Jewish World Review Sept. 25, 2001 / 9 Tishrei, 5762

Advances in the detection of breast cancer

By Robert A. Wascher, M.D., F.A.C.S. -- A DUTCH research group has reported on a comparison between magnetic resonance imaging (MRI) and standard mammography for early detection of breast cancer. As reported in the Journal of the National Cancer Institute, 179 women with a family history of breast cancer underwent annual breast exams, mammography and MRI of the breasts.

It is important to note that these women were defined to be at increased hereditary risk of breast cancer, and were screened at a younger average age than the general public (in women who have not yet undergone menopause, the breast tissue tends to be more dense, making mammography less sensitive). A total of 13 breast cancers were detected in these 179 women using MRI, while 7 of these 13 tumors were not detected by mammography.

The authors concluded that MRI appears to be more sensitive than mammography, particularly for young women at increased risk of developing breast cancer. They recommend that a large multicenter study be initiated to further evaluate MRI as a routine screening tool for breast cancer.

Narrowing of the arteries (atherosclerosis) that supply blood to the legs and feet is part of the overall syndrome referred to as peripheral arterial disease (PAD), and affects some 8 to 12 million Americans. In addition to potentially causing pain and weakness of the extremities, advanced cases of PAD can lead to eventual loss of part or all of the legs or feet. PAD also serves as a "marker" for vascular disease in the arteries that feed the heart and brain, as well. Factors that can increase the incidence of PAD include smoking, obesity, diabetes, elevated cholesterol levels, male gender and sedentary lifestyle.

University of Minnesota researchers reported in this week's Journal of the American Medical Association that a simple measurement of the blood pressure in the arms and legs, which can be performed in most primary care doctors' office using inflatable cuffs, can identify patients with previously unknown PAD.

The blood pressure test, which measures the "ankle-brachial index" (ABI), was performed on 6,979 patients. PAD was diagnosed in 1865 (29%) of these patients using this simple noninvasive screening test. Among these 1,865 patients with an abnormal ABI, 83% of patients were previously aware that they had PAD, but only 49% of their primary care physicians were previously aware of the diagnosis in their patients! The study's authors recommend that this test be routinely performed, by primary care physicians, in patients with known risk factors for PAD, so that preventive treatments can be targeted at some of these risk factors before PAD becomes advanced.

Arsenic is a naturally occurring metal in ground water supplies, and is especially common in the western United States. Removing arsenic from ground water sources is an expensive and complex proposition. Shortly after taking office, the Bush administration suspended a Clinton administration directive to tighten the standards for allowable arsenic levels in the nation's water supplies.

Tightening of the arsenic level standards by the Clinton administration was based upon preliminary evidence that the then existing standards might be linked to an increased risk of lung and bladder cancer. The National Academy of Sciences (NAS) was asked by Bush officials to further study the issue, while many public health advocates decried the new administration's perceived efforts to dilute or revoke Clinton's more stringent standards.

In this week's issue of the journal Science, the NAS reported its findings. Surprisingly, they found that even the Clinton administration's more stringent standard for arsenic levels in public water supplies (10 parts per billion) was linked to an excessive number of cancer cases. The Clinton era Environmental Protection Agency (EPA) studies had estimated that the incidence of lung and bladder cancer were predicted to reach 0.8 extra cases per 1000 people at the newly proposed 10 parts per billion arsenic level. The NAS, however, estimates the true increased risk at 1.3 to 3.7 extra cases per 1000 people. Although the EPA has not yet made recommendations to the new administration, the bets are that the president will likely find himself signing off on even more stringent arsenic standards than those proposed by his predecessor.

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.


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© 2001, Dr. Robert A. Wascher