Longer Wait for Mammogram After Benign Breast Biopsy May Be Warranted

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Longer Wait for Mammogram After Benign Breast Biopsy May Be Warranted

By Kathleen Doheny
HealthDay Reporter

THURSDAY, May 2 (HealthDay News) -- Women who have a breast biopsy that turns out to be benign are typically told to undergo another imaging test, such as a mammogram, in six to 12 months. Now, a new study suggests that the longer interval might be better.

Researchers who followed women who had benign breast biopsies say having that test less than a year later finds few cancers and is a drain on health care dollars.

''Doing a follow-up imaging study six months after a benign needle breast biopsy has a low likelihood of finding breast cancer at the biopsy site," said study author Dr. Andrea Barrio, an attending breast surgeon at Bryn Mawr Hospital, in Pennsylvania.

Most of these women, she said, can wait longer than six months before repeating the mammogram, ultrasound or MRI.

Dr. Demitra Manjoros, a breast fellow at Bryn Mawr, is due to present the research Thursday at the American Society of Breast Surgeons' annual meeting, in Chicago.

A biopsy is done after an abnormality is found on an imaging test such as a mammogram. The standard of care is to perform an image-guided needle biopsy, Barrio said.

"However, when you do a needle biopsy, you only sample the lesion or abnormality, instead of removing it," she said.

So, the follow-up imaging was suggested. Under current National Comprehensive Cancer Network guidelines, the repeat imaging is recommended six to 12 months after a benign breast biopsy.

"In my practice, I perceived that this short-term imaging did not seem to add anything to the care of the patient," Barrio said.

So, she launched the study, focusing on 337 women who had benign biopsies and met one other criterion: Their pathologic findings explained the finding on the image. Researchers then looked to see if the interval for repeat imaging made a difference in finding cancer.

Of the 337 women, 169 had imaging repeated less than 12 months after their benign biopsy result. Another 101 had no documented imaging test repeated. And another 67 had repeat imaging 12 months or later after the biopsy.

Of the 169, just one breast cancer was identified. Of the 67 who had repeat imaging at 12 months, no malignancies were found.

The cost of detecting a missing cancer with the shorter interval follow-up was nearly $193,000 in this group.

The study findings support a policy of discontinuing repeat testing less than 12 months after such a benign finding, Barrio said.

The findings don't mean no one should have shorter-term imaging follow up, Barrio said. While in general, routine short-term repeat imaging after such a benign biopsy is not needed, she said, "I'm not saying nobody should do it."

"Certain women would require six months follow-up," she said. For instance, a woman whose initial imaging findings were vague or not specific might be advised to get repeat imaging in less than a year, she said.

A breast cancer expert commented on the new research.

The study is sound, said Dr. Laura Kruper, director of the Cooper Finkel Women's Health Center and co-director of the breast cancer program at the City of Hope Comprehensive Cancer Center in Duarte, Calif.

"I think most women would be fine having repeat imaging in 12 months," she said, "but it should be done on a selective basis." A doctor must take the whole patient into account, she said, weighing such factors as family history and a woman's views of the testing intervals.

"There are some patients who are going to be so nervous waiting a year," Kruper said.

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Andrea Barrio, M.D., attending breast surgeon, Bryn Mawr Hospital, Bryn Mawr, Pa.; Laura Kruper, M.D., director, Cooper Finkel Women's Health Center, and co-director, breast cancer program, City of Hope Comprehensive Cancer Center, Duarte, Calif.; May 2, 2013, presentation, American Society of Breast Surgeons annual meeting, Chicago

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Kids With Past Concussions Take Longer to Recover

Study has implications for how long children should wait to resume activities, experts say

By Amy Norton

HealthDay Reporter

MONDAY, June 10 (HealthDay News) -- Kids who suffer a concussion may have a substantially slower recovery if they've sustained one or more blows to the head in the past, a new study finds.

Researchers report that among 280 kids and young adults who sustained a concussion over one year, those who'd suffered one in the past took twice as long to recover -- typically 24 days, versus 12 days for kids with no history of concussion.

What's more, the number of past concussions, and the timeframe of kids' head injuries, appeared key. Young people who'd sustained a concussion in the past year had a prolonged recovery from the current one -- typically 35 days.

