Estrogen Therapy Boosts Clotting Risk in Postmenopausal Women. [United States] Estrogen therapy appears to increase the risk of blood clots in the veins of postmenopausal women who have had their uterus removed. These latest results from the Women's Health Initiative (WHI) were unexpected, even to the study's lead author. "It surprised us all how few benefits have come out of this and how many negatives," said Dr. J. David Curb, a professor of geriatric medicine at the University of Hawaii and president/director of the Pacific Health Research Institute, both in Honolulu. "This is not where I would have predicted we would be. I was a believer [that estrogen would not increase the risk of blood clots]. The data have convinced me that I was wrong." The risk is still less than that of estrogen plus progestin, the combination hormone therapy given if a woman still has her uterus. The study appears in the April 10 issue of the Archives of Internal Medicine.

Two Breast Cancer Studies Question Old Treatments. [United States] Two important studies published Wednesday challenge conventional thoughts about treating and avoiding breast cancer. One suggests doctors may eventually be able to identify women who do not need chemotherapy. The other says women who have had hysterectomies can take estrogen to relieve symptoms of menopause without increasing their risk of breast cancer. The first study, published in the Journal of the American Medical Association, indicates that many of the 70 percent of women whose cancers are fed by estrogen get so much benefit from estrogen-blocking hormonal therapy that chemotherapy provides few if any additional advantages. The caveat, though, is that there is as yet no reliable way to identify the women who may not need chemotherapy from those who would be helped by it. Currently, guidelines call for women to get chemotherapy if their tumors are of a certain size. The second paper, also published Wednesday in the Journal of the American Medical Association, involved a U.S. government study of more than 10,700 healthy women whose uteruses had been removed. The question was: What are the health consequences of taking estrogen for the relief of menopausal symptoms? The new report does not apply to most menopausal women, but only to those who have had hysterectomies. In this case, the Women's Health Initiative found that estrogen did not increase the women's risk of breast cancer. But they did have more abnormal mammograms results, usually requiring that the test be repeated, and more breast biopsies. The study ended early, at the end of February 2004, when the investigators found that estrogen increased the risk of strokes and of blood clots in the legs. The study also found that estrogen taken alone increased the risk of dementia in women over age 65, decreased the risk of hip fractures and had no effect on heart disease. But the question of estrogen's effects on breast cancer risk had been uncertain until now, when the women had been followed for seven years. The results in women with hysterectomies contrast with those from another arm of the study involving women who had not had hysterectomies and who took estrogen and progesterone. In that case the hormone combination led to more breast cancer and more heart disease. It remains a puzzle why estrogen, which can fuel the growth of many breast cancers, did not increase the breast cancer risk in this study.

Many Cancer Survivors Stop Mammographies. [United States] More than a third of breast cancer survivors gradually stop getting annual mammographies, according to a new study. The results may indicate women grow complacent about medical screening once they get past the medical scare, said the study's lead author, Dr. Chyke Doubeni of the University of Massachusetts. Others said it's more likely survivors avoid screenings because they dread a recurrence of the cancer and additional treatment. "They're fearful something's going to be found," said Dr. Kathryn Edmiston, a Worcester, Mass., oncologist who specializes in breast cancer patients. The study found just 63 percent of women were getting annual mammographies five years after breast cancer surgery. The findings are reported in Cancer, a medical journal published by the Atlanta-based American Cancer Society. About 2.3 million U.S. women have been treated for breast cancer, and they are considered to be at three times the risk for tumors in the other, unaffected breast than women with no such medical history.

Deaths After RU-486. [United States] Reports that up to six American and one Canadian women have died after pill-induced abortions in recent years are making the regimen based on RU-486 look a lot less attractive than once thought. Conservatives in Congress and anti-abortion organizations are demanding that RU-486 be withdrawn from the market. That seems premature given the uncertainties and small number of deaths in a still-unfolding story. But women seeking an abortion will need to weigh the risks and benefits carefully before deciding which method to choose. Based on admittedly shaky data, pill-induced or medical abortions look riskier and less certain to fully terminate a pregnancy than surgical abortions. The deaths after medical abortions, though very rare, have some alarming and puzzling characteristics. Most of the women were healthy, had apparently successful abortions, died within a week of the procedure and were infected with a dangerous bacterium. The women first took oral doses of RU-486, also known as Mifeprex, followed two days later by a second drug, misoprostol, to help expel the fetus. But, in a departure from the regimen approved by the Food and Drug Administration, they were allowed to insert the second drug into their vaginas at home - at a higher dose than first recommended - instead of taking it orally in a doctor's office. Those changes and others were justified by scientific analyses that the new regimen would be safe and effective and could be used later in a pregnancy. But the deaths suggest that the changes may have been imprudent. Health authorities will need to sort out which drug, if either, might be at fault, whether vaginal insertion is to blame and whether changes in a family of bacteria have made them more lethal. Meanwhile, women who live in areas where surgical abortions are hard to obtain or who simply prefer pills to surgery should be alert to any symptoms of illness after a medical abortion. The danger is slight but for a few women could be catastrophic.  

Heart Research Turns to Women. [United States] Coronary artery disease is the leading cause of death in women over 25, killing more than 250,000 a year in the United States. Before they reach their 60s, women are less likely than men to develop heart problems, but once the disease does occur, women often fare worse than men. Since 1984, more women than men have died each year from heart disease, and though overall coronary death rates have dropped in recent decades, most of the improvements have been in men. Puzzling differences have emerged between men and women with heart disease, making it plain that past studies, mostly on men, do not always apply to women. Researchers have come to realize that to improve diagnosis and treatment for women, they must sort out the differences. Among the differences are these: 1) Women with chest pain and other heart symptoms are more likely than men to have clear coronary arteries when tests are performed, a surprising result that suggests there may be another cause for their problems. 2) When women do have blocked coronary arteries, they tend to be older than men with similar blockages and to have worse symptoms, including more chest pain and disability. These women are also more likely to have other problems like high blood pressure, high cholesterol and diabetes, which may make surgery riskier. And they are more likely than men to develop heart failure, a weakening of the heart muscle that can be debilitating and ultimately fatal. 3) When women have bypass surgery or balloon procedures for coronary blockages, they are less likely than men to have successful outcomes, and they are more likely to suffer from bad side effects. 4) Blood tests that reliably pick up signs of heart damage in men do not always work in women. 5) Women seem much more likely than men to develop a rare, temporary type of heart failure in response to severe emotional stress.

Younger Women at Increased Risk for Depression After Heart Attack. [India] Women age 60 years or younger are more likely than other patients to be depressed during hospitalization for heart attack, according to a study in the April 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Depressed heart attack patients are more likely to be hospitalized and die of heart problems and tend to have worse health and higher health care costs than heart attack patients who are not depressed. Identifying patients who are likely to be depressed after heart attack could help physicians screen and treat those at highest risk.