Women More Vulnerable To Tobacco Carcinogens, European Conference Finds

Women may be more vulnerable than men to the cancer-causing effects of smoking tobacco, according to new results reported this week at the European Multidisciplinary Conference in Thoracic Oncology (EMCTO), Lugano, Switzerland.

Swiss researchers studied 683 lung cancer patients who were referred to a cancer center in St Gallen between 2000 and 2005 and found women tended to be younger when they developed the cancer, despite having smoked on average significantly less than men.

“Our findings suggest that women may have an increased susceptibility to tobacco carcinogens,” reported Dr. Martin Frueh and colleagues.

Dr. Enriqueta Felip from Val d’Hebron University Hospital in Barcelona, Spain, conference co-chair, notes that the results support a growing awareness that smoking presents greater risks to women than men.

“In the early 1900s lung cancer was reported to be rare in women, but since the 1960s it has progressively reached epidemic proportions, becoming the leading cause of cancer deaths among women in the United States,” Felip said.

“Lung cancer is not only a man’s disease, but women tend to be much more aware of other cancers, such as breast cancer,” she said. “Several case-control studies seem to suggest that women are more vulnerable to tobacco carcinogens than men.”

On the positive side, other research presented at the conference suggests that women tend to do better than men after surgery to remove lung tumors.

Irish researchers led by Dr. Bassel Al-Alao studied 640 patients whose non-small-cell lung cancer was surgically removed over a 10-year period, 239 of whom were women.

They found that median survival after surgery was 2.1 years for men, and 4.7 years for women.

For more information, visit: www.esmo.org.

“Million Women Study” Shows Even Moderate Alcohol Consumption Increases Cancer Risk

Low to moderate alcohol consumption among women is associated with a statistically significant increase in cancer risk and may account for nearly 13 percent of the cancers of the breast, liver, rectum and upper aero-digestive tract combined, according to a report in the Journal of the National Cancer Institute.

With the exception of breast cancer, little has been known about the impact of low to moderate alcohol consumption on cancer risk in women, researchers noted.

To determine the impact of alcohol on overall and site-specific cancer risk, Dr. Naomi Allen, of the University of Oxford, U.K., and colleagues examined the association of alcohol consumption and cancer incidence in the “Million Women Study,” which included 1,280,296 middle-aged women in the United Kingdom. Participants were recruited to the study between 1996 and 2001. Researchers identified cancer cases through the National Health Service Central Registries.

Women in the study who drank alcohol consumed, on average, one drink per day, which is typical in most high-income countries such as the U.K. and the U.S. Very few drank three or more drinks per day. With an average follow-up time of more than 7 years, 68,775 women were diagnosed with cancer, the researchers found.

The risk of any type of cancer increased with increasing alcohol consumption, as did the risk of some specific types of cancer, including cancer of the breast, rectum and liver. Women who also smoked had an increased risk of cancers of the oral cavity and pharynx, esophagus, and larynx. The type of alcohol consumed–wine versus spirits or other types–did not alter the association between alcohol consumption and cancer risk, the researchers claimed.

Each additional alcoholic drink regularly consumed per day was associated with 11 additional breast cancers per 1000 women up to age 75; one additional cancer of the oral cavity and pharynx; one additional cancer of the rectum; and an increase of 0.7 each for esophageal, laryngeal and liver cancers. For these cancers combined, there was an excess of about 15 cancers per 1000 women per drink per day. The background incidence for these cancers was estimated to be 118 per 1000 women in developed countries, the researchers noted.

“Although the magnitude of the excess absolute risk associated with one additional drink per day may appear small for some cancer sites, the high prevalence of moderate alcohol drinking among women in many populations means that the proportion of cancers attributable to alcohol is an important public health issue,” the authors wrote.

In an accompanying editorial, Dr. Michael Lauer and Dr. Paul Sorlie,of the National Heart, Lung, and Blood Institute, in Bethesda, M.D., emphasized that these new results derived from such a large study population that it should give readers pause. Although previous epidemiological studies have suggested that there is a cardiovascular benefit associated with moderate alcohol consumption, the excess cancer risk identified in the current study may outweigh that benefit.

“From a standpoint of cancer risk, the message of this report could not be clearer. There is no level of alcohol consumption that can be considered safe,” the editorialists wrote.

