The mammography dilemma: 50 years of analysis

A comprehensive review of 50 year’s worth of international studies assessing the benefits and harms of mammography screening suggests that the benefits of the screening are often overestimated, while harms are underestimated. And, since the relative benefits and harms of screening are related to a complex array of clinical factors and personal preferences, physicians and patients need more guidance on how best to individualize their approach to breast cancer screening.The results of the review by researchers at Harvard Medical School’s Department of Health Care Policy and Brigham and Women’s Hospital are published today in JAMA.The American Cancer Society estimates that about 40,000 U.S. women will die of breast cancer this year. In 2009, based on evidence that the benefit-risk ratio for mammography screening is higher among women over 50 and with less frequent screening, the U.S. Preventive Services Task Force (USPSTF) reversed its previous recommendation of mammography every one to two years beginning at age 40, and recommended routine screening every two years starting at age 50, the researchers noted. The recommendations remain controversial among the general public and the medical community. Recent evidence suggests that use of mammography in the U.S. has not changed following the updated recommendations.”What I tell my patients is that the mammogram is not a perfect test,” said Nancy Keating, co-author of the report, associate professor of Health Care Policy at HMS and associate professor of medicine at Brigham and Women’s. “Some cancers will be missed, some people will die of breast cancer regardless of whether they have a mammogram, and a small number of people that might have died of breast cancer without screening will have their lives saved.”The authors report that the best estimate of the reduction in mortality from breast cancer due to annual screening for women overall is about 19 percent. For women in their 40s, the reduction in risk was about 15 percent, and for women in their 60s, about 32 percent. …

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Why breastfed babies are so smart: Moms who breastfeed are often responsive and read to their babies

Loads of studies over the years have shown that children who were breastfed score higher on IQ tests and perform better in school, but the reason why remained unclear.Is it the mother-baby bonding time, something in the milk itself or some unseen attribute of mothers who breastfeed their babies?Now a new study by sociologists at Brigham Young University pinpoints two parenting skills as the real source of this cognitive boost: Responding to children’s emotional cues and reading to children starting at 9 months of age. Breastfeeding mothers tend to do both of those things, said lead study author Ben Gibbs.”It’s really the parenting that makes the difference,” said Gibbs. “Breastfeeding matters in others ways, but this actually gives us a better mechanism and can shape our confidence about interventions that promote school readiness.”Gibbs authored the study with fellow BYU professor Renata Forste for the March issue of The Journal of Pediatrics. According to their analysis, improvements in sensitivity to emotional cues and time reading to children could yield 2-3 months’ worth of brain development by age 4 (as measured by math and reading readiness assessments).”Because these are four-year-olds, a month or two represents a non-trivial chunk of time,” Gibbs said. “And if a child is on the edge of needing special education, even a small boost across some eligibility line could shape a child’s educational trajectory.”The BYU scholars utilized a national data set that followed 7,500 mothers and their children from birth to five years of age. The data set is rich with information on the home environment, including how early and how often parents read to their kids. Additionally, each of the mothers in the study also participated in video-taped activities with their children. As the child tried to complete a challenging task, the mother’s supportiveness and sensitivity to their child’s emotional cues were measured.The study gained editorial praise from child development expert Sandra Jacobson of Wayne State University School of Medicine. She noted that children in the study who were breastfed for 6 months or longer performed the best on reading assessments because they also “experienced the most optimal parenting practices.”Gibbs and Forste found that reading to an infant every day as early as age 9 months and sensitivity to the child’s cues during social interactions, rather than breastfeeding per se, were significant predictors of reading readiness at age 4 years,” wrote Jacobson.The BYU researchers note that the most at-risk children are also the least likely to receive the optimal parenting in early childhood. Single moms in the labor force, for example, don’t have the same luxuries when it comes to breastfeeding and quality time with the children. …

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BPA exposure disrupts human egg maturation

July 31, 2013 — As many as 20 percent of infertile couples in the United States have unexplained reasons for their infertility. Now, new research led by Catherine Racowsky, PhD, director of the Assisted Reproductive Technologies Laboratory at Brigham and Women’s Hospital (BWH), shows that exposure to BPA (Bisphenol-A) could be a contributing factor as to why some infertile couples are having difficulty conceiving.Share This:The study will be published online on July 31, 2013 in the journal Human Reproduction.”To our knowledge, this is the first study that has shown that BPA has a direct effect on egg maturation in humans,” said Dr. Racowsky. “Because exposure to BPA is so ubiquitous, patients and medical professionals should be aware that BPA may cause a significant disruption to the fundamentals of the human reproductive process and may play a role in unexplained infertility.”The randomized trial examined 352 eggs from 121 consenting patients at a fertility clinic. The eggs, which would have otherwise been discarded, were exposed to varying levels (20 ng/ml, 200 ng/ml and 20 µg/ml) of BPA in a laboratory setting. An egg from each patient was not exposed to BPA and served as the control. Researchers then examined the eggs and found that exposure to BPA caused:A decrease in the percentage of eggs that matured. An increase in the percentage of eggs that degenerated. An increase in the percentage of eggs that underwent spontaneous activation, the abnormal process when an egg acts as though it has been fertilized, even though it has not been. As the BPA dose increased, there was a decreased likelihood of maturity, an increased likelihood of degeneration and an increased likelihood of spontaneous activation. …

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If you’re not looking for it, you probably won’t see it

