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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

More than 50 million US women have used oral contraceptives (OCs) in the past 25 years, and the consensus is that the benefits and advantages of OC use outweigh most of the disadvantages. Side effects have been reduced or eliminated by reduced dosage preparations, and effectiveness has been virtually 100%. Despite this widespread use, most US women are misinformed about OCs, perhaps because pediatricians, family physicians, and nurse-practitioners are insufficiently informed. The economic power of the drug manufacturers has been brought to bear on the medical profession to prescribe OCs for virtually every woman of child-bearing age. The drug industry which has been touting the safety of OCs has recently introduced new progestins which are supposed to be "lipid-neutral" and have fewer androgenic effects. Therefore, the potentially harmful effects of the old progestins were deemphasized deliberately. A cautious but advisable approach for physicians to follow in prescribing OCs has 8 points. 1) All sexually active females should be advised that barrier contraception is the best protection (except abstinence) from sexually transmitted diseases, including AIDS. 2) OCs with more than 35 mcg estrogen should be withdrawn from the market. 3) All patients should be encouraged to lead a healthy lifestyle. 4) Barrier methods should be encouraged for patients with such medical conditions as migraine headaches, prominent varicose veins, diabetes, increasing weight gain, hypertension, thyroid dysfunction, and mitral valve prolapse. 5) Switching to a preparation with the new progestins should be considered for some patients who are smokers or have abnormal lipid profiles. 6) It might be advantageous under certain circumstances for a patient to discontinue OC use for a period of time. 7) Women who no longer desire a pregnancy should be encouraged to consider surgical sterilization. 8) Nulliparous women over 30 years old should discontinue OC use to diminish their risk of breast cancer. This last point is controversial, and the editors of this publication invite the readers' comments.
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PMID:A practical guide for prescribing birth control pills. 804 4

This paper examines the evidence that connects calcium intake and vitamin D status to bone fragility, hypertension, colon cancer, and breast cancer. Human calcium physiology, with an intestinal absorptive barrier and inefficient conservation, reflects the abundance of calcium in the primordial human food supply. The calcium intake of stone-age adults is estimated at 50 to 75 mmol/d, three to five times the median calcium intake of present-day U.S. adults. Long-term calcium restriction and/or insufficient vitamin D may promote the development of bone fragility, high blood pressure, colon cancer, and breast cancer in susceptible individuals. Conversely, improvement in calcium intake and/or in vitamin D status may help to prevent these serious health problems. At least 12 intervention studies have established the skeletal benefit of increased calcium intake among women in the late postmenopause. Other reports suggest that adequate calcium may protect against salt-sensitive and pregnancy-associated hypertension. High intakes of both dietary calcium and vitamin D are associated with reduced development of precancerous changes in colonic mucosa. Preliminary findings also suggest that vitamin D has a protective effect against breast cancer.
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PMID:The role of calcium intake in preventing bone fragility, hypertension, and certain cancers. 806 93

Overweight patients are common in veterinary medicine, just as they are in human medicine. Although animals also suffer from diseases in the general categories of cancer, hypertension, diabetes, and digestive diseases, many of the specific problems of obese humans do not afflict obese pets. Of tumors, only adenocarcinoma of the breast is a significant problem in dogs and cats. Moreover, a high intake of dietary fat and table food has been reported to be protective in adult dogs; in women, increasing dietary fat has been associated with increased breast cancer risk. Two experimental studies in dogs notwithstanding, no published data have been provided suggesting that hypertension accompanies obesity in companion animals currently. Hyperinsulinemia and glucose intolerance has been reported in diabetic obese dogs as well as in humans. Whether or not weight reduction would correct these abnormalities has not been reported. In humans, central distribution of fat may be more pathological than a peripheral distribution, increasing morbidity due to cardiovascular disease, diabetes, and hypertension. The presence of differences in fat distribution have not been described in companion animals, even though they may influence the risk of obesity-related diseases in pets as well. No studies of investigation of the success of maintenance of the lost weight in client animals exist. Recently reported studies of obese women suggest that maintenance of lost weight may be better maintained with continuous care programs, and support the view that obesity should be treated like other chronic diseases, by providing ongoing care for the rest of the life of the patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Management of obesity--the clinical nutritionist's experience. 808 62

