Up to 1/3 of Breast Cancer Can Be Avoided

Associated Press

BARCELONA, Spain — Up to a third of breast cancer cases in Western countries could be avoided if women ate less and exercised more, researchers at a conference said, renewing a sensitive debate about how lifestyle factors affect the disease.

Better treatments, early diagnosis and mammogram screenings have dramatically slowed breast cancer, but experts said the focus should now shift to changing behaviors like diet and physical activity.

"What can be achieved with screening has been achieved. We can't do much more," Carlo La Vecchia, head of epidemiology at the University of Milan, said in an interview. "It's time to move on to other things."

Mr. La Vecchia spoke Thursday at a European breast cancer conference in Barcelona. He cited figures from the International Agency for Research on Cancer, which estimates that 25 to 30% of breast cancer cases could be avoided if women were thinner and exercised more. The agency is part of the World Health Organization.

His comments are in line with recent health advice that lifestyle changes in areas such as smoking, diet, exercise and sun exposure can play a significant role in risk for several cancers.

Dr. Michelle Holmes of Harvard University, who has studied cancer and lifestyle factors, said people might wrongly think their chances of getting cancer depend more on their genes than their lifestyle.

"The genes have been there for thousands of years, but if cancer rates are changing in a lifetime, that doesn't have much to do with genes," she told The Associated Press in a phone interview from Cambridge, Massachusetts.

Breast cancer is the most common cancer in women. In Europe, there were about 421,000 new cases and nearly 90,000 deaths in 2008, the latest available figures. The United States last year saw more than 190,000 new cases and 40,000 deaths.

A woman's lifetime chance of getting breast cancer is about one in eight. Obese women are up to 60% more likely to develop any cancer than normal-weight women, according to a 2006 study by British researchers.

Many breast cancers are fueled by estrogen, a hormone produced in fat tissue. So experts suspect that the fatter a woman is, the more estrogen she's likely to produce, which could in turn fuel breast cancer. Even in slim women, experts believe exercise can help reduce the cancer risk by converting more fat into muscle.

Yet any discussion of weight and breast cancer is considered sensitive because some may misconstrue that as the medical establishment blaming women for their disease.

Tara Beaumont, a clinical nurse specialist at Breast Cancer Care, a British charity, said her agency has always been careful about giving lifestyle advice. She noted that three of the major risk factors for breast cancer — gender, age and family history — are clearly beyond anyone's control.

"It is incredibly difficult to isolate specific factors. Therefore women should in no way feel that they are responsible for developing breast cancer," she said.

Yet Karen Benn, a spokeswoman for Europa Donna, a patient-focused breast cancer group, said it was impossible to ignore the increasingly stronger links between lifestyle and breast cancer.

"If we know there are healthier choices, we can't not recommend them just because people might misinterpret the advice and feel guilty," she said. "If we are going to prevent breast cancer, then this message needs to get out, particularly to younger women."

That means avoiding becoming overweight as an adult. Robert Baan, a cancer expert with the international cancer research agency, said it isn't clear if women who lose weight can lower their risk to the level of a woman who was never fat.

The American Cancer Society Web site says the connection between weight and cancer risk is complex. It says risk appears to increase for women who gain weight as adults, but not for women who have been overweight since childhood. The cancer society recommends 45 to 60 minutes of physical activity five or more days a week to reduce the risk of breast cancer.

Drinking less alcohol might also help. Experts estimate that having more than a couple of drinks a day can boost the risk of breast cancer by 4 to 10 percent.

After studies several years ago linked hormone-replacement therapy to cancer, millions of women abandoned the treatment, leading to a sharp drop in breast cancer rates. Experts said a similar reduction might be seen if women ate healthier and exercised more.

Dr. Holmes, the Harvard expert, said changing diet and nutrition is arguably easier than tackling other breast cancer risk factors.

In the 1980s and 1990s, breast cancer rates steadily increased, paralleling a rise in obesity and the use of estrogen-containing hormones after menopause.

Mr. La Vecchia said countries like Italy and France — where obesity rates have been stable for the past two decades — show that weight can be controlled at a population level.

