That’s according to a new analysis of earlier data from postmenopausal women who had had their uterus removed (hysterectomy).

Previous studies of women with intact uteruses had shown that taking combined estrogen and progestin — a synthetic version of the hormone progesterone — raised the chances of dying from lung cancer (see Reuters Health story of September 21, 2009).

Estrogen alone, however, resulted in only one more lung cancer death than placebo pills over nearly eight years, Dr. Rowan T. Chlebowski, of Harbor-UCLA Medical Center in Torrance, California, and colleagues reported Friday.

Overall, the researchers calculated that eight in 10,000 women would die from lung cancer every year, regardless of whether they took estrogen or placebo pills.

“These findings should be reassuring for women with previous hysterectomy, who use estrogen alone” for menopause symptoms, they write in the Journal of the National Cancer Institute.

Hormone replacement therapy (HRT) remains the most effective therapy for menopausal symptoms like severe hot flashes and night sweats and has been shown to preserve women’s bone mass.

But millions of women stopped using it after a large U.S. government study in 2002 found that postmenopausal women given estrogen-plus-progestin had higher risks of heart attack, stroke, breast cancer and blood clots than women given a placebo.

The new study was based on more than 10,000 women, aged 50 to 79 years, who were randomly assigned to take either an estrogen pill or placebo.

In the hormone group, 61 women (0.15 percent per year) developed lung cancer, compared to 54 (0.13 percent per year) in the placebo group. The researchers found this small difference could easily have been due to chance, but they add that it requires further investigation.

“This is good news, and one less thing to worry about for women who are taking estrogen alone,” said Dr. Nanette Santoro, who was not involved in the research, although she added that no single study can be definitive.

Santoro, chair of obstetrics and gynecology at the University of Colorado at Denver in Aurora, cautioned that estrogen alone was only an option for women who do not have a uterus.

For those who do, progesterone is necessary to prevent abnormal changes — and possibly cancer — in the lining of the uterus.

The new results agree with a large study published earlier this year that found no link between estrogen-only HRT and lung cancer risk (see Reuters Health story of February 24).

When compared with combined HRT, estrogen-only also seems to have a lower risk of breast cancer.

But it doesn’t protect against colon cancer, as combined HRT appears to do, and the risk of heart disease and stroke are comparable between the two treatments, Chlebowski and colleagues note.

Experts recommend that menopausal women weigh the benefits and risks of HRT with their doctor.

“Severity of symptoms, desire for relief, and prior adverse reactions to medications all go into the decision making process,” Santoro told Reuters Health by e-mail.

“Sometimes hormones are a great idea and sometimes they are not, so for most women I try to reassure them at first that we are very likely to be able to help reduce symptoms, but that some trial and error may be necessary.”

SOURCE: http://link.reuters.com/vag94n the Journal of the National Cancer Institute.

“This is a readily applicable approach that improves quality of life and reduces medicine intake in cancer survivors. This is a real positive,” said Dr. Douglas W. Blayney, president of the American Society of Clinical Oncology (ASCO). “This is also a creative application of scientific technique to complementary and alternative medical approaches. This applies real science.

“There is an increased importance of amelioration of the complications of therapy in long-term cancer survivors,” added Blayney, who is medical director of the Comprehensive Cancer Center at the University of Michigan. “There are literally millions of patients to whom this might be applicable.”

The results of the trial, the largest randomized, controlled study on this topic to date, are to be presented at ASCO’s annual meeting, being held in June in Chicago.

Some 80 percent of cancer patients have trouble sleeping while undergoing treatment, and about two-thirds say the problems persist after treatment ends.

Despite these large numbers, few solutions exist.

The study authors involved 410 cancer survivors, average age 54, who had finished treatment two to 24 months before and who still reported greater-than-average sleep disruptions. Almost all of the participants were women, and three-quarters had had breast cancer, although the cancer had not spread. None had done any yoga in the past three months.

Participants were randomized either to receive regular follow-up care for cancer survivors or to receive regular care plus two 75-minute sessions of yoga per week for four weeks.

“We pulled components from gentle Hatha yoga and restorative yoga,” explained study author Karen Mustian, an assistant professor of radiation oncology and community and preventive medicine at the University of Rochester Medical Center in New York. “The actual components of each class included seated, standing, transitional and supine postures, and breathing exercises known as pranayama.”

