Fran Lowry

Vulvovaginal atrophy, a condition that is readily treatable and can lead to serious urogynecologic problems if left untreated, is a taboo subject among women and their physicians.

Dr. James A. Simon, professor of obstetrics and gynecology at George Washington University in Washington, lays the blame for this “conspiracy of silence” on the shoulders of clinicians. But he also says that women should become proactive and lose their inhibitions about broaching the subject with their doctors.

“How can we do anything about this problem if women are reluctant to complain and ask for treatment, and their doctors don't even ask them about the health of their vaginas?” Dr. Simon said in an interview at the annual meeting of the North American Menopause Society.

He and his associates surveyed the attitudes of postmenopausal women to vulvovaginal atrophy and its symptoms in a random sample of 2,744 women 45 years of age and older who were culled from a database of 60,000 households throughout the United States. These women had all responded positively to a screening question that asked: “Are you postmenopausal and experiencing symptoms of vaginal discomfort, such as dryness, pain, irritation, itching, or similar symptoms?”

The women answered the questions online, “in the privacy of their own home, without the impediments of a clinical setting. Our hope was that the women would respond normally and that we would learn what their true attitudes were,” Dr. Simon explained.

Subjects were asked how their symptoms affected their sexual function, relationships with partners, self-esteem, and feelings of well-being, and then to rate how worrisome this was to them on a Likert scale ranging from 1 (not a problem) to 7 (a very significant problem).

Over half of the respondents (1,619 women) somewhat or strongly agreed that long-term vulvar/vaginal symptoms negatively affected their moods. One-third admitted their symptoms affected their self-esteem, and half said that their symptoms were making sexual intimacy a problem.

These women also admitted they were reluctant about initiating a conversation about vaginal dryness problems with their doctor. Close to half of those surveyed (49% or 1,345 women) said they would not bring it up, and the majority (72% or 1,976 women) said they had never been asked about vaginal dryness by their doctor.

When the women were asked if they would seek medical care for vulvovaginal atrophy if they knew that it was treatable and that left untreated, it could lead to long-term urologic complications, just half agreed they would bring it up with their practitioner.

“So we have a problem. Actually, we have two problems. One, patients know they have a condition that impacts their life, but half of them won't bring it up with their practitioners. And two-thirds of practitioners don't even bring it up with their patients,” said Dr. Simon.

He added that he is concerned by these findings. “Although it is exciting from a researcher's perspective to learn just how great the abyss is between having vulvovaginal atrophy and telling one's clinician about it, it bothers me that women are still so loathing of their vaginas that they won't even bring up the subject.”

The problem revealed in his survey may represent only the tip of the iceberg, because, unlike many postmenopausal women, the participants had access to computers. Many postmenopausal women do not own computers or even know how to use them, he said.

“We haven't done a good job of capturing those people, and we may actually have underestimated how bad the problem is because vaginal atrophy and its symptoms tend to get worse as women age. Aging Americans are having sex for sure, and we've probably missed many of them in this study because they're not Internet savvy,” Dr. Simon said.

Vulvovaginal atrophy, a condition that is readily treatable and can lead to serious urogynecologic problems if left untreated, is a taboo subject among women and their physicians.

Dr. James A. Simon, professor of obstetrics and gynecology at George Washington University in Washington, lays the blame for this “conspiracy of silence” on the shoulders of clinicians. But he also says that women should become proactive and lose their inhibitions about broaching the subject with their doctors.

“How can we do anything about this problem if women are reluctant to complain and ask for treatment, and their doctors don't even ask them about the health of their vaginas?” Dr. Simon said in an interview at the annual meeting of the North American Menopause Society.

He and his associates surveyed the attitudes of postmenopausal women to vulvovaginal atrophy and its symptoms in a random sample of 2,744 women 45 years of age and older who were culled from a database of 60,000 households throughout the United States. These women had all responded positively to a screening question that asked: “Are you postmenopausal and experiencing symptoms of vaginal discomfort, such as dryness, pain, irritation, itching, or similar symptoms?”

The women answered the questions online, “in the privacy of their own home, without the impediments of a clinical setting. Our hope was that the women would respond normally and that we would learn what their true attitudes were,” Dr. Simon explained.

Subjects were asked how their symptoms affected their sexual function, relationships with partners, self-esteem, and feelings of well-being, and then to rate how worrisome this was to them on a Likert scale ranging from 1 (not a problem) to 7 (a very significant problem).

Over half of the respondents (1,619 women) somewhat or strongly agreed that long-term vulvar/vaginal symptoms negatively affected their moods. One-third admitted their symptoms affected their self-esteem, and half said that their symptoms were making sexual intimacy a problem.

These women also admitted they were reluctant about initiating a conversation about vaginal dryness problems with their doctor. Close to half of those surveyed (49% or 1,345 women) said they would not bring it up, and the majority (72% or 1,976 women) said they had never been asked about vaginal dryness by their doctor.

When the women were asked if they would seek medical care for vulvovaginal atrophy if they knew that it was treatable and that left untreated, it could lead to long-term urologic complications, just half agreed they would bring it up with their practitioner.

“So we have a problem. Actually, we have two problems. One, patients know they have a condition that impacts their life, but half of them won't bring it up with their practitioners. And two-thirds of practitioners don't even bring it up with their patients,” said Dr. Simon.

He added that he is concerned by these findings. “Although it is exciting from a researcher's perspective to learn just how great the abyss is between having vulvovaginal atrophy and telling one's clinician about it, it bothers me that women are still so loathing of their vaginas that they won't even bring up the subject.”

The problem revealed in his survey may represent only the tip of the iceberg, because, unlike many postmenopausal women, the participants had access to computers. Many postmenopausal women do not own computers or even know how to use them, he said.

“We haven't done a good job of capturing those people, and we may actually have underestimated how bad the problem is because vaginal atrophy and its symptoms tend to get worse as women age. Aging Americans are having sex for sure, and we've probably missed many of them in this study because they're not Internet savvy,” Dr. Simon said.

Vulvovaginal atrophy, a condition that is readily treatable and can lead to serious urogynecologic problems if left untreated, is a taboo subject among women and their physicians.

Dr. James A. Simon, professor of obstetrics and gynecology at George Washington University in Washington, lays the blame for this “conspiracy of silence” on the shoulders of clinicians. But he also says that women should become proactive and lose their inhibitions about broaching the subject with their doctors.

“How can we do anything about this problem if women are reluctant to complain and ask for treatment, and their doctors don't even ask them about the health of their vaginas?” Dr. Simon said in an interview at the annual meeting of the North American Menopause Society.

He and his associates surveyed the attitudes of postmenopausal women to vulvovaginal atrophy and its symptoms in a random sample of 2,744 women 45 years of age and older who were culled from a database of 60,000 households throughout the United States. These women had all responded positively to a screening question that asked: “Are you postmenopausal and experiencing symptoms of vaginal discomfort, such as dryness, pain, irritation, itching, or similar symptoms?”

The women answered the questions online, “in the privacy of their own home, without the impediments of a clinical setting. Our hope was that the women would respond normally and that we would learn what their true attitudes were,” Dr. Simon explained.

Subjects were asked how their symptoms affected their sexual function, relationships with partners, self-esteem, and feelings of well-being, and then to rate how worrisome this was to them on a Likert scale ranging from 1 (not a problem) to 7 (a very significant problem).

Over half of the respondents (1,619 women) somewhat or strongly agreed that long-term vulvar/vaginal symptoms negatively affected their moods. One-third admitted their symptoms affected their self-esteem, and half said that their symptoms were making sexual intimacy a problem.

These women also admitted they were reluctant about initiating a conversation about vaginal dryness problems with their doctor. Close to half of those surveyed (49% or 1,345 women) said they would not bring it up, and the majority (72% or 1,976 women) said they had never been asked about vaginal dryness by their doctor.

When the women were asked if they would seek medical care for vulvovaginal atrophy if they knew that it was treatable and that left untreated, it could lead to long-term urologic complications, just half agreed they would bring it up with their practitioner.

“So we have a problem. Actually, we have two problems. One, patients know they have a condition that impacts their life, but half of them won't bring it up with their practitioners. And two-thirds of practitioners don't even bring it up with their patients,” said Dr. Simon.

He added that he is concerned by these findings. “Although it is exciting from a researcher's perspective to learn just how great the abyss is between having vulvovaginal atrophy and telling one's clinician about it, it bothers me that women are still so loathing of their vaginas that they won't even bring up the subject.”

The problem revealed in his survey may represent only the tip of the iceberg, because, unlike many postmenopausal women, the participants had access to computers. Many postmenopausal women do not own computers or even know how to use them, he said.

“We haven't done a good job of capturing those people, and we may actually have underestimated how bad the problem is because vaginal atrophy and its symptoms tend to get worse as women age. Aging Americans are having sex for sure, and we've probably missed many of them in this study because they're not Internet savvy,” Dr. Simon said.

NEW ORLEANS — The fat that surrounds the heart is associated with cardiac abnormalities, including low stroke volume and cardiac output, that are independent of body mass index, a study has found.

The finding casts doubt on the widespread practice of using body mass index (BMI) as an indicator of cardiovascular disease risk, Dr. Zhongjing Chen, of Boston University, said at the annual meeting of NAASO, the Obesity Society.

Dr. Chen and colleagues assessed 13 obese women with metabolic syndrome—but no recognized atherosclerosis—using magnetic resonance imaging. The patients' average age was 47 years (range 30–59).

The women had a mean BMI of 30 kg/m

“The limit for weight was 275 pounds, and for waist circumference 50 inches, because of the table weight and size limits of our scanner,” Dr. Chen said.

The researchers used special software that had been developed by Boston University's Center for Biomedical Imaging to calculate epicardial and periaortic fat and they then analyzed stroke volume, end diastolic wall mass, and ejection fraction, as well as flow volume and peak blood velocity.

