Why baby boomers need a hepatitis C screening

Electronic medical record alerts contribute to dramatic rise in HepC screening

September 13, 2016--Baby boomers, adults born between 1945 and 1965, are five times more likely to have been exposed to the hepatitis C virus (HCV).

As a result, the Centers for Disease Control and Prevention and the U.S. Preventive Service Task Force recommend that all patients in that age group get tested.

But the simple blood test, designed to detect and prevent illness before the virus wreaks havoc, is infrequently performed on baby boomers whose routine medical appointments are often crammed with other preventive measures and tests -- as well as time spent addressing active problems that require a doctor's immediate attention.

Investigators at the University of Michigan Health System recently found an easy way to help primary care physicians ensure that an HCV screening is part of the routine: Electronic medical record alerts.

The automated alert, programmed to appear if a patient was within the at-risk age group, reminds doctors not only to issue the test but also provide educational materials about the virus.

Implemented in fall 2015 in primary care clinics throughout the U-M health system, the strategy contributed to a significant rise in screenings -- an eightfold boost -- in the first six months alone.

"A large part of the success was figuring out how to take the logistical work away, which involves more than looking at a patient's date of birth," says Monica Konerman, M.D., M.Sc., a hepatologist at the University of Michigan who treats patients facing the prospect of hepatitis damaging their liver.

A population in need

It isn't entire clear why hepatitis C rates are higher in baby boomers -- although many, according to the CDC, are believed to have become infected during the 1970s and 80s when rates were highest (and before screenings of donated blood and organs became available in 1992).

Hepatitis C, likewise, can be asymptomatic for decades. Many patients could have been exposed to risk factors years ago but never sought testing or treatment.

A universal one-time HCV screening based on age, then, can bypass the discomfort of having to talk about potentially embarrassing topics such as prior drug use or sharing needles.

It also helps democratize preventive care. Prior to launching the alert, HCV screening was higher in men, Asian and African Americans, and in patients with Medicaid insurance. Screening rates also varied greatly by clinic site (ranging from 20 to 32 percent).

After the alert was adopted, however, screenings increased equally among genders, races, insurance plans and UMHS clinic sites.

Why screening matters

The screening test for hepatitis C is the virus antibody. If the hepatitis C antibody is detected, a confirmation test for the virus' RNA (genetic material) is recommended to confirm chronic infection.

Of the 16,773 baby boomers targeted for screening via electronic alert at UMHS, fewer than 1 percent tested positive for the hepatitis C antibody.

Despite that low rate, the alert system nonetheless helped identify people who would benefit from curative hepatitis C treatment, says Konerman, who presented the findings in May at the Digestive Disease Week conference in San Diego.

After all, a new era in hepatitis treatment began in 2013 with the approval of interferon-free oral combination therapy that was demonstrated in clinical trials studies led by the U-M to cure hepatitis C in 95 percent of patients. If treated and the body responds, patients can get rid of the virus before liver damage and liver failure occur.

Which is why the new alert technology is crucial for a population that could benefit most from HCV screening.

"The availability of direct-acting antiviral agents has been a game-changer," says Konerman.

"Previously, many providers thought screening had low utility: (that) the treatment was terrible and didn't work well. Today, short courses of all oral treatments are highly effective and can prevent progressive liver disease."

Measure Up/Pressure Down® Campaign's National Day of Action Reaches 35.4 Million Americans

Newswise, September 13, 2016--AMGA today announced the results and impact of its third annual Measure Up/Pressure Down® National Day of Action: Roll Up Your Sleeves! event. 

On May 5, during National High Blood Pressure Education Month, a record-setting 144 campaign supporters across the country collectively took nearly 200 "actions" for blood pressure control―including blood pressure screenings, materials dissemination, social media posts, web chats, website content updates, employee trainings, health fairs, and garnering media coverage―reaching 35.4 million Americans.