For more information, please visit: www.jncicancerspectrum.oupjournals.org.

Secondhand Smoke Raises Odds Of Fertility Problems In Women

Scientists at the University of Rochester Medical Center have found that women exposed to second hand smoke, either as adults or children, were significantly more likely to face fertility problems and suffer miscarriages.

An epidemiologic analysis of more than 4,800 non-smoking women showed those who were exposed to second hand smoke six or more hours per day as children and adults faced a 68 percent greater chance of having difficulty getting pregnant and suffering one or more miscarriages.

“These statistics are breathtaking and certainly points to yet another danger of second hand smoke exposure,” said Dr. Luke J. Peppone, research assistant professor at Rochester’s James P. Wilmot Cancer Center.

In the study, 4 out of 5 women reported exposure to second hand smoke during their lifetime. Half of the women grew up in a home with smoking parents and nearly two-thirds of them were exposed to some second hand smoking at the time of the survey.

More than 40 percent of these women had difficulty getting pregnant (infertility lasting more than a year) or suffered miscarriages, some repeatedly, said researchers.

“We all know that cigarettes and second hand smoke are dangerous. Breathing the smoke has lasting effects, especially for women when they’re ready for children,” said Peppone, who analyzed information in the Patient Epidemiology Data System, a well-studied cohort that has yielded information on a variety of cancers.

Peppone analyzed surveys collected from 4,804 women who visited Roswell Park Cancer Institute for health screenings or cancer care from 1982-1998. The 16-page survey focused on lifestyle, habits, family and personal health history, and occupational and environmental exposures. Each participant in this study reported that they had never smoked, and had been pregnant at least once or tried to become pregnant.

Participants reported whether one or both of their parents smoked and if they lived with or worked with smokers as adults. They also estimated the amount of time they were exposed to second hand smoke.

Peppone acknowledges that the data is based upon self-reporting and that is not perfect. However, he said “Women, especially mothers, have extremely accurate recall. Mothers can easily recall details like how long they breastfed, what vitamins they took during prenatal care, and childhood activities.”

Many of the women in the study grew up in the 1940s and 1950s, long before the surgeon general issued the first warning about the dangers of cigarette smoking in 1964. Since then, millions of dollars were spent to study the dangers of cigarette smoking. Tobacco use contributes to more than nearly 90 percent of all deadly lung cancers and 30 percent of all cancer deaths in the U.S., and a host of other health problems, said researchers.

Since the mid-1960s, smoking bans and government-funded, anti-smoking campaigns have encouraged smokers to quit and discouraged others from starting using a number of passive and aggressive techniques. Smoking rates have declined, however people continue to use tobacco and suffer the health risks.

The study was funded by a National Cancer Institute grant and was previously presented at the Society for Behavioral Medicine and Society of Research of Nicotine and Tobacco conferences; it is published online in Tobacco Control.

For more information, please visit: www.urmc.rochester.edu.

Newborns Exposed To Maternal Smoking More Irritable, Difficult To Soothe

Recent study by The Miriam Hospital went beyond the common outcomes of low birth weight and sudden infant death syndrome risks to reveal babies exposed to tobacco in utero are less likely to self-soothe and are more aroused and excitable than newborns whose mothers did not smoke during pregnancy.

Researchers from The Miriam Hospital’s Centers for Behavioral and Preventive Medicine said early identification and targeted intervention efforts aimed at both infants and parents may help prevent possible disruption in early maternal-infant bonding and, ultimately, long-term adverse outcomes.

“A baby who is harder to soothe and more irritable could be more difficult to take care of and could potentially affect the developing mother-child relationship, especially for mothers who are already stressed and have fewer resources,” said lead author Dr. Laura Stroud, a psychologist with The Miriam Hospital’s Centers for Behavioral and Preventive Medicine. “We need better treatment programs to help women not smoke during pregnancy, to keep them from starting smoking after the baby is born, and to help them take care of an excitable or colicky baby.”

Between 11 and 30 percent of women continue to smoke during pregnancy, according to the Centers for Disease Control and Prevention. In addition to the physical side effects, tobacco exposure in utero has also been linked to long-term adverse neurobehavioral outcomes in children, including conduct disorder and hyperactivity. However, researchers say relatively less attention has focused on the effects of maternal smoking on newborn neurobehavior.