Both stroke volume and cardiac output were negatively correlated with epicardial and periaortic fat, and this negative correlation was statistically significant. Ascending aorta compliance also worsened in the presence of epicardial and periaortic fat.

However, there were no correlations between stroke volume, cardiac output, or ascending aorta compliance and the subjects' BMI, Dr. Chen said.

“The major morbidities that are associated with metabolic syndrome and stroke and myocardial infarction. People have been correlating body mass index with these risks, but our results indicate that it's the fat stores around the heart that are important risk factors,” she said in an interview.

Dr. Chen added that MRI is noninvasive and therefore provides an excellent way of measuring epicardial fat and cardiovascular disease risk.

“Epicardial and periaortic fat can be directly detected and quantified with MRI to give us a good reading of cardiac function and vessel wall properties. We would like to see whether reducing those fat deposits is associated with improvements in cardiac or vascular function,” she said.

Dr. Chen added that more studies would be needed to address that question.

In this MRI, solid white areas around the heart and aorta show epicardial fat in a woman with a BMI of 44 kg/m

This woman, with a BMI of 34, has notably more epicardial and periaortic fat than the woman with the higher BMI. Photos courtesy Dr. Zhongjing Chen

NEW ORLEANS — The fat that surrounds the heart is associated with cardiac abnormalities, including low stroke volume and cardiac output, that are independent of body mass index, a study has found.

The finding casts doubt on the widespread practice of using body mass index (BMI) as an indicator of cardiovascular disease risk, Dr. Zhongjing Chen, of Boston University, said at the annual meeting of NAASO, the Obesity Society.

Dr. Chen and colleagues assessed 13 obese women with metabolic syndrome—but no recognized atherosclerosis—using magnetic resonance imaging. The patients' average age was 47 years (range 30–59).

The women had a mean BMI of 30 kg/m

“The limit for weight was 275 pounds, and for waist circumference 50 inches, because of the table weight and size limits of our scanner,” Dr. Chen said.

The researchers used special software that had been developed by Boston University's Center for Biomedical Imaging to calculate epicardial and periaortic fat and they then analyzed stroke volume, end diastolic wall mass, and ejection fraction, as well as flow volume and peak blood velocity.

Both stroke volume and cardiac output were negatively correlated with epicardial and periaortic fat, and this negative correlation was statistically significant. Ascending aorta compliance also worsened in the presence of epicardial and periaortic fat.

However, there were no correlations between stroke volume, cardiac output, or ascending aorta compliance and the subjects' BMI, Dr. Chen said.

“The major morbidities that are associated with metabolic syndrome and stroke and myocardial infarction. People have been correlating body mass index with these risks, but our results indicate that it's the fat stores around the heart that are important risk factors,” she said in an interview.

Dr. Chen added that MRI is noninvasive and therefore provides an excellent way of measuring epicardial fat and cardiovascular disease risk.

“Epicardial and periaortic fat can be directly detected and quantified with MRI to give us a good reading of cardiac function and vessel wall properties. We would like to see whether reducing those fat deposits is associated with improvements in cardiac or vascular function,” she said.

Dr. Chen added that more studies would be needed to address that question.

In this MRI, solid white areas around the heart and aorta show epicardial fat in a woman with a BMI of 44 kg/m

This woman, with a BMI of 34, has notably more epicardial and periaortic fat than the woman with the higher BMI. Photos courtesy Dr. Zhongjing Chen

NEW ORLEANS — The fat that surrounds the heart is associated with cardiac abnormalities, including low stroke volume and cardiac output, that are independent of body mass index, a study has found.

The finding casts doubt on the widespread practice of using body mass index (BMI) as an indicator of cardiovascular disease risk, Dr. Zhongjing Chen, of Boston University, said at the annual meeting of NAASO, the Obesity Society.

Dr. Chen and colleagues assessed 13 obese women with metabolic syndrome—but no recognized atherosclerosis—using magnetic resonance imaging. The patients' average age was 47 years (range 30–59).

The women had a mean BMI of 30 kg/m

“The limit for weight was 275 pounds, and for waist circumference 50 inches, because of the table weight and size limits of our scanner,” Dr. Chen said.

The researchers used special software that had been developed by Boston University's Center for Biomedical Imaging to calculate epicardial and periaortic fat and they then analyzed stroke volume, end diastolic wall mass, and ejection fraction, as well as flow volume and peak blood velocity.

Both stroke volume and cardiac output were negatively correlated with epicardial and periaortic fat, and this negative correlation was statistically significant. Ascending aorta compliance also worsened in the presence of epicardial and periaortic fat.

However, there were no correlations between stroke volume, cardiac output, or ascending aorta compliance and the subjects' BMI, Dr. Chen said.

“The major morbidities that are associated with metabolic syndrome and stroke and myocardial infarction. People have been correlating body mass index with these risks, but our results indicate that it's the fat stores around the heart that are important risk factors,” she said in an interview.

Dr. Chen added that MRI is noninvasive and therefore provides an excellent way of measuring epicardial fat and cardiovascular disease risk.

“Epicardial and periaortic fat can be directly detected and quantified with MRI to give us a good reading of cardiac function and vessel wall properties. We would like to see whether reducing those fat deposits is associated with improvements in cardiac or vascular function,” she said.

Dr. Chen added that more studies would be needed to address that question.

In this MRI, solid white areas around the heart and aorta show epicardial fat in a woman with a BMI of 44 kg/m

This woman, with a BMI of 34, has notably more epicardial and periaortic fat than the woman with the higher BMI. Photos courtesy Dr. Zhongjing Chen

TORONTO — Laparoscopic appendectomy in pregnant patients is as safe as open appendectomy and has several advantages, according to a review presented at the annual meeting of the Canadian Association of Thoracic Surgeons. A retrospective study of 40 cases of suspected appendicitis treated laparoscopically at St. François d'Assise Hospital in Quebec City showed that immediate complication rates and preterm labor rates were similar to those after open appendectomies, Dr. Patrice Lemieux said at the meeting.

The review, which Dr. Lemieux called the second-largest series of laparoscopic appendectomies in pregnancy in the literature, also showed that the laparoscopic approach was more versatile in cases where the appendix was displaced by the gravid uterus.

Appendicitis in pregnancy is a diagnostic challenge for the surgeon. CT scanning is not an option, and ultrasound is often suboptimal, said Dr. Lemieux, of Laval University, Quebec City.

He and his colleagues evaluated their institution's 10-year experience with laparoscopic appendectomy in 14 first-trimester, 20 second-trimester, and 6 third-trimester patients. They looked at the immediate preterm delivery rate, which they defined as delivery within 1 month of surgery, short-term complications, and pregnancy outcomes. The women were contacted by telephone if relevant information was missing in their charts.

Three women experienced minor complications—wound infection, cystitis, and ileus—and were treated with medication. Major complications occurred in two women: an intra-abdominal abscess and a uterine perforation. This patient did well and delivered a healthy baby at 36 weeks and 4 days, he added.

There were no cases of immediate preterm labor in the month following surgery. The mean delivery time was 38 weeks. No differences were found between trimesters of pregnancy in preterm labor rates, complication rates, or operative time. The mean operative time was 49 minutes.

There were no fetal mortalities, which contrasted with published rates of 5%–14%. This may have been because of the low perforated appendix rate—9%—in the series, Dr. Lemieux said.

TORONTO — Laparoscopic appendectomy in pregnant patients is as safe as open appendectomy and has several advantages, according to a review presented at the annual meeting of the Canadian Association of Thoracic Surgeons. A retrospective study of 40 cases of suspected appendicitis treated laparoscopically at St. François d'Assise Hospital in Quebec City showed that immediate complication rates and preterm labor rates were similar to those after open appendectomies, Dr. Patrice Lemieux said at the meeting.

The review, which Dr. Lemieux called the second-largest series of laparoscopic appendectomies in pregnancy in the literature, also showed that the laparoscopic approach was more versatile in cases where the appendix was displaced by the gravid uterus.

Appendicitis in pregnancy is a diagnostic challenge for the surgeon. CT scanning is not an option, and ultrasound is often suboptimal, said Dr. Lemieux, of Laval University, Quebec City.

He and his colleagues evaluated their institution's 10-year experience with laparoscopic appendectomy in 14 first-trimester, 20 second-trimester, and 6 third-trimester patients. They looked at the immediate preterm delivery rate, which they defined as delivery within 1 month of surgery, short-term complications, and pregnancy outcomes. The women were contacted by telephone if relevant information was missing in their charts.

Three women experienced minor complications—wound infection, cystitis, and ileus—and were treated with medication. Major complications occurred in two women: an intra-abdominal abscess and a uterine perforation. This patient did well and delivered a healthy baby at 36 weeks and 4 days, he added.

There were no cases of immediate preterm labor in the month following surgery. The mean delivery time was 38 weeks. No differences were found between trimesters of pregnancy in preterm labor rates, complication rates, or operative time. The mean operative time was 49 minutes.

There were no fetal mortalities, which contrasted with published rates of 5%–14%. This may have been because of the low perforated appendix rate—9%—in the series, Dr. Lemieux said.

TORONTO — Laparoscopic appendectomy in pregnant patients is as safe as open appendectomy and has several advantages, according to a review presented at the annual meeting of the Canadian Association of Thoracic Surgeons. A retrospective study of 40 cases of suspected appendicitis treated laparoscopically at St. François d'Assise Hospital in Quebec City showed that immediate complication rates and preterm labor rates were similar to those after open appendectomies, Dr. Patrice Lemieux said at the meeting.

The review, which Dr. Lemieux called the second-largest series of laparoscopic appendectomies in pregnancy in the literature, also showed that the laparoscopic approach was more versatile in cases where the appendix was displaced by the gravid uterus.

Appendicitis in pregnancy is a diagnostic challenge for the surgeon. CT scanning is not an option, and ultrasound is often suboptimal, said Dr. Lemieux, of Laval University, Quebec City.

