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Some risk factors known to increase the odds of breast cancer in white women have less impact on Hispanic women, a new study shows.

For instance, for postmenopausal women in the study, “recent hormone use and younger age at menarche did not appear to play as big a role in Hispanics,” said Dr. Lisa M. Hines, an assistant professor of biology at the University of Colorado and lead author of the study, published online April 26 in Cancer.

For younger women studied, family history and taller height — found in general to slightly increase breast cancer risk, Hines said — did not appear to be as strongly linked with breast cancer among Hispanics as among whites, the study found.

Researchers have long known that breast cancer rates, as well as death rates from the disease, vary by ethnic group. For instance, according to a national database, Hispanic women are less likely to get breast cancer than are white women, with 89 of every 100,000 Hispanic women getting a breast cancer diagnosis, compared with 132 of every 100,000 non-Hispanic white women.

However, Hispanic women are more likely to die from the disease, the statistics show.

“That’s been known for a long time,” Hines said. “The question is why.”

About 15 percent of the U.S. population is Hispanic, and their numbers are growing, Hines noted, but few studies have looked at breast cancer risk in the Hispanic population to see if the accepted risks for breast cancer — identified from analyses that included predominately white populations — hold for Hispanic women.

For the new study, Hines and her colleagues analyzed information on white and Hispanic women enrolled in the 4-Corners Breast Cancer Study, so named because participants lived in New Mexico, Utah, Arizona and Colorado, four states whose boundaries touch at one point.

They evaluated data on 4,809 women — 3,134 postmenopausal and 1,675 premenopausal. Women with breast cancer had been diagnosed from 1999 to 2002. All participants had been asked about accepted factors known to affect breast cancer risk, including their reproductive history, activity level, height, hormone use, alcohol intake and family history.

The links for some risk factors were either weaker or not found at all in postmenopausal Hispanic women, who did not seem to be affected by recent hormone therapy use or by having started their menstrual periods at a younger age, the study found.

Among younger Hispanic women, taller height and family history were not found to be linked with increased risk, as they were among white women.

The established risk factors accounted for up to 75 percent of the breast cancers in premenopausal white women, but just 36 percent of the cancers in premenopausal Hispanic women, the study found. For older women, the established risk factors accounted for 62 percent of the cancers in white women and just 7 percent of those in Hispanic women.

Exactly why different risk factors have a different impact is not known, Hines said.

The results also beg the question: Are there other unknown risk factor that elevate Hispanics’ breast cancer risk? More study is needed in both areas, she said.

Jane Delgado, president and chief executive of the National Alliance for Hispanic Health in Washington, D.C., said the research was welcome and timely.

“As one in every six women is Hispanic, it is good to do a study like this,” Delgado said. “The issue is that we know that cancer is not one disease but many diseases, and how it presents itself is going to show great variability by individuals.”

For now, Hines said, Hispanic women should still follow the same cancer-prevention advice as others. That means getting regular exercise, eating a healthy diet and, for older women, scheduling mammograms regularly.

SOURCES: Lisa Hines, Sc.D., assistant professor, biology, University of Colorado, Colorado Springs; Jane Delgado, Ph.D., president and CEO, National Alliance for Hispanic Health, Washington, D.C.

Botulinum toxin, which smoothes facial wrinkles through injections of the drug Botox, can also help people who suffer from “tennis elbow,” a new study finds.

But the researchers warn that it must be injected carefully, and there’s a potentially nettlesome side effect, according to the report published online April 26 in the Canadian Medical Association Journal.

Researchers at the Imam Khomeini Hospital Complex at Tehran University in Iran gave botulinum toxin injections to 48 patients with tennis elbow who hadn’t been helped by previous treatments. Tennis elbow, which causes pain and inflammation in the upper arm near the elbow, affects some people who repeatedly move their wrists or forearms while taking part in activities like tennis.

The researchers customized the injection sites based on the length of each patient’s forearm instead of giving injections at the same location in each person. Giving the injection at the same location can lead to insufficient paralysis, Dr. S.M. Javad Mortazavi and colleagues explained.

