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Drug Bests Estrogen in Study

June 21, 1999|SHARI ROAN

Last week's medical news featured two prominent reports on breast cancer that should help women with prevention and treatment.

The Journal of the American Medical Assn. published a study on use of the new drug Raloxifene and the development of breast cancer. Raloxifene, a so-called designer drug, is a selective estrogen receptor modulator, or SERM. It is approved for treatment of osteoporosis. Experts hope that for post-menopausal women SERMs could provide the benefits of estrogen therapy, such as prevention and treatment of osteoporosis, without the side effects thought to be linked to estrogen, such as an increased risk of breast cancer.

The study of 7,705 post-menopausal women with osteoporosis showed that being treated with Raloxifene reduced the risk by 76% of a particular type of breast cancer that grows in the presence of estrogen. The study took place at 180 medical centers in the United States and Europe and was led by Dr. Steven R. Cummings of UC San Francisco.

More studies are needed to determine whether Raloxifene may be better than traditional estrogen therapy for post-menopausal women, the authors said. But early findings suggest that Raloxifene also may help women in reducing heart disease.

Tamoxifen Helpful in Early Breast Cancer

Another SERM, tamoxifen, has been shown to help women with a type of early-stage breast cancer (ductal carcinoma in situ) prevent the spread of the cancer. The study, written by the National Surgical Adjuvant Breast and Bowel Project, appeared in Lancet.

Women with the early-stage breast cancer typically undergo lumpectomy and radiation therapy. The study of 1,804 women compared those treated with lumpectomy and radiation alone to those who also received tamoxifen. The tamoxifen group experienced 43% fewer invasive breast cancers after five years.

The same research group had earlier determined that adding radiation therapy to lumpectomy also reduced the rate of cancer recurrence. Adding both radiation therapy and tamoxifen to the surgical treatment created a 77% reduction in invasive breast cancers and a 64% reduction in noninvasive breast cancers, the group said.

Who Should Have Prenatal Testing?

Most obstetricians advise women 35 and older to undergo prenatal genetic testing for chromosomal disorders. But a new study in the Journal of Women's Health and Gender-Based Medicine suggests that there may be more appropriate criteria than age for recommending the tests, such as the mother's attitude toward screening. While the risk of having a child with a disorder rises with age, the study makes clear that women consider many more factors than risk in deciding whether to undergo testing.

The study, by researchers at UC San Francisco, solicited opinions on testing from a diverse group of 75 pregnant women. The study found substantial differences in attitudes toward testing based on moral reasons, family and social influences, perceptions of one's own health, the difficulty experienced in getting pregnant, and willingness to put the fetus at risk during a test.

"Women indicated that prenatal tests represent a trade-off. As other authors have noted, with increased availability of information regarding one's pregnancy come increased burdens of decisions, such as whether or not one wants this information," the authors concluded.

Doctors Underestimate Asthma Severity in Test

A new study has found evidence that it pays to see a specialist for the treatment of asthma. Researchers reported in June's American Journal of Respiratory and Critical Care Medicine that asthma specialists (pulmonologists and allergists) had the best understanding of the government's new asthma guidelines for diagnosing the disease.

In the study, 108 doctors in various specialties were asked to complete a 31-question test on asthma knowledge and the new guidelines. Overall, the doctors appropriately estimated the severity of the patients' disease in 46% of patients. Most of the erroneous diagnoses involved underestimating the severity. Asthma specialists showed a much better understanding of the federal guidelines.

Fewer Teen Fathers Than Teen Mothers

Confirming what many health experts have long suggested, the fathers of babies born to teenage females are likely to be 20 or older, according to an analysis in this month's Family Planning Perspectives. While 18% of births in the analysis of 1994 statistics were to teen females, only 9% of fathers were teen males. The study also found that 53% of conceptions occur within marriage. And three out of four pregnancies result in births.

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