The Measure Up/Pressure Down campaign, administered through AMGA Foundation, the association’s nonprofit arm, encouraged key stakeholders―including medical groups, health systems, sponsors, partners, and other organizations―to "roll up their sleeves" on the same day in support of improving high blood pressure awareness, detection, and control around the country.

"We were honored to have our third Measure Up/Pressure Down National Day of Action recognized by U.S. Representative Donald S. Beyer and Senators Tim Kaine and Mark Warner,” said Donald W. Fisher, Ph.D., CAE, president and chief executive officer of AMGA and secretary of the AMGA Foundation Board of Directors.

“Together with our members and other supporters, we are raising awareness and making a dramatic difference in the health and well-being of patients with this life-threatening condition.”

National support and participation enabled Measure Up/Pressure Down to educate millions of patients with or at risk for high blood pressure and empower these patients to actively manage their own health in conjunction with their healthcare team.

The National Day of Action also engaged providers to better detect and treat high blood pressure in their patient populations through trainings, guideline implementation, patient engagement programs, and other evidence-based care processes.

A full list of National Day of Action supporters, including campaign sponsors and partners, is available at www.MeasureUpPressureDown.com.

Background

As part of its efforts, Measure Up/Pressure Down mobilizes medical groups and health systems to achieve the goal of having 80 percent of their patients with high blood pressure under control by 2016.

The central mission of the campaign is to encourage medical groups and organized systems of care to adopt one or more evidence-based care processes that lead to measurable improvements in high blood pressure outcomes.

Nearly 150 AMGA medical groups and health systems, delivering care to more than 42 million patients, have joined Measure Up/Pressure Down. Since launching in 2012, the campaign has improved hypertension detection and/or control for 542,069 patients.

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About AMGA Foundation
The AMGA Foundation is AMGA’s nonprofit arm that enables medical groups and other organized systems of care to consistently improve health and health care. The AMGA Foundation serves as a catalyst, connector, and collaborator for translating the evidence of what works best in improving health and health care in everyday practice. www.amga.org/foundation

About AMGA
AMGA is a trade association leading the transformation of health care in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 170,000 physicians practice in our member organizations, delivering care to one in three Americans. For more information, visit amga.org

11 ANSWERS TO TOUGH QUESTIONS ABOUT LIVER CANCER

Liver cancer, one of the more preventable diseases, rises for non-Asians living in Los Angeles County.The Los Angeles Cancer Surveillance Program (CSP), a state-mandated database managed by the Keck School and the USC Norris Comprehensive Cancer Center, provides scientists everywhere with essential statistics on cancer

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Newswise, August 22, 2016In the past four decades, liver cancer rates have more than doubled among non-Asians living in Los Angeles County, according to a recently released report card administered by USC.

The increase is also reflected among the county’s Asian-Americans.

For some perspective, in the seven years between 2005 and 2012, liver cancer rates increased by 33 percent among white men and by 21 percent among Latino men. The increase was more modest with women in these groups — partially because liver cancer is more common in men.

While Vietnamese are the most likely ethnic group to be diagnosed with the disease, between 2005 and 2012, liver cancer rates actually dropped. The decrease was 1.3 percent among Vietnamese men and 8.7 percent for Vietnamese women.

The data comes from “Cancer in Los Angeles County: Trends by Race/Ethnicity 1976-2012.” Released on Aug. 15, the book is based on all cancers diagnosed among Los Angeles County residents over the past 37 years — more than 1.3 million cases.

Each year about 16,000 men and 8,000 women die from liver cancer in the United States, according to the Centers for Disease Control and Prevention.

V. Wendy Setiawan, assistant professor of preventive medicine at the Keck School of Medicine of USC, is an expert in cancer epidemiology. She shares her thoughts on the deadly but often preventable malady.

Q: Why is liver cancer on the rise among whites in L.A. County?

VWS: We know that chronic hepatitis C is a major risk factor for liver cancer in whites. We are seeing the rise because of the elevated prevalence of hepatitis C infection among white baby boomers who used illicit drugs in the ’60s and ’70s. The increasing number of people who are overweight/obese and/or diabetics have also contributed to this trend.