Recovery was also slower for those who'd had two or more concussions in the past, at any time. It typically took 28 days for their symptoms to fully resolve.

Experts said the findings, reported online June 10 and in the July print issue of Pediatrics, have implications for managing kids' head injuries.

When they have had multiple concussions, or a relatively recent one, parents and doctors should probably be "extra cautious" about letting them back into sports, said lead researcher Dr. Matthew Eisenberg, of Boston Children's Hospital.

Sports are a major cause of young people's concussions -- and accounted for almost two-thirds of those in this study. In general, experts say those kids should not get back into the game until all of their symptoms have resolved, and a health professional gives them the OK.

So be even more patient when a youngster has a history of concussions, Eisenberg said. That means not only waiting until any symptoms go away to get active again, but gradually moving back into the normal routine.

"You do not want them to go from zero to 60," Eisenberg said.

That gradual return is important any time an athlete has had a concussion. But it's probably even more vital with repeat concussions, agreed Keith Yeates, chief of pediatric psychology and neuropsychology at Nationwide Children's Hospital in Columbus, Ohio.

"It's been part of the medical lore, this idea that multiple concussions are 'bad,' and having a repeat concussion within a short amount of time is bad," Yeates said. But this study, he added, helps confirm that.

One of the big remaining questions, though, is whether kids with repeat concussions suffer any long-term consequences, Yeates said.

"We don't know if there are any effects on long-term cognition or memory," study author Eisenberg agreed. There have been reports that professional athletes who suffer blows to the head may be at heightened risk of degenerative brain diseases later on. A recent study found increased risks of Alzheimer's and Lou Gehrig's disease in retired pro football players, for example.

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Vegetarians May Live Longer

California research finds 12% lower risk of dying for those who don't eat meat

By Denise Mann

HealthDay Reporter

MONDAY, June 3 (HealthDay News) -- Vegetarians may live longer than meat-lovers, new research suggests.

Scientists in California analyzed the diets of 73,300 Seventh Day Adventists, and found that vegetarians were less likely to die from any cause or from cause-specific reasons, except for cancer, compared to those who ate meat.

"Certain vegetarian diets are associated with reductions in all causes of [death] as well as some specific causes including heart disease, kidney-related deaths and endocrine disease-related death such as diabetes," said lead researcher Dr. Michael Orlich, a preventive medicine specialist at Loma Linda University in Loma Linda.

The big question is why, and the study wasn't designed to answer that, Orlich noted.

"Reductions in meat in the vegetarian diet may be part of it, but it may be due to higher quantities of plant foods," he added, although it is also possible that vegetarians may lead more healthy lives.

The research was published online June 3 in the journal JAMA Internal Medicine.

For the study, the researchers used a food questionnaire to assess dietary patterns and looked at men and women who adhered to one of five diets: non-vegetarian; semi-vegetarian (eats meat or fish no more than once a week); pesco-vegetarian (consumes seafood); lacto-ovo-vegetarian (includes both dairy products and eggs), and vegans, who don't eat any animal products.

During the course of the more than five-year study, 2,570 people died. But vegetarians were about 12 percent less likely to die from any cause than their meat-eating counterparts, the study showed. And the survival edge seemed to be stronger in men than women.

In addition, the researchers noted that vegetarians tended to be older and more educated, exercised more and were less likely to drink alcohol or smoke than their carnivorous counterparts.

The study also did not pinpoint which type of vegetarian diet provides the greatest survival benefit because the vegetarian diets were compared to non-vegetarian diets only, not to one another.

The research team now plans to look at the patterns of food consumption seen in each vegetarian diet. "We want to see what they eat more or less of, and then investigate the effect on mortality or associated with specific foods," Orlich said. "Are there particular foods that account for most of this apparent association. Is the lack of meat the big issue, or is the amount of plant-based foods responsible?"

Nancy Copperman, a dietician at North Shore Long Island Jewish Health System in Great Neck, N.Y. , said that the fiber in vegetarian diets may be what's driving the survival edge. "It's not just fruit and vegetables, but all types of fiber [including whole grains] that seems to really reduce health risks," she said. "The new study pushes the literature that we are building about the impact that whole grains and fruits and vegetables can have on your health."

