Health & Medicine
Unequal Treatment
More women die each year from heart disease than men, yet they're less likely than men to get screening tests and treatment to prevent the disease. In a survey of more than 50,000 men and women enrolled in Medicare or a private managed-care plan, researchers from Rand found that diabetic women, already at increased risk for heart disease, were 19 percent less likely than diabetic men to have normal cholesterol levels, which probably means they were getting fewer treatments. Women with private insurance were also 13 percent less likely to get a beta blocker drug after a heart attack and 9 percent less likely to get an ACE inhibitor to treat congestive heart failure, according to the study in the May/June issue of the journal Women' Health Issues. "One possibility is that doctors haven't gotten the message that women are at risk of cardiovascular disease," says study author and Rand sociologist Chloe Bird. "Women need to be proactive in terms of finding out from their doctors what they need for care."
A Decline in Mammograms
Women are not following their doctors' orders. After years of increase, the percentage of women getting mammograms is falling. Between 2000 and 2005, the rate of women over the age of 40 getting the lifesaving breast cancer screens dropped from 70 percent to 66 percent, researchers found by analyzing data from the National Health Interview Survey. The findings are in the journal Cancer. There are several possibilities for the drop-a rise in the number of uninsured women, higher insurance copayments, and confusion over the effectiveness of the screens-but the news is troubling, as most experts consider screens the best way to catch breast cancer early when it can be treated. The biggest drop was among women who rely on public health insurance, but affluent women also contributed to the trend. "Lack of access and time seem important, but we need more hard data to determine why this is happening," says Nancy Breen, the National Cancer Institute researcher who led the study.
If you need a mammogram, here's what the National Cancer Institute suggests you do: Ask your doctor about a referral, check with your insurance plan about how much it will cover and any copayments (for older women, Medicare will pay most of the cost of an annual mammogram), make an appointment with an FDA-approved mammography center, don't apply antiperspirant or deodorant or wear lotions to the appointment, and follow up to get the results. - Adam Voiland
A Lower Dose for Mild Asthmatics
Asthma sufferers often end up on more potent drugs after a flare-up. But it's much less common for doctors to "step down" treatment when symptoms are controlled. A study in last week's New England Journal of Medicine found that many people with mild, persistent asthma who are on a twice daily dose of inhaled corticosteroids can safely drop to a lighter dose.
The study compared two alternatives: montelukast (Singulair), and a combination of fluticasone and salmeterol (Advair Diskus). The former is a once-a-day pill; the latter is delivered once daily by inhaler. The researchers found that both treatments were about as effective as fluticasone alone, though montelukast was slightly less so. When you next visit your doctor, talk about your options, advises Stephen Peters, one of the study leaders. - A.V.
Hold Off on Those Extra Vitamins
Men popping more than seven multivitamin pills a week could be increasing their risk of advanced and fatal prostate cancer. A large study from the National Cancer Institute found that while high multivitamin use did not correlate with higher rates of localized cancer, it increased the risk of advanced cancer by 32 percent and nearly doubled the risk of fatal prostate cancer. Taking additional beta carotene and zinc supplements increased the risk even more. An editorial with the study in the Journal of the National Cancer Institute points out that the average American diet already provides 120 percent of the beta carotene and vitamins A and C needed. The study also provided strong evidence that taking just one multivitamin a day did not cause harm. "That was the reassuring part," says Michael Leitzmann, a coauthor of the study. - A.V.
This story appears in the May 28, 2007 print edition of U.S. News & World Report.