The treatment reduced pain but also reduced strength levels in the patients, the study authors found. They also pointed out that the treatment isn’t appropriate for patients who need to extend their fingers, and added that more research is needed to figure out whether the treatment relieves pain after four months.

In an accompanying commentary, Dr. Rachelle Buchbinder, of Monash University in Australia, wrote that tennis elbow can cause disability and require workers to take sick leave. There’s still much that’s not known about botulinum toxin as a treatment for the condition, Buchbinder added, and patients may be unhappy if they suffer from a side effect: the partial loss of the ability to move their third and fourth fingers.

SOURCE: Canadian Medical Association Journal.

It’s well-known that smoking is bad for the heart and other parts of the body, and researchers now have chronicled in detail one reason why — because continual smoking causes progressive stiffening of the arteries.

In fact, smokers’ arteries stiffen with age at about double the speed of those of nonsmokers, Japanese researchers have found.

Stiffer arteries are prone to blockages that can cause heart attacks, strokes and other problems.

“We’ve known that arteries become more stiff in time as one ages,” said Dr. William B. Borden, a preventive cardiologist and assistant professor of medicine at Weill Cornell Medical Center in New York City. “This shows that smoking accelerates the process. But it also adds more information in terms of the role smoking plays as a cause of cardiovascular disease.”

For the study, researchers at Tokyo Medical University measured the brachial-ankle pulse wave velocity, the speed with which blood pumped from the heart reaches the nearby brachial artery, the main blood vessel of the upper arm, and the faraway ankle. Blood moves slower through stiff arteries, so a bigger time difference means stiffer blood vessels.

Looking at more than 2,000 Japanese adults, the researchers found that the annual change in that velocity was greater in smokers than nonsmokers over the five to six years of the study.

Smokers’ large- and medium-sized arteries stiffened at twice the rate of nonsmokers’, according to the report released online April 26 in the Journal of the American College of Cardiology by the team from Tokyo and the University of Texas at Austin.

That’s no big surprise, said Borden, noting there’s definitely a dose-response relationship. “The more smoking, the more arterial stiffening there is per day.”

The study authors measured stiffening by years, not by day, but the damaging effect of smoking was clear over the long run.

The finding gives doctors one more argument to use in their continuing effort to get smokers to quit, said Dr. David Vorchheimer, associate professor of medicine and cardiology at Mount Sinai Medical Center in New York City.

“One of the challenges that physicians face when trying to get people to stop smoking is the argument, ‘Well, I’ve been smoking for years and nothing has happened to me yet,’” Vorchheimer said. “What this study emphasizes is that the damage is cumulative. The fact that you’ve gotten away with it so far doesn’t mean you’ll get away with it forever.”

The stiffening of arteries is “one of the earliest and most subtle changes that occur” in smokers’ bodies, Vorchheimer said. “Some people’s arteries can be safe for a few years. The good thing about that is the possibility that the damage will heal if you give up smoking.”

Another notable aspect of the study was the analysis of the effect of smoking on C-reactive protein, a molecular marker of inflammation that appears to play a role in cardiovascular disease. The study found no relationship between blood levels of C-reactive protein and arterial stiffening.

That finding adds one more piece to the puzzle of C-reactive protein and cardiovascular disease that researchers are trying to assemble, Borden said. “We’re still trying to understand the role of CRP, whether it’s a cause or a marker of other factors that lead to cardiovascular disease,” he said.

SOURCES: William B. Borden, M.D., M.B.A., assistant professor, medicine, Nanette Laitman Clinical Scholar in Public Health, Weill Cornell Medical Center, New York City; David Vorchheimer, M.D., associate professor, medicine, Mount Sinai Medical Center, New York City;

A widely used type of antidepressant may help protect cardiovascular health by slowing the clumping of blood platelets, thus reducing the risk of hardening of the arteries and blood clots that can cause heart attack and stroke, U.S. researchers say.

The new study compared 25 depressed patients taking a selective serotonin reuptake inhibitor (SSRI) and 25 healthy people who weren’t taking an antidepressant. Blood samples were taken at the start of the study and again four and eight weeks later.