He and his colleagues evaluated their institution's 10-year experience with laparoscopic appendectomy in 14 first-trimester, 20 second-trimester, and 6 third-trimester patients. They looked at the immediate preterm delivery rate, which they defined as delivery within 1 month of surgery, short-term complications, and pregnancy outcomes. The women were contacted by telephone if relevant information was missing in their charts.

Three women experienced minor complications—wound infection, cystitis, and ileus—and were treated with medication. Major complications occurred in two women: an intra-abdominal abscess and a uterine perforation. This patient did well and delivered a healthy baby at 36 weeks and 4 days, he added.

There were no cases of immediate preterm labor in the month following surgery. The mean delivery time was 38 weeks. No differences were found between trimesters of pregnancy in preterm labor rates, complication rates, or operative time. The mean operative time was 49 minutes.

There were no fetal mortalities, which contrasted with published rates of 5%–14%. This may have been because of the low perforated appendix rate—9%—in the series, Dr. Lemieux said.

Preliminary data from a phase II pilot study suggest that flaxseed may be a useful alternative to estrogen in the management of hot flashes, according to Dr. Sandhya Pruthi of the Mayo Clinic, Rochester, Minn., and associates.

A 6-week regimen of crushed flaxseed, given at 40 g daily, decreased the number of hot flashes from a mean of 7.3 per day to 3.6 per day in women who did not wish to receive estrogen therapy, Dr. Pruthi and associates reported in the Journal of the Society for Integrative Oncology.

Estrogen therapy has been the effective hot-flash treatment most commonly used, but fears that it may cause breast cancer have made many postmenopausal women reluctant to take it for their menopausal symptoms. Their concerns have prompted a search for nonhormonal alternatives.

The authors tested the tolerability and effect of flaxseed therapy in 28 women who had at least 14 bothersome hot flashes per week for more than 1 month before study entry. Participants were instructed to sprinkle 2 tablespoons of crushed flaxseed on cereal, in juice, in yogurt, or on fruit twice daily for 6 weeks. Each tablespoon provided 10 g of flaxseed, and the women were instructed to drink at least 150 mL of liquid for each 10 g of flaxseed they consumed (J. Soc. Integr. Oncol. 2007;5:106–12).

In the last week of flaxseed therapy, the hot-flash score—a measure of hot-flash frequency and severity—decreased by a mean of 57%, with a median decrease of 62%. The mean decrease in the number of hot flashes per day (from 7.3 to 3.6) was significant. Participants also reported a statistically significant improvement in quality of life, with less anger, anxiety, and fatigue at the end of the trial than at the beginning.

Abdominal distention or bloating was experienced by half of the women at some time during the study, and six women failed to complete the full 6 weeks of flaxseed therapy because of abdominal toxicities, weight gain, or taste intolerance, the authors reported. “These issues need to be evaluated further in a placebo-controlled manner. It is possible that initiating flaxseed therapy at a lower dose—and titrating the dose upward—may decrease abdominal toxicities,” Dr. Pruthi and associates wrote.

Flaxseed contains weak estrogenic properties that “seem to account for the most likely mechanism of its effectiveness in reducing hot-flash activity,” according to the investigators.

Preliminary data from a phase II pilot study suggest that flaxseed may be a useful alternative to estrogen in the management of hot flashes, according to Dr. Sandhya Pruthi of the Mayo Clinic, Rochester, Minn., and associates.

A 6-week regimen of crushed flaxseed, given at 40 g daily, decreased the number of hot flashes from a mean of 7.3 per day to 3.6 per day in women who did not wish to receive estrogen therapy, Dr. Pruthi and associates reported in the Journal of the Society for Integrative Oncology.

Estrogen therapy has been the effective hot-flash treatment most commonly used, but fears that it may cause breast cancer have made many postmenopausal women reluctant to take it for their menopausal symptoms. Their concerns have prompted a search for nonhormonal alternatives.

The authors tested the tolerability and effect of flaxseed therapy in 28 women who had at least 14 bothersome hot flashes per week for more than 1 month before study entry. Participants were instructed to sprinkle 2 tablespoons of crushed flaxseed on cereal, in juice, in yogurt, or on fruit twice daily for 6 weeks. Each tablespoon provided 10 g of flaxseed, and the women were instructed to drink at least 150 mL of liquid for each 10 g of flaxseed they consumed (J. Soc. Integr. Oncol. 2007;5:106–12).

In the last week of flaxseed therapy, the hot-flash score—a measure of hot-flash frequency and severity—decreased by a mean of 57%, with a median decrease of 62%. The mean decrease in the number of hot flashes per day (from 7.3 to 3.6) was significant. Participants also reported a statistically significant improvement in quality of life, with less anger, anxiety, and fatigue at the end of the trial than at the beginning.

Abdominal distention or bloating was experienced by half of the women at some time during the study, and six women failed to complete the full 6 weeks of flaxseed therapy because of abdominal toxicities, weight gain, or taste intolerance, the authors reported. “These issues need to be evaluated further in a placebo-controlled manner. It is possible that initiating flaxseed therapy at a lower dose—and titrating the dose upward—may decrease abdominal toxicities,” Dr. Pruthi and associates wrote.

Flaxseed contains weak estrogenic properties that “seem to account for the most likely mechanism of its effectiveness in reducing hot-flash activity,” according to the investigators.

Preliminary data from a phase II pilot study suggest that flaxseed may be a useful alternative to estrogen in the management of hot flashes, according to Dr. Sandhya Pruthi of the Mayo Clinic, Rochester, Minn., and associates.

A 6-week regimen of crushed flaxseed, given at 40 g daily, decreased the number of hot flashes from a mean of 7.3 per day to 3.6 per day in women who did not wish to receive estrogen therapy, Dr. Pruthi and associates reported in the Journal of the Society for Integrative Oncology.

Estrogen therapy has been the effective hot-flash treatment most commonly used, but fears that it may cause breast cancer have made many postmenopausal women reluctant to take it for their menopausal symptoms. Their concerns have prompted a search for nonhormonal alternatives.

The authors tested the tolerability and effect of flaxseed therapy in 28 women who had at least 14 bothersome hot flashes per week for more than 1 month before study entry. Participants were instructed to sprinkle 2 tablespoons of crushed flaxseed on cereal, in juice, in yogurt, or on fruit twice daily for 6 weeks. Each tablespoon provided 10 g of flaxseed, and the women were instructed to drink at least 150 mL of liquid for each 10 g of flaxseed they consumed (J. Soc. Integr. Oncol. 2007;5:106–12).

In the last week of flaxseed therapy, the hot-flash score—a measure of hot-flash frequency and severity—decreased by a mean of 57%, with a median decrease of 62%. The mean decrease in the number of hot flashes per day (from 7.3 to 3.6) was significant. Participants also reported a statistically significant improvement in quality of life, with less anger, anxiety, and fatigue at the end of the trial than at the beginning.

Abdominal distention or bloating was experienced by half of the women at some time during the study, and six women failed to complete the full 6 weeks of flaxseed therapy because of abdominal toxicities, weight gain, or taste intolerance, the authors reported. “These issues need to be evaluated further in a placebo-controlled manner. It is possible that initiating flaxseed therapy at a lower dose—and titrating the dose upward—may decrease abdominal toxicities,” Dr. Pruthi and associates wrote.

Flaxseed contains weak estrogenic properties that “seem to account for the most likely mechanism of its effectiveness in reducing hot-flash activity,” according to the investigators.

CHICAGO — Ductal carcinoma in situ is associated with good long-term disease-specific survival, although the small percentage of tumors that do recur—particularly after radiotherapy—confers an increased risk of death.

The good outcomes were seen in two studies presented at the annual meeting of the American Society of Clinical Oncology. In a retrospective study of more than 50,000 women with ductal carcinoma in situ (DCIS) treated with total mastectomy or breast-conserving surgery plus radiation between 1988 and 2003, both treatments yielded similar 10-year disease-specific survival rates by Cox multivariate analysis, said Dr. Mohammed Nazir Ibrahim of Sligo General Hospital, Ireland.

The investigators analyzed the Surveillance, Epidemiology, and End Results (SEER) dataset of 543,261 individuals with invasive and noninvasive breast tumors.

Of these, 88,285 were in situ tumors; 33% of patients had total mastectomies and 30% had breast-conserving surgery (lumpectomy) with radiotherapy. Nearly all of the remaining patients had breast-conserving therapy only; 2.4% did not undergo surgery or radiotherapy, and 0.3% had radiotherapy only.

Women treated in the early part of the study were more likely to have total mastectomies, but breast-conserving surgery plus radiation became more common over time, he noted.

The analysis also revealed that the diagnosis of carcinoma in situ is increasing in the United States at a rate of 0.5% annually, Dr. Ibrahim said.

Tumor grade, ethnicity, and receptor status were found to be important prognostic factors in disease-specific survival.

Grade IV tumors had a hazard ratio (HR) of 1.7 compared with grade I tumors, African Americans had a more than twofold risk of death compared with Caucasians (HR 2.1), and hormone receptor-negative status likewise conferred a twofold increase in the risk of death (HR 2.2).

In another study, Dr. Irene Wapnir of the Stanford (Calif.) Comprehensive Cancer Center presented long-term outcomes after invasive breast tumor recurrence in women with primary DCIS in National Surgical Adjuvant Breast and Bowel Project trials B-17 and B-24.

The two trials included 2,612 women randomized between 1985 and 1994 to either lumpectomy alone or lumpectomy plus whole-breast irradiation (B-17), or to lumpectomy plus whole-breast irradiation with or without tamoxifen (B-24). The median follow-up was more than 12 years.

There were 336 deaths, 83 of which were from breast cancer. However, the breast cancer deaths included deaths that were potentially due to contralateral breast cancers, Dr. Wapnir said.

Breast cancer-specific survival ranged from 96% to 98%, and patients receiving lumpectomy, radiation, and tamoxifen had the best survival.

