Jewish World Review Sept. 25, 2001 / 9 Tishrei, 5762
By Robert A. Wascher, M.D., F.A.C.S.
http://www.jewishworldreview.com --
A DUTCH research group has reported on a comparison between magnetic
resonance imaging (MRI) and standard mammography for early detection of
breast cancer. As reported in the Journal of the National Cancer Institute,
179 women with a family history of breast cancer underwent annual breast
exams, mammography and MRI of the breasts.
It is important to note that
these women were defined to be at increased hereditary risk of breast
cancer, and were screened at a younger average age than the general public
(in women who have not yet undergone menopause, the breast tissue tends to
be more dense, making mammography less sensitive). A total of 13 breast
cancers were detected in these 179 women using MRI, while 7 of these 13
tumors were not detected by mammography. The authors concluded that MRI
appears to be more sensitive than mammography, particularly for young women
at increased risk of developing breast cancer. They recommend that a large
multicenter study be initiated to further evaluate MRI as a routine
screening tool for breast cancer.
PRIMARY CARE PHYSICIAN AWARENESS OF PERIPHERAL ARTERIAL DISEASE University of Minnesota researchers reported in
this week's Journal of the American Medical Association that a simple
measurement of the blood pressure in the arms and legs, which can be
performed in most primary care doctors' office using inflatable cuffs, can
identify patients with previously unknown PAD. The blood pressure test,
which measures the "ankle-brachial index" (ABI), was performed on 6,979
patients. PAD was diagnosed in 1865 (29%) of these patients using this
simple noninvasive screening test. Among these 1,865 patients with an
abnormal ABI, 83% of patients were previously aware that they had PAD, but
only 49% of their primary care physicians were previously aware of the
diagnosis in their patients! The study's authors recommend that this test
be routinely performed, by primary care physicians, in patients with known
risk factors for PAD, so that preventive treatments can be targeted at some
of these risk factors before PAD becomes advanced.
ARSENIC IN THE WATER
Tightening of the arsenic level standards by the
Clinton administration was based upon preliminary evidence that the then
existing standards might be linked to an increased risk of lung and bladder
cancer. The National Academy of Sciences (NAS) was asked by Bush officials
to further study the issue, while many public health advocates decried the
new administration's perceived efforts to dilute or revoke Clinton's more
stringent standards. In this week's issue of the journal Science, the NAS
reported its findings. Surprisingly, they found that even the Clinton
administration's more stringent standard for arsenic levels in public water
supplies (10 parts per billion) was linked to an excessive number of cancer
cases. The Clinton era Environmental Protection Agency (EPA) studies had
estimated that the incidence of lung and bladder cancer were predicted to
reach 0.8 extra cases per 1000 people at the newly proposed 10 parts per
billion arsenic level. The NAS, however, estimates the true increased risk
at 1.3 to 3.7 extra cases per 1000 people. Although the EPA has not yet
made recommendations to the new administration, the bets are that the
president will likely find himself signing off on even more stringent
arsenic standards than those proposed by his
JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at
the John Wayne Cancer Institute in Santa Monica, CA.
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Advances in the detection of breast cancer
Narrowing of the arteries (atherosclerosis) that supply blood to the legs
and feet is part of the overall syndrome referred to as peripheral arterial
disease (PAD), and affects some 8 to 12 million Americans. In addition to
potentially causing pain and weakness of the extremities, advanced cases of
PAD can lead to eventual loss of part or all of the legs or feet. PAD also
serves as a "marker" for vascular disease in the arteries that feed the
heart and brain, as well. Factors that can increase the incidence of PAD
include smoking, obesity, diabetes, elevated cholesterol levels, male gender
and sedentary lifestyle.
Arsenic is a naturally occurring metal in ground water supplies, and is
especially common in the western United States. Removing arsenic from
ground water sources is an expensive and complex proposition. Shortly after
taking office, the Bush administration suspended a Clinton administration
directive to tighten the standards for allowable arsenic levels in the
nation's water supplies.
09/17/01: In perspective
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