July 19, 2013 — If you were working on something at your computer and a gorilla floated across your computer screen, would you notice it? You would like to think yes, however, research shows that people often miss such events when engaged in a difficult task. This is a phenomenon known as inattentional blindness (IB). In a new study from Brigham and Women’s Hospital (BWH) in Boston, researchers have found that even expert searchers, operating in their domain of expertise, are vulnerable to inattentional blindness.Share This:This study published this week Psychological Science.”When engaged in a demanding task, attention can act like a set of blinders, making it possible for stimuli to pass, undetected, right in front of our eyes,” explained Trafton Drew, PhD, post-doctoral researcher at BWH and lead author on this study. “We found that even experts are vulnerable to this phenomenon.”The researchers asked 24 radiologists to perform a familiar lung nodule detection task. They examined five scans; each scan contained an average of 10 nodules. A gorilla, 48 times larger than the average nodule, was inserted in the last scan. The researchers found that 83 percent of radiologists did not report seeing the gorilla. With the help of Melissa Le-Hoa Vo, post-doctoral researcher at BWH, the researchers tracked the eye-movements of the radiologists and found that that the majority of those who missed the gorilla looked directly at it.”The radiologists missed the gorillas not because they could not see them, but because the way their brains had framed what they were doing. They were looking for cancer nodules, not gorillas,” explained Jeremy Wolfe, senior psychologist and director of the Visual Attention Laboratory at BWH. …

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Strong pregnancy outcomes for survivors of childhood cancer

July 13, 2013 — Although women who survived childhood cancer face an increased risk of infertility, nearly two-thirds of those who tried unsuccessfully to become pregnant for at least a year eventually conceived, according to clinical researchers at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Brigham and Women’s Hospital. This is comparable to the rate of eventual pregnancy among all clinically infertile women.”Most women think that if they had cancer as a child, then they’ll never have children. It turns out that many of them can get pregnant. It just might be a little harder,” said senior author Lisa Diller, MD, chief medical officer of Dana-Farber/Boston Children’s and medical director of the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber Cancer Institute.The paper, published July 13 in Lancet Oncology, is the first large-scale study of female childhood cancer survivors that examines outcomes for those who experienced infertility, as defined by the typical clinical definition of infertility (attempting to conceive for a year or more without success).Overall, 15.9 percent of women who survived childhood cancer were affected by infertility, with 12.9 percent trying to conceive for at least one year without success. The remainder of survivors included in the infertile group had ovarian failure and may not have even attempted pregnancy. In a comparison group composed of sisters of childhood cancer survivors, 10.8 percent experienced infertility. This translates to a roughly 50 percent higher risk of infertility among the survivors of childhood cancer.The new study is based on data from the Childhood Cancer Survivor Study, a cohort study of five-year survivors from 26 institutions who were under 21 when diagnosed with cancer between 1970 and 1986. Researchers studied 3,531 sexually active female survivors, age 18-39, and a control group of 1,366 female siblings of participants in the large-scale survivor study.”This is the first study to examine direct questions about infertility and the use of infertility services,” said lead author Sara Barton, MD, a clinical fellow of reproduction and infertility at Brigham and Women’s Hospital at the time of the research. …

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Childhood abuse linked with food addiction in adult women

May 29, 2013 — Women who experienced severe physical or sexual abuse during childhood are much more likely to have a food addiction as adults than women who did not experience such abuse, according to a new study published in the journal Obesity. The study’s findings provide valuable new information regarding potential causes and treatments for food addiction and obesity.

National surveys indicate that more than a third of American women experienced some form of physical or sexual abuse before they reached 18 years of age. Also, research shows that such childhood abuse has consequences not only for women’s mental health, but also for their physical health. In particular, many studies have documented a link between childhood abuse and later obesity, possibly because stress may cause one to overeat high-sugar and high-fat “comfort” foods in an uncontrolled manner.

Because of these findings, Susan Mason, PhD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, and her colleagues looked for a link between childhood abuse and addiction-like eating behaviors in women. The researchers studied 57,321 adult participants in the Nurses’ Health Study II, which ascertained physical and sexual child abuse histories in 2001 and current food addiction in 2009. (Food addiction was defined as three or more addiction-like eating behaviors severe enough to cause significant distress or loss of function.)

The analysis revealed that addiction-like eating behaviors were relatively common among women in the study, with eight percent meeting the criteria for food addiction. Women who had experienced physical or sexual abuse before the age of 18 years were almost twice as likely to have a food addiction in middle adulthood compared with women without a history of childhood abuse.. The likelihood of food addiction was increased even further for women who had experienced both physical and sexual abuse in childhood. The food addiction prevalence varied from six percent among women without a history of physical or sexual abuse to 16 percent among women with a history of both severe physical and sexual abuse. Also, women with a food addiction were generally heavier than women without a food addiction.

Dr. Mason and her co-authors caution that the study’s findings are exploratory and will need to be replicated before any conclusions can be drawn about a causal link between childhood abuse victimization and addiction-like overeating. If enough evidence of this association accumulates, the next step will be to find ways to reduce the risk of addiction-like overeating among women who experienced childhood abuse. “Women with histories of trauma who show a propensity toward uncontrolled eating could potentially be referred for prevention programs, while obese women might be screened for early trauma and addiction-like eating so that any psychological impediments to weight loss could be addressed,” said Dr. Mason. “Of course, preventing childhood abuse in the first place would be the best strategy of all, but in the absence of a perfect child abuse prevention strategy, it is important that we try to head off its negative long-term health consequences,” she added.

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