STUDY: Alternative Methods to deal wth the pain of labor

JOURNAL: University Hospital

AUTHORS: Britt-Ingjerd Nesheim, MD; Ragnhild Kinge, RN;

ABSTRACT: Acupuncture during labor reduced the requirement for other painkillers and has high patient satisfaction in this randomized, unblinded, controlled study.

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COMMENTARY: One group received acupuncture (N = 106); another did not (N = 92). A second control group (N = 92), drawn from the labor ward protocol, consisted of patients who met the eligibility criteria for the study and were matched to the "no acupuncture" group by parity, but who had not been offered the opportunity to take part. Outcome measure "effectiveness of acupuncture" was measured by the requirement for use of meperidine.

Meperidine was given to 11% of the acupuncture group, 37% of the no acupuncture group (P < 0.0001), and 29% of the control group.

The use of other analgesics was also lower in the acupuncture group.

Patient satisfaction was high: 89 of 103 patients asked said they would want acupuncture during another labor.

STUDY: Stop Smoking

JOURNAL: Eur J Cancer 2002;38:1520-1525.

AUTHORS: Dr. M. Prochazka

ABSTRACT: An international team of researchers report in the European Journal of Cancer that women with a history of breast cancer have a "significantly increased risk of developing a subsequent lung cancer, possibly related to an interaction between radiotherapy and smoking."

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COMMENTARY: Dr. M. Prochazka of the Karolinska Institute in Stockholm and colleagues there and at Georgetown University in Washington, DC, set out to analyze the adverse effects of breast cancer therapy in light of prolonged survival in these patients.

Using the Swedish Cancer Registry, the investigators identified approximately 141,000 women with breast cancer diagnosed between 1958 and 1997. The cohort was then followed for the development of lung cancer.

Dr. Prochazka and colleagues found 613 subsequent lung cancer cases among this cohort and "a statistically significant increased risk of lung cancer was seen > 5 years after breast cancer diagnosis, in contrast to a significantly decreased risk in the first 5 years after the breast cancer diagnosis."

Women with a history of breast cancer who continue to smoke may experience an interaction between smoking and radiotherapy that makes them more susceptible to subsequent lung cancer, Dr. Prochazka's group concludes.

STUDY: more frequent examinations needed

JOURNAL: Journal of the American Medical Association

AUTHORS: Robert Schoen

ABSTRACT: Colon cancer can develop more quickly than previously thought.Older adults should undergo more frequent examinations to look for the disease

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COMMENTARY: Colon Cancer, the third most common cause of cancer death in the United States after lung and breast cancer, was found in nearly 1 percent of 9,000 patients who were shown to be free of the disease just three years earlier.

Precancerous polyps were discovered in 14 percent of the returning patients, who averaged 66 years old.

The patients underwent a sigmoidoscopy, in which a doctor guides a camera-equipped tube through the lower portion of the colon to search for cancerous lesions or polyps.

The study's findings suggested the currently recommended five-year interval between sigmoidoscopy exams and the 10-year wait for a more thorough colonoscopy might be too long.

Colon cancer will be diagnosed in nearly 150,000 Americans this year and will kill 57,000.

The study discovered cancer in places that had been looked at three years earlier, indicating "these lesions ... can crop up in a smaller period of time," said Robert Schoen, who led the study published in the Journal of the American Medical Association.

STUDY: Stress reduction a must

JOURNAL: Proceedings of the National Academy of Sciences.

AUTHORS: Kiecolt-Glaser

ABSTRACT: It's no surprise that constant stress can make people sick, and now a team of researchers has figured out how.

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COMMENTARY: A study focused on 119 men and women who were taking care of spouses with dementia.

The health of the caregivers was compared with that of 106 people of similar ages who were not living under the stress of constant care giving.

Blood tests showed that a chemical called Interleukin-6 sharply increased in the blood of the stressed caregivers compared with blood of the others in the test.

Previous studies have associated IL-6 with several diseases, including heart disease, arthritis, osteoporosis, type-2 diabetes and certain cancers.

The study also found the increase in IL-6 can linger in caregivers for as long as three years after a caregiver had ceased that role because of the spouse's death. Of the test group, 78 spouses died during the survey.

"This really makes a link to why chronic stress can actually kill people," said Janice Kiecolt-Glaser, professor of psychology and psychiatry at Ohio State University. "We haven't had a good mechanism before."

She explained that people under stress tend to respond by doing things that can increase their levels of IL-6.

For example, they may smoke or overeat; smoking raises IL-6 levels, and the chemical is secreted by fat cells. Stressed people also may not get enough exercise or sleep, she added. Exercise reduces IL-6, she said, and normal sleep helps regulate levels of the chemical.

It clearly points to the need to control stress better, she said.

STUDY: One more nail

JOURNAL: JAMA. 2003;289:3243-3253, 3254-3263, 3304-3306

AUTHORS: Rowan T. Chlebowski, MD,

ABSTRACT: Two studies in the June 25 issue of The Journal of the American Medical Association provide more evidence against the use of combined hormone therapy (CHT) in postmenopausal women. The first study, from the Women's Health Initiative (WHI), shows that not only is the incidence of breast cancer increased with CHT, but that it is diagnosed at a more advanced stage. The second study again shows that progestin, not estrogen, is primarily responsible for the increase in breast cancer risk.

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COMMENTARY: "Relatively short-term combined estrogen plus progestin use increases incident breast cancers, which are diagnosed at a more advanced stage compared with placebo use, and also substantially increases the percentage of women with abnormal mammograms," write Rowan T. Chlebowski, MD, PhD, from Harbor-UCLA Research and Education Institute in Torrance, California, and colleagues from the WHI Randomized Trial.

These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis.

The WHI was a randomized, placebo-controlled trial of CHT in 16,608 postmenopausal women. As Medscape has reported previously, the WHI was stopped early, on July 9, 2002, when interim analysis revealed that the overall health risks associated with CHT, including breast cancer, exceeded the benefits. The present analysis determined the association of CHT with breast cancer characteristics and annual mammography findings.

After one year, the percentage of women with abnormal mammograms was 9.4% (716 of 7,656) in the CHT group and 5.4% (398 of 7,310) in the placebo group (P < .001). Throughout the study, more women receiving CHT had abnormal mammograms than did women receiving placebo.

According to the authors, about 3 million postmenopausal women in the U.S. currently use CHT, so the absolute increase in abnormal mammograms of about 4% per year with CHT is equivalent to approximately 120,000 otherwise avoidable abnormal mammograms annually in these women.

The breast cancers diagnosed in women in the [CHT] group had similar histology and grade but were more likely to have advanced stage vs. women in the placebo group.

These results suggest that invasive breast cancers developing in women receiving estrogen plus progestin therapy may have an unfavorable prognosis.

Consideration for use of estrogen plus progestin for any duration by postmenopausal women should incorporate the current findings into established and emerging risks and benefits of these agents."

In an accompanying editorial, admin H. Gann, MD, ScD, and Monica Morrow, MD, from the Feinberg School of Medicine at Northwestern University in Chicago, Illinois, refer to CHT as "a single-edged sword."

Commenting on the WHI trial, they note that "alteration of a woman's basic hormonal physiology over decades in the interest of long-term disease prevention is fraught with hazard."

They point out that CHT increases the risk of developing breast cancer while decreasing mammographic sensitivity and thereby delaying detection of the cancer.