Women Who Quit Smoking Quickly Reduce Heart Risk But Lungs Take Longer

Women who quit smoking significantly reduce risk of death from coronary heart disease within 5 years, but impact on risk of death from lung and other cancers take longer.

These are the findings of Dr. Stacey A Kenfield, of the Harvard School of Public Health, Boston, USA, and colleagues in a new study published in the May 7th issue of the Journal of the American Medical Association, JAMA.

According to the World Health Organization, about 5 million deaths were smoking related in 2000, and estimates suggest that by 2030, this figure will rise to 10 million worldwide, 7 million of which will be in developing countries, wrote the authors, who also said that tobacco use is the leading cause of death in the United States.

But while the link between smoking and increased risk of death from a range of diseases has been well established, the effect of quitting compared to continuing to use tobacco has not.

Kenfield and colleagues examined data from the Nurses' Health Study on over 100,000 women who were followed from 1980 to 2004. In this group there were nearly 12,500 deaths, with nearly 4,500 among never smokers (36 per cent), 3,600 among current smokers (29 per cent) and just under 4,400 among past smokers (35 per cent).

They calculated the relative risks (as hazard ratios) among the three subgroups of death from any cause, and from specific diseases such as cardiovascular, respiratory, lung and other cancers, and other causes.

The results showed that:

* There was a 13 per cent reduction in the risk of death from any cause within the first 5 years of quitting compared to continuing to smoke.

* This risk reduced to the same level as the never smokers after 20 years of quitting.

* Within this overall 20 year figure some causes took less time to go down to the never smokers' risk level and others took longer.

* Vascular disease showed the most rapid reduction in risk to the never smokers' level, with much of it showing in the first 5 years of quitting.

* These included coronary heart disease (62 per cent of excess risk gone in first 5 years of quitting) and cerebrovascular disease (42 per cent of excess risk gone in first 5 years of quitting).

* These figures were obtained from comparing the hazard ratios of recent quitters of less than 5 years with long term quitters of 20 years or more.

* Death from respiratory diseases showed an 18 per cent reduction in risk of death 5 to 10 years after quitting, going down to the never smokers' level after 20 years.

* Risk of death from lung cancer showed a significant 21 per cent reduction in the first 5 years of quitting compared to continuing to smoke, but the excess risk did not go away for 30 years.

* Past smokers who had quit for 20 but less than 30 years, had an 87 per cent reduction in risk of death from lung cancer compared to current smokers.

* When risk of death from other smoking-related cancers was included, this figures approached the never smokers' risk level more than 20 years after quitting.

* Risk of death from all causes, respiratory diseases, and smoking related cancers, was significantly higher among women who started smoking at a younger age.

* The figures also showed smoking was linked to increased risk of death from colorectal cancer but not ovarian cancer.

* About 64 per cent of deaths among current smokers and 28 per cent among past smokers were linked to cigarette smoking.

The authors concluded that:

"Most of the excess risk of vascular mortality due to smoking in women may be eliminated rapidly upon cessation and within 20 years for lung diseases."

They added that:

"Postponing the age of smoking initiation reduces the risk of respiratory disease, lung cancer, and other smoking-related cancer deaths but has little effect on other cause-specific mortality. These data suggest that smoking is associated with an increased risk of colorectal cancer mortality but not ovarian cancer mortality."

The researchers emphasized the importance of maintaining school programs on preventing tobacco use and enforcing laws that deny young people access to tobacco, given that early initiation is linked to higher risk of death. They also wrote that:

"Effectively communicating risks to smokers and helping them quit successfully should be an integral part of public health programs."

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Breast Cancer Radiotherapy: A Possibility For Fewer Doses

Breast cancer patients can receive radiotherapy in a lower overall dose, given in fewer, larger administrations, while maintaining similar tumor control and creating fewer adverse side effects than current therapy. These conclusions come from the United Kingdom's Standardization of Breast Radiotherapy Trials A and B (START A and B), and were released on March 19, 2008 in Lancet Oncology and The Lancet respectively.

The international standard radiotherapy schedule for early breast cancer administers 50 Grays (Gy) of radiation total, separated into 25 small fractions of 2.0 Gy over five weeks. Cancer specialists have long believed that, when delivered in fewer, larger fractions, a lower total dose could be as safe and effective as this standard.

The START trials collaborative group, including Professor John Yarnold, Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, UK, and Professor Judith Bliss, Clinical Trials and Statistics Unit, Institute of Cancer Research, Sutton, UK, and colleagues from 35 UK cancer centers investigated this option. The study took ten years, and was jointly funded by Cancer Research UK, the UK Medical Research Council, and the UK Department of Health.

