Jewish World Review March 15, 2002 / 2 Nisan, 5762

Mammography debate continues...

By Robert A. Wascher, M.D., F.A.C.S. | As I have previously reported, a recently published study (in Lancet) disputed the findings of older studies supporting the use of routine screening mammography, and promptly instigated a furious debate around the world.

The Lancet article that criticized previous mammography research trials particularly emphasized the Swedish "Malmö Trial." Now, the authors of the original Malmö trial have fired back at their critics in a new article just published in Lancet. Updating their results through 1996, the Swedes have compiled data on 129,750 women undergoing regular mammography versus a control group of 117,260 women who did not receive routine screening mammograms.

After a median follow-up of almost 16 years, the authors found that regular mammograms reduced the risk of dying from breast cancer by 31% among women aged 65-69 years, by 32% in women aged 60-64 years, and by 24% in women aged 55-59 years. In women between 50 and 54 years of age, the reduction in breast cancer death risk was a more modest 5%.

The authors of the updated Swedish trial have, once again, demonstrated that, among women followed for nearly two decades, routine screening mammography leads to a reduced risk of death due to breast cancer in women 55 years of age and older. They, in turn, vigorously dispute the findings of the recent and critical Lancet study that questioned the scientific evidence for any survival benefit from routine mammography.


The "statins" are drugs commonly prescribed to lower elevated cholesterol blood levels. There has been some evidence that statins may also increase bone mineral density and reduce the risk of fracture in older patients. A new study in the Archives of Internal Medicine suggests that the use of statins may actually decrease the incidence of fractures from minor trauma by a whopping 60%, although the authors identified only a 3% increase in the bone density of the hip bones of patients taking these drugs. This suggests that statins significantly reduce the risk of fractures secondary to osteoporosis ("thin bones"), but through a mechanism other than via an increase in bone mineral density.


The role of exercise in health is known to be beneficial in terms of reducing the risk of dying from cardiovascular disease and stroke, and also reduces the risk of depression and other chronic disorders. This week's New England Journal of Medicine contains a revealing analysis of the impact of the lack of exercise on the health of Americans, and the news is not good.

To briefly summarize, the study determined that physical fitness, as measured by an exercise treadmill test, was a more powerful predictor of the risk of premature death than any of the other traditional risk factors associated with cardiovascular disease (e.g., obesity, smoking, elevated blood cholesterol levels, high blood pressure, family history and male gender).

By comparing the death rates of a group of patients with known cardiovascular disease and a group without such a history, the study's authors concluded that a person's level of physical fitness was a more important determinant of their survival than the presence or absence of cardiovascular disease. What this means, quite simply, is that you are statistically likely to live longer, even if you have a history of cardiovascular disease, if you are very physically fit than is a person who has no history of heart disease but who is physically very unfit. This is another powerful argument for moderate and regular exercise, and for avoiding obesity.

Of course, before you start a new exercise program, you should always consult first with your physician!


Archives of Internal Medicine: Among women aged 25-42 years, modest alcohol intake (0.25-1.0 drinks per day, on the average) was associated with a mild decrease in the risk of developing high blood pressure, compared to non-drinkers, while heavier drinkers experienced a greater risk of hypertension than non-drinkers.

Archives of Internal Medicine: Prior infection with the Chlamydia pneumonia (CP) bacterium has been suggested as a risk factor for developing atherosclerosis ("hardening of the arteries"), which is the underlying cause of cardiovascular and peripheral vascular disease (and many strokes). This study found x-ray evidence of increased thigh artery atherosclerosis among people with evidence of prior CP infection, as well as an increased risk of future death due to coronary heart disease.

Nature: Monkeys with a special electrode implanted in their brains have been linked with a computer at Brown University. Based upon electrical impulses generated by thinking alone, the monkeys were able to play a simple computer video game by moving a cursor around on the screen. This research may someday allow people with severe paralysis to operate computers and other sophisticated equipment, including devices that might be able to translate their brain impulses into stimuli that will move their paralyzed muscles.