At four weeks, the rate of platelet clumping was 95 percent in the healthy volunteers and 37 percent in the patients taking an SSRI. However, platelet clumping in the SSRI-treated patients was higher at eight weeks than at four weeks. This suggests that SSRIs have the greatest effect on platelet clumping in the early stage of treatment, the study authors explained.

The study findings are scheduled to be presented Monday at the American Physiological Society conference, held April 24 to 28 in Anaheim, Calif.

The researchers plan to analyze blood samples taken after 12 weeks and will also conduct a study using a different brand of SSRI.

“The reason we’re doing this is to better the lives of depressed patients,” study author Dr. Evangelos Litinas, a research associate at the Loyola University Medical Center in Maywood, Ill., said in a news release from the American Physiological Society.

“There is clear evidence that depressed patients have a higher risk of cardiovascular disease, and we want to eliminate that. Since depression can be treated with an SSRI, maybe the cardiovascular disease risk can also be decreased. We want our patients to live longer and happier lives, without depression or the risk of heart problems,” Litinas said.

A program designed to boost doctor-patient communication and patients’ compliance with treatment may not have the intended effects, a new study suggests.

The study looked at a program dubbed “Ask Me 3,” which encourages patients to ask three basic questions at each doctor visit: “What is my main problem?” “What do I need to do (about the problem)?” and “Why is it important for me to do this?”

The goal is to help patients better understand any health problems they have, and make them more likely to stick with treatment or lifestyle changes.

But in the new study, patients at medical practices that promoted the “Ask Me 3″ program were no more likely to ask those questions or to fill their prescriptions than patients at a group of practices used for comparison. Nor did they show a greater understanding of any recommended lifestyle changes.

However, the researchers point out that most patients at all practices in the study were good at asking questions. So it may simply have been too hard for the “AM3″ program to improve upon that.

In a report in the Annals of Family Medicine, they say future studies should look at the program’s effects among patients whose communication with their doctors is not so strong.

For the study, researchers led by Dr. James M. Galliher, of the American Academy of Family Physicians National Research Network, randomly assigned 20 U.S. medical practices to an intervention or a control group. Staff at the 10 practices in the intervention group gave patients pamphlets with the AM3 questions and reminded them to ask their doctor the three questions.

The researchers used audio recordings of patient visits, along with follow-up interviews, to see how effective the program was.

Overall, they found that among 829 patients across the 20 practices, there were no clear benefits from the AM3 program. Ninety-two percent of patients in both the intervention and control groups asked at least one of the three questions. And patients in both groups averaged six to seven questions of any kind per visit.

The two groups also showed little difference when it came to treatment compliance, based on interviews done within three weeks of their visit.

Of patients who said their doctor had given them a new prescription, 81 percent to 82 percent of patients in each group said they had filled it. And of those who said their doctor had recommended lifestyle changes, 91 percent to 92 percent in each group claimed to have attempted the changes.

The only clear difference was that patients in the comparison group were more likely to accurately recall that their doctor had advised lifestyle changes: 68 percent did so, versus 59 percent in the AM3 group.

According to Galliher’s team, the high rates of question-asking and treatment compliance in the study group as a whole may have been too tough to improve upon. They also note that the study group had fairly strong scores on a questionnaire of “health literacy” — a measure of, for instance, how well a person can fill out medical forms or understands written information on their health condition.

“We believe that programs like AM3 should be systematically implemented and studied across time with patients whose health literacy skills are challenged,” Galliher noted in an email to Reuters Health.

“Our view is that asking questions opens the door for good patient and (doctor) communication and thus hopefully a better understanding by the patient of his/her possible health conditions and needs that can then be addressed by the patient and the (doctor),” Galliher added.

Conventional wisdom has dictated that fat from red meat is a risk factor for heart disease, but a new analysis from Harvard researchers finds it’s eating processed meat — not unprocessed red meat — that increases the risk for heart disease and even diabetes.

The term “processed meat” refers to any meat preserved by smoking, curing or salting or with the addition of chemical preservatives. The researchers defined “red meat” as unprocessed meats such as beef, hamburger, lamb and pork.