Q: Why is liver cancer becoming more prevalent among Latinos?

VWS: Liver cancer is becoming more common in Latinos because obesity and metabolic syndrome [diabetes] — important risk factors for liver cancer — have become a big problem in this population. Public health efforts to prevent and control diabetes and obesity in this population may reduce the liver cancer burden. Lifestyle changes are advisable.

Q: Why are immigrants from East Asia and Southeast Asia at higher risk of liver cancer?

VWS: In most Asian countries and for immigrants from these countries, liver cancer is mainly due to chronic hepatitis B infection. Vietnamese, for example, have the highest liver cancer rates in L.A. County. Studies have shown that the prevalence of hepatitis B virus carriers is quite high among Vietnamese.

Fortunately, hepatitis B infection can be prevented; the hepatitis B vaccine is safe and highly effective. With the implementation of this vaccination program in newborns, the rate of liver cancer has been declining in high-risk Asian countries. We expect the rate of hepatitis B-related liver cancer will continue to decline.

Q: How is coffee a protective agent against liver cancer? How much coffee should someone drink for this protective effect?

VWS: There are thousands of compounds in coffee. The most studied compounds in relation to liver function and disease are caffeine, diterpenes and chlorogenic acids, but the exact constituents that protect against liver cancer are still unknown. A recent World Health Organization report showed that coffee drinkers’ risk of liver cancer decreases 15 percent for each cup they drink per day.

In my study, we compared coffee drinkers to non-coffee drinkers. People who reported drinking two to three cups of coffee per day had a 38 percent drop in liver cancer risk. For those who drank four or more cups daily, their risk of developing liver cancer dropped by 41 percent. We mainly observed the beneficial association with caffeinated coffee, not with decaf tea, tea [green/black] or soda.

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Anthony El-Khoueiry, chair of the Clinical Investigations Support Office at the USC Norris Comprehensive Cancer Center and an associate professor of clinical medicine at the Keck School, is known nationwide for his clinical research on liver cancer. He answers some important questions about the disease.

Q: Why do men tend to have higher liver cancer rates than women?

AEK: There is no clear answer. Scientists are looking at the role of hormones. One hypothesis is that estrogen has a protective effect on women, especially in the premenopausal years, but that alone cannot explain everything. Some studies in laboratory animals also suggest that androgen male hormones may contribute to the risk of liver cancer.

Q: Long-term alcohol abuse increases the risk of liver cancer. At what consumption level does alcohol become a serious risk factor?

AEK: Hepatologists usually say an average of three alcoholic drinks a day or higher puts people at high risk for cirrhosis, where healthy liver tissue is replaced with scar tissue. Cirrhosis could lead to liver cancer.

Q: Should people who have liver cancer abstain from alcoholic beverages?

AEK: This is a poorly studied area. Continuing alcohol consumption may not impact the behavior of the cancer itself; however, it could negatively impact underlying liver function, which could in turn prevent oncologists from being able to treat tumors properly. It would be best to discontinue alcohol consumption if one has liver cancer in order to minimize the ongoing insult to the liver and prevent added pressure on the already compromised liver function.

Q: What is causing the drastic increase of liver cancer cases?

AEK: Scientists believe hepatitis C and obesity, along with diabetes, are the main causes for the increasing rates of liver cancer. Obesity and metabolic syndrome — characterized by abdominal obesity, diabetes, high blood pressure or high cholesterol — are established risk factors of liver cancer. Metabolic syndrome could lead to non-alcoholic steatohepatitis (inflammation in the liver along with fat deposition), which can lead to cirrhosis and liver cancer.

These are relatively recent observations, so therapeutic interventions to lower liver cancer risk have not been fully established. One could, of course, follow common sense: lower weight, have a healthy diet, exercise regularly to prevent metabolic syndrome.

