute treatment, called Emotional Freedom Technique, involves holding your most craved treat in one hand while pressure point treatment is applied at the same time.

Senior lecturer in medicine at Griffith Dr Peta Stapleton conducted the one year study on 96 overweight and obese adults and found that EFT had an immediate effect on reducing food cravings, resulting in weight loss over time. "We actually got them to bring their own individual food to the session – most people chose chocolate," Dr Stapleton said.

"They looked at and smelled the food while the EFT was applied. By tapping on pressure points it releases endorphins which then relaxes your body and results in a decrease in the food craving."

Remedial therapist Bernice Vergou, 60, has been practising EFT for nine years and has dealt with various clients who want to reduce food cravings and lose weight.

"I've helped many clients stop craving their favourite foods," she said. "EFT is non-invasive, it's user-friendly and so easy to do yourself. Not one week goes by where I don't have a client contact me for positive feedback.

One of her customers, Maria Bottin, 47, said it only took one session of EFT to kill her craving for hot chips. "I would be driving home from work late at night and stop at McDonald's to fulfil my craving," she said. "After the EFT they tasted disgusting it really blew me away." She is now using the therapy to conquer cravings for her second favourite treat, chocolate.


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