Adding radiation therapy reduced the risk of an invasive breast tumor recurrence by 59%, and adding tamoxifen to lumpectomy plus radiation further reduced the risk of an invasive breast cancer recurrence, Dr. Wapnir said.

Although overall mortality was low, the subsequent recurrence of an invasive breast tumor doubled the risk of death. Mortality risk was even higher for women who received lumpectomy plus whole-breast irradiation, Dr. Wapnir said. (See chart, below right.)

Among 242 cases of invasive breast tumor recurrence, there were 35 deaths, 22 of which were breast cancer-related. Of these deaths, 9 occurred in the lumpectomy-alone patients, 21 in the lumpectomy plus radiation patients, and 5 in the lumpectomy plus radiation plus tamoxifen patients. (See chart, below left.)

Although the recurrence of invasive breast tumor is the most common first-failure event in lumpectomy-treated patients with DCIS, overall breast cancer-specific mortality for all treatment modalities in the two trials is low, Dr. Wapnir concluded.

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — Ductal carcinoma in situ is associated with good long-term disease-specific survival, although the small percentage of tumors that do recur—particularly after radiotherapy—confers an increased risk of death.

The good outcomes were seen in two studies presented at the annual meeting of the American Society of Clinical Oncology. In a retrospective study of more than 50,000 women with ductal carcinoma in situ (DCIS) treated with total mastectomy or breast-conserving surgery plus radiation between 1988 and 2003, both treatments yielded similar 10-year disease-specific survival rates by Cox multivariate analysis, said Dr. Mohammed Nazir Ibrahim of Sligo General Hospital, Ireland.

The investigators analyzed the Surveillance, Epidemiology, and End Results (SEER) dataset of 543,261 individuals with invasive and noninvasive breast tumors.

Of these, 88,285 were in situ tumors; 33% of patients had total mastectomies and 30% had breast-conserving surgery (lumpectomy) with radiotherapy. Nearly all of the remaining patients had breast-conserving therapy only; 2.4% did not undergo surgery or radiotherapy, and 0.3% had radiotherapy only.

Women treated in the early part of the study were more likely to have total mastectomies, but breast-conserving surgery plus radiation became more common over time, he noted.

The analysis also revealed that the diagnosis of carcinoma in situ is increasing in the United States at a rate of 0.5% annually, Dr. Ibrahim said.

Tumor grade, ethnicity, and receptor status were found to be important prognostic factors in disease-specific survival.

Grade IV tumors had a hazard ratio (HR) of 1.7 compared with grade I tumors, African Americans had a more than twofold risk of death compared with Caucasians (HR 2.1), and hormone receptor-negative status likewise conferred a twofold increase in the risk of death (HR 2.2).

In another study, Dr. Irene Wapnir of the Stanford (Calif.) Comprehensive Cancer Center presented long-term outcomes after invasive breast tumor recurrence in women with primary DCIS in National Surgical Adjuvant Breast and Bowel Project trials B-17 and B-24.

The two trials included 2,612 women randomized between 1985 and 1994 to either lumpectomy alone or lumpectomy plus whole-breast irradiation (B-17), or to lumpectomy plus whole-breast irradiation with or without tamoxifen (B-24). The median follow-up was more than 12 years.

There were 336 deaths, 83 of which were from breast cancer. However, the breast cancer deaths included deaths that were potentially due to contralateral breast cancers, Dr. Wapnir said.

Breast cancer-specific survival ranged from 96% to 98%, and patients receiving lumpectomy, radiation, and tamoxifen had the best survival.

Adding radiation therapy reduced the risk of an invasive breast tumor recurrence by 59%, and adding tamoxifen to lumpectomy plus radiation further reduced the risk of an invasive breast cancer recurrence, Dr. Wapnir said.

Although overall mortality was low, the subsequent recurrence of an invasive breast tumor doubled the risk of death. Mortality risk was even higher for women who received lumpectomy plus whole-breast irradiation, Dr. Wapnir said. (See chart, below right.)

Among 242 cases of invasive breast tumor recurrence, there were 35 deaths, 22 of which were breast cancer-related. Of these deaths, 9 occurred in the lumpectomy-alone patients, 21 in the lumpectomy plus radiation patients, and 5 in the lumpectomy plus radiation plus tamoxifen patients. (See chart, below left.)

Although the recurrence of invasive breast tumor is the most common first-failure event in lumpectomy-treated patients with DCIS, overall breast cancer-specific mortality for all treatment modalities in the two trials is low, Dr. Wapnir concluded.

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — Ductal carcinoma in situ is associated with good long-term disease-specific survival, although the small percentage of tumors that do recur—particularly after radiotherapy—confers an increased risk of death.

The good outcomes were seen in two studies presented at the annual meeting of the American Society of Clinical Oncology. In a retrospective study of more than 50,000 women with ductal carcinoma in situ (DCIS) treated with total mastectomy or breast-conserving surgery plus radiation between 1988 and 2003, both treatments yielded similar 10-year disease-specific survival rates by Cox multivariate analysis, said Dr. Mohammed Nazir Ibrahim of Sligo General Hospital, Ireland.

The investigators analyzed the Surveillance, Epidemiology, and End Results (SEER) dataset of 543,261 individuals with invasive and noninvasive breast tumors.

Of these, 88,285 were in situ tumors; 33% of patients had total mastectomies and 30% had breast-conserving surgery (lumpectomy) with radiotherapy. Nearly all of the remaining patients had breast-conserving therapy only; 2.4% did not undergo surgery or radiotherapy, and 0.3% had radiotherapy only.

Women treated in the early part of the study were more likely to have total mastectomies, but breast-conserving surgery plus radiation became more common over time, he noted.

The analysis also revealed that the diagnosis of carcinoma in situ is increasing in the United States at a rate of 0.5% annually, Dr. Ibrahim said.

Tumor grade, ethnicity, and receptor status were found to be important prognostic factors in disease-specific survival.

Grade IV tumors had a hazard ratio (HR) of 1.7 compared with grade I tumors, African Americans had a more than twofold risk of death compared with Caucasians (HR 2.1), and hormone receptor-negative status likewise conferred a twofold increase in the risk of death (HR 2.2).

In another study, Dr. Irene Wapnir of the Stanford (Calif.) Comprehensive Cancer Center presented long-term outcomes after invasive breast tumor recurrence in women with primary DCIS in National Surgical Adjuvant Breast and Bowel Project trials B-17 and B-24.

The two trials included 2,612 women randomized between 1985 and 1994 to either lumpectomy alone or lumpectomy plus whole-breast irradiation (B-17), or to lumpectomy plus whole-breast irradiation with or without tamoxifen (B-24). The median follow-up was more than 12 years.

There were 336 deaths, 83 of which were from breast cancer. However, the breast cancer deaths included deaths that were potentially due to contralateral breast cancers, Dr. Wapnir said.

Breast cancer-specific survival ranged from 96% to 98%, and patients receiving lumpectomy, radiation, and tamoxifen had the best survival.

Adding radiation therapy reduced the risk of an invasive breast tumor recurrence by 59%, and adding tamoxifen to lumpectomy plus radiation further reduced the risk of an invasive breast cancer recurrence, Dr. Wapnir said.

Although overall mortality was low, the subsequent recurrence of an invasive breast tumor doubled the risk of death. Mortality risk was even higher for women who received lumpectomy plus whole-breast irradiation, Dr. Wapnir said. (See chart, below right.)

Among 242 cases of invasive breast tumor recurrence, there were 35 deaths, 22 of which were breast cancer-related. Of these deaths, 9 occurred in the lumpectomy-alone patients, 21 in the lumpectomy plus radiation patients, and 5 in the lumpectomy plus radiation plus tamoxifen patients. (See chart, below left.)

Although the recurrence of invasive breast tumor is the most common first-failure event in lumpectomy-treated patients with DCIS, overall breast cancer-specific mortality for all treatment modalities in the two trials is low, Dr. Wapnir concluded.

ELSEVIER GLOBAL MEDICAL NEWS

ELSEVIER GLOBAL MEDICAL NEWS

CHICAGO — Once bone pain appears in patients with hormone-refractory prostate cancer, it is often too late for docetaxel therapy to have an impact on their survival, according to a poster presentation at the annual meeting of the American Society of Clinical Oncology.

For this reason, docetaxel (Taxotere) should be started earlier, when it can do some good, said Dr. Stéphane Oudard, professor of medicine at Georges Pompidou European Hospital, Paris.

He and his colleagues conducted a retrospective analysis of 145 consecutive chemotherapy-naive, hormone-refractory prostate cancer patients. The median 3-year survival rate for 25 patients with moderate or severe pain within the 90 days of starting chemotherapy was 4% vs. 11% for 41 patients who had mild pain, and 29% for the 79 patients who had no or minimal pain. One-year survival was 52%, 56%, and 75%, respectively.

Patients with minimal or no pain survived a median of 21.4 months; those with mild bone pain 15 months, and those with moderate or severe pain 13.1 months.

Bone pain in hormone-resistant prostate cancer patients is usually associated with poor Eastern Cooperative Oncology Group (ECOG) performance status, short prostate-specific antigen (PSA) doubling time, more aggressive disease, and worse prognosis. The study was designed to explore the impact of the presence and intensity of bone pain on overall survival, and also to test the link between PSA doubling time and survival of patients with minimal or no pain.

To do so, the researchers retrospectively analyzed their institution's database of 145 consecutive chemotherapy-naive patients who had failed androgen blockade and anti-androgen withdrawal. Patients had an ECOG performance status of 2 or less and were treated with docetaxel 70–75 mg/m

CHICAGO — Once bone pain appears in patients with hormone-refractory prostate cancer, it is often too late for docetaxel therapy to have an impact on their survival, according to a poster presentation at the annual meeting of the American Society of Clinical Oncology.

For this reason, docetaxel (Taxotere) should be started earlier, when it can do some good, said Dr. Stéphane Oudard, professor of medicine at Georges Pompidou European Hospital, Paris.