In the study, Stroud and colleagues from Women & Infants Hospital in Providence, RI, and the Warren Alpert Medical School of Brown University focused on newborns between 10 and 27 days old. The researchers decided on this infant age range because it is well past the half-life of nicotine, meaning the acute effects of nicotine withdrawal were unlikely to be a factor in the study. All 56 babies – 28 smoking-exposed and 28 unexposed – were healthy and full-term. Maternal social class, age and alcohol use were similar in each group.

Mothers in the study were assigned to the smoking or non-smoking group based on self-reports of cigarette use during pregnancy assessed shortly after babies were born. This was verified biochemically by measuring cotinine, the primary metabolite of nicotine, in the mother’s saliva. Cotinine is readily passed from mother to infant, with the baby absorbing nearly as much as the mother does.

On average, the number of cigarettes mothers smoked each day decreased over the course of the pregnancy, from about 15 cigarettes per day in the first trimester to approximately five cigarettes in the third trimester.

Postnatal smoke exposure was quantified by infant saliva cotinine levels. All infants were then assessed using the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale, a tool developed for the National Institutes of Health to measure the effects of prenatal drug exposure in infants, including withdrawal and general signs of stress.

According to the study’s findings, smoking-exposed infants showed a greater need for handling, or external intervention, in order to be soothed and calmed down. These babies also tended to be more easily aroused and excitable.

“Although the effects of maternal smoking at 10 to 27 days were subtle, in combination with a high-stress postnatal environment and deficits in parenting, they could represent early precursors for long-term, negative behavioral outcomes,” said Stroud, who is also an assistant professor of psychiatry (research) at Alpert Medical School.

The study was funded by the National Institutes of Health; Stroud was supported by a grant from the Robert Wood Johnson Foundation Tobacco Etiology Research Network. Co-authors were Barry Lester, PhD, Amy Salisbury, PhD, and Linda Lagasse, PhD, from Women & Infants Hospital and the Brown Center for the Study of Children at Risk; George D. Papadonatos, PhD, from the Center for Statistical Sciences at Brown University; and Rachel L. Paster, Raymond Niaura, PhD, and Cynthia Battle, PhD, from Alpert Medical School.

The study was published online by the Journal of Pediatrics, and more information can be found by visiting: www.lifespan.org.

Study Determined Two Drinks A Day Are OK For Women’s Heart Beat

Women who have up to two alcoholic drinks per day do not appear to be at increased risk of atrial fibrillation (irregular heart beat), but drinking more than that amount is associated with a higher risk, according to a new study.

Studies assessing the effects of regular alcohol consumption on the risk of atrial fibrillation have provided inconsistent results, with several studies finding significant associations between moderate to high amounts of alcohol intake and increased risks of atrial fibrillation among men, but not among women. However, these studies were not of adequate size to detect significant associations among women, according to background information in the article published in the December issue of the Journal of American Medical Association.

Dr. David Conen, of Brigham and Women’s Hospital, Harvard Medical School, Boston, and University Hospital, Basel, Switzerland, and colleagues analyzed data from a completed randomized controlled trial involving 34,715 women participating in the Women’s Health Study, to assess the effects of regular alcohol consumption on the risk of atrial fibrillation.

The participants were older than 45 years and had no atrial fibrillation at the start of the study and underwent follow-up from 1993 to October 2006. Alcohol consumption was assessed via questionnaires at the beginning of the trial and at 48 months of follow-up and was grouped into 4 categories: 0 drinks per day, greater than 0 and less than 1, 1 or more and less than 2, and 2 or more drinks per day. Atrial fibrillation was self-reported on the yearly questionnaires and subsequently confirmed by electrocardiogram and medical record review.

During a median follow-up of 12.4 years, there were 653 confirmed cases of new atrial fibrillation. Among women consuming no alcohol (n = 15,370), there were 294 events (1.9 percent); for women consuming more than 0 and less than 1 drink per day (n = 15,758), there were 284 events (1.8 percent); for 1 to 2 drinks per day (n = 2,228), there were 35 events (1.6 percent); and for women consuming 2 or more drinks per day (n = 1,359), there were 40 atrial fibrillation events (2.9 percent).

