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Drug's Ability to Battle Cancer Questioned

July 13, 1998

Earlier this year, U.S. scientists found the drug tamoxifen seemed to prevent cancer. Preliminary results indicated there were 45% fewer breast cancers in the group using the drug than in a group using placebos. But two new studies in the July 11 Lancet find no such benefit from tamoxifen. Although the studies have some differences in experimental design, the conflicting results suggest that more trials will be needed before physicians can routinely recommend use of the drug in high-risk women.

In the first of the new papers, Dr. Umberto Veronesi of the European Institute of Oncology, head of the Italian Tamoxifen Prevention Study, and his colleagues in Milan and Bologna randomly assigned 5,408 women who had undergone hysterectomies to either tamoxifen or a placebo. After 46 months of follow-up, they found "no difference in breast cancer frequency between the placebo (22 cases) and tamoxifen (19 cases) arms [of the study]."

In the second trial, which involved 2,494 women with family histories of breast cancer, Dr. Trevor Powles of the Royal Marsden NHS Trust in London and his colleagues also report no differences in breast cancer frequency between those taking tamoxifen and those receiving a placebo. The U.S. study was larger, enrolling more than 13,000 women, and the women were older--factors that might explain the discrepancies. But in an editorial in the journal, Dr. Kathleen Pritchard of the University of Toronto argued that "the results cast doubt on the wisdom of the rush, at least in some places, to prescribe tamoxifen widely for prevention."

Money Strain Blamed in Many Depression Cases

Unemployment and poverty are often the triggers that lead to the two most common mental disorders, anxiety and depression, British researchers find. Dr. Scott Welch and his colleagues at the Royal Free Hospital School of Medicine studied mental disorders in 7,726 adults in England, Wales and Scotland.

They report in the July 11 British Journal of Medicine that financial strain was a powerful predictor of both the onset and maintenance of cases of anxiety and depression, even after taking into account different standards of living.

Walking During Labor Won't Reduce Waiting

Scientists report in Thursday's New England Journal of Medicine that whatever makes prospective mothers comfortable during labor, such as pacing maternity wards, is just fine, but it won't reduce the time they wait for birth. The study of 1,067 women delivering at Parkland Memorial Hospital in Dallas found that the decision to move about or to remain in bed had no effect on the duration of labor or on the need for painkillers, caesarean section or drugs to speed delivery.

"Since our results provide no objective evidence for or against walking during labor, it seems reasonable to let women elect either alternative," said the team, led by Dr. Steven Bloom of the University of Texas Southwestern Medical Center in Dallas. "It appears that we have come full circle during this century to the conclusion that during labor a woman 'should not be compelled to take to her bed unless she feels so inclined,' " they said, quoting a 1903 medical textbook.

AIDS Drug 3TC May Slow Some Liver Damage

A standard AIDS drug appears to slow liver damage caused by hepatitis B, according to researchers from the University of Tokyo. A study in the July 9 New England Journal of Medicine looked at the effects of the drug 3TC on people with long-standing infections with the virus. It found that after a year of treatment, signs of inflammatory infection fell significantly in more than half of those getting the medicine, compared with one-quarter of those on dummy medication.

The drug, also known as lamivudine or Epivir, is one of several that block production of an essential viral protein known as reverse transcriptase. Both the AIDS virus and hepatitis B use this enzyme. Worldwide, more than 300 million people are infected with hepatitis B, and three-quarters of them are of Asian origin. The virus can cause cirrhosis and liver cancer. Currently, the only approved treatment is interferon-alpha, which can cause flu-like side effects. The researchers said 3TC is easier to take and may work better, although the two medicines have not been compared head to head.

Some Migraine Medicine Can Constrict Arteries

People who have clogged arteries should not take certain migraine medications, such as sumatriptan, Dutch researchers reported in the July 6 Circulation: Journal of the American Heart Assn. Laboratory studies show that many of the medications cause contractions of the arteries, some of them lasting up to 90 minutes.

"For most migraine sufferers, this is not a problem," said pharmacologist Antoinette Maasen VanDenBrink of Erasmus University in Rotterdam. "But if the coronary artery is already narrowed, there might not be enough reserve. In such cases, a small additional contraction may cause problems."

The drugs already carry a warning that they should not be given to people with coronary artery disease or those who might have heart disease that has not yet been diagnosed. The researchers said their tests confirmed that the warnings were important and that new formulations of drugs did not erase the problem.

National Teleconference Planned on Cancer Trials

A one-hour national teleconference to explain the benefits and problems of cancer treatment trials will be held Wednesday, beginning at 9 a.m. The featured presenter will be nurse Mary McCabe, director of the Office of Clinical Research Promotion at the National Cancer Institute.

Participation is free, and no phone charges apply. To register, call (800) 813-HOPE or (212) 302-2400. Additional information about the conference is available at http://www.cancercare.org. General information about cancer trials is available at http://cancertrials.nci.nih.gov.

--Compiled by THOMAS H. MAUGH II

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