START A was comprised of 2,236 women with early breast cancer at 17 different centers in the UK. They were randomly assigned, after primary surgery to one of the following groups:

* 34% (749 women) to receive 50 Gy total in 25 fractions of 2.0 Gy each, the highest total dosage and the international standard;
* 34% (750 women) to receive 41.6 Gy total in 13 fractions of 3.2 Gy each, the intermediate total dosage;
* 33% (737 women) to receive 39 Gy total in 13 fractions of 3.0 Gy each, the lowest total dosage.

Treatment was administered in all groups over a five week period. Women were considered eligible if they were over 18 years of age, did not have immediate surgical reconstruction, and were available for follow up. The endpoints of the trial were: tumor relapse, which was defined as cancer reappearance at the sites which were irradiated; any effects of the treatment on normal or "cancer free" tissues; and effects on the quality of life for the patient.

After a median follow up of 5.1 years, tumor relapse at five years was 3.6% for the highest total dosage group (50 Gy), 3.5% for the intermediate total dosage (41.6 Gy) and 5.2% for the lowest total dosage group (39 Gy.) Late adverse effects and local tumor relapse rates for the highest and intermediate total dosages were similar, which in the lowest dose the absolute difference could range from 1.3% better to 2.6% worse in the lowest dose group. Patient self-assessments as well as photographic surveys indicated that there were lower rates of late adverse effects in the lowest dosage group than in the highest.

In conclusion to the START A study, the authors state that this modification to the international standard regimen could have promise: "A lower total dose (41·6 Gy) in a smaller number of fractions could offer similar rates of tumor control and normal tissue damage as the international standard fractionation schedule of 50 Gy in 25 fractions."

START B tested 2,215 women with early breast cancer at 23 centers in the UK. They were also randomly assigned after primary surgery, but to one of the following groups:

* 50% (1105 women) to receive 50 Gy total in 25 fractions of 2.0 Gy each, over 5 weeks, the international standard;
* 50% (1110 women) to receive 40 Gy total in 15 fractions of 2.67 Gy each, over 3 weeks, a lower total dose and a shorter administration period.

Just as in START A, women were considered eligible if they were over 18 years of age, did not have immediate surgical reconstruction, and were available for follow up. Additionally, the measured endpoints of the trial were: tumor relapse, any effects of the treatment on normal or "cancer free" tissues, and effects on the quality of life for the patient.

In a median follow-up of 6.0 years, the rate of tumor relapse at five years was 2.2% in the shorter and lower total dosage group and 3.3% in the international standard group. Statistically, this represents an absolute difference ranging from 0.9% worse and 1.7% better in this group from the standard. Photographic evidence and patient self-assessments both confirmed that lower rates of adverse events were seen after the lower, shorter dose.

From these results of the START B study, the authors conclude that this lower dose in combination with the shorter total administration time can also yield comparable results to the presently used standard: "After surgery for early breast cancer, a radiotherapy schedule delivering 40 Gy in 15 fractions over three weeks seems to offer local regional tumor control and rates of late normal tissue effects at least as good as the accepted international standard of 50 Gy in 25 fractions over five weeks."

Dr. Harry Bartelink, Netherlands Cancer Institute, Amsterdam, Netherlands, and Dr. Rodrigo Arriagada, Institut Gustave Roussy, Villejuif, France, contributed an accompanying comment in which they note the merits of this new therapy while caution against sudden changes in in the international standard treatment regimen: "We realise that hypofractionation is convenient for patients, because it reduces the number of visits to radiotherapy departments and waiting lists in several cancer centers. Nevertheless we have to wait for data on longer follow-up before final conclusions can be drawn from the START trials."

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Mo. Appeals Court Rules On Challenge To Ballot Summary Of Stem Cell Research Ban

The Western District of the Missouri Court of Appeals on Friday ruled that part of a ballot summary for an initiative to limit stem cell research prepared by Secretary of State Robin Carnahan (D) is "unfair and insufficient," the AP/Columbia Missourian reports. According to the AP/Missourian, the court's ruling is "largely symbolic" because supporters of the measure did not plan to continue gathering signatures to place the initiative on the November ballot. The group Cures Without Cloning would have needed to gather about 150,000 signatures by Sunday. The group said it now will try to place the initiative on the 2010 ballot (Marshall, AP/Columbia Missourian, 5/2).

The proposal would have continued an existing prohibition on human cloning but would have banned a particular kind of embryonic stem cell research -- called somatic cell nuclear transfer -- that is allowable under a constitutional amendment narrowly approved by Missouri voters in November 2006. Carnahan's original summary said the proposal would "repeal the ban on human cloning or attempted human cloning to criminalize and impose civil penalties for some existing research, therapies and cures." Cole County, Mo., Circuit Court Judge Patricia Joyce in February effectively rewrote the language of the initiative's summary and largely adopted the language suggested by Cures Without Cloning (Daily Women's Health Policy Report, 2/22).

The appellate court's opinion, written by Judge Lisa White Hardwick, agreed with Joyce that Carnahan's use of the word "repeal" was insufficient and unfair. However, the appellate court did not agree that Joyce should have rewritten the entire summary.