“In the present study, alcohol consumption of up to 2 drinks per day was not associated with an increased risk of incident atrial fibrillation among initially healthy, middle-aged women. In contrast, the small group of women who consumed 2 or more alcoholic beverages per day had a 1.6-fold greater risk for atrial fibrillation relative to nondrinking women. While this finding needs to be interpreted with some caution because of the small number of women in some subgroups, it supports a possible threshold effect in the relationship between alcohol consumption and risk of atrial fibrillation among women,” the authors wrote.

For more information on the article, “Alcohol Consumption and Risk of Incident Atrial Fibrillation in Women,” please visit: www.jamamedia.org.

Two Antidepressants Taken During Pregnancy Linked To Heart Anomalies In Babies

Women who took the antidepressant fluoxetine during the first three months of pregnancy gave birth to four times as many babies with heart problems as women who did not and the levels were three times higher in women taking paroxetine, according to a recent study.

Although some of the conditions were serious, others were not severe and resolved themselves without the need for medical intervention, according to a three-country study in the British Journal of Clinical Pharmacology.

Researchers have advised women taking the drugs to continue unless they are advised to stop by their doctor or consultant. But they are being urged to give up smoking, as the study also found that more than 10 cigarettes a day was associated with a five-fold increase in babies with major heart problems.

The team has also suggested that women on fluoxetine should be given a foetal echocardiogram in their second trimester to diagnose possible heart anomalies.

International researchers from Israel, Italy and Germany followed the pregnancies of 2,191 women – 410 who had taken paroxetine during pregnancy, 314 who had taken fluoxetine and 1,467 controls who hadn’t taken either of the drugs.

“After we excluded genetic and cytogenic anomalies, we found a higher rate of major heart anomalies in the women who had been taking the antidepressants” said lead author Professor Asher Ornoy from the Israeli Teratology Information Service in Jerusalem, Israel.

“Further analysis showed a strong association between major heart anomalies and taking fluoxetine in the first trimester. Women who smoked more than 10 cigarettes a day also had more babies with heart anomalies,” Ornoy added.

Women taking paroxetine or smoking less than 10 cigarettes a day also faced elevated risks, but not to the same extent.

The women had all contacted either the Israeli Teratology Information Service in Jerusalem, Israel, the Servizio di Informazione Teratologica in Padua, Italy, or the Pharmakovigilanz-und Beratungszentrum fur Embryonaltoxikologie in Berlin, Germany.

All three belong to the European Network of Teratology Information Services, which comprises organisations that investigate, and provide counseling on environmental exposure during pregnancy.

The women in the control group had contacted the services because of concerns about exposure to substances that are not known to cause birth defects and the women in the medication groups because of their use of paroxetine and fluoxetine.

When the researchers looked at the outcomes of all of the pregnancies they found that:

• The prevalence of major heart anomalies was 2.8 percent in the fluoxetine group, 2 percent in the paroxetine group and 0.6 percent in the control group. There was no increase in other major congenital anomalies.
• Previous pregnancy terminations were also higher in the fluoxetine and paroxetine groups than the control group (7.8, 4.8 and 2.8 percent). All groups included some terminations because of diagnosed anomalies.
• Birth weights were slightly lower in the fluoxetine and paroxetine groups than the control group (3200g, 3250g and 3300g).
• Women taking fluoxetine and paroxetine were more likely to smoke than women in the control group (20.1, 20.7 and 7.5 percent) and more likely to smoke more than ten cigarettes a day (12.3, 14 and 4.4 percent).

Taking all the factors into account, the authors calculated that the overall risk posed by antidepressant use and cigarette consumption was as follows:

• Women who took fluoxetine during pregnancy were 4.47 times more likely to have a baby with a heart anomaly and women who took paroxetine were 2.66 times more likely.
• Those smoking more than ten cigarettes a day were 5.40 times more likely to have a baby with a heart anomaly and women smoking less than ten cigarettes a day were 2.75 times more likely.

“These findings clearly show a significant association between major heart anomalies and taking fluoxetine and smoking during pregnancy” said Ornoy.

“There is an ongoing debate in the medical literature about the possible association between women taking one of these two drugs during pregnancy and having a baby with a heart anomaly and we are keen to see further research in this area. We should point out that there is no evidence of any increased risk posed by citalopram and sertraline, which belong to the same group of antidepressants,” Ornoy continued.