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Marriages Forged on the Internet May Last Longer

Study found couples who met online were slightly more likely to stay together

By Randy Dotinga

HealthDay Reporter

MONDAY, June 3 (HealthDay News) -- If you're looking for the perfect mate, a new study suggests you might be on the right track if you turn to the Internet: Married couples who met online were slightly more likely to be happy and stay together than those who ran into each other the old-fashioned way.

The difference was small, although the number of people who met online was big, and researchers who study marriage say the study has some weaknesses. Still, lead author John Cacioppo, of the University of Chicago, said it should give comfort to anyone who fears that meeting online isn't the best way to begin a romantic relationship.

"I hope this encourages people to feel authentic and not odd if they feel so busy that they're going online to meet people," said Cacioppo, director of the university's Center for Cognitive and Social Neuroscience. "It's a new environment and a new world, and it's not one we should be afraid of."

In the new study, eHarmony, an online dating service, commissioned Harris Interactive to conduct an online survey of more than 19,000 people in the United States who were married to members of the opposite sex between 2005 and 2012. Independent statisticians verified the results of the survey.

Since the marriages were so recent, the rates of divorce (5 percent) and separation (2.5 percent) were low.

The researchers found that more than a third of those surveyed met their spouses online. Of those, 45 percent met through dating sites, while 21 percent met through social networks like Facebook.

Those who met offline were more likely to be very old, very young and not wealthy; they also were most likely to meet each other at work (22 percent), through friends (19 percent) or at school (11 percent).

The researchers found that 7.6 percent of those who met offline had gotten divorced, compared to 5.9 percent of those who met online. This difference held up even when researchers adjusted their statistics to account for high or low numbers of people who shared similarities like age or income.

The study also found that those who met online were slightly happier in their marriages. Their spouses, however, didn't get a say in the survey, and the study doesn't provide a layperson-friendly way to understand the differences in how happy the marriages seemed to be.

Why might marriages that had their start online be happier and more stable? One possibility is that they're more focused on finding relationships "rather than falling into a relationship with someone they met through a friend or at work," said Elizabeth Schoenfeld, a graduate student at the University of Texas who studies human behavior. "It is possible that this initial motivation to secure a relationship partner may translate into a later motivation to stay in the relationship."

Markie Blumer, an assistant professor at the University of Nevada, Las Vegas, who studies marriage, said the study is "pretty solid," although it has some flaws.

For one, she said, it's an online survey that would naturally include people who are especially Internet-savvy. For another, it ignores same-sex couples, which are even more likely to meet online, she said.

Future research, Blumer suggested, should take a closer look at how relationships evolve with or without technology. It's possible, for example, that some people meet online but then develop their romance in person.

The study appears in this week's online issue of the journal Proceedings of the National Academy of Sciences.

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Tofu-Rich Diet May Help Women With Lung Cancer Live Longer

Title: Tofu-Rich Diet May Help Women With Lung Cancer Live Longer
Category: Health News
Created: 3/26/2013 10:35:00 AM
Last Editorial Review: 3/26/2013 12:00:00 AM

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Tofu-Rich Diet May Help Women With Lung Cancer Live Longer

Chinese study found eating high amounts before diagnosis boosted survival rates

By Mary Brophy Marcus

HealthDay Reporter

TUESDAY, March 26 (HealthDay News) -- Eating tofu and other soy foods may help women who develop lung cancer increase their odds of living longer.

A study of women from Shanghai, China, published in the March 25 issue of the Journal of Clinical Oncology, links high soy consumption before a lung cancer diagnosis with longer survival.

"This is the first study to suggest an association between soy food consumption and lung cancer survival," said study author Dr. Gong Yang, a research associate professor of medicine in the division of epidemiology at Vanderbilt University Medical Center, in Nashville.

Eating soy products in small amounts in the years preceding a lung cancer diagnosis didn't seem to pose a benefit, though.

Lung cancer is the leading cause of death among women in the world. It forms in the tissues of the lungs, usually in the cells that line the air passageways. The five-year survival rate is poor compared to breast cancer; it is estimated that by 2012, lung cancer will cause twice as many deaths as breast cancer, Yang said.

Cigarette smoking is the top cause of the disease in the United States, according to the U.S. Centers for Disease Control and Prevention, but in the study, most of the women from China were nonsmokers.

