For Breast Cancer Patients Early Switch To An Aromatase Inhibitor Increases Survival

For breast cancer patients taking tamoxifen, switching to an aromatase inhibitor within three years significantly improves survival rates, according to a new study. Published in the March 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that the clear survival benefit was also achieved without an increased risk of death from other causes - a significant risk associated with tamoxifen.



Hormone modulating therapies have made a significant impact on the survival rates of women with estrogen-sensitive breast cancer over the last two decades. The drugs are used as adjuvant to primary surgical treatment for a period of five years.



Tamoxifen was the first estrogen modulator shown to increase survival and reduce the risk of breast cancer recurrence. However, tamoxifen is associated with increased risk of death from other causes, such as strokes and endometrial cancer. Despite this risk, tamoxifen and another drug in this class, raloxifene, remain an extensively used and popular treatment.



Aromatase inhibitors, such as aminoglutethimide and anastrozole, work in a different way to lower estrogen levels. Recent evidence shows aromatase inhibitors used alone or in follow-up after two years of tamoxifen therapy demonstrates clear and, in some cases, improved reduction of recurrence risk. However, there is conflicting evidence about mortality benefits.



Led by Professor Francesco Boccardo, M.D. of the National Cancer Research Institute and the University of Genoa in Italy, researchers pooled data from two studies (828 women) comparing five year treatment with tamoxifen alone (415 women) or tamoxifen for two to three years followed by an aromatase inhibitor for the remaining treatment period (413 women).



Dr. Boccardo and his colleagues found that compared to treatment with tamoxifen alone, all cause mortality risk and breast cancer-related mortality risk both fell significantly for women switching to an aromatase inhibitor. In addition, there was no increased risk of death from other causes in women who were prescribed the aromatase inhibitor.



"This pooled analysis provides solid evidence that switching to an aromatase inhibitor following a few years of tamoxifen treatment, implies a mortality benefit over continued tamoxifen and that the benefit on breast cancer-related mortality is mainly due to the effect of switching," conclude the authors.







Article: "Switching to an Aromatase Inhibitor Provides Mortality Benefit in Early Breast Carcinoma. Pooled Analysis of 2 Consecutive Trials," F. Boccardo, A. Rubagotti, D. Aldrighetti, F. Buzzi, G. Cruciani, A. Farris, G. Mustacchi, M. Porpiglia, G. Schieppati, P. Sismondi, CANCER; Published Online: February 12, 2007 (DOI: 10.1002.cncr.22513); Print Issue Date: March 15, 2007.



Contact: David Greenberg


John Wiley & Sons, Inc.

Blogs Comment On Obama Faith-Based Initiatives, State Reproductive Health Developments

The following summarizes women's health-related blog entries.

~ "Faith-Based Initiatives Office To 'Address' Teen Pregnancy? Let's Reduce It," Frances Kissling, RH Reality Check: Last week, President Obama "unveiled his plans for the new White House Office on Faith-Based and Neighborhood Partnerships and signed an executive order authorizing it and naming the first 15 of the eventual 25 council members who will advise him," Kissling writes in a blog entry. There was "little change in the council's core mission -- helping faith groups get government funding for social services, education and humanitarian efforts," Kissling writes, adding, "More alarming was the planned incursion of the Faith based Office into reproductive health and rights. Suddenly, one of the four top priorities for the office is to examine 'ways to support women and children, address teen pregnancy and reduce the need for abortion.'" According to Kissling, the "very wording of the mandate makes clear the conservative bias of the office." She adds that although the "goal is clear" in terms of abortion, where "teen pregnancy is concerned, we have no idea if addressing teen pregnancy means more abstinence-only programming or high schools in which teens who carry pregnancies to term get day care." This is "one of those issues the women's movement and the reproductive health movement cannot ignore," Kissling writes, adding that there are "10 seats left on this committee, and we need to insist that those seats be held by religious and secular leaders ... who are both anti-poverty and pro-choice." She concludes, "After we get those names to the president, we need to let the president know that it is the women's movement and the reproductive health movement that he needs to look to on our issues. When we are ignored on these issues, the president is not on common ground, he is on shaky ground and is bound to stumble" (Kissling, RH Reality Check, 2/9).