“To lower risk of heart attacks and diabetes, people should avoid eating too much processed meats — for example, hot dogs, bacon, sausage or processed deli meats,” said lead researcher Renata Micha, a research fellow at the Harvard School of Public Health. “Based on our findings, eating up to one serving per week would be associated with relatively small risk.”

Micha was scheduled to present the finding Friday at an American Heart Association conference on cardiovascular disease in San Francisco.

For the study, Micha’s team analyzed data from 20 studies that included more than 1.2 million participants. Among them, 23,889 had coronary heart disease, 2,280 had had a stroke and 10,797 had diabetes.

The researchers found that people who ate unprocessed red meat did not significantly increase their chances of developing heart disease or diabetes. However, eating processed meat was linked to an increased risk for the two conditions.

In fact, for every 50-gram (1.8-ounce) serving, the risk for heart disease jumped 42 percent and the risk for diabetes increased 19 percent.

Though neither unprocessed red meat nor processed meats were linked to an increased risk for stroke, the researchers pointed out that just three studies looked at the connection between eating meat and stroke, so the data was insufficient to draw a valid conclusion.

“When we looked at average nutrients in unprocessed meats and processed meats eaten in the U.S., we found that they contained similar amounts of saturated fat and cholesterol,” Micha said. “In contrast, processed meats contained, on average, four times higher amounts of sodium and two times higher amounts of nitrate preservatives.”

This suggests that salt and other preservatives, rather than fats, probably explain the higher risk for heart attacks and diabetes seen with processed meats, Micha said.

“Health effects of unprocessed red meats and processed meats should be separately considered,” she said. “More research is needed into which factors in meats — especially salt or other preservatives — are most important for health effects.”

Samantha Heller, a registered dietitian, clinical nutritionist and exercise physiologist in Fairfield, Conn., said that “scientists are looking into why processed meats are so hazardous to our health.”

“They may never know the exact reason, but we do know that people should limit their consumption of foods such as bacon, hot dogs, salami and pepperoni to reduce the risk of chronic diseases,” Heller said.

“In addition, studies show that eating unprocessed red meat does increase the risk for disease as well,” she said. “A study of over 500,000 people found that people who ate the most both red and processed meats had a higher risk of mortality, cancer and cardiovascular disease than those who ate lesser amounts of these foods.”

Both red and processed meat and other foods, such as butter and cheese, that are high in saturated fat have been linked to chronic disease, Heller said, adding that people should limit consumption of them as well.

“Going low- or no-fat with dairy products helps lower our intake of saturated fat,” she said. “Choosing healthy protein sources — such as white-meat poultry, low-mercury fish, soy, nuts and beans — and focusing on moving in the direction of a more plant-based diet will help us all live longer, healthier lives.”

Dr. Gregg Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles, said that “various studies have suggested that higher levels of consumption of red and processed meat is associated with higher risk of heart disease, stroke, diabetes, cancer and premature death.”

However, the results have not always been consistent, and some earlier studies have suggested there may be differences in health risk between unprocessed red meat and processed meat, he said. More study is needed to verify the link and explore the mechanisms behind it, Fonarow said.

Although unprocessed red meat might not increase the risk for heart disease or diabetes, it might increase the risk for some cancers, according to a 2007 report from researchers at the U.S. National Cancer Institute.

They found elevated risks for colorectal and lung cancer with high consumption of both processed and unprocessed meats, along with borderline higher risks for advanced prostate cancer. High intake of red meat was also associated with an increased risk for esophageal and liver cancer and a borderline increased risk for laryngeal cancer. And high consumption of processed meat was linked to a borderline increased risk for bladder cancer and myeloma, a kind of bone cancer.

SOURCES: Renata Micha, R.D., Ph.D., research fellow, Harvard School of Public Health, Boston; Samantha Heller, M.S., R.D., dietitian, nutritionist and exercise physiologist, Fairfield, Conn.; Gregg Fonarow, M.D., professor, cardiovascular medicine, University of California, Los Angeles; presentation, American Heart Association’s Cardiovascular Disease Epidemiology and Prevention annual conference, San Francisco.