One expert noted another difference between the two populations of women that does not bode well for Chinese women.

"Far more never-smoking women in Asia get lung cancer than in the United States," said Dr. Jyoti Patel, an associate professor of medicine at the Robert H. Lurie Comprehensive Cancer Center at the Northwestern University Feinberg School of Medicine, in Chicago. "We're not sure why this is, but they may have a predilection for developing mutations ... that cause lung cancer to grow."

The study participants were part of a larger observational study called the Shanghai Women's Health Study, which tracked the incidence of cancer in about 75,000 women. Diet information was collected, including how much soy food -- such as soy milk, tofu, fresh and dry soybeans, and soy sprouts -- women ate.

The authors reported that about 450 women were diagnosed with lung cancer during the study. They were divided into three groups according to the amount of soy food they had eaten before their lung cancer diagnosis. The highest intake levels of tofu were equal to about 4 ounces a day, while the lowest soy consumers ate less than 2 ounces daily.

During the study, more than 300 of the lung cancer patients died, Yang said. Sixty percent of the women in the highest soy-eating group and 50 percent in the low soy consumer group were alive twelve months after diagnosis. A patient's risk of death decreased with increasing soy intake, but leveled off at 4 ounces of daily tofu consumption.

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A Few Extra Pounds Linked to a Longer Life

Jan. 1, 2013 -- Overall, people who carry a few extra pounds tended to live longer than those who are either normal weight or very obese, new research shows.

The review, of 97 studies that included a combined 2.88 million people, questions the notion that people of normal weight live longest.  

“It is possible that under certain circumstances, being a little overweight is good as opposed to bad,” says Steven B. Heymsfield, MD, executive director of the Pennington Biomedical Research Center in Baton Rouge, La. Heymsfield wrote an editorial on the review but was not involved in the research.

About 30% of women and 40% of men in the U.S. are overweight based on their body mass index (BMI), a measure of size that takes into account a person’s height and weight.

While they may not be able to wear their favorite clothing size, Heymsfield says it doesn’t necessarily mean they are sicker than people who are at so-called normal BMIs.

“You have to separate out the cosmetic part from the health part,” he says.

The review, which is published in the Journal of the American Medical Association, takes a fresh look at nearly two decades of research into the relationship between body weight and death risk.

“We have a huge amount of data because we collected almost 100 studies,” says researcher Katherine Flegal, PhD, a distinguished consultant with the CDC’s National Center for Health Statistics in Bethesda, Md.

People with BMIs under 30 but above normal were less likely to die during the studies compared to people with normal BMIs.

A reduction in the risk of death from all causes was about 6% lower for people who were overweight, and it was remarkably consistent from study to study, Flegal says.

Those people considered obese based on BMI, however, were worse off. They were about 18% more likely to die of any cause compared to those of normal weights.

Though the findings are provocative, they come with some important caveats.

The study only looked at the association between death and body size. It didn’t include other measures of health that may be related to weight.

“Total mortality [death from all causes] is important, but it doesn’t tell you much about quality of life,” says Heymsfield. “It’s not whether you’re at risk of developing diabetes. It’s not whether you’re at risk for developing joint problems."

The study also just shows an association; it doesn’t prove that body weight is the reason that some bigger people tended to live longer than those at normal weights.

For that reason, Flegal says, people shouldn’t give up on their goals to eat right and exercise.

“We’re not trying to make any recommendations,” she says. “It’s not intended as a call to any kind of action.”

But the findings may be reassuring to people who carry some extra weight but are otherwise healthy.

“Maybe a few extra pounds is not as lethal as we’ve been led to believe,” Heymsfield says.

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Olympic Medalists Live Longer

Dec. 13, 2012 -- We watch the Olympic Games with awe and marvel at the athletes’ power and grace. 

But are Olympic athletes really any healthier than the rest of us? Do they live longer? And if they do, what does it mean for the rest of us mere mortals?

These are some of the questions that two new studies in the BMJ set out to answer.

The first study showed Olympic medalists do live close to three years longer than the rest of us, regardless of their country, medal won, or type of sport played.  

A second study involving Olympic athletes, however, found that athletes who participated in high- or moderate-intensity sports don’t live any longer than athletes who excel in low-intensity sports such as golf. But boxers and rugby and ice hockey players are at greater risk of dying due to the physical contact associated with their sports.

