Entries for January 2009

Two studies out this week underscore just how much is still unknown about breast cancer and how difficult some decisions can be when it comes to dealing with your own individual risk. A study published yesterday in the Journal of the American Medical Association finds that a significant number of women ages 25 to 40 who had chest radiation for a childhood cancer aren't getting screening mammograms, even though they have up to a 20 percent chance of developing breast cancer by the time they're 45. The study found that only 23 percent of the young women who had previous radiation-treated cancers, like leukemia, lymphoma or a bone tumor, had gotten a screening mammogram in the past year; about 47 percent of this under-40 group had never had a mammogram at all. The American Cancer Society recommends yearly mammograms beginning at age 25 or eight years after treatment, whichever comes last.

It seems strange to me that these women (or their doctors) would be negligent enough to ignore a dire health risk. But the authors of the editorial that accompanied the study point out that "the standard mammogram in detecting preinvasive and invasive breast cancer is known to be relatively poor in young women due to the density of breast tissue in this age group." What's more, screening mammograms provide a small dose of radiation, and it's not known whether repeated small doses of radiation further increase the risk of breast cancer in women who've already received high doses of radiation.

Reproductive-rights activists gathered yesterday to blow out 36 candles on Roe v. Wade's birthday cake, feeling particularly giddy over the new president's staunch support of abortion rights. Indeed, Obama yesterday affirmed his belief in a woman's "right to choose," saying the government shouldn't intrude on "our most private family matters." And today he plans to overturn the global gag rule, which restricted U.S. funding for foreign health clinics that provided abortions or referrals for abortions.

While that's music to the ears of the pro-choice community—Planned Parenthood, the National Organization for Women, et al.—abortion opponents would like this to be the last birthday celebration for Roe. Yesterday they had a "march for life" rally on the National Mall attended by thousands. They're worried that abortions will increase under Obama if, say, Medicaid begins granting coverage for them or U.S. military hospitals start providing them.

While reconnecting with old friends over dinner in Miami two nights ago, I was horrified to hear that they'd lost several million dollars—nearly their entire savings—in the Madoff scheme. Faced with a substantial loss of yearly income needed to pay their mortgage and private-school tuition, my friend Loren told me her anxiety was so severe that she literally couldn't keep any food down. Just the mention of Bernie Madoff on the news sent her rushing to the bathroom with dry heaves. At her doctor's urging, she decided last month to go on the antidepressant Lexapro. As it happens, a study out this week in the Journal of the American Medical Association suggests that Lexapro is helpful for treating seniors who have chronic, difficult-to-control fears and worries known as generalized anxiety disorder.

But Loren, a 42-year-old mother of four, is in a completely different category. She's normally a cheerful, do-it-all optimist—think Energizer bunny—and her crying jags and heaving were entirely understandable under the circumstances. "Having a sudden, shocking reversal of fortune is the sort of situation where any healthy, stable individual would experience extreme anxiety for a period of time," explains Jerome Wakefield, a professor of social work at New York University and author of The Loss of Sadness. "Your friend is grappling with building a new sense of her future, a new sense of safety."

As a health reporter, I feel as if I'm always a bit of a downer, reporting sobering news like this new government report that finds that sexually transmitted diseases are rising and that women bear the brunt of the burden. We pay a hefty toll for such ills as gonorrhea and chlamydia—which go undiagnosed half the time—in the form of lifelong infertility. Women, especially black women, account for the highest rates of both of these diseases. And consider these consequences reported by the Centers for Disease Control and Prevention:

• Up to 40 percent of women with untreated gonorrhea and chlamydia develop pelvic inflammatory disease, which can cause ectopic pregnancy, infertility, and chronic pelvic pain. Most of the time, these infections cause no symptoms, so women have no idea they've contracted an STD.

Last year, I contemplated my risk of staying on birth control pills until I reach menopause and lamented the dearth of research on the long-term use of contraceptives by women. Well, I feel a little vindicated after reading a review paper published yesterday in the Journal of the American College of Cardiology. The authors, female cardiologists from Cedars-Sinai Medical Center in Los Angeles, complain that there aren't well-designed trials looking specifically at how birth control pills and other hormonal products affect a woman's risk of developing heart disease.

While a woman's risk of having a heart attack in her 30s or 40s is extremely low, heart disease death rates have recently risen in women ages 35 to 44, and no one knows exactly why. This could be due to an increase in obesity, sedentary lifestyle, and smoking, all of which raise heart disease risk. But it could also be because more middle-aged women are using hormonal contraceptives today than ever before. The paper, study coauthor Noel Bairey Merz tells me, is a resounding call for more research.

The news today that early elective cesarean sections pose serious risks to newborns should have every pregnant woman on high alert. The study, published in the New England Journal of Medicine , found that babies delivered via a scheduled C-section before the 39th week of pregnancy were more likely to have breathing problems that required a ventilator, infections, and low blood sugar.

There's nothing new in that finding. Previous studies have shown the same thing—which is why the American College of Obstetricians and Gynecologists recommends against scheduling C-sections more than a week before a woman's due date. What's highly troubling, though, is that 36 percent of the more than 24,000 elective C-sections studied (in which the surgery was performed for no good medical reason) were done before 39 weeks—in flagrant disregard of ACOG's sensible guidelines.

Bristol Palin just gave birth, teen virginity pledges are useless, and now we hear that teen birthrates are up in 26 states, which means that whatever we're doing to prevent teen pregnancy isn't working very well. The government data show significant surges for 2006, the most recent data available, for more than half of states compared with increases in just one state in two previous years.

The amount of money that we shell out for healthcare certainly isn't shrinking but, hey, at least it increased at a slower pace last year, the slowest in a decade. That's according to a new report from the U.S. Centers for Medicare and Medicaid Services, which found that our health expenses only increased by only 6.1 percent in 2007 compared with 6.7 percent in 2006.

The reason? Many of us have switched to generic drugs, particularly as the patents have expired in recent years on some of the pricier blockbuster brand-name drugs like the cholesterol-lowering statin Zocor and the antidepressant Zoloft. I, too, made a huge cost-saving switch this year. After blogging about drugstores offering steep discounts on generic birth control pills, I decided to switch to a generic version of a brand-name product I was using.