He and his colleagues conducted a retrospective analysis of 145 consecutive chemotherapy-naive, hormone-refractory prostate cancer patients. The median 3-year survival rate for 25 patients with moderate or severe pain within the 90 days of starting chemotherapy was 4% vs. 11% for 41 patients who had mild pain, and 29% for the 79 patients who had no or minimal pain. One-year survival was 52%, 56%, and 75%, respectively.

Patients with minimal or no pain survived a median of 21.4 months; those with mild bone pain 15 months, and those with moderate or severe pain 13.1 months.

Bone pain in hormone-resistant prostate cancer patients is usually associated with poor Eastern Cooperative Oncology Group (ECOG) performance status, short prostate-specific antigen (PSA) doubling time, more aggressive disease, and worse prognosis. The study was designed to explore the impact of the presence and intensity of bone pain on overall survival, and also to test the link between PSA doubling time and survival of patients with minimal or no pain.

To do so, the researchers retrospectively analyzed their institution's database of 145 consecutive chemotherapy-naive patients who had failed androgen blockade and anti-androgen withdrawal. Patients had an ECOG performance status of 2 or less and were treated with docetaxel 70–75 mg/m

CHICAGO — Once bone pain appears in patients with hormone-refractory prostate cancer, it is often too late for docetaxel therapy to have an impact on their survival, according to a poster presentation at the annual meeting of the American Society of Clinical Oncology.

For this reason, docetaxel (Taxotere) should be started earlier, when it can do some good, said Dr. Stéphane Oudard, professor of medicine at Georges Pompidou European Hospital, Paris.

He and his colleagues conducted a retrospective analysis of 145 consecutive chemotherapy-naive, hormone-refractory prostate cancer patients. The median 3-year survival rate for 25 patients with moderate or severe pain within the 90 days of starting chemotherapy was 4% vs. 11% for 41 patients who had mild pain, and 29% for the 79 patients who had no or minimal pain. One-year survival was 52%, 56%, and 75%, respectively.

Patients with minimal or no pain survived a median of 21.4 months; those with mild bone pain 15 months, and those with moderate or severe pain 13.1 months.

Bone pain in hormone-resistant prostate cancer patients is usually associated with poor Eastern Cooperative Oncology Group (ECOG) performance status, short prostate-specific antigen (PSA) doubling time, more aggressive disease, and worse prognosis. The study was designed to explore the impact of the presence and intensity of bone pain on overall survival, and also to test the link between PSA doubling time and survival of patients with minimal or no pain.

To do so, the researchers retrospectively analyzed their institution's database of 145 consecutive chemotherapy-naive patients who had failed androgen blockade and anti-androgen withdrawal. Patients had an ECOG performance status of 2 or less and were treated with docetaxel 70–75 mg/m

CHICAGO — A prospective analysis of a phase II Eastern Cooperative Oncology Group study confirms what has up to now been reported only in retrospective, single-institution studies: head and neck squamous cell cancer patients infected with the human papilloma virus have significantly better survival than do their counterparts without the virus.

Human papilloma virus (HPV) positivity conferred a 79% lower risk of death in the multicenter ECOG 2399 study, Dr. Carole Fakhry reported at the annual meeting of the American Society of Clinical Oncology. She said HPV status should now be considered a biomarker for prognosis in head and neck squamous cell cancer (HNSCC). Moreover, these results may necessitate a reinterpretation of survival rates in previous trials to determine whether survival differences were in fact due to HPV status, rather than to the actual therapy that was used, according to Dr. Fakhry of the Johns Hopkins Medical Institutions in Baltimore.

The primary objective of ECOG 2399 was to assess organ preservation with taxane-based induction chemotherapy followed by taxane-based concurrent chemoradiation in resectable stage III and IV larynx and oropharyngeal cancer patients. The trial also sought to estimate disease-free survival and patterns of failure.

Dr. Fakhry and associates evaluated pathologic tissue samples from 96 study participants for the presence of HPV infection, then determined prognostic factors, treatment response, and survival outcomes in terms of HPV status.

HPV status—in particular HPV-16, the dominant viral isolate known to be responsible for a subset of HNSCC—was assessed with in situ hybridization, polymerase chain reaction, and line blot tests. These tests also screened for HPV-31, 33, and 35, which are the other isolates that have been linked to HNSCC.

A total of 40% of patients (38) were found to be HPV positive, and all had oropharyngeal tumors. They were more likely to have a better ECOG performance status and lower cumulative lifetime exposure to smoking than were HPV-negative patients. They were also more likely to be male, have less weight loss on presentation, and present with a stage T2 tumor, Dr. Fakhry reported.

HPV-positive patients had a higher response to induction and chemoradiation therapy. Response rates after induction chemotherapy were 81.6% for HPV-positive patients vs. 55.2% for HPV-negative patients (p=0.01). After chemoradiotherapy, they were 84.2% vs. 56.9%, respectively (p=0.07).

At a median follow-up of 39 months, progression risk was 72% lower and risk of death was 79% lower in HPV-positive patients, compared with HPV-negative patients. These figures were derived from a Cox proportional hazards model, Dr. Fakhry said.

Discussant Thomas F. Pajak, Ph.D., of the Radiation Therapy Oncology Group in Philadelphia said these results are impressive at first glance, but that he was troubled by the Cox analysis in the trial. He proposed that the investigators generate a new Cox model, restrict it only to oropharyngeal patients, and compare HPV status to no more than three other factors in order to obtain a new, and more reliable, estimate of the risk of death. "A Cox model with too many variables in it is unreliable," he said.

In another presentation that looked at HPV-associated HNSCC, Dr. Anil K. Chaturvedi of the National Cancer Institute reported that HPV-related HNSCC has increased in the United States during the last three decades, particularly among white men aged 40-59 years.

Using data from the Surveillance, Epidemiology, and End Results (SEER) registry for the period 1973-2003, Dr. Chaturvedi and co-investigators also found that HPV-related HNSCCs were being diagnosed at more advanced stages and at significantly younger ages. These trends became apparent in the early 1990s. Meanwhile, the incidence of cancers not related to HPV decreased in both men and women, especially in those over the age of 40.

He said the increasing incidence of HPV-linked HNSCC could be due to changes in sexual behavior, and that the decreasing incidence of cancers not related to HPV could be due to the decreased prevalence of smoking.

CHICAGO — A prospective analysis of a phase II Eastern Cooperative Oncology Group study confirms what has up to now been reported only in retrospective, single-institution studies: head and neck squamous cell cancer patients infected with the human papilloma virus have significantly better survival than do their counterparts without the virus.

Human papilloma virus (HPV) positivity conferred a 79% lower risk of death in the multicenter ECOG 2399 study, Dr. Carole Fakhry reported at the annual meeting of the American Society of Clinical Oncology. She said HPV status should now be considered a biomarker for prognosis in head and neck squamous cell cancer (HNSCC). Moreover, these results may necessitate a reinterpretation of survival rates in previous trials to determine whether survival differences were in fact due to HPV status, rather than to the actual therapy that was used, according to Dr. Fakhry of the Johns Hopkins Medical Institutions in Baltimore.

The primary objective of ECOG 2399 was to assess organ preservation with taxane-based induction chemotherapy followed by taxane-based concurrent chemoradiation in resectable stage III and IV larynx and oropharyngeal cancer patients. The trial also sought to estimate disease-free survival and patterns of failure.

Dr. Fakhry and associates evaluated pathologic tissue samples from 96 study participants for the presence of HPV infection, then determined prognostic factors, treatment response, and survival outcomes in terms of HPV status.

HPV status—in particular HPV-16, the dominant viral isolate known to be responsible for a subset of HNSCC—was assessed with in situ hybridization, polymerase chain reaction, and line blot tests. These tests also screened for HPV-31, 33, and 35, which are the other isolates that have been linked to HNSCC.

A total of 40% of patients (38) were found to be HPV positive, and all had oropharyngeal tumors. They were more likely to have a better ECOG performance status and lower cumulative lifetime exposure to smoking than were HPV-negative patients. They were also more likely to be male, have less weight loss on presentation, and present with a stage T2 tumor, Dr. Fakhry reported.

HPV-positive patients had a higher response to induction and chemoradiation therapy. Response rates after induction chemotherapy were 81.6% for HPV-positive patients vs. 55.2% for HPV-negative patients (p=0.01). After chemoradiotherapy, they were 84.2% vs. 56.9%, respectively (p=0.07).

At a median follow-up of 39 months, progression risk was 72% lower and risk of death was 79% lower in HPV-positive patients, compared with HPV-negative patients. These figures were derived from a Cox proportional hazards model, Dr. Fakhry said.

Discussant Thomas F. Pajak, Ph.D., of the Radiation Therapy Oncology Group in Philadelphia said these results are impressive at first glance, but that he was troubled by the Cox analysis in the trial. He proposed that the investigators generate a new Cox model, restrict it only to oropharyngeal patients, and compare HPV status to no more than three other factors in order to obtain a new, and more reliable, estimate of the risk of death. "A Cox model with too many variables in it is unreliable," he said.

In another presentation that looked at HPV-associated HNSCC, Dr. Anil K. Chaturvedi of the National Cancer Institute reported that HPV-related HNSCC has increased in the United States during the last three decades, particularly among white men aged 40-59 years.

Using data from the Surveillance, Epidemiology, and End Results (SEER) registry for the period 1973-2003, Dr. Chaturvedi and co-investigators also found that HPV-related HNSCCs were being diagnosed at more advanced stages and at significantly younger ages. These trends became apparent in the early 1990s. Meanwhile, the incidence of cancers not related to HPV decreased in both men and women, especially in those over the age of 40.

He said the increasing incidence of HPV-linked HNSCC could be due to changes in sexual behavior, and that the decreasing incidence of cancers not related to HPV could be due to the decreased prevalence of smoking.

CHICAGO — A prospective analysis of a phase II Eastern Cooperative Oncology Group study confirms what has up to now been reported only in retrospective, single-institution studies: head and neck squamous cell cancer patients infected with the human papilloma virus have significantly better survival than do their counterparts without the virus.