No one has yet conducted a definitive, prospective, controlled study in 35-50 year old women that examines the relationship between oral contraceptive (OC) use and thromboembolism, myocardial infarction (MI), stroke, and cancers of the breast and genital organs. The available data derive from large studies on women in all age groups. These studies, mostly from the US and the UK, demonstrate that older women are somewhat more likely to be at risk of thromboembolism, MI, and stroke. Yet, the risk does not tend to be limited to OC users and is likely associated with other risk factors for cardiovascular disease. The risk of thromboembolism is greatest in smokers. It is also associated with the estrogen dose, which is lower today than it was in the past (= or 50 mcg vs. = or 100 mcg). The relationship between breast cancer and OC use is not clear, but the data suggest that the risk of breast cancer is elevated slightly among current OC users. The data confirm, however, that OCs protect against endometrial and ovarian cancer. Since many women older than 35 years old need safe, reversible contraception, the US Food and Drug Administration Advisory Committee concluded that healthy older women with no risk factors can safely use OCs. Women who should avoid OCs include those with a hormone-related history of thromboembolism, coronary artery disease, hypertension, diabetes, and other conditions that might cause adverse effects. Women with a clear family history of endometrial or ovarian cancer could likely benefit from OC use. Prospective studies of such women who do use OCs should be conducted to determine whether the protective effects of OCs can be extended. If the results are favorable, providers can emphasize OC benefits rather than risks. OCs are safe and effective for women over 35 who have no risk factors.
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PMID:Risks of oral contraceptive use in women over 35. 812 Aug 60

Medical conditions related to hormonal abnormalities were investigated in a case-control study of breast cancer among women who attended a screening centre. Information was obtained by telephone interview regarding physician-diagnosed medical conditions such as thyroid or liver diseases, diabetes, and hypertension, as well as hirsutism, acne, galactorrhoea, and reproductive, menstrual, and gynaecological factors. Results are presented for 354 cases and 747 controls. Women with fertility problems who never succeeded in becoming pregnant were at significantly increased breast cancer risk (adjusted odds ratio [OR] = 3.5; 95% confidence interval [CI]:1.1-10.9). An elevated cancer risk was also associated with having excess body hair (OR = 1.5; 95% CI:1.0-2.3), or having excess body hair in addition to persistent adult acne (OR = 6.8; 95% CI:1.7-27.1). Recurrent amenorrhea (OR = 3.5; 95% CI:1.1-11.5), and a treated hyperthyroid condition (OR = 2.2; 95% CI:1.1-4.4) were significantly associated with risk. A non-significant elevation of risk was present for endometrial hyperplasia (OR = 1.8; 95% CI: 0.8-4.0). There was a suggestion of an association between a history of galactorrhoea and breast cancer risk (OR = 2.0; 95% CI:0.8-4.9) among premenopausal women. No associations were found with other medical or gynaecological factors. The possibility that some of these findings are due to chance cannot be excluded because of the problem of multiple comparisons.
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PMID:The influence of medical conditions associated with hormones on the risk of breast cancer. 814 80

Women with breast cancer (cases = 196) and without the disease (controls = 566), selected from the Life Span Study sample of A-bomb survivors and nonexposed residents of Hiroshima and Nagasaki, Japan, and matched on age at the time of the bombings, city, and estimated radiation dose, were interviewed about reproductive and medical history. A primary purpose of the study was to identify strong breast cancer risk factors that could be investigated further for possible interactions with radiation dose. As expected, age at first full-term pregnancy was strongly and positively related to risk. Inverse associations were observed with number of births and total, cumulative period of breast feeding, even after adjustment for age at first full-term pregnancy. Histories of treatment for dysmenorrhea and for uterine or ovarian surgery were associated positively and significantly with risk at ages 55 or older, a finding that requires additional study. Other factors related to risk at older ages were the Quetelet index (weight [kg]/height [cm]2) at age 50, history of thyroid disease, and hypertension. Neither age at menarche nor age at menopause was associated significantly with risk. Subjects appeared to be poorly informed about history of breast cancer or other cancer in themselves or in their close relatives; this finding suggests that innovative strategies may be required when studying familial cancer patterns in Japanese populations.
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PMID:A case-control interview study of breast cancer among Japanese A-bomb survivors. I. Main effects. 816 63

The menopause is defined as cessation of menstruation, ending the fertile period. The hormonal changes are a decrease in progesterone level, followed by a marked decrease in estrogen production. Symptoms associated with these hormonal changes may advocate for hormonal replacement therapy. This review is based on the English-language literature on the effect of estrogen therapy and estrogen plus progestin therapy on postmenopausal women. The advantages of hormone replacement therapy are regulation of dysfunctional uterine bleeding, relief of hot flushes, and prevention of atrophic changes in the urogenital tract. Women at risk of osteoporosis will benefit from hormone replacement therapy. The treatment should start as soon after menopause as possible and it is possible that it should be maintained for life. The treatment may be supplemented with extra calcium intake, vitamin D, and maybe calcitonin. Physical activity should be promoted, and cigarette smoking reduced if possible. Women at risk of cardiovascular disease will also benefit from hormone replacement therapy. There is overwhelming evidence that hormone therapy will protect against both coronary heart disease and stroke, and there is no increased risk of venous thrombosis or hypertension. A disadvantage of hormone replacement therapy is an increased risk of forming gall-bladder stones and undergoing cholecystectomy. Unopposed estrogen therapy gives a higher incidence of endometrial cancer in women with an intact uterus, but the contribution of progestins for about 10 days every month excludes this risk. Breast cancer in relation to estrogen-progestogen therapy has been given much concern, and the problem is still not fully solved. If there is a risk, it is small, and only after prolonged use of estrogen (15-20 years). The decision whether or not to use hormone replacement therapy should, of course, be taken by the individual woman in question, but her decision should be based on the available scientific information. It is the opinion of the authors that the advantages of hormone replacement therapy far exceed the disadvantages. We suggest that every woman showing any signs of hormone deprivation should be treated with hormone replacement therapy. This includes women with subjective or objective vaso-motor symptoms, genito-urinary symptoms, women at risk of osteoporosis (fast bone losers), and women at risk of cardiovascular diseases.
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PMID:Postmenopausal hormone replacement therapy--clinical implications. 819 55