British Journal of Cancer: Resveratrol, found in red wine and grapes, has previously been shown to have significant anticancer properties. Researchers have found that some cancer cells convert this substance into another substance (piceatannol) which was previously known to inhibit the growth of leukemia cells. This study, therefore, offers a glimpse into the mechanism whereby red wine and red grapes may play a potentially important role in cancer prevention.

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.


03/08/02:Blows to the chest & sudden cardiac death; air quality & the risk of lung cancer; tomatoes and your prostate
03/01/02: Diet & the risk of ovarian cancer; lifetime risk of developing high blood pressure; Osteoporosis prevention with a once-a-year injection?
02/26/02: The continuing controversy regarding screening mammography
02/22/02: Lowering body temperature after heart attack improves outcome; A silver lining for the chronically sleep-deprived?
02/15/02: Hormone replacement therapy & the risk of breast cancer; use it or lose it: Alzheimer's disease & cognitive stimulation; stress, divorce & death; child daycare, infections & parental guilt
02/08/02: Possible breakthrough in early cancer diagnosis; mammography: the controversy continues; CPR techniques revisited
02/01/02: Antibiotics in livestock feed & human disease; genetic detection of early colon cancer in the stool; genetic analysis of breast cancers may help decide treatment
01/25/02: Drug increases lifespan (if you're a fly...); workplace attitudes and smoking cessation; effects of inadequate sleep on surgeons
01/18/02: Lifelong effects of premature birth; smokers under the knife; aspirin and cardiovascular health
01/11/02: Estrogen levels in the blood & breast cancer risk; Heart attack: sex and survival; dangerous lettuce invaders
01/09/02: Cancer & aging: Two sides of the same coin?
01/04/02: Vitamin a & the risk of hip fracture in postmenopausal women; ovarian cancer risk and oral contraceptives
12/28/01: Magnetic Resonance Imaging (MRI) detects coronary artery disease; new development in obesity research; adverse childhood experiences & the risk of suicide attempts
12/21/01: Vaccination of children controls hepatitis a in the community; a possible cure for sickle cell disease; leptin and the risk of heart attacks
12/14/01: Chernobyl and the Risk of Thyroid Cancer in hildren; children & obesity; gastroesophageal reflux disease update
12/07/01: Update on school shootings; new implantable heart-assist device approved for further evaluation; prevention of fungal infections in pre-term babies
11/30/01: Flu vaccination in asthmatics; low-tar cigarettes are not less harmful; beans and your heart
11/21/01: Modified smallpox vaccine may reduce risk of cervical cancer; New approach to breast cancer diagnosis; New non-invasive prenatal diagnostic test for down's syndrome
11/16/01: Cholesterol-lowering drugs reduce risk of heart attack; supplemental radiation therapy reduces risk of breast cancer recurrence; brains of women may answer age-old questions
11/09/01: Bio-warfare (redux); my gray matter is bigger than yours; mad elk disease?
11/02/01: Making sense of bio-warfare
10/26/01: The impact of mammography on deaths due to breast cancer; diet & exercise may slow cancer cell growth; antidepressants and the risk of heart disease
10/19/01: New insights into autism; the wiley appendix
10/12/01: More bad news about obesity links to other diseases…Hey dad, can I borrow the car keys?
10/05/01: California leads nation in reduction of tobacco-related disease; exercise as an antidepressant?
09/25/01: Advances in the detection of breast cancer; primary care physician awareness of peripheral arterial disease; arsenic in the water
09/17/01: In perspective
09/12/01: Genes may hold secret to long life; men and women: cognitive function in the elderly; physical activity, obesity and the risk of pancreatic cancer
09/05/01: English milk cows prefer Beethoven and Simon & Garfunkel over Bananarama; new prostate cancer prevention study: looking for a few good men; exercise & diet can help prevent diabetes
08/28/01: Arthritis drugs may be linked with increased risk of heart disease; errors in blood clotting tests can be fatal; infant soy formula not associated with reproductive side effects

© 2002, Dr. Robert A. Wascher