"It's hard to lose weight, but it's not impossible," he said. "The potential benefit of preventing cancer is worth it."

Copyright 2010 Associated Press

An Hour of Daily Exercise Helps Ward Off Weight Gain in Middle-Aged Women

Patients may ask about a widely reported JAMA study suggesting that 1 hour of moderate exercise daily is needed to prevent weight gain in middle-aged women.


Roughly 34,000 women (mean age at enrollment, 54) in the Women's Health Study answered questionnaires about their weight and exercise habits at baseline and periodically over 13 years' follow-up.


After adjusting for reported diet at baseline, researchers found that over any 3-year period, women who exercised <150 minutes weekly or 150 to <420 minutes weekly were, respectively, 11% and 7% more likely to gain 2.3 kg (5 lb.), compared with women who exercised ≥420 minutes a week.


The authors point out that the association was observed only among women with a body-mass index less than 25, noting that "among heavier women, there was no relation, emphasizing the importance of controlling caloric intake for weight maintenance in this group."


JAMA article

FDA Says No "Clear Connection" Between Bisphosphonate Use and Femur Fracture Risk

March 11, 2010 — The US Food and Drug Administration (FDA) announced yesterday that patients taking bisphosphonates should continue to do so, barring any recommendation from their physician, as the agency had no evidence to conclude that the drugs increased the risk for femur fractures just below the hip joint.

The FDA advisory came a day after ABC News cited "mounting evidence" allegedly showing that long-term use of alendronate (Fosamax, Merck), a popular bisphosphonate, or its generic versions could cause spontaneous femur fractures in some women.

"At this point, the data that FDA has reviewed have not shown a clear connection between bisphosphonate use and a risk of atypical subtrochanteric femur fractures," the FDA stated, adding that it has been working closely with outside experts to investigate the issue. The FDA began their ongoing investigation on this topic in June 2008.

The FDA notes that healthcare professionals should follow the recommendations on the drug label when prescribing bisphosphonates, and adverse events potentially associated with bisphosphonates should be reported to MedWatch, the FDA's safety information and adverse event reporting program.

More information is available on the FDA Web site.

Minorities are at Higher Risk For Alzheimer's

Minorities are at greater risk for the degenerative disease, according to an Alzheimer's Association report released Tuesday. It found that African-Americans are about two times more likely and Hispanics are about 1.5 times more likely to develop Alzheimer's and other forms of dementia.

The reasons why minorities are at higher risk are unclear but not believed to be genetic.

The disease is indiscriminately devastating, robbing memories and personality as brain cells deteriorate.

But Alzheimer's for minorities presents unique challenges. Socioeconomic disparities can prevent access to health care, early detection or proper management of other conditions linked to the disease such as high blood pressure or diabetes, said Angela Geiger, the chief strategy officer for the Alzheimer's Association.

"African-Americans and Hispanics are less likely to know they have Alzheimer's and dementia," she said. "That has significant impact on the quality of life."

Some families ignore the symptoms, such as behavioral changes and memory loss, because their culture respects the elderly so much that they try to conceal their flaws, said Dolores Gallagher-Thompson, a professor of psychiatry and behavioral sciences at the Stanford University School of Medicine.

Minorities may not get early treatment, when medications are more likely to be effective and when patients are more capable of making plans, according to the report. At doctor's offices, some can encounter language barriers and difficulties navigating a complicated health care system.

The Alzheimer's Association's report estimated that 11 million Americans provide 12.5 billion hours of unpaid care for loved ones.

Minority families often feel a filial obligation to take care of their elderly at home, said Gallagher-Thompson, who is also director of the Stanford Geriatric Education Center.

But the stress of caregiving is enormous, as many family members (often called "the sandwich generation") work full-time and raise their own children.

Soft Drink Sales Decrease in Schools

By BETSY MCKAY

The main trade association representing Coca-Cola Co., PepsiCo Inc., and other beverage companies plans to release a report Monday showing that sales of soda and other drinks in U.S. secondary schools have dropped sharply since 2004, in a sign that efforts to improve nutrition in schools are progressing.

