International News

Internal Medicine World Report, September 2007, Volume 0, Issue 0

Women's Fear of Breast Cancer No Reason to Avoid Short-Term HRT

AMSTERDAM, the Netherlands—Menopausal women should not steer clear of using hormone replacement therapy (HRT) out of concern that it will increase the likelihood of breast cancer, an expert in women's health said at the Amsterdam Menopause Symposium.

Henry Burger, MD, formerly the director of Prince Henry's Institute of Medical Research in Melbourne, Australia, said it is lamentable that the announcement 5 years ago that HRT caused a 26% increase in breast cancer risk prompted widespread anxiety and "abandonment" of HRT use in millions of women worldwide, following the publication of the Women's Health Initiative (WHI) study involving more than 27,000 women.

Dr Burger said that no significant increased risk in breast cancer occurred after 5.6 years of HRT treatment in the roughly 75% of WHI trial participants who were first-time HRT users. Although combined HRT use may increase breast cancer risk after continuous use for 5 to 7 years, this is not the case with short-term therapy, particularly in overweight or obese patients, he added. Some increase in risk may occur in women of normal weight; however, the size of that risk during the first 5 years of treatment is not clear.

Low-dose HRT is now the preferred treatment for peri- and postmenopausal women with menopausal symptoms; it provides effective relief while minimizing side effects, Dr Burger noted. Low doses, such as 0.5 to 1.0 mg 17-ß estradiol, can treat menopausal symptoms and prevent osteoporosis. Physicians should also counsel postmenopausal women on diet, exercise, smoking, and alcohol measures to maintain health.

In the United Kingdom alone, the number of women using HRT decreased from 2 million in 2002 to 1 million in 2005.

Low-Glycemic-Load Diet Has Potential as Acne Treatment

MELBOURNE, Australia—A diet that contains a low glycemic load may help eradicate acne, investigators reported in the American Journal of Clinical Nutrition (2007;86: 107-115). Robyn Smyth, MD, with RMIT University in Melbourne, Australia, and colleagues randomized 43 men with acne vulgaris to follow a low-glycemic-load diet or a normal diet for 12 weeks. With the low-glycemic-load diet, 25% of energy was derived from protein and 45% from low-glycemic-index carbohydrates.

The pathogenesis of acne is not known, but recent studies of non-Western populations have suggested a possible role for dietary factors, including the glycemic load, Dr Smyth said.

At 12 weeks, the mean decrease in total acne lesion count was ?23.5 in the low-glycemic-load group versus ?12.0 in the control group. Weight was reduced by 2.9 kg and increased by 0.5 kg, respectively, and body mass index decreased by 0.92 kg/m2 and increased by 0.01 kg/m2, respectively. Patients assigned to the low-glycemic-load diet also had a larger improvement in insulin sensitivity.

This may mean that nutrition and lifestyle-related factors play a role in acne onset.

Pegylated Interferon plus Ribavirin Combo Shows Promise in HIV/HCV Coinfection

SYDNEY, Australia&#8212;Most patients coinfected with HIV and acute hepatitis C virus (HCV) achieve a viral load of <50 copies/mL after 24 weeks of treatment with pegylated interferon alfa-2a and ribavirin, according to data released at the International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention.

Gail Matthews, MB, ChB, of the National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, and coinvestigators administered the drug combination to 18 patients coinfected with HIV and acute HCV.

After 24 weeks of treatment, 89% of the patients had an HCV viral load <50 copies/mL (ie, an undetectable level). The sustained virologic response rate was 72%.

Dr Matthews said that the findings, although preliminary, are encouraging, given that HIV-positive patients with concurrent acute HCV infection are less likely to spontaneously clear the virus than patients without HIV.In addition, HIV-positive patients with acute HCV infection who progress to chronic HCV infection are usually less responsive to treatment and are more likely to develop liver disease.

Office Smog Poses Health Risk

LONDON, England&#8212;Perhaps not surprising, electronic smog generated by office equipment, including computers and printers, exposes workers to an increased risk of respiratory disease, according to new research published in Atmospheric Environment (2007;41:5224-5235).

Keith Jamieson, Dip.AAS, BSc(Hons), of the Imperial College Center for Environmental Policy in London, and colleagues examined why office workers complain of asthma, influenza, and other respiratory diseases after spending long periods working with electronic equipment.

They found that the electronic fields emitted by office equipment charge minuscule particles in the air, such as viruses, bacteria, allergens, and highly toxic pollutants. The electrical charge causes the tiny particles, which are constantly airborne, to adhere to lung and respiratory tract tissue, which leads to infection. Ensuring that electronic devices are grounded may help reduce the health risk.

Future research should address whether electromagnetic radiation from mobile phone masts and Wi-Fi systems confers the same risks.