Breast Cancer – Another Perspective

Scientists reported updated results on the number and characteristics of breast cancer, as well as the frequency of abnormal mammograms, in the estrogen and progestin (E+P) arm of the Women’s Health Initiative Study (WHI). When comparing patients who developed invasive breast cancer to those on placebo, tumors in the E+P group were larger (mean 1.7 cm vs 1.5 cm for placebo [0.2 cm larger]); associated more often with positive lymph nodes (25.9% vs 15.8% in the placebo group); were more likely to present at an advanced stage of disease (regional or metastatic disease was observed in 25.4% of patients vs 16.0% of those on placebo; regional spread only was observed in 24.4% of patients vs 14.0% of placebo; metastatic spread was observed in 1% of patients vs 2% of placebo). Thus, the major difference between the E+P and placebo users is the increased number of patients with node-positive disease (nearly a 10% increase) in the hormone therapy (HT) group.

The findings of slightly larger and more advanced node-positive tumors is in sharp contrast to prior observational studies which had found smaller breast cancers, with less node positivity and better survival in women on HT. Survival data from the WHI is mostly unknown at this early time, but with no significant difference to date. Conclusive data about whether HT will be more harmful (because of larger tumors with greater incidence of lymph node spread) will require longer follow-up and analysis of survival data.

Information regarding the 4% increase in abnormal mammograms seen at year 1 and continuing throughout the study needs to be relayed to patients. There were 9.4% (716/7656) abnormal mammograms in the E+P group vs 5.4% (398/7310) in the placebo group. It is well known that E+P increases breast density, which can make mammography more difficult to interpret; the discontinuation of E+P therapy for a 2-week period will allow resolution of 75% of the abnormalities seen. However, the need for repeat mammogram, spot compressions, or extra views significantly increases patient anxiety. The use of digital mammography rather than standard mammography may lesson this problem to some extent. In addition, in women who initiate hormone therapy close to the time of the menopause, breast density tends to be maintained rather than increased. Based on these findings, it seems likely that tumors in patients on E+P may be more difficult to find, partly because of the increase in breast density. The WHI investigators will be evaluating the mammograms in more detail to determine whether there is a correlation between hormone-induced breast density and the risk of later developing a breast cancer.

It is important to remember that the estrogen-only arm of the WHI is continuing, and that as of May 2003, no increase in adverse events significant enough to stop the study has been found. Thus, this increased risk of breast cancer so far appears to be only in the E+P group, and not in the estrogen-only arm.

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HIV Causes Aids?

There are many issues about the HIV causes AIDS paradigm that have been questioned since the general acceptance of HIV as the causal agent of AIDS. For example:

  • HIV has never been convincingly shown to cause AIDS.
  • HIV testing/detection is invalid, with inaccurate or meaningless results.
  • HIV infection is merely a risk marker, or passenger virus, of AIDS.
  • HIV does not exist at all as an exogenous retrovirus.
  • AIDS is caused by lifestyle risk factors.
  • AIDS is a re-naming of old diseases that are themselves caused by other factors.
  • Anti-viral therapy is not effective.
  • Anti-viral therapy causes AIDS.

There was always a degree of debate about the cause of AIDS (as there is about any new disease), but for some this did not disappear with the naming of HIV as the cause. Prof Duesberg (a Nobel prize nominee), for example, re-examined the infectious nature of AIDS in 1987 and put forward his own theory based on drug toxicity and lifestyle factors. He is not alone: Dr Kary Mullis, inventor of the PCR reaction, also questions the HIV/AIDS paradigm, and there are many other individuals of a scientific background who agree with them.

For some people the views above may seem ludicrous, yet those who argue them use the scientific literature to support their views. How they might be reconciled with the HIV causes AIDS hypothesis is fuel for much debate.

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Dieting Tips

Diet Tip #1 – Acknowledge your feelings and identify the reasons why you overeat. If you eat when you are sad and depressed you will need to find another outlet for those feelings.

Diet Tip #2 – Find healthy outlets for stress, anxiety, or other emotions that does not involve eating.

Diet Tip #3 – No not eat a large meal before going to bed. Your body is unable to digest a large dinner eaten late at night properly because its metabolic functions slow down while in a state of sleep.

Diet Tip #4 – Don’t get immediately discouraged because you do not see signficant weight loss. It often takes time for outr bodies to adjust to certain changes in its biochemistry and to the patterns of the nutrients being digested.

Diet Tip #5 – Don’t obsess over every pound lost or gained. Think of long term benefits rather than letting your emotions become slaves to the readings of your scale.

Diet Tip #6 – Combine any diet with a healthy lifestyle and routine exercise program. You should get a minimum of 20 minutes of aerobic exercise, three times a week.

Diet Tip #7 – Don’t give up because you feel as though you have hit a weight loss plateau. Many times, as people begin to exercise and lose weight, they will replace the weight they have lost in fat, to muscle weight. Because muscle weight more than fat, you can actually be getting much more healthy, without this being apparent from the reading on your scale. (See dieting tip 5)

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HIV/AIDS Acute Questions

What more can the richer governments do to help?
Countries like the US, Japan, the European Community and others are actually very well-off by world standards and can easily the afford the small amounts needed to help stop AIDS. These counties need to provide, together, about $10 billion a year to finance programs of prevention, care and treatment. They need to stop lending money irresponsibly and they should cancel old debts so the debt payments can be put into AIDS and other programs. They also need to make sure poor countries can buy AIDS medications at generic prices.

What do these victims really need the most?
They need those of us living in wealthy countries to support the efforts these victims are already making to stop the crisis. Africans and others are not at all helpless – but they do need support for their courageous efforts to address the AIDS catastrophe. Educational programs, prevention campaigns, treatment with affordable, effective medication, functioning health care systems, care for the sick and dying, care for orphans, clean water – all of these things are desperately needed. Plus respect for human rights and dignity.

What’s going to happen if this goes on without help?
If we don’t act now, HIV/AIDS will have infected 50 million people by 2005. Last year (2000) 5.3 million more people became infected. Besides in Africa, UNAIDS reports that AIDS is spreading rapidly in the Caribbean, Eastern Europe, and many parts of Asia. If we don’t do all we can, the global number of AIDS orphans may reach 40 million before the year 2010.

What does “drop the debt” mean? And, why?
Many countries heavily impacted by AIDS also owe billions of dollars to wealthy creditors. Because of downturns in the world economy countries were not able to make their payments and the debts piled up. The indebtedness has meant that countries have spent more on payments on their debts than they have available to pay for education or health care for their people.The limited debt relief already provided some impoverished countries has saved them a a total of almost $1 billion in debt payments. As a result of receiving debt relief, several countries have stepped up spending on AIDS programs. Yet, impoverished countries participating in the debt relief programs are still paying out more than $700 million yearly in debt service to the IMF and World Bank. Debt cancellation can contribute to stopping the AIDS crisis if it is made deeper than the current package. In addition, the debts of a broader group of countries must be addressed.

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