~ "Faith-Based Teen Pregnancy and Abortion Reduction?" Amie Newman, RH Reality Check: It was "startling" that Obama decided to "maintain the Office of Faith-Based and Neighborhood Initiatives," Newman writes, adding, "Reducing teen pregnancy is a virtuous and appropriate goal for the federal administration -- as is reducing unintended pregnancies." However, it is "unclear ... why these issues are being placed under the Office of Faith-Based Initiatives, or how faith-based organizations that receive federal funds will use said funds to 'reduce the need for abortion' or reduce teen pregnancy," according to Newman. She adds that when Obama "declares that the Office of Faith-Based Initiatives is going to take on the reduction of teen pregnancy and the need for abortion, one has to ask, how exactly? With such a mission at the heart of an office expressly formed to funnel federal funds to faith- and neighborhood-based programs, there is cause for concern. This office could very well continue to support abstinence-only programs via faith-based organizations that make a case for the continued funding." In addition, "'abortion reduction' or 'reducing the need for abortion' is a poor excuse for a goal," Newman writes, adding, "For one thing, most women do not 'need' an abortion -- they decide to have an abortion based on a variety of personal and private factors." According to Newman, the goals should be to improve "women's access to health services, including family planning for women and their partners, contraception and overall sexual and reproductive health services; and to improve "every young person's sexual and reproductive health and well-being by providing comprehensive sexual health education that teaches them how to protect and care for their health, how to navigate their own sexuality, ... and how to engage in healthy relationships." Newman adds that she is "cautious about the ways in which the Office of Faith-Based Initiatives is going to tackle critical health care issues like the reduction of teen pregnancy and the need for abortion, considering the larger issues of access to family planning, contraception, comprehensive sexual education and more that have yet to be addressed" (Newman, RH Reality Check, 2/6).














~ "Abortion, Contraception and Sex Ed in the States in 2008," Rachel Gold/Elizabeth Nash, RH Reality Check: Although social issues such as reproductive health were not the "top priority" for state legislators in 2008, there were 1,001 measures introduced in 44 states and Washington, D.C., related to reproductive health and rights, resulting in 33 new laws in 20 states, Gold and Nash write in a blog entry that examines several of the new laws. They write that none of the 17 abortion-related laws expand access, but a few states passed laws that "promote reproductive health by requiring hospitals to provide information on emergency contraception" to victims of sexual assault, lay the "groundwork" for expanding Medicaid coverage of family planning services and require insurance coverage of the human papillomavirus vaccine. Gold and Nash continue that Ohio, South Carolina, South Dakota and Oklahoma passed laws requiring abortion providers to perform or offer to perform an ultrasound, bringing the total number of states with ultrasound laws to 16. According to Gold and Nash, Oklahoma's new law requires abortion providers to "verbally describe the image to the woman and position the monitor so she is able to see it" but is not yet " in effect pending the outcome of a legal challenge." They continue that Oklahoma and Idaho passed laws that address "coerced abortion," which "are the result of efforts by [abortion-rights] opponents to characterize abortion providers as often being complicit in forcing women to have abortions, despite the absence of data to substantiate their claims." Six states, including Maryland and Iowa, addressed funding for abortion or abortion alternatives. According to Gold and Nash, Oklahoma's omnibus abortion law contains two provisions not found in any abortion-related measure enacted in 2008, including one that "prohibits a woman from suing a medical provider who does not give full and accurate information about her pregnancy if the misinformation results in her carrying the pregnancy to term" and a second that "greatly expands the ability of health care professionals and facilities in the state to refuse to provide or refer for abortion." Gold and Nash write that three new laws in Wisconsin, Colorado and Iowa "were designed to improve access to contraception and other preventive services," while a second law in Colorado and a similar one in Michigan "continued existing restrictions on state family planning funds." According to the authors, the issue of sexual education "did not elicit significant attention in 2008," with the only related measure enacted in New Hampshire to permit "a student to be excused from health or sex education for religious reasons" (Gold/Nash, RH Reality Check, 2/10).