The authors say that it is important that women are aware of these findings, especially if they smoke. However if they are taking fluoxetine, they should speak to their family doctor or consultant and should not stop taking their medication unless advised to do so.

“It’s estimated that as many as one in seven women suffer from clinical depression during pregnancy and clinicians need to weigh up the individual risks of pregnant women taking, or not taking, drugs like fluoxetine,” stressed Ornoy.

“Many heart anomalies can now be treated, so it is important to bear that in mind when making a decision about whether or not to continue with one of these drugs during pregnancy. The health of the mother and the baby are both important. We hope that this study will provide both doctors and pregnant women on antidepressants with some of the information they need to help them make those difficult decisions,” Ornoy concluded.

For more information, please visit: www.blackwellpublishing.com.

Smoking Increases Depression In Women

A new study revealed that women who smoke are at greater risk of developing major depressive disorder; the study has been published in the British Journal of Psychiatry.

Researchers from the University of Melbourne and Barwon Health assessed a group of 1043 Australian women, whose health had been monitored for a decade as part of the Geelong Osteoporosis Study.On their ten year follow up participants were given an additional test of a psychiatric assessment.

“It was at this point we were able to determine if depression had developed and investigate whether or not smoking pre-dated the onset of depression” said University of Melbourne researcher, Associate Professor Julie Pasco, who led the study within the Clinical and Biomedical Sciences at Barwon Health.

Results revealed that women with depression were more likely to have been smokers than those without depression. Compared with non-smokers, the likelihood for developing depression more than doubled for heavy smokers (those who smoked more than 20 cigarettes a day).

The researchers also examined longitudinal data to determine the risk of women developing a new major depressive disorder over time.

A total of 671 women with no history of major depressive disorders were studied. Of the 87 women who were smokers, 13 – 15 percent – went on to develop major depressive disorder. However, among 584 non-smokers, just 38 – 6.5 percent – developed major depressive disorder during a decade of follow-up.

“This shows us that non smokers were at lower risk for developing major depressive disorder, suggesting that smoking may play a role in the development of the disease in women, “ Pasco said.

Previous research has shown that smoking is a risk factor for depression. There is also increasing evidence that smoking may aggravate mental illness or contribute to its onset. However, most previous studies have involved short time frames, and this study is the first to investigate smoking using longitudinal data that extends over a 10-year period.

The researchers observed that depression is a leading contributor to the global disease burden, and called for greater efforts to encourage smokers to quit.

For more information, please visit: www.unimelb.edu.au/.

Exercise Effective In Helping Pregnant Women Kick The Habit

Exercise could be a useful tool in helping pregnant women to give up smoking, according to new research. Despite the warnings, 17 percent of women in the UK and 20 percent of women in the US still admit to smoking during pregnancy.

This often leads to lower birth weight, higher infant mortality, and is linked to learning difficulties, problem behavior and asthma in childhood, said researchers.

Most attempts to give up smoking unaided end in failure. The most successful methods of stopping smoking involve a combination of nicotine replacement and behavioral therapy, but there are concerns that nicotine replacement may harm the fetus. Exercise can reduce the cravings experienced by smokers and there is some evidence to show that it can help non-pregnant women to quit.

Dr. Michael Ussher and colleagues from St George’s, University of London conducted two pilot studies into whether physical exercise could feasibly help pregnant women quit smoking.

For both studies, pregnant women over 18-years-old, who smoked at least a cigarette a day, were recruited 12 to 20 weeks into pregnancy. In one study, women did supervised exercise once a week for six weeks; in the other, women did two sessions of exercise a week for six weeks, then one session a week for three weeks. The participants were also encouraged to do additional exercise on their own and all received advice and counseling towards stopping smoking and becoming more active.

A quarter of the 32 women recruited for the studies gave up smoking before giving birth. This is similar to the number of non-pregnant smokers that quit using nicotine replacement. Furthermore, participants reported other positive benefits including weight loss, improved self-image and reduced cravings, said researchers.

According to Ussher, “these results are very encouraging and we are now conducting a randomized controlled trial with 850 women. Regular exercise is ideal for any pregnant women who smoke as it’s obviously safe and the benefits are enormous.”

For more information, please visit: www.alphagalileo.org.