Both supporters and opponents of the ballot proposal lauded the ruling, the AP/Missourian reports. Carnahan's office in a statement said that the ruling "validates our summary statement as fair and accurate, while only replacing one word." Cures Without Cloning officials said they are pleased that part of Carnahan's statement was ruled insufficient and unfair but added that they plan to appeal the ruling to the state Supreme Court because the appeals court did not rule that Carnahan violated the group's constitutional rights (AP/Columbia Missourian, 5/2).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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A New Method To Establish The Antioxidant Capacity Of Extra Virgin Olive Oil

A group of scientists from the Nutrition and Food Science Departments from the Faculty of Pharmacy of the University of Granada have reported the beneficial effects of extra virgin olive oil on human health, determining in vitro and in vivo the antioxidant power that the examined extra virgin olive oil samples present. With this work, researchers have discovered a more effective method in order to establish the antioxidant capacity of extra virgin olive oil.

Research has been directed by doctors M. Carmen López Martínez, Herminia López García de La Serrana and José Javier Quesada Granados, and its main author is Cristina Samaniego Sánchez. The scientists have prepared four methods to determine the antioxidant capacity and the beneficial effect of the extra virgin olive oil obtained from olives of the Picual variety.

Work "in vitro"

In order to carry out this work, they determined the best method to calculate the in vitro antioxidant capacity in oil samples. They concluded that, among all the applied methods, the ABTS was the most suitable in order to study this kind of samples as it shows the correlation with the total polyphenol index in a better way. Moreover, scientists observed that the reproducibility of the results of these methods is good and that the variation coefficients obtained by the different methods are acceptable, which makes it possible to conclude, generally, that the four studied methods could be applied to measure the antioxidant oil capacity.

Scientists from Granada are not discarding the idea of registering some patents related to this research soon, since they already have experience in getting patents related to other studies on food, such as alcoholic drinks. Their research is applicable to every kind of olive oil, and these methods could be used in the areas where olive groves are cultivated, regardless of the variety of olive used in the oil obtaining process.

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Two Groundbreaking Scientists Share America's Largest Medicine Prize

America's largest prize for work in medicine, amounting to half a million dollars, is shared this year by two scientists, Elizabeth Blackburn of the University of California, San Francisco and Joan Streitz of Yale University, for their groundbreaking work in molecular research that opens up development of new and effective treatments for a range of diseases.

This is the first time that women have received the prestigious Albany Medical Center Prize in Medicine and Biomedical Research.

Blackburn is Morris Herzstein Professor of Biology and Physiology at UCSF. She has a worldwide reputation for her pioneering work on telomeres, the DNA sequences at the end of chromosomes (the "bookends" that hold everything together). She discovered the ribonucleoprotein enzyme telomerase, which strengthens telomeres.

Before this research, the "clock" of cellular life was a mystery to scientists. Telomeres becomes progressively shorter over the life of a cell and when they become too short, the cell dies. Blackburn showed that telomerase can add DNA back to the ends of telomeres and effectively turn back the clock.

Blackburn's more recent work with psychology has shown a link between low levels of telomerase and chronic stress that can lead to early onset of a range of age-related conditions such as neurodegenerative and cardiovascular diseases. She also hopes to find out if it is possible to stop cancer by manipulating telomerase.

President and chief executive officer of Albany Medical Center, James J. Barba, who chaired the National Selection Committee, said:

"Dr. Blackburn's studies of this fascinating enzyme and its effect on cellular aging may hold the key to prolonging life by helping to treat a variety of diseases and disorders from cancer to chronic stress."

Steitz is Sterling Professor of Molecular Biophysics and Biochemistry at Yale. She achieved global recognition when she found out how small ribonucleoproteins (snRNPs) behave in pre-messenger RNA, the earliest product of DNA transcription. She discovered that snRNPs get rid of introns, the useless chunks of DNA and pre-messenger RNA, by "splicing" them out and then joining the severed ends together to make messenger RNA. Messenger RNA then instruct the production of proteins, the essential building blocks of the body's biology.

Steitz's work shed light on the formation of proteins, and especially on the intricate transformations that occur as the immune system and brain develop. Understanding more about the "splicing" function of snRNPs may lead to discoveries about how to prevent many human diseases.

Barba said that:

"Many scientists believe that Dr. Steitz's research may ultimately lead to breakthroughs in treating a variety of autoimmune diseases including lupus."

"Dr. Steitz and Dr. Blackburn are among the greatest scientists of our generation. The potential impact of their research is extraordinary and we all owe them a great debt of gratitude," he added.

The Albany Medical Center Prize in Medicine and Biomedical Research started in 2000 with a 50 million dollar endowment from the Marty and Dorothy Silverman Foundation to enable the prize to be given annually for 100 years. The late Morris "Marty" Silverman was a businessman from New York.

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