Q: What preventive measures can be taken?

AEK: The risk factors for liver cancer are alcohol, hepatitis B and C, autoimmune hepatitis or any continuous inflammation of the liver that leads to cirrhosis.

• Avoid excessive intake of alcohol.
• Get the hepatitis B vaccination.
• Avoid dangerous behavior that increases the risk of hepatitis C: sharing needles or syringes, multiple sex partners, unsafe sex with infected individuals.
• Get FDA-approved treatments for hepatitis C.
• If you know that you have any form of chronic liver disease, it is important to see a liver specialist [hepatologist] and have routine surveillance to catch cancer early. Surveillance includes liver ultrasound and a blood test for a tumor marker known as alpha fetoprotein.

Q: How important is early diagnosis?

AEK: If the disease is caught early, then you can cure it. Surveillance for people who have chronic liver disease is helpful to catch small tumors early. The chances of cure are much higher when the cancer is early (no more than 3 tumors and less than 3 centimeters in maximum size). The two main treatments that provide a cure include liver transplant and surgery to remove the tumor.

Q: Have there been any breakthroughs in treatment?

AEK: The challenge in the treatment of liver cancer is that doctors have to balance the cancer and the underlying liver disease and cirrhosis. Patients do better with liver cancer when they are treated by a multidisciplinary team of doctors that includes different specialties. At USC, any patient with liver cancer is reviewed at a multidisciplinary tumor board to make a joint and comprehensive plan that maximizes the patient’s chances.

Historically, we have had limited treatment options for patients with advanced liver cancer who are not candidates for surgery or liver transplant. Things are changing rapidly in this area thanks to new research and clinical trials. One of the exciting areas that is showing promise is using drugs that stimulate the patient’s own immune system to recognize and fight the cancer. USC has played a leading role in the early studies to evaluate this approach, which is now showing good promise and is being studied in large, international clinical trials.

Eight Years Old and Growing Fast: DIAN Is Becoming an Alzheimer’s Movement

Newswise, August 22, 2016 — When the Dominantly Inherited Alzheimer’s Network started in 2008, there were questions about whether it could succeed. It did.

At eight years old, DIAN has fully enrolled its first therapeutic trial and more trials are in planning stages, and its observational cohort study is producing longitudinal data for a quantitative prediction model of Alzheimer’s disease progression.

Underpinning the science is a growing international community of families who support each other with warmth and considerable spunk as they navigate both the disease and their intensive research participation to beat it. In a five-part series, Gabrielle Strobel takes the movement’s measure.

About Us

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Our site expands the traditional mode of scientific communication by reporting the latest scientific findings and industry news with insightful analysis that puts breaking news into context.

We advance research by developing open-access databases of curated, highly specific scientific content to visualize and facilitate the exploration of complex data. Alzforum is a platform to disseminate the evolving knowledge around basic, translational, and clinical research in the field of AD.

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Together with a distinguished Scientific Advisory Board, and the active participation of a global network of scientists, we strive to produce unbiased content to a rigorous editorial standard.

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EXPERT ANSWERS 7 QUESTIONS ABOUT MELANOMA

While the deadly skin cancer has risen nationally for more than 30 years, its growth in Los Angeles County has slowed.

The Los Angeles Cancer Surveillance Program (CSP), a state-mandated database managed by the Keck School and the USC Norris Comprehensive Cancer Center, provides scientists everywhere with essential statistics on cancer.

Newswise, August 22, 2016 — The melanoma rate among white women living in Los Angeles is declining for the first time in 37 years, according to a new cancer report card administered by USC.

Between 2005 and 2012, white women experienced a 4 percent decrease in the rates of melanoma diagnoses. Latina, Filipina and Chinese women also experienced a slight decrease.

In comparison, the proportion of white male Angelenos developing the malignant form of skin cancer has slowed but is still on the rise, as has been the case since 1976. Between 2000 and 2005, their melanoma rate rose by 15 percent. Seven years later, the rate of increase was only 4 percent.