People with Parkinson’s disease face an increased risk of the most deadly type of skin cancer, new research confirms.

Exams of more than 2,000 people with Parkinson’s disease found that about 1 percent currently had melanoma, Dr. John M. Bertoni of the University of Nebraska Medical Center in Omaha and his colleagues found. Based on the findings, they say, people with the degenerative nerve disease should receive regular skin cancer screening.

A number of studies have found a higher risk for melanoma among people with Parkinson’s disease, which occurs when brain cells that produce dopamine — a signaling chemical with many important functions in the brain — die off. But it hasn’t been clear whether this increased risk is due to the drugs people take to treat Parkinson’s disease or to the disease itself.

To investigate further, Bertoni and colleagues at 31 different centers across North America studied 2,106 patients with Parkinson’s disease. The patients first underwent a neurological exam, and then at a second visit had a dermatologic exam, which included biopsies of any suspicious moles or growths.

The researchers found 20 localized melanomas among the study participants and 4 that had spread beyond the original site, while another 68 patients reported having a history of melanoma.

Among the patients living in the US, the likelihood of having melanoma was more than double that of the general US population, the researchers found. When the findings were compared to statistics from skin cancer screening programs run by the American Academy of Dermatology, the researchers found a more than seven-fold increased risk of melanoma for US Parkinson’s patients.

Since the 1970s, a number of case reports have suggested that levodopa therapy for Parkinson’s disease increases the risk of skin cancer. In the current study, nearly 85 percent of the patients had taken levodopa, but the researchers found no evidence that this drug was associated with melanoma risk.

This study, conclude Bertoni and colleagues, provides more evidence that melanoma occurs more often in patients with Parkinson’s disease than in the population at large and “supports increased melanoma screening” in patients with Parkinson’s disease.

SOURCE: Archives of Neurology.

New research suggests that the type of specialist a prostate cancer patient sees — rather than the patient’s own preference — may determine the treatment he receives.

This is problematic, the study’s authors say, because none of the options now available for treating localized prostate cancer have been shown to be any better than the others.

“The different treatments for prostate cancer…entail different side effects, different recovery profiles, and they require different time commitments,” Dr. Thomas L. Jang of The Cancer Institute of New Jersey in New Brunswick, one of the study’s authors, told Reuters Health. For this reason, he and his colleagues say, it should be the patient’s preferences — rather than the physician’s specialty — that guides treatment decisions.

Current options available for treating prostate cancer that has not spread include watchful waiting, in which a patient receives no treatment but is monitored closely; hormone therapy; radiation therapy; or surgery to remove the prostate. Radiation and surgery both carry the risk of urinary incontinence and impotence; hormone therapy can cause hot flashes, breast tenderness, and loss of sex drive; while watchful waiting may lead to anxiety in men who fear their cancer will spread.

Surveys have suggested that specialists are more likely to recommend the type of treatment they provide; for example, radiation oncologists prefer radiation therapy, while urologists choose surgery.

To investigate whether the type of physician a prostate cancer saw would actually influence the type of treatment he got, Jang and his team looked at Medicare data on more than 85,000 men 65 and older diagnosed between 1994 and 2002 with localized prostate cancer. Within nine months of diagnosis, 21 percent had undergone prostate removal; 42 percent had radiation; 17 percent had hormone therapy; and 20 percent watchful waiting. Jang conducted the study, which is published in the Archives of Internal Medicine, while at Memorial-Sloan Kettering Cancer Center in New York City.

Half of the men had only seen a urologist, while 44 percent had seen a radiation oncologist and a urologist, 3 percent had seen a urologist and a medical oncologist, and 3 percent had seen all three specialists.

One-third of the men who had only seen a urologist underwent prostate surgery, and surgery was the most common treatment for the men who were 65 to 74 years old and only saw a urologist. However, among men of any age who saw a radiation oncologist as well as a urologist, radiation therapy was the most common treatment; 83 percent of these men received radiation therapy.

And men who had been seen by a urologist and a medical oncologist, or a urologist only, were more likely to receive watchful waiting or hormone therapy than men who had seen both urologists and radiation oncologists.