Emphasis was on breathing from the diaphragm rather than the chest and on mindfulness, visualization and guided meditation, she explained.

Yoga participants reported an improvement in sleep quality of 22 percent, while controls reported an improvement of only 12 percent, Mustian said.

Thirty-one percent of participants in the yoga group who had started out with clinically impaired sleep quality recovered vs. only 16 percent in the control group.

Fatigue in the yoga group was decreased by 42 percent, compared with only 12 percent in the control group.

Yoga participants reduced daytime sleepiness by 20 percent as compared to only 5 percent in the usual care group.

Quality of life improved, on average, 6 percent in the yoga group and not at all in the other group.

While the yoga group was able to get by with less sleep medication, people in the control group actually used more.

“It is possible that gentle Hatha yoga classes and restorative yoga classes might be useful to cancer survivors in communities across the U.S. in helping with side effects of cancer treatment, which help create impairments in quality of life,” Mustian said. “What we can’t say at this time is that other forms of yoga, such as heated, or more rigorous types of yoga would be effective in mitigating these side effects or be safe for cancer survivors.”

SOURCES:  2010, news conference with: Karen Mustian, Ph.D., assistant professor, radiation oncology and community and preventive medicine, University of Rochester Medical Center, New York, and Douglas W. Blayney, M.D., ASCO president, professor, internal medicine, University of Michigan Medical School, and medical director, Comprehensive Cancer Center, University of Michigan

The finding is leading the researchers to develop an eye test for early signs of Alzheimer’s in both disorders.

“People with Down syndrome develop symptoms of Alzheimer’s-type dementia often by the age of 30,” said study co-author Dr. Lee E. Goldstein, associate professor at Boston University School of Medicine, in a statement. “This is because they have an extra copy of a key Alzheimer’s gene that leads to increased amyloid-beta accumulation in the brain. We discovered that this same protein starts to accumulate very early in the lens of the eye, even in children.”

“The results are striking,” added Dr. David G. Hunter, ophthalmologist-in-chief at Children’s Hospital Boston and vice chairman of the department of ophthalmology at Harvard Medical School. “We have known that these cataracts are prevalent in people with Down syndrome and are sometimes seen at birth, but we never knew how they were related to the disorder. Now we know. These distinctive cataracts appear only in people with advanced Alzheimer’s disease and much earlier in Down syndrome.”

Goldstein said the team is developing an eye scanner to measure amyloid-beta, the protein in question, in the lens. “This approach may provide a way for early detection and monitoring of related pathology in the brain. Effective treatments for the brain disease in Down syndrome and Alzheimer’s disease are on the horizon, and early detection is the key for successful intervention.”

An estimated 24.3 million people worldwide suffer from dementia, which can stem from Alzheimer’s disease or other causes.

In the new study, Dr. Sudha Seshadri, of Boston University School of Medicine, and colleagues examined the medical records of 733 people with an average age of 60. About 70 percent were women.

The research confirms that increasing levels of body-mass index — a measurement of whether someone’s height and weight are proportional — in middle-aged people corresponds with lower brain volumes when they are older, Seshadri said in a news release.

“More importantly, our data suggests a stronger connection between central obesity, particularly the visceral fat component of abdominal obesity, and risk of dementia and Alzheimer’s disease,” Seshadri said.

“Our findings, while preliminary, provide greater understanding of the mechanisms underlying the link between obesity and dementia,” Seshadri said. “Further studies will add to our knowledge and offer important methods of prevention.”

SOURCE: American Neurological Association, press release.

“Comprehensive smoking bans have been implemented in some states, but not in every state,” noted lead researcher Dr. Mouaz Al-Mallah, co-director of Cardiac Imaging Research at Henry Ford Hospital, in Detroit.

Currently, 39 states have some type of public smoking bans, with 26 banning smoking in any enclosed public space, while 11 states have no bans at all.

Based on the finding, Al-Mallah said that he would “encourage all states to institute a ban on smoking in public place to protect people from secondhand smoke. Authorities should do everything possible to prevent healthy individuals from being exposed to secondhand smoke, and one of the ways is by passing such laws. ”

Al-Mallah was scheduled to present the findings Thursday at the American Heart Association’s annual Quality of Care and Outcomes Research conference in Washington, D.C.

For the study, the researchers looked at data from 13 states that do not have laws banning smoking in public places. In states without smoking bans there were 169,043 hospitalizations for heart attack, the researchers found.