Human papilloma virus (HPV) positivity conferred a 79% lower risk of death in the multicenter ECOG 2399 study, Dr. Carole Fakhry reported at the annual meeting of the American Society of Clinical Oncology. She said HPV status should now be considered a biomarker for prognosis in head and neck squamous cell cancer (HNSCC). Moreover, these results may necessitate a reinterpretation of survival rates in previous trials to determine whether survival differences were in fact due to HPV status, rather than to the actual therapy that was used, according to Dr. Fakhry of the Johns Hopkins Medical Institutions in Baltimore.

The primary objective of ECOG 2399 was to assess organ preservation with taxane-based induction chemotherapy followed by taxane-based concurrent chemoradiation in resectable stage III and IV larynx and oropharyngeal cancer patients. The trial also sought to estimate disease-free survival and patterns of failure.

Dr. Fakhry and associates evaluated pathologic tissue samples from 96 study participants for the presence of HPV infection, then determined prognostic factors, treatment response, and survival outcomes in terms of HPV status.

HPV status—in particular HPV-16, the dominant viral isolate known to be responsible for a subset of HNSCC—was assessed with in situ hybridization, polymerase chain reaction, and line blot tests. These tests also screened for HPV-31, 33, and 35, which are the other isolates that have been linked to HNSCC.

A total of 40% of patients (38) were found to be HPV positive, and all had oropharyngeal tumors. They were more likely to have a better ECOG performance status and lower cumulative lifetime exposure to smoking than were HPV-negative patients. They were also more likely to be male, have less weight loss on presentation, and present with a stage T2 tumor, Dr. Fakhry reported.

HPV-positive patients had a higher response to induction and chemoradiation therapy. Response rates after induction chemotherapy were 81.6% for HPV-positive patients vs. 55.2% for HPV-negative patients (p=0.01). After chemoradiotherapy, they were 84.2% vs. 56.9%, respectively (p=0.07).

At a median follow-up of 39 months, progression risk was 72% lower and risk of death was 79% lower in HPV-positive patients, compared with HPV-negative patients. These figures were derived from a Cox proportional hazards model, Dr. Fakhry said.

Discussant Thomas F. Pajak, Ph.D., of the Radiation Therapy Oncology Group in Philadelphia said these results are impressive at first glance, but that he was troubled by the Cox analysis in the trial. He proposed that the investigators generate a new Cox model, restrict it only to oropharyngeal patients, and compare HPV status to no more than three other factors in order to obtain a new, and more reliable, estimate of the risk of death. "A Cox model with too many variables in it is unreliable," he said.

In another presentation that looked at HPV-associated HNSCC, Dr. Anil K. Chaturvedi of the National Cancer Institute reported that HPV-related HNSCC has increased in the United States during the last three decades, particularly among white men aged 40-59 years.

Using data from the Surveillance, Epidemiology, and End Results (SEER) registry for the period 1973-2003, Dr. Chaturvedi and co-investigators also found that HPV-related HNSCCs were being diagnosed at more advanced stages and at significantly younger ages. These trends became apparent in the early 1990s. Meanwhile, the incidence of cancers not related to HPV decreased in both men and women, especially in those over the age of 40.

He said the increasing incidence of HPV-linked HNSCC could be due to changes in sexual behavior, and that the decreasing incidence of cancers not related to HPV could be due to the decreased prevalence of smoking.

CHICAGO – No increase was seen in the cumulative incidence of cardiac dysfunction associated with trastuzumab for HER2-positive, node-positive breast cancer after 5 years of follow-up, said Dr. Priya Rastogi, who reported on behalf of the National Surgical Adjuvant Breast and Bowel Project B-31 trial.

Updated results of the NSABP B-31 trial, which compared treatment regimens with and without trastuzumab (Herceptin), showed that the incidence of cardiac events in patients taking trastuzumab remained essentially unchanged from its value 2 years before, at 3.8%, Dr. Rastogi said at the annual meeting of the American Society of Clinical Oncology.

Trastuzumab, a monoclonal antibody that blocks human epidermal growth factor receptor 2 (HER2) from instigating the growth of breast cancer cells, has been a major advance in the treatment of both early- and late-stage breast cancer, but at the price of increased cardiotoxicity.

In the original NSABP B-31 trial (N. Engl. J. Med. 2005;353:1673-84), the addition of trastuzumab significantly improved 3-year disease-free survival and overall survival when combined with anthracycline-based chemotherapy plus paclitaxel.

However, the incidence of cardiotoxicity, specifically congestive heart failure, among the 850 patients randomized to the regimen with trastuzumab, was 4.1%, compared with 0.8% among the 814 patients who did not get trastuzumab (J. Clin. Oncol. 2005;23:7811-9).

With an additional 2 years of follow-up, the cumulative incidence of cardiac events in the patients who received chemotherapy plus trastuzumab was 3.8%, compared with 0.9% in those who received chemotherapy alone.

Importantly, the majority of patients who had a decline in cardiac function experienced a recovery in ejection fraction within 18 months of taking trastuzumab.

“We were very heartened by this result,” Dr. Rastogi, also of the University of Pittsburgh Medical Center, said at a press briefing.

The update also allowed the NSABP investigators to create a model to predict which women would be most likely to develop cardiotoxicity from trastuzumab. (See box.) Age, use of antihypertensive medications, and poor heart function as measured by a low ejection fraction at baseline were the most important predictors of risk.

“Incorporating these factors into the model allows us to calculate a cardiac risk score, which gives a percentage of risk of a cardiac event within 3 years. This is important because it now lets us choose trastuzumab-containing regimens based on an individual patient's risk and benefit profile,” Dr. Rastogi said in an interview.

She added that the next step is to validate the model in a similar group of patients. “But we do have the model now, and it can be used. So you can tell the patient who is sitting face to face with you that, based on these risk factors of age, hypertensive medication, and baseline cardiac function, this is her risk for developing a cardiac event.”

Dr. Julie Gralow, moderator of the press briefing, told reporters that such a model represented a very important development for women with HER2-positive breast cancer, who account for roughly 25% of breast cancer patients. “I am thrilled to have a new risk model to help me discuss with my patients the risks and benefits from adding trastuzumab,” said Dr. Gralow of the University of Washington, Seattle.

Dr. Gralow also reminded reporters that trastuzumab cut the incidence of recurrences by almost 50% and deaths by approximately one-third in such patients, and that it was very reassuring to see no increase in cardiotoxicity in the B-31 update.

In the discussion that followed Dr. Rastogi's formal presentation, Dr. Sharon Hunt, professor of medicine at Stanford (Calif.) University, cautioned that 5 years of follow-up is not long enough to assuage concerns about the cardiotoxic effects of trastuzumab.

The cardiotoxicity that is being noted with these 3- and 5-year follow-ups is “probably the tip of a very big iceberg. Left ventricular dysfunction, which you are rather simply measuring as ejection fraction, is a lifelong problem in many patients, and even though the numbers may improve, the structural damage done to the heart persists for the life of the patient,” Dr. Hunt said.

Decrying the lack of information in the B-31 study about whether any therapy for heart failure had been given to patients, Dr. Hunt called for greater collaboration between oncologists and cardiologists.

“We need to know the time course of this cardiotoxicity. Is the optimistic view that it is reversible and not a cause for concern valid? Will preemptive therapy with well-proven heart failure prevention medications such as ACE inhibitors and β-blockers abrogate any of this cardiotoxicity?”

Finding the balance between improved survival from breast cancer and the down side of cardiotoxicity “is one of the most important things we need to do in the field,” she said.

You can tell the patient that, based on the factors in our model, this is her risk for a cardiac event. DR. RASTOGI

Cardiotoxicity Prediction Model

To obtain the cardiac risk score (percentage of risk of a cardiac event within3 years), take the constant of 7.4 plus 0.03 times the patient's age, minus 0.1 times the baseline left ventricular ejection fraction plus the addition of 0.68 if the patient is on blood pressure medications or 0 if the patient is not on blood pressure medicines times 100 divided by 4.82.

CHICAGO – No increase was seen in the cumulative incidence of cardiac dysfunction associated with trastuzumab for HER2-positive, node-positive breast cancer after 5 years of follow-up, said Dr. Priya Rastogi, who reported on behalf of the National Surgical Adjuvant Breast and Bowel Project B-31 trial.

Updated results of the NSABP B-31 trial, which compared treatment regimens with and without trastuzumab (Herceptin), showed that the incidence of cardiac events in patients taking trastuzumab remained essentially unchanged from its value 2 years before, at 3.8%, Dr. Rastogi said at the annual meeting of the American Society of Clinical Oncology.

Trastuzumab, a monoclonal antibody that blocks human epidermal growth factor receptor 2 (HER2) from instigating the growth of breast cancer cells, has been a major advance in the treatment of both early- and late-stage breast cancer, but at the price of increased cardiotoxicity.

In the original NSABP B-31 trial (N. Engl. J. Med. 2005;353:1673-84), the addition of trastuzumab significantly improved 3-year disease-free survival and overall survival when combined with anthracycline-based chemotherapy plus paclitaxel.

However, the incidence of cardiotoxicity, specifically congestive heart failure, among the 850 patients randomized to the regimen with trastuzumab, was 4.1%, compared with 0.8% among the 814 patients who did not get trastuzumab (J. Clin. Oncol. 2005;23:7811-9).

With an additional 2 years of follow-up, the cumulative incidence of cardiac events in the patients who received chemotherapy plus trastuzumab was 3.8%, compared with 0.9% in those who received chemotherapy alone.

Importantly, the majority of patients who had a decline in cardiac function experienced a recovery in ejection fraction within 18 months of taking trastuzumab.

“We were very heartened by this result,” Dr. Rastogi, also of the University of Pittsburgh Medical Center, said at a press briefing.