Only about one in five men saw their primary care physician after their diagnosis of prostate cancer and before they received treatment (or within nine months of diagnosis). Nearly 60 percent of these men received watchful waiting, compared to 7 percent of men who hadn’t seen their primary care doctor.

When the researchers looked at individual urologists who had cared for at least 10 of the study participants, they found sharp doctor-to-doctor differences in whether a patient was referred to a radiation oncologists; some urologists frequently made these referrals, while others did so much less often.

Men newly diagnosed with prostate cancer face “a lot of confusion,” Jang noted, because there are so many treatment options available. “The physician who is providing the counseling for these patients should go to great lengths to provide a balanced perspective, an unbiased perspective, on these treatment options.”

And if patients don’t feel they are getting unbiased advice, Jang added, they should get a second opinion. “It’s really our responsibility to provide these men with every single available treatment option.”

SOURCE: Archives of Internal Medicine.

Among people who suffer a stroke, one in 12 are likely to have another stroke soon after the initial attack and one in four will die within a year, according to a new study by researchers from the Medical University of South Carolina.

The state-wide statistics highlight the importance of recognizing that anyone who has had a stroke is at a high risk for having another one and also has an increased likelihood of having other problems, such as a heart attack, experts say

“Our findings suggest that South Carolina and possibly other parts of the United States may have a long way to go in terms of preventing and reducing the risk factors for recurrent strokes,” said Dr. Wuwei Feng, a neurology resident at the university and the study’s lead researcher.

For the study, published in the Feb. 16 issue of Neurology, Feng’s team collected data on almost 10,400 people in South Carolina who’d had a stroke.

They found that 25 percent of those who had a stroke died within a year, and eight percent had another stroke within a year of their first stroke.

After one year, the risk for another stroke or death continued to rise, the researchers found, with about 18 percent having had another stroke within four years. In that time, about six percent had a heart attack and 41 percent had died from any cause, including 27 percent whose deaths were attributed to a stroke or heart attack.

The risks were higher among blacks than among whites, the study noted. The risks also increased with age and the number of other medical problems that people had.

“Stroke is a devastating disease,” Feng said. “Once you have it, you are at a high risk to have another one, as well as heart attack or death.”

Dr. Majaz Moonis, director of stroke services at the University of Massachusetts, said that “this is one more study that essentially points to what many others have already.”

Moonis believes the key to preventing second strokes is aggressive care and follow-up. “It is important to continue to point out the health-care disparities and the need for more aggressive care,” he said.

“In our stroke prevention clinic — where we regularly follow patients with ischemic stroke on a six-month basis with imaging, labs and vascular studies and treat them with very aggressive measures for stroke prevention — the annual rate of recurrent stroke is 1.5 percent, far lower than the community,” Moonis said.

Another stroke expert, Dr. Larry B. Goldstein, director of the Duke University Stroke Center, noted that his own study of stroke patients throughout the United States showed that the highest rate for recurrent stroke was in the Southeast, which has been called the “stroke belt.”

Of course, having a first stroke puts you at a 10-fold increased risk of having another, he said, and “in the country overall, about 20 percent of strokes are recurrent strokes.”

Goldstein also said that, in many cases, not enough effort is directed at preventing a second stroke. Using blood thinners, for example, can reduce the risk for a second stroke by about 48 percent, he said.

“Adequate treatment of high blood pressure reduces the risk by about 40 percent,” Goldstein said. “The use of antiplatelet drugs reduces the risk by about 16 to 20 percent. The use of a statin reduces the risk by about 16 percent.”

In addition, lifestyle changes such as a following a healthier diet, exercising more and quitting smoking will also reduce the risk of a second stroke, he said.

“There are a ton of things we try to do to reduce the risk of recurrent stroke,” Goldstein said.

SOURCES: Wuwei Feng, M.D., resident in neurology, department of neuroscience, Medical University of South Carolina, Charleston, S.C.; Larry B. Goldstein, M.D., professor and director, Duke Stroke Center, Duke University, Durham, N.C.; Majaz Moonis, M.D., director, stroke services, University of Massachusetts Medical School, Worcester, Mass.