Antiabortion-Rights Blog

~ "Obama, Stem Cells, Mexico City and More," National Right to Life blog: According to an antiabortion-rights National Right to Life blog entry, President Obama's remarks at the National Prayer Breakfast last week was an example of "unintentionally inclusionary language." NRLC reports that Obama said, "'There is no God who condones taking the life of an innocent human being. This much we know.'" The blog entry continues, "Still another batch of good news on the alternative-to-embryonic stem cell front" is the news that Northwestern University researcher Richard Burt is publishing a study that "showed improvement in four in five multiple sclerosis patients by using bone marrow stem cell transplants to 'reset' their immune system," in the journal Lancet-Neurology. The blog entry continues that Bishop Joseph Francis Martino of the Scranton, Pa., diocese wrote an open letter to Sen. Robert Casey (D-Pa.) that "criticized the freshman senator for failing to vote in favor of an amendment that would have made the 'Mexico City' policy permanent." According to NRLC Legislative Director Douglas Johnson, the effect of reversing the Mexico City policy is "to put hundreds of millions of taxpayer dollars into the hands of organizations that aggressively promote abortion as a population-control tool in the developing world" (National Right to Life blog, 2/9).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

Elsevier Announces The 2008 Supplement Of Reproductive Health Matters

Elsevier has announced the publication of Reproductive Health Matters 2008 Supplement on the theme of "Second trimester abortion: women's health and public policy". Second trimester abortion raises complex issues regarding methods, values, stigma, the burden on providers of service delivery and the sometimes complicated reality of women's lives and decisions. This issue of Reproductive Health Matters grew out of a conference on second trimester abortion convened in London in 2007 by the International Consortium on Medical Abortion and attended by 90 expert clinicians and advocates from all over the world.



In many countries, legislation prohibits or restricts the grounds for second trimester abortions. Instead of preventing women from having abortions, these laws often force them to risk their lives doing so. There will always be women who need abortions after 12 weeks of pregnancy, but the numbers diminish greatly by 20 weeks, and become rare after 24 weeks.



Abortion-related deaths have been declining globally in the past three decades because many more countries now have safe, legal abortion. Methods have become substantially safer and simpler, more providers have been trained, and women with complications are more likely to seek and to receive medical help, even where abortion is still legally restricted.



This issue calls for the need for second trimester abortion to be met in a safe, timely and sympathetic manner In-depth, country-based research is needed, to bring out the facts on second trimester abortion, as evidence of why it should be treated as a legitimate form of women's health care and supported in public health policy. Papers in this supplement cover the law and safety of second trimester abortion; women's and providers' perspectives; policy, politics and values; moving from unsafe to safe service delivery; currently recommended methods; methods that should go out of use; and recommendations for advocacy and action from the ICMA conference.



Titles include:
A critical appraisal of laws on second trimester abortion


Reasons for second trimester abortions in England and Wales


A week in the life of an abortion doctor, Western Cape Province, South Africa


Decision-making after ultrasound diagnosis of fetal abnormality


Fetal pain: do we know enough to do the right thing?

Among papers on the law and safety of second trimester abortion; women's and providers' perspectives; policy, politics and values; service delivery; and recommended methods and methods that should go out of use. Other articles focus on countries such as Cuba, India, Mongolia, Mozambique, Nepal, the Netherlands, USA and Vietnam.







About Reproductive Health Matters (RHM)



Reproductive Health Matters is published twice a year, in May and November in English, with editions in translation in Arabic, Chinese, French, Hindi, Portuguese, Russian and Spanish. RHM covers laws, policies, research and services that meet women's reproductive health needs. Each issue focuses on a main theme and includes feature papers, topical papers on other subjects and a round-up of information from published literature.
















About Elsevier



Elsevier is a world-leading publisher of scientific, technical and medical information products and services. Working in partnership with the global science and health communities, Elsevier's 7,000 employees in over 70 offices worldwide publish more than 2,000 journals and 1,900 new books per year, in addition to offering a suite of innovative electronic products, such as ScienceDirect (sciencedirect/), MD Consult (mdconsult/), Scopus (info.scopus/), bibliographic databases, and online reference works.



Elsevier (elsevier/) is a global business headquartered in Amsterdam, The Netherlands and has offices worldwide. Elsevier is part of Reed Elsevier Group plc (reedelsevier/), a world-leading publisher and information provider. Operating in the science and medical, legal, education and business-to-business sectors, Reed Elsevier provides high-quality and flexible information solutions to users, with increasing emphasis on the Internet as a means of delivery. Reed Elsevier's ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).



Source: Minke Havelaar


Elsevier

Women Smokers' Longevity Cut By 14.5 Years Because Of Smoking

One in every five adult women in the United States still smokes, even though smoking takes an average of 14.5 years off their lives, says the American College of Obstetricians and Gynecologists (ACOG).