The update also allowed the NSABP investigators to create a model to predict which women would be most likely to develop cardiotoxicity from trastuzumab. (See box.) Age, use of antihypertensive medications, and poor heart function as measured by a low ejection fraction at baseline were the most important predictors of risk.

“Incorporating these factors into the model allows us to calculate a cardiac risk score, which gives a percentage of risk of a cardiac event within 3 years. This is important because it now lets us choose trastuzumab-containing regimens based on an individual patient's risk and benefit profile,” Dr. Rastogi said in an interview.

She added that the next step is to validate the model in a similar group of patients. “But we do have the model now, and it can be used. So you can tell the patient who is sitting face to face with you that, based on these risk factors of age, hypertensive medication, and baseline cardiac function, this is her risk for developing a cardiac event.”

Dr. Julie Gralow, moderator of the press briefing, told reporters that such a model represented a very important development for women with HER2-positive breast cancer, who account for roughly 25% of breast cancer patients. “I am thrilled to have a new risk model to help me discuss with my patients the risks and benefits from adding trastuzumab,” said Dr. Gralow of the University of Washington, Seattle.

Dr. Gralow also reminded reporters that trastuzumab cut the incidence of recurrences by almost 50% and deaths by approximately one-third in such patients, and that it was very reassuring to see no increase in cardiotoxicity in the B-31 update.

In the discussion that followed Dr. Rastogi's formal presentation, Dr. Sharon Hunt, professor of medicine at Stanford (Calif.) University, cautioned that 5 years of follow-up is not long enough to assuage concerns about the cardiotoxic effects of trastuzumab.

The cardiotoxicity that is being noted with these 3- and 5-year follow-ups is “probably the tip of a very big iceberg. Left ventricular dysfunction, which you are rather simply measuring as ejection fraction, is a lifelong problem in many patients, and even though the numbers may improve, the structural damage done to the heart persists for the life of the patient,” Dr. Hunt said.

Decrying the lack of information in the B-31 study about whether any therapy for heart failure had been given to patients, Dr. Hunt called for greater collaboration between oncologists and cardiologists.

“We need to know the time course of this cardiotoxicity. Is the optimistic view that it is reversible and not a cause for concern valid? Will preemptive therapy with well-proven heart failure prevention medications such as ACE inhibitors and β-blockers abrogate any of this cardiotoxicity?”

Finding the balance between improved survival from breast cancer and the down side of cardiotoxicity “is one of the most important things we need to do in the field,” she said.

You can tell the patient that, based on the factors in our model, this is her risk for a cardiac event. DR. RASTOGI

Cardiotoxicity Prediction Model

To obtain the cardiac risk score (percentage of risk of a cardiac event within3 years), take the constant of 7.4 plus 0.03 times the patient's age, minus 0.1 times the baseline left ventricular ejection fraction plus the addition of 0.68 if the patient is on blood pressure medications or 0 if the patient is not on blood pressure medicines times 100 divided by 4.82.

CHICAGO – No increase was seen in the cumulative incidence of cardiac dysfunction associated with trastuzumab for HER2-positive, node-positive breast cancer after 5 years of follow-up, said Dr. Priya Rastogi, who reported on behalf of the National Surgical Adjuvant Breast and Bowel Project B-31 trial.

Updated results of the NSABP B-31 trial, which compared treatment regimens with and without trastuzumab (Herceptin), showed that the incidence of cardiac events in patients taking trastuzumab remained essentially unchanged from its value 2 years before, at 3.8%, Dr. Rastogi said at the annual meeting of the American Society of Clinical Oncology.

Trastuzumab, a monoclonal antibody that blocks human epidermal growth factor receptor 2 (HER2) from instigating the growth of breast cancer cells, has been a major advance in the treatment of both early- and late-stage breast cancer, but at the price of increased cardiotoxicity.

In the original NSABP B-31 trial (N. Engl. J. Med. 2005;353:1673-84), the addition of trastuzumab significantly improved 3-year disease-free survival and overall survival when combined with anthracycline-based chemotherapy plus paclitaxel.

However, the incidence of cardiotoxicity, specifically congestive heart failure, among the 850 patients randomized to the regimen with trastuzumab, was 4.1%, compared with 0.8% among the 814 patients who did not get trastuzumab (J. Clin. Oncol. 2005;23:7811-9).

With an additional 2 years of follow-up, the cumulative incidence of cardiac events in the patients who received chemotherapy plus trastuzumab was 3.8%, compared with 0.9% in those who received chemotherapy alone.

Importantly, the majority of patients who had a decline in cardiac function experienced a recovery in ejection fraction within 18 months of taking trastuzumab.

“We were very heartened by this result,” Dr. Rastogi, also of the University of Pittsburgh Medical Center, said at a press briefing.

The update also allowed the NSABP investigators to create a model to predict which women would be most likely to develop cardiotoxicity from trastuzumab. (See box.) Age, use of antihypertensive medications, and poor heart function as measured by a low ejection fraction at baseline were the most important predictors of risk.

“Incorporating these factors into the model allows us to calculate a cardiac risk score, which gives a percentage of risk of a cardiac event within 3 years. This is important because it now lets us choose trastuzumab-containing regimens based on an individual patient's risk and benefit profile,” Dr. Rastogi said in an interview.

She added that the next step is to validate the model in a similar group of patients. “But we do have the model now, and it can be used. So you can tell the patient who is sitting face to face with you that, based on these risk factors of age, hypertensive medication, and baseline cardiac function, this is her risk for developing a cardiac event.”

Dr. Julie Gralow, moderator of the press briefing, told reporters that such a model represented a very important development for women with HER2-positive breast cancer, who account for roughly 25% of breast cancer patients. “I am thrilled to have a new risk model to help me discuss with my patients the risks and benefits from adding trastuzumab,” said Dr. Gralow of the University of Washington, Seattle.

Dr. Gralow also reminded reporters that trastuzumab cut the incidence of recurrences by almost 50% and deaths by approximately one-third in such patients, and that it was very reassuring to see no increase in cardiotoxicity in the B-31 update.

In the discussion that followed Dr. Rastogi's formal presentation, Dr. Sharon Hunt, professor of medicine at Stanford (Calif.) University, cautioned that 5 years of follow-up is not long enough to assuage concerns about the cardiotoxic effects of trastuzumab.

The cardiotoxicity that is being noted with these 3- and 5-year follow-ups is “probably the tip of a very big iceberg. Left ventricular dysfunction, which you are rather simply measuring as ejection fraction, is a lifelong problem in many patients, and even though the numbers may improve, the structural damage done to the heart persists for the life of the patient,” Dr. Hunt said.

Decrying the lack of information in the B-31 study about whether any therapy for heart failure had been given to patients, Dr. Hunt called for greater collaboration between oncologists and cardiologists.

“We need to know the time course of this cardiotoxicity. Is the optimistic view that it is reversible and not a cause for concern valid? Will preemptive therapy with well-proven heart failure prevention medications such as ACE inhibitors and β-blockers abrogate any of this cardiotoxicity?”

Finding the balance between improved survival from breast cancer and the down side of cardiotoxicity “is one of the most important things we need to do in the field,” she said.

You can tell the patient that, based on the factors in our model, this is her risk for a cardiac event. DR. RASTOGI

Cardiotoxicity Prediction Model

To obtain the cardiac risk score (percentage of risk of a cardiac event within3 years), take the constant of 7.4 plus 0.03 times the patient's age, minus 0.1 times the baseline left ventricular ejection fraction plus the addition of 0.68 if the patient is on blood pressure medications or 0 if the patient is not on blood pressure medicines times 100 divided by 4.82.

CHICAGO – The Oncotype DX, a 21-gene assay that has been shown to be useful in predicting relapse risk in breast cancer patients with no lymph node involvement, can also predict risk of relapse in patients who have up to three positive lymph nodes, according to a poster presented at the annual meeting of the American Society of Clinical Oncology.

“The results of this analysis, aided by ongoing studies, may tell us which patients with early-stage, node-positive breast cancer actually need chemotherapy,” Dr. Lori J. Goldstein, director of the Breast Evaluation Center and leader of the Breast Cancer Research Program at Fox Chase Cancer Center, Philadelphia, said in an interview.

She and her coinvestigators tested the predictive value of the Oncotype DX Recurrence Score (Genomic Health Inc.) in 465 patients who were part of Intergroup Trial E2197, an Eastern Cooperative Oncology Group study of women with early breast cancer treated with standard chemotherapy. Of these patients, 203 had one to three positive lymph nodes, and 262 had no lymph node involvement.

Patients were treated with doxorubicin plus cyclophosphamide if they were hormone-receptor negative, and with docetaxel and hormonal therapy if hormone-receptor positive. The median follow-up was 76 months, and there was no difference in disease-free survival between treatment arms.

Recurrence scores were divided into three categories: low (less than 18), intermediate (18-30), and high (31 or above). The Oncotype DX Recurrence Score was a significant predictor of recurrence in patients with zero to three positive lymph nodes despite treatment with standard chemotherapy. Those whose risk score was less than 18 had excellent outcomes, with less than a 5% risk of recurrence at 5 years; those who had intermediate and high risk scores had a recurrence risk that was two and three times greater, respectively, Dr. Goldstein said.

“These data show the assay can be used to stratify patients at residual risk after being treated with chemotherapy,” said Dr. Soonmyung Paik, director of pathology for the National Surgical Adjuvant Breast and Bowel Project, who was instrumental in developing the assay. “Perhaps patients [with] a high oncotype assay result should be treated with something in addition to chemotherapy. This is an important study,” he said in an interview.

CHICAGO – The Oncotype DX, a 21-gene assay that has been shown to be useful in predicting relapse risk in breast cancer patients with no lymph node involvement, can also predict risk of relapse in patients who have up to three positive lymph nodes, according to a poster presented at the annual meeting of the American Society of Clinical Oncology.