Based on their calculations of an 11 percent drop in heart attacks if bans were instituted nationwide, there would be 18,596 fewer hospitalizations for heart attack in the first year.

In addition, there would be a savings of $92 million in costs of caring for these patients, the researchers said.

In 2008, Al-Mallah found that a smoking ban in Michigan would result in a 12 percent drop in heart attacks in that state.

Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, said that, “smoking and exposure to environmental tobacco smoke are well established and modifiable risk factors for heart attack, stroke and premature cardiovascular death.”

He said that a number of studies have demonstrated that when communities adopt comprehensive smoking bans, substantial reductions in heart attacks follow.

“Adopting a national comprehensive smoking ban would prevent cardiovascular events, reduce death and disability due to cardiovascular disease, and greatly improve the cardiovascular health of this nation,” Fonarow said.

Another expert agreed, and said that bans’ benefits extend to nonsmokers as well by reducing secondhand smoke.

“This is another important piece of evidence that smoke-free laws protect health,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids said. “It shows why it is critical that every state pass a comprehensive smoke-free law that protects all workers and applies to all workplaces and public places.”

SOURCES: Mouaz Al-Mallah, M.D., co-director, Cardiac Imaging Research, Henry Ford Hospital, Detroit; Gregg C. Fonarow, M.D., professor, medicine, and director, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles; Matthew L. Myers, President , Campaign for Tobacco-Free Kids;

It’s been the long-standing notion of doctors and patients that when joint pain is relieved after surgery, the barriers to exercise will be ameliorated and weight loss can be achieved. “Our findings do not support this notion,” Joseph Zeni, Jr., and L. Snyder-Mackler of the University of Delaware in Newark report.

People typically undergo knee replacement to treat severe osteoarthritis, they note. Due to pain, stiffness and muscle weakness, they add, people with severely arthritic joints may become sedentary, while excess weight in and of itself can worse osteoarthritis by stressing the joint.

Zeni and Snyder-Mackler investigated the long-term effects of knee replacement on body weight. They followed 106 people who underwent a single-knee replacement and 31 people of similar ages who weren’t suffering from knee pain.

Two years after the operation, the researchers found, two-thirds of patients had gained weight; on average, they put on about 12 pounds. The remaining third lost an average of about four pounds. However, there was no increase in body weight in the control group.

The knee replacement patients who gained weight showed a weakening in their quadriceps or thigh muscles between one and two years after the operation, while there was no change in quad strength seen in those who had lost weight. The control group also showed some thigh muscle weakening, but less than was seen in the knee replacement patients who had gained weight.

Given the heavy additional load placed on the knees of people who gain a significant amount of weight after knee surgery — as well as the fact that people tend to put more weight on their non-operated knee after the procedure — weight gain would likely speed up the progression of arthritis in that knee, the researchers note.

The fact that people who gained weight also had weaker quads, which is associated with worse functioning, could also increase their likelihood of needing to have the other knee replaced, they add.

What’s more, being sedentary and gaining weight can also up people’s risk of heart attacks and other cardiovascular problems, the researchers point out.

Zeni and Snyder-Mackler advise that doctors talk with their knee replacement patients before and after surgery about the importance of maintaining a healthy weight.

If a person is still experiencing knee pain that makes exercising difficult, they add, they can try water aerobics, swimming, or upper body exercises to get the cardiovascular workout they need.

SOURCE: Osteoarthritis and Cartilage, 2010.

For many people, these factors lead to delays in seeking care of six hours or more from the onset of symptoms, according to the new findings.

The study, reported in the April 14 issue of the Journal of the American Medical Association, shows that, even among people with private health insurance, money worries are associated with delays in getting to the hospital for treatment.

“We’ve identified something that potentially could be a big player in shaping how patients come to the hospitals, not only for heart attack but potentially for other emergencies,” said Dr. Paul S. Chan, the study’s senior author and a cardiologist with Mid America Heart Institute at St. Luke’s Health System in Kansas City, Mo.

Whether people have insurance and the type of coverage they have are potentially modifiable, Chan explained, whereas factors previously linked to delays in heart attack care — such as being black or female — are not.

National health-reform legislation will expand access to coverage, experts say, but it’s no panacea for Americans’ concerns about paying their share of the health-care tab, including deductibles and co-insurance for hospital admissions.