Estrogen deficiency is the main cause of postmenopausal osteoporosis. Replacement estrogen therapy protects the bone by reducing bone resorption and activating osteoblasts, as well as by promoting absorption of calcium and production of calcitonin. These preventive effects are especially marked in cancellous bone, provided estrogen therapy is initiated as soon as menstruation stops. Effects are dose-dependent and efficacy of the treatment is noticeable mainly during the period of administration. The rare contra-indications to estrogen therapy include hormone-dependent cancers, cholestatic jaundice, and large uterine myomas (for which surgical treatment is recommended). Metabolic disorders, arterial hypertension, and thyroid function disorders are less common with the new natural estrogens (estradiol) given orally or percutaneously to avoid hepatic passage of the drug. As for treatment induced cancers, sequential administration of a progestagen protects the endometrium and the relative risk seems negligible for breast cancer. Although concomitant use of a progestagen is mandatory, either natural progesterone or norpregnanes should be given to avoid adverse metabolic effects. Emphasis has recently been put on the role of concomitant progestagen therapy which may promote the formation of bone, probably by competing for glucocorticoid receptors in bone. There is still a need for prospective epidemiological studies, although evaluation methods and the long follow-ups needed raise significant problems.
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PMID:[Substitutive hormone therapy in postmenopausal osteoporosis. Are there any contraindications?]. 823 58

Dietary assessment plays a crucial role in our ability to detect relationships between dietary exposure and disease causation. Nutritional problems are at the root of major mass diseases that are impediments to progress toward national and international health goals. This is true for chronic undernutrition and famine as well as many of the chronic diseases afflicting middle-aged and elderly people in industrialized and developing countries. High-quality dietary assessment provides a sound scientific foundation for the primary prevention of mass diseases, whereas inadequate assessment can produce false-negative results and result in apparent inconsistencies between cross-population and within-population findings for a particular disease. The critical role of dietary assessment in the elucidation of disease causation is discussed with regard to high blood pressure, heart disease, breast cancer, and several other major chronic diseases. Improved approaches to dietary assessment need to be made more widely known, not only among research scientists and health practitioners, but also among policymakers who require high-quality dietary data for establishing nutrition goals and making policy decisions.
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PMID:Assessing diets to improve world health: nutritional research on disease causation in populations. 827 13

Recent studies suggest a high specificity of 99mTc-galactosyl neoglycoalbumin (99mTc-NGA) receptor scanning in vivo by providing both morphological and functional diagnosis of liver disease. In 22 patients with advanced breast cancer 99mTc-NGA (150 MBq; 50 nmol) was exclusively trapped by the liver, the images showing 'cold spots' in areas of liver metastases formation. A two-tailed analysis was performed: the time activity curves recorded for the liver and precordial area were subjected to a kinetic receptor-calculating model allowing an estimation of the NGA-receptor concentration of the liver (i.e. hepatic binding protein, HBP) as well as calculation of the residual functional liver volume (RFLV) via the S.P.E.C.T.-study. In breast cancer patients with liver metastases a significantly (P < 0.01) lower HBP-concentration was estimated (0.65 +/- 0.16 vs 0.82 +/- 0.17 mumol l-1) as evidenced by a lower 99mTc-NGA-accumulation in the liver resulting also in a significantly (P < 0.001) lower RFLV (739 +/- 348 vs 1336 +/- 184 ml). In four amonafide-treated patients (800 mg m-2 intravenous infusion over 3 h) approximately one week after one chemotherapy cycle a significant (P < 0.05) increase in HBP-concentration (0.56 +/- 0.10 vs 0.72 +/- 0.06 mumol l-1) of the liver was found corresponding with an increase in RVLF (546 +/- 297 vs 670 +/- 265 ml). These regulatory mechanisms at the HBP level measured in vivo provide further evidence that 99mTc-NGA should have promise as a clinically useful receptor radiopharmaceutical for both quantification of liver function and assessment of liver morphology.
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PMID:Scintigraphic evaluation of functional hepatic mass in patients with advanced breast cancer. 835 45


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