The report comes as first lady Michelle Obama is leading a campaign to combat childhood obesity and as Congress is poised to consider regulating the drinks allowed in school-vending machines.

Sales volume of beverages shipped to schools from bottlers fell 72% between the first semester of the 2004-05 school year and the first semester of the current academic year, according to the report, which was compiled for the American Beverage Association by economic research firm Keybridge Research LLC. The report showed a 95% decline in sales volume of full-calorie soft drinks, such as Coca-Cola and Pepsi-Cola, and a 94% decline in juice drinks. Full-calorie soft drinks accounted for just 6.8% of beverage volume shipped to schools last semester, while they made up 40% of the product mix in 2004.
[SODA]

Shipments of most other types of drinks also fell significantly. Volume dropped 77% for bottled tea, 67% for sports drinks and 47% for diet soda. Even sales of bottled water and flavored or fortified waters, the most popular drinks now sold in schools, slid 15%. The result was an 88% decrease in beverage calories shipped to schools, the ABA said.

While state and local restrictions on sales of sweetened beverages in schools are responsible for some of the decline, voluntary guidelines adopted by the beverage companies and their bottlers in May 2006 played a significant role, Susan Neely, the ABA's president and chief executive, said in an interview. "We've successfully change the beverage landscape in a very meaningful way," she said.

Soft-drink consumption generally has been down nationwide, but the report didn't address consumption by students outside of school.

The ABA report's results bring the beverage makers close to fulfilling an agreement with an alliance formed by the William J. Clinton Foundation and the American Heart Association to fight childhood obesity. Under the 2006 agreement, the companies pledged to eliminate sales of full-calorie sodas to schools by the current school year, replacing them with lower-calorie options in smaller portion sizes. High-school sales were limited to diet sodas, sports drinks, waters, unsweetened juices, and milk products.

At the beginning of this school year, 98.8% of schools and school districts measured were in compliance with the guidelines, the report found. To measure school compliance, Keybridge surveyed 12 bottlers representing about 90% of national shipments to schools of drinks marketed by Coke, Pepsi, and Dr Pepper Snapple Group Inc.

American Heart Association President Clyde Yancy said he was "really floored" by the decline in calories sold and the change in product mix. He said he hoped the improved choices in schools would have an impact beyond the classroom. "Children take these messages home to their families," he said in an interview.

Margo Wootan, director of nutrition policy for the Center for Science in the Public Interest, a Washington consumer-advocate group, said the beverage industry has made "a very strong good faith effort to get full-calorie soft drinks out of schools." More has been done to get sodas out of schools than snacks, said Ms. Wootan, who hadn't seen the latest ABA report.

Five Foods You Should Eat Every Day

Eating right on a budget can be a challenge, but it's certainly not impossible. Consider this your cheat sheet to the 5 inexpensive foods you should eat everyday for optimum health.



#1 Leafy greens
Medical experts call them one of nature's miracle foods. Leafy greens like Swiss chard and kale are high in nutrients like folate and vitamins A and C that can lower your risk of cancer. Just one cup of dark, leafy greens a day could also prevent diabetes and high blood pressure.

#2 Nuts
Many nutritionists recommend nuts like almonds, cashews and walnuts because they're high in natural fiber. Fiber slows your digestive process, keeping hunger and unhealthy mid-afternoon snacks at bay. Goodbye vending machine runs!

#3 Onions
Studies show that consuming onions on a regular basis may reduce symptoms of asthma and the risk of developing stomach cancer. Add them to soups and stir-fry, and just remember -- the stronger the onion, the greater the health benefit.

#4 Whole grains
Refined grains, like white rice and pasta, have lost 90% of their nutritional value through the refining process. As if that weren't reason enough to choose whole grains like brown rice, quinoa and whole oats, a recent study showed that a diet rich in whole grains actually flattens your belly by reducing fat storage in your lower abdominal region.

#5 Yogurt
Making yogurt part of your daily eating routine can improve your digestion -- if you're buying the right stuff. Check that the label lists "active cultures" to make sure you're getting healthy probiotics, and pick a yogurt rich in vitamin D to prevent osteoporosis.