Dr. Clyde W. Yancy, medical director of the Heart and Vascular Institute at Baylor University Medical Center in Dallas and president of the American Heart Association, described the study findings as striking.

“What it means is that the critical window when we can intervene most successfully is closed when those patients present for heart attack care — meaning they have more consequences, meaning that, ironically, they have more health-care need,” Yancy said.

Dr. Angela F. Gardner, an assistant professor of emergency medicine at the University of Texas Southwestern Medical Center in Dallas and president of the American College of Emergency Physicians, said the findings ring true with what physicians experience in everyday practice.

“I think that people do delay care based on fears of the financial repercussions of it,” she said, describing incidents in which people report having symptoms long before going to see a physician or refuse ambulance transportation because of cost concerns.

For the study, lead author Kim G. Smolderen of Tilburg University in the Netherlands and her fellow researchers in the United States examined data from a registry of 3,721 people who had heart attacks and were admitted to one of 24 U.S. hospitals between April 11, 2005 and Dec. 31, 2008.

Using information from medical records to determine insurance status and interviews to assess financial concerns, researchers classified people one of three ways: insured without financial concerns, insured but with financial concerns about accessing care, or uninsured.

Nearly two-fifths of the people in the study were either uninsured (19.8 percent) or had financial concerns about accessing care (18.5), the researchers found.

Among those with insurance who had financial concerns, 82.8 percent said they avoided medical care, 55.6 percent avoided taking medications and 12.8 percent reported having trouble obtaining health-care services because of costs.

Delays in arriving at the hospital of six or more hours were more prevalent among the uninsured (48.6 percent) and people who were insured but also had money worries (44.6 percent) than among the insured who had no financial concerns (39.3 percent). Likewise, a greater proportion of insured patients without money worries (36.6 percent) arrived at the hospital within two hours of symptom onset than did the insured with financial concerns (33.5 percent) and uninsured patients (27.5 percent).

The paper underscores the “handicap” that the uninsured and underinsured have, Yancy noted, “but it also highlights the impediment that even the insured have in accessing health care.”

The message to patients? Hours and minutes can make a difference between life and death, so don’t delay seeking emergency care.

“If you are concerned that you’re having a heart attack or a stroke, you should call 911 and get to a hospital,” Gardner said. “The barrier of money should not stop a patient from being cared for if they have an emergency condition.”

SOURCES: Paul S. Chan, M.D., cardiologist, Mid America Heart Institute, St. Luke’s Health System, Kansas City, Mo.; Clyde W. Yancy, M.D., medical director, Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas; Angela F. Gardner, M.D., assistant professor, emergency medicine, University of Texas Southwestern Medical Center, Dallas;

The 10-year population study found 39 percent fewer admissions for cardiovascular conditions such as heart attack, angina and stroke, and 33 percent fewer admissions for respiratory problems such as asthma, emphysema, and pneumonia or bronchitis after the ban went into effect.

The findings are “consistent with the evidence that exposure to secondhand smoke is detrimental to health and legitimizes legislative efforts to further reduce exposure,” wrote Dr. Alisa Naiman, of the Institute for Clinical Evaluative Sciences at the University of Toronto, and colleagues.

Further research is needed to determine which types of smoking bans are most effective, they added.

The study appears April 12 in the Canadian Medical Association Journal.

Tobacco is the leading cause of preventable disease and death worldwide, and secondhand smoke is the third leading cause of preventable health problems and premature death in developed countries.

SOURCE: Canadian Medical Association Journal, news release

A new British study supports that notion, but it also finds that light drinking’s benefit in lowering stroke risk does not apply to smokers.

“Any potential beneficial effect of drinking moderate amounts of alcohol on stroke may be counteracted by cigarette smoking,” said lead researcher Yangmei Li, a doctoral candidate in the Institute of Public Health at the University of Cambridge.

Li presented her findings Monday at a press conference held by the American Academy of Neurology during its annual meeting in Toronto.

The authors note that prior studies exploring the potential protective relationship between stroke risk and light-to-moderate drinking have found conflicting results. The fact that many people both drink and smoke might be a factor.

Smoking is a significant risk factor for stroke, Li noted, with current smokers having a 64 percent higher risk for stroke than those who have never smoked.

To help tease out these relationships, the authors tracked the drinking and smoking histories of more than 22,500 British residents (approximately 10,000 men and 12,000 women) for an average of 12 years.