ACOG said that approximately 438,000 men and women in the USA die prematurely as a result of smoking directly or passively - add to this total about 8.6 million people who have developed serious, preventable illnesses as a result of smoking.


ACOG urges all women smokers to do everything they can to give up. Women should take advantage of every resource available, choose a day when to quit, and take steps now towards giving up tobacco.


ACOG Fellow Sharon Phelan, MD, who helped develop ACOG's smoking cessation materials for health care providers, said "Smoking shaves an average of 14.5 years off the lives of female smokers, yet nearly one in five women 18 and older still light up. "The damaging effects of smoking on women are extensive, well-documented, and can be observed from the cradle to the premature grave. Smoking is a harmful habit that negatively affects nearly every organ in the body. There's just no good reason not to quit."


More women die from lung cancer than from any other cancer, informs ACOG. The number of annual lung cancer deaths of women in the USA has increased six-fold since the middle of the last century. Several other cancer risks are increased if you smoke, such as oral cancer, and cancers of the breast, larynx, esophagus, pancreas, kidney, bladder, uterus, and cervix.


A female smoker runs double the risk of developing coronary heart disease, compared to a non smoker - the chance of developing COPD (chronic obstructive pulmonary disease) is ten times bigger.


More Risks


Compared to somebody who does not smoke, a woman's risk of developing the following diseases, conditions and unpleasant events is significantly higher??


-- Bronchitis

-- Cataracts

-- Early Menopause

-- Emphysema

-- Gum Disease

-- Lower Bone Density after Menopause

-- Osteoporosis

-- Premature Skin Aging

-- Rheumatoid Arthritis

-- Tooth Loss


Risks During Pregnancy And Risks For Babies/Children


The percentage of smoking women who have problems conceiving when they want to have a baby is much higher than for non-smoking women. When a female smoker does get pregnant, she runs a significantly higher risk of delivering a premature baby, a low-weight full-term baby, a baby with poor lung function, bronchitis or asthma. Breastfeeding smoking mothers pass on the harmful chemicals they have consumed from smoking onto their offspring through breast milk.















A woman who takes birth control pills, smokes, and is older than 35 years of age runs a much higher than normal risk of developing lethal blood clots.


Dr. Phelan emphasized "Pregnant women should absolutely not smoke, and smoking should not be allowed in the home after a baby is born. Unfortunately, we know that infants and young children are more heavily exposed to secondhand smoke than adults, and parents, guardians, or other members of the household often smoke around them."


A baby whose mother smoked during pregnancy runs a higher risk of SIDS (sudden infant death syndrome - known in the UK as Cot Death), as does an infant who is exposed to secondhand smoke.


The CDC (Centers for Disease Control and Prevention) estimates that there could be as many as 300,000 children in the USA under the age of 18 months who get lower respiratory tract infections because of their exposure to secondhand smoke. Exposure to secondhand smoke can raise a baby's risk of having asthma attacks, ear problems and respiratory infections.


One quarter of current teenage smokers go on to become regular adult smokers.


Out of the estimated 4,000 American teenagers who take up smoking each day in the USA, about 1,100 will become people who smoke every day for many years. Just under one quarter of high school girls and one tenth of middle school girls smoke regularly in America.


The lower down the socioeconomic ladder a child is in America, the more likely he/she is to take up smoking. The likelihood of a child taking up smoking is much greater if he/she has parents who smoke - healthcare professionals believe this is partly because children have more access to tobacco at home, while at the same time they see smoking as something acceptable if it occurs normally in the house. ACOG also informs that research has shown that teenagers who smoke are more likely to engage in higher-risk sexual activities, and to consume alcohol and illegal drugs.


Hope for those who quit


Dr. Phelan said "Soon after a woman stops smoking, her heart rate and blood pressure drop to healthier levels, and breathing, circulation, and sense of smell and taste may improve. Heart attack risk decreases by 50% within the first year of quitting, and the risk of developing some cancers, heart disease, and other ailments falls to nearly that of a nonsmoker within the first few years."


Dr. Phelan added "It takes most smokers several attempts to kick cigarettes for good. Going cold turkey can be extremely difficult because of nicotine withdrawal and cravings. Physicians can suggest nicotine replacement products - patches, gums, nasal sprays, etc. - to help with cravings. They can also prescribe medications such as bupropion or varenicline, which in combination with nicotine replacement, can double the chances of quitting."


Source - American College of Obstetricians and Gynecologists.


- Christian