“The results of this analysis, aided by ongoing studies, may tell us which patients with early-stage, node-positive breast cancer actually need chemotherapy,” Dr. Lori J. Goldstein, director of the Breast Evaluation Center and leader of the Breast Cancer Research Program at Fox Chase Cancer Center, Philadelphia, said in an interview.

She and her coinvestigators tested the predictive value of the Oncotype DX Recurrence Score (Genomic Health Inc.) in 465 patients who were part of Intergroup Trial E2197, an Eastern Cooperative Oncology Group study of women with early breast cancer treated with standard chemotherapy. Of these patients, 203 had one to three positive lymph nodes, and 262 had no lymph node involvement.

Patients were treated with doxorubicin plus cyclophosphamide if they were hormone-receptor negative, and with docetaxel and hormonal therapy if hormone-receptor positive. The median follow-up was 76 months, and there was no difference in disease-free survival between treatment arms.

Recurrence scores were divided into three categories: low (less than 18), intermediate (18-30), and high (31 or above). The Oncotype DX Recurrence Score was a significant predictor of recurrence in patients with zero to three positive lymph nodes despite treatment with standard chemotherapy. Those whose risk score was less than 18 had excellent outcomes, with less than a 5% risk of recurrence at 5 years; those who had intermediate and high risk scores had a recurrence risk that was two and three times greater, respectively, Dr. Goldstein said.

“These data show the assay can be used to stratify patients at residual risk after being treated with chemotherapy,” said Dr. Soonmyung Paik, director of pathology for the National Surgical Adjuvant Breast and Bowel Project, who was instrumental in developing the assay. “Perhaps patients [with] a high oncotype assay result should be treated with something in addition to chemotherapy. This is an important study,” he said in an interview.

CHICAGO – The Oncotype DX, a 21-gene assay that has been shown to be useful in predicting relapse risk in breast cancer patients with no lymph node involvement, can also predict risk of relapse in patients who have up to three positive lymph nodes, according to a poster presented at the annual meeting of the American Society of Clinical Oncology.

“The results of this analysis, aided by ongoing studies, may tell us which patients with early-stage, node-positive breast cancer actually need chemotherapy,” Dr. Lori J. Goldstein, director of the Breast Evaluation Center and leader of the Breast Cancer Research Program at Fox Chase Cancer Center, Philadelphia, said in an interview.

She and her coinvestigators tested the predictive value of the Oncotype DX Recurrence Score (Genomic Health Inc.) in 465 patients who were part of Intergroup Trial E2197, an Eastern Cooperative Oncology Group study of women with early breast cancer treated with standard chemotherapy. Of these patients, 203 had one to three positive lymph nodes, and 262 had no lymph node involvement.

Patients were treated with doxorubicin plus cyclophosphamide if they were hormone-receptor negative, and with docetaxel and hormonal therapy if hormone-receptor positive. The median follow-up was 76 months, and there was no difference in disease-free survival between treatment arms.

Recurrence scores were divided into three categories: low (less than 18), intermediate (18-30), and high (31 or above). The Oncotype DX Recurrence Score was a significant predictor of recurrence in patients with zero to three positive lymph nodes despite treatment with standard chemotherapy. Those whose risk score was less than 18 had excellent outcomes, with less than a 5% risk of recurrence at 5 years; those who had intermediate and high risk scores had a recurrence risk that was two and three times greater, respectively, Dr. Goldstein said.

“These data show the assay can be used to stratify patients at residual risk after being treated with chemotherapy,” said Dr. Soonmyung Paik, director of pathology for the National Surgical Adjuvant Breast and Bowel Project, who was instrumental in developing the assay. “Perhaps patients [with] a high oncotype assay result should be treated with something in addition to chemotherapy. This is an important study,” he said in an interview.

ORLANDO — Chronic use of nonsteroidal anti-inflammatory agents promotes sodium-retention weight gain and can cause blood pressure to rise by an average of 5 mm Hg, Dr. Matthew R. Weir said at a meeting sponsored by the National Kidney Foundation.

The increase is “not insignificant” when one considers how widely used these drugs are, said Dr. Weir, professor of medicine at the University of Maryland, Baltimore.

Most clinicians are familiar with the renal syndromes caused by NSAIDs and tend to be concerned about acute kidney disease or dysfunction. However, these effects tend to be reversible.

The effects of NSAIDs on blood pressure may pose a more serious issue, Dr. Weir said. “One has to view NSAIDs as antinatriuretic compounds. This is a concern because, depending on how much salt you eat, the actual dose of the NSAID you are taking, and your preexisting levels of blood pressure, you can get very different effects on overall changes in blood pressure over time.”

The age-related changes in renal blood supply that occur over time may be an important issue in older patients, who are more likely to be using NSAIDs for conditions such as arthritis.

To avoid adverse cardiovascular effects, always use the lowest possible dose of anti-inflammatory drug, regardless of class. Consider using shorter-acting agents, which may allow the kidney to restore its sodium and water balance, he advised.

Advise patients who are taking NSAIDs to try to avoid dietary sodium, Dr. Weir said.

Blood pressure must be monitored carefully in persons taking NSAIDs, and blood pressure medications adjusted accordingly.

Calcium channel blockers in particular appear to retain their lowering effect on blood pressure despite chronic NSAID use.

“We are not sure why, but calcium channel blockers may have natriuretic properties that are independent of so-called prostaglandin-dependent mechanisms within the kidney,” he said.

“We studied this years ago and found that calcium channel blockers helped alleviate any blood pressure-associated change with nonsteroidal anti-inflammatory drugs,” Dr. Weir said.

Don't overlook over-the-counter NSAIDs, he added. “Take a careful history on the use of over-the-counter nonsteroidal anti-inflammatory drugs. They don't often appear on medication lists.”

Calcium channel blockers have been shown to help alleviate any blood pressure-related change with NSAIDs. DR. WEIR

ORLANDO — Chronic use of nonsteroidal anti-inflammatory agents promotes sodium-retention weight gain and can cause blood pressure to rise by an average of 5 mm Hg, Dr. Matthew R. Weir said at a meeting sponsored by the National Kidney Foundation.

The increase is “not insignificant” when one considers how widely used these drugs are, said Dr. Weir, professor of medicine at the University of Maryland, Baltimore.

Most clinicians are familiar with the renal syndromes caused by NSAIDs and tend to be concerned about acute kidney disease or dysfunction. However, these effects tend to be reversible.

The effects of NSAIDs on blood pressure may pose a more serious issue, Dr. Weir said. “One has to view NSAIDs as antinatriuretic compounds. This is a concern because, depending on how much salt you eat, the actual dose of the NSAID you are taking, and your preexisting levels of blood pressure, you can get very different effects on overall changes in blood pressure over time.”

The age-related changes in renal blood supply that occur over time may be an important issue in older patients, who are more likely to be using NSAIDs for conditions such as arthritis.

To avoid adverse cardiovascular effects, always use the lowest possible dose of anti-inflammatory drug, regardless of class. Consider using shorter-acting agents, which may allow the kidney to restore its sodium and water balance, he advised.

Advise patients who are taking NSAIDs to try to avoid dietary sodium, Dr. Weir said.

Blood pressure must be monitored carefully in persons taking NSAIDs, and blood pressure medications adjusted accordingly.

Calcium channel blockers in particular appear to retain their lowering effect on blood pressure despite chronic NSAID use.

“We are not sure why, but calcium channel blockers may have natriuretic properties that are independent of so-called prostaglandin-dependent mechanisms within the kidney,” he said.

“We studied this years ago and found that calcium channel blockers helped alleviate any blood pressure-associated change with nonsteroidal anti-inflammatory drugs,” Dr. Weir said.

Don't overlook over-the-counter NSAIDs, he added. “Take a careful history on the use of over-the-counter nonsteroidal anti-inflammatory drugs. They don't often appear on medication lists.”

Calcium channel blockers have been shown to help alleviate any blood pressure-related change with NSAIDs. DR. WEIR

ORLANDO — Chronic use of nonsteroidal anti-inflammatory agents promotes sodium-retention weight gain and can cause blood pressure to rise by an average of 5 mm Hg, Dr. Matthew R. Weir said at a meeting sponsored by the National Kidney Foundation.

The increase is “not insignificant” when one considers how widely used these drugs are, said Dr. Weir, professor of medicine at the University of Maryland, Baltimore.

Most clinicians are familiar with the renal syndromes caused by NSAIDs and tend to be concerned about acute kidney disease or dysfunction. However, these effects tend to be reversible.

The effects of NSAIDs on blood pressure may pose a more serious issue, Dr. Weir said. “One has to view NSAIDs as antinatriuretic compounds. This is a concern because, depending on how much salt you eat, the actual dose of the NSAID you are taking, and your preexisting levels of blood pressure, you can get very different effects on overall changes in blood pressure over time.”

The age-related changes in renal blood supply that occur over time may be an important issue in older patients, who are more likely to be using NSAIDs for conditions such as arthritis.

To avoid adverse cardiovascular effects, always use the lowest possible dose of anti-inflammatory drug, regardless of class. Consider using shorter-acting agents, which may allow the kidney to restore its sodium and water balance, he advised.

Advise patients who are taking NSAIDs to try to avoid dietary sodium, Dr. Weir said.

Blood pressure must be monitored carefully in persons taking NSAIDs, and blood pressure medications adjusted accordingly.

Calcium channel blockers in particular appear to retain their lowering effect on blood pressure despite chronic NSAID use.

“We are not sure why, but calcium channel blockers may have natriuretic properties that are independent of so-called prostaglandin-dependent mechanisms within the kidney,” he said.

“We studied this years ago and found that calcium channel blockers helped alleviate any blood pressure-associated change with nonsteroidal anti-inflammatory drugs,” Dr. Weir said.

Don't overlook over-the-counter NSAIDs, he added. “Take a careful history on the use of over-the-counter nonsteroidal anti-inflammatory drugs. They don't often appear on medication lists.”

Calcium channel blockers have been shown to help alleviate any blood pressure-related change with NSAIDs. DR. WEIR