The study began as early as 1993 and ended by 2008. All the study subjects were between the ages of 39 and 79, and none had a history of heart attack, cancer, or stroke prior to the study launch. By the end of the study, 864 strokes had occurred.

The researchers found that heavy drinkers gained no protection from stroke relative to non-drinkers. In fact, excessive alcohol use was linked to a potential rise in stroke risk.

On the other hand, light-to-moderate drinking did appear to lower the odds for stroke compared to no alcohol consumption. That’s in keeping with other studies on moderate drinking and cardiovascular health.

However, the apparent protective effect of moderate tippling did not hold true for smokers.

The lowest stroke risk was observed among nonsmokers who consumed between three to 14 “units” of alcohol per week, each unit being equal to about a glass of wine.

This level of consumption — below what the authors defined as the upper “moderate consumption” limit of 21 glasses per week — afforded participants a 37 percent reduction in stroke risk.

However, smokers who drank a similar amount of alcohol had no such decline in their odds for stroke.

Li and her colleagues conclude that “smoking may modify [the] relationship between alcohol and stroke risk.”

For his part, Dr. Ralph Sacco, chairman of the department of neurology at the University of Miami, said the finding confirms that “smoking is a powerful risk factor for stroke”.

“In my own research, the protective affect of moderate alcohol consumption was seen among both smokers and nonsmokers,” he noted. “However, it is possible that we’ll ultimately find that smoking wipes out the benefit, because it certainly does increase stroke risk in general.”

“And so while it’s hard for us to advocate that people should start drinking a little alcohol if they don’t do so already, we do need to get the message out that if you’re currently drinking heavy amounts of alcohol you need to reduce down to small amounts,” Sacco said. “And we need to make sure that people don’t smoke.”

SOURCES: Yangmei Li, M.Phil, Ph.D. candidate, Institute of Public Health, University of Cambridge, U.K.; Ralph Sacco, M.D., chairman, department of neurology, University of Miami;

The study included data from more than 89,500 patients collected from 1973 to 2006. There were 12,559 subsequent cancers, including 3,094 melanomas.

While not the most common form of skin cancer, melanoma is the most serious and most likely to be fatal. The American Cancer Society estimates that 68,720 Americans were diagnosed in 2009 with melanoma and that 6,850 Americans died from the disease.

Noting that most people with melanoma – more than 92 percent of white women, and nearly 87 percent of white men – survive at least 5 years after diagnosis, Dr. Portia T. Bradford and colleagues wanted to measure the risks of the disease coming back or of survivors developing a second melanoma or another type of cancer.

“The risk of subsequent cancer is important for melanoma survivors,” they write in the March issue of the Archives of Dermatology.

Analyzing data collected by the Surveillance, Epidemiology, and End Results (SEER) program, they concluded that survivors had a 28 percent increased risk of a second cancer, mostly due to their 9-times greater likelihood of developing another melanoma than the general population. The most common second cancers after melanoma were breast, prostate, and non-Hodgkin’s lymphoma.

Over the span of the study, doctors diagnosed 1,156 female breast cancers, 2,200 prostate cancers and 481 non-Hodgkin’s lymphomas among the more than 89,000 melanoma survivors. In each case, the number of secondary cancers reported among survivors was higher than what would have been expected in the general population.

The risks of a second cancer were highest within the first year and declined somewhat over time but “remained quite elevated more than 20 years” after the first diagnosis.

Despite high survival rates for melanoma, there’s no international consensus on how melanoma survivors should be followed-up.

The National Comprehensive Cancer Network, an alliance of 21 cancer centers and a respected authority on cancer practice guidelines, acknowledges that there’s a wide variety of opinions about what a melanoma survivor follow-up program should look like – how long and how often survivors should be screened.

Because of the costs involved and the lack of clear data, “the optimal duration of follow-up remains controversial,” they write in the 2010 version of the NCCN’s melanoma practice guidelines.

Guidelines recommend exams more than once a year for anywhere from two to ten years, but they are often vague on what to do after that time. The NCCN recommends lifelong follow-up, but their guidelines are currently under review.

Dr. Bradford says the evidence is building for longer follow-up. “Our study adds to the scientific literature on melanoma, and provides further evidence for lifelong medical surveillance of patients who have been diagnosed with melanoma for new melanomas and other cancers,” she wrote in an email to Reuters Health.

SOURCE: Archives of Dermatology.