Jewish World Review Feb. 15, 2002 /4 Adar, 5762

Hormone replacement therapy & the risk of breast cancer

By Robert A. Wascher, M.D., F.A.C.S.

http://www.NewsAndOpinion.com -- FROM this week's Journal of the American Medical Association (JAMA) comes further evidence linking the use of estrogen supplements in postmenopausal women with an increased risk of breast cancer. Altogether, 705 women with a history of recently diagnosed breast cancer and 692 women without a history of breast cancer (all were 50 to 74 years of age) were queried regarding their history of hormone supplement usage during the preceding six years.

Among long-term users of estrogen hormone replacement therapy (HRT), there was an estimated 60-85% increase in the risk of breast cancer. All types of breast cancer occurred more frequently in patients on long-term HRT, but the risk of lobular breast cancer, in particular, was notably increased. Lobular carcinoma, as opposed to the more common ductal carcinoma, tends to occur in multiple positions in the breast, as well as in both breasts.

Although the benefits of HRT may outweigh the risks in some women, all women on HRT should be carefully followed with-at least-annual physician breast exams and mammograms. Women with a prior history of breast cancer (and especially estrogen receptor-positive cancer), or a family history of breast cancer, should carefully discuss the issue of HRT with their physicians before embarking on such treatment.

USE IT OR LOSE IT: ALZHEIMER'S DISEASE & COGNITIVE STIMULATION

Also in this week's JAMA is a study that appears to confirm prior research regarding the link between cognitively stimulating activities and the risk of Alzheimer's disease. A total of 801 elderly volunteers, all without evidence of dementia, were evaluated over an average of 4.5 years. Records were kept of the volunteers' lifestyles. Time spent in "cognitively stimulating activities," such as reading, were then tallied and analyzed. The researchers noted a 33% reduction in the risk of developing Alzheimer's disease among the elderly volunteers who regularly indulged in cognitively stimulating activities, as well as a 60% reduction in memory loss in this group. This study adds to the accumulating evidence that the continuously challenged brain is significantly less likely to develop Alzheimer's disease and other forms of dementia than is the lazy brain.

STRESS, DIVORCE & DEATH...

Previous epidemiological studies have suggested that high levels of stress and, at least in men, divorce, lead to premature death. In this week's Archives of Internal Medicine, a study of 12,336 men at above-average risk of coronary heart disease (CHD), over a period of nine years, is described. All of the study participants had one or more of the following CHD risk factors: high blood pressure, elevated cholesterol levels, and/or tobacco use. However, none of these men had known CHD.

Among those men reporting chronic work stress, there was a 26% increase in the risk of death due to CHD. Among the men who divorced during the study period, there was a 37% increase in the risk of death due to CHD when compared to the still-married men. While this study looked only at men who were already at a relatively high risk of developing CHD in the future, it confirms what most of us already intuitively believe: a stress-filled life, whether due to chronic stress at work or due to the loss of a marriage, can affect our cardiovascular health in a very deleterious way.

CHILD DAYCARE, INFECTIONS & PARENTAL GUILT...

Both my wife and I have professional careers, necessitating that we place our 6-month old baby in daycare. During the current winter, Alexis has had one respiratory infection after the other, and my wife and I have subsequently caught most of them from her (I am still trying to get over my third cold of the season). Most parents already know that daycare facilities increase the exposure of their children to viruses and bacteria circulating throughout the community.

Like my wife and I, many moms and dads work full-time, and are wracked with guilt over leaving their precious bundles of joy in the care of non-family members, and at the mercy of whatever communicable disease(s) that is circulating at the moment. However, a new study in this month's Archives of Pediatric & Adolescent Medicine should serve to assuage at least some of that guilt.

To briefly summarize, 1,246 children were evaluated for frequency of colds. Parents were asked to report the frequency of colds during the preceding year when their children were 2, 3, 6, 8, 11 and 13 years of age. The study 's authors then compared the incidence of respiratory infections, at each age level, among children enrolled in daycare programs versus those kids who stayed at home with a parent.

Not surprisingly, children enrolled in daycare programs had more colds than the at-home kids at 2 years of age. However, the daycare kids actually had fewer than one-half as many colds at ages 6 through 11 than the kids who stayed at home. The explanation for this finding is that the kids who were exposed to viruses that cause respiratory illnesses at daycare, during their early life, developed immunity to these germs before starting school.

The kids who remained safely ensconced at home during their preschool years, however, were not exposed to many of these circulating viruses and, therefore, did not develop immunity against them. While this study is unlikely to erase all of the guilt and regret that most of us feel when we drop off our precious babies at the daycare facility, at least it helps to know that our babies' immune system are being armed against future illness with each bout of respiratory illness that he or she develops.

All the same, I'm looking forward to the end of the winter season, and the repeated spells of sore throats, coughs, fevers, clogged nasal passages and sneezes that have plagued us so far this winter!

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.