In the first study, researchers compared life expectancy among 15,174 Olympic athletes who won medals between 1896 and 2010 to that of people in the general population. Winners lived about of 2.8 years longer than non-Olympic medalists in eight of the nine country groups studied. It didn’t matter if they took home the gold, silver, or bronze, either.  

“We were a little surprised that survival advantage among Olympians was so pervasive,” says researcher Philip M. Clarke. He is a professor of health economics at the University of Melbourne in Australia. “It can be observed across almost all countries, sports, and medal type. Olympians are much more like each other when they are compared with the general population.”

The study wasn’t designed to figure out why Olympic athletes live longer, but the researchers do have some theories.

“There are a range of explanations including genetic factors, physical activity, healthy lifestyle, and the wealth and status that comes from international sporting glory,” Clarke says. “While it is hard to disentangle these effects, what we do show is winning a gold medal does not confer any additional survival advantage. So maybe any wealth and fame that can flow from winning is playing less of a role, but we really need another study to examine this issue in detail.”

You don’t have to be a Gabby Douglas to reap these benefits. "For those of us who are unable to win an Olympic medal, the one thing we can do to improve our life expectancy is to engage in regular exercise, which has been shown to protect against major diseases like type 2 diabetes," he says.

In the second study, researchers tracked almost 10,000 athletes with a known age at death who took part in at least one Olympics between 1896 and 1936.

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Olympic Medalists Live Longer

ByDenise Mann
WebMD Health News Reviewed byLaura J. Martin, MD

Dec. 13, 2012 -- We watch the Olympic Games with awe and marvel at the athletes’ power and grace. 

But are Olympic athletes really any healthier than the rest of us? Do they live longer? And if they do, what does it mean for the rest of us mere mortals?

These are some of the questions that two new studies in the BMJ set out to answer.

The first study showed Olympic medalists do live close to three years longer than the rest of us, regardless of their country, medal won, or type of sport played.  

A second study involving Olympic athletes, however, found that athletes who participated in high- or moderate-intensity sports don’t live any longer than athletes who excel in low-intensity sports such as golf. But boxers and rugby and ice hockey players are at greater risk of dying due to the physical contact associated with their sports.

In the first study, researchers compared life expectancy among 15,174 Olympic athletes who won medals between 1896 and 2010 to that of people in the general population. Winners lived about of 2.8 years longer than non-Olympic medalists in eight of the nine country groups studied. It didn’t matter if they took home the gold, silver, or bronze, either.  

“We were a little surprised that survival advantage among Olympians was so pervasive,” says researcher Philip M. Clarke. He is a professor of health economics at the University of Melbourne in Australia. “It can be observed across almost all countries, sports, and medal type. Olympians are much more like each other when they are compared with the general population.”

The study wasn’t designed to figure out why Olympic athletes live longer, but the researchers do have some theories.

“There are a range of explanations including genetic factors, physical activity, healthy lifestyle, and the wealth and status that comes from international sporting glory,” Clarke says. “While it is hard to disentangle these effects, what we do show is winning a gold medal does not confer any additional survival advantage. So maybe any wealth and fame that can flow from winning is playing less of a role, but we really need another study to examine this issue in detail.”

You don’t have to be a Gabby Douglas to reap these benefits. "For those of us who are unable to win an Olympic medal, the one thing we can do to improve our life expectancy is to engage in regular exercise, which has been shown to protect against major diseases like type 2 diabetes," he says.

The 30-Minute Workout Routine

Intensity of Sport Doesn’t Matter

In the second study, researchers tracked almost 10,000 athletes with a known age at death who took part in at least one Olympics between 1896 and 1936.

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Longer Tamoxifen Use Helps Breast Cancer Survival

ByBrenda Goodman, MA
WebMD Health News Reviewed byLouise Chang, MD

Dec. 5, 2012 -- Doubling the time that breast cancer patients take tamoxifen cuts the risk that the cancer will come back and further lowers the risk of dying of the disease, a new study shows.

The study is expected to change the way doctors prescribe tamoxifen, a drug that blocks the effects of estrogen on breast cells. About 80% of all breast cancers are sensitive to the hormone estrogen for growth.

The research also hints that longer courses of other kinds of hormone-reducing medications may also work better than shorter courses after breast cancer surgery, though trials testing that theory are ongoing.

“I think the result of this trial will have a major immediate impact on premenopausal women,” says Peter Ravdin, MD, PhD. Ravdin is the director of the Breast Health Clinic at the Cancer Therapy and Research Center at the University of Texas Health Science Center, in San Antonio.

Newer kinds of estrogen-reducing drugs, called aromatase inhibitors, have largely replaced tamoxifen as the preferred therapy for postmenopausal women with estrogen-sensitive cancers. This study won’t change that.

But those kinds of drugs don’t work for women before menopause. For them, doctors still recommend taking tamoxifen.

Current guidelines recommend that women stop tamoxifen after five years because the drug increases the risk of uterine cancers and dangerous blood clots.

The new study found small increases in cases of uterine cancer in women who took the drug for an additional five years. Those women also had slightly higher risks of developing a blood clot in their lungs. But those additional risks did not appear to outweigh the survival benefits of staying on the drug.

“I think that for women who are now approaching five years of therapy, where we’d usually be telling them -- up to this point -- that we’re going to be stopping the tamoxifen, now we’re going to be telling them that there is clinical evidence that 10 years is superior to five years, and I’m going to be comfortable doing that,” says Ravdin, who led a news briefing on the study but was not involved in the research.

The study was published in the Lancet and presented to doctors at the 2012 San Antonio Breast Cancer Symposium.

A Visual Guide to Breast Cancer

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The Secret to a Longer Life? Children

ByKathleen Doheny
WebMD Health News Reviewed byLouise Chang, MD

Dec. 5, 2012 -- Many parents might good-naturedly scoff at the notion, but a new study shows that being a parent may help you live longer.

Danish researchers compared men and women who had children with those who did not to see if the childless were more likely to die early.

They were. "Childless couples are at increased risk of dying early of all causes," says researcher Esben Agerbo, PhD, associate professor at Aarhus University in Aarhus, Denmark.

The benefit of parenthood on longevity was stronger for women than for men, says Agerbo.

The study findings echo those of previous research. It is published in the Journal of Epidemiology and Community Health.

Children & Longevity: Details

Agerbo used health and social registers in Denmark. He focused on more than 21,000 childless couples who registered for IVF treatment between 1994 and 2005.

He followed them from the time they began IVF treatment until the end of 2008, their death, their emigration, or a diagnosis of mental illness, another link he was exploring.

During the time period, more than 15,000 babies were born. Another 1,564 were adopted.

Death was rare. During the study period, 96 women and 220 men died. Parenthood apparently decreased the risk of early death. Mothers with a biological child were four times less likely to die an early death than childless women.

Fathers with a biological child were two times less likely to die an early death than childless men.

Men who adopted were nearly half as likely to die early as men who had no children.

For women, the effect of adoption on longevity was not significant, Agerbo says.

Explaining the Parenthood & Longevity Link

Agerbo says he found a link, not a proven cause and effect.

He can only speculate as to why parenthood may increase longevity.

''My best guess is health behaviors," he says. "When people have kids, they tend to live healthier."

They pay more attention, he says, to lifestyle habits. For instance, they may get to bed earlier and get more sleep, knowing they have to get up early to feed children and do other tasks.

Parenthood & Longevity: Perspective

The new findings echo those of Michael Eisenberg, MD, director of male reproductive medicine and surgery at Stanford University.

In a study published in 2011, he found that childless married men had a higher risk of dying from heart disease acquired after age 50 than did men with two or more children.

The new study findings, he says, are ''certainly consistent with the identified link between childlessness and cardiovascular mortality."

As for how to explain the link, he says, "our group [of researchers] subscribes to a biologic link."

He says that fertility problems, common among the childless, may share some of the same origins as other health problems.

View Article Sources

SOURCES:

Esben Agerbo, PhD, associate professor, Aarhus University, Aarhus, Denmark.

Michael Eisenberg, MD, director of male reproductive medicine and surgery, Stanford University, Stanford, Calif.

Agerbo, E. Journal of Epidemiology and Community Health, published online Dec. 5, 2012.

Eisenberg, M. Human Reproduction, September 2011.

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