This data comes from “Cancer in Los Angeles County: Trends by Race/Ethnicity 1976-2012.” Released on Aug. 15, the book is based on all cancers diagnosed among Los Angeles County residents over the past 37 years — more than 1.3 million cases.

Melanoma accounts for only 1 percent of skin cancers, yet it is the reason for the majority of skin cancer deaths. Most people affected by the disease are white. Those who are fair-skinned and burn easily or individuals with a large number of moles are at higher risk.

One in 50 whites, 1 in 200 Hispanics and 1 in 1,000 blacks develops melanoma. Thus, whites are at higher risk of developing melanoma.

In 2016, California is expected to have the most cases of melanoma (8,560), according to the American Cancer Society. Florida comes in a distant second (6,200), followed by New York (4,250).

Ashley Wysong, assistant professor of clinical dermatology and director of Mohs (a relatively new surgical technique) and dermatologic surgery at the Keck School of Medicine of USC, shares her expertise and provides skin care advice.

Q: Why have melanoma rates doubled between 1982 and 2011?

AW: In fact, there has been a 619 percent increase since 1950. The majority of melanoma cases can be explained by a combination of genetics and ultraviolet exposure from the sun as well as artificial UV through tanning beds.

We also are seeing a worrisome increase in melanoma rates among adolescents and young adults.

Q: Why have skin cancer rates among Hispanics risen by almost 20 percent?

AW: Skin cancer is not just a problem for people with fair skin. Because skin cancer often is not of concern in patients with skin color, we often see delays in diagnosis and treatment, with associated higher rates of morbidity and death.

The cumulative effects of UV over a lifetime are associated with increased rates of most skin cancers. Efforts are being made to educate Latino, Asian, black, Native American and other ethnic communities about the importance of skin self-examination and skin cancer screening.

Q: If people are more likely to use SPF and have a better skin care regimen now compared to the 1970s, why are melanoma rates rising?

AW: The most common mistakes people make when applying sunscreen is:

• not picking the appropriate sunscreen
• not applying enough sunscreen
• not reapplying often enough

When choosing a sunscreen:

• Individuals should look for sunscreens labeled as “broad spectrum,” which means that they have both UVA and UVB protection.
• The sunscreens should be at least SPF 30.

When applying sunscreen lotion, you typically need to apply generously (a golf ball-sized amount) to the entire body. Sunscreen should be reapplied every two hours and after swimming or significant sweating.

To be honest, most people find it difficult to follow these recommendations for various reasons, myself included! Because of this, I often recommend to my patients to avoid sun exposure during peak UV hours of 10 a.m. to 4 p.m. and to invest in wide-brimmed hats, UV sunglasses and photoprotective clothing. Many clothing brands have started carrying UPF clothing (UPF is similar to SPF) that is comfortable, breathable and easy to wear.

Q: Melanoma is the deadliest type of skin cancer. What happens when it is caught early?

AW: When caught in the early stages, melanoma very rarely goes outside of the skin and is highly curable. Your dermatologist or dermatologic surgeon could surgically remove the cancer using local anesthesia.

Q: If I’m a redhead or if I freckle easily, should I be on high alert about skin cancer?

AW: Redheads, blondes and people that freckle easily often have less natural protection from the sun. Melanin, the natural UV protection found in the top layer of the skin, is present in lower amounts in light-skinned and light-haired individuals. Because of this, redheads, blondes and individuals that freckle easily have to be even more careful in the sun.

Q: How safe is tanning and the ointments used to tan?

AW: There is no such thing as a “safe” tan. Both baby oil and tanning oil are dangerous. In general, being outdoors without proper photoprotective clothing, hats, sunglasses or sunscreen increases one’s risk of developing melanoma and non-melanoma skin cancers. Tanning in and of itself, as well as freckles and “sun spots,” are signs of damage to the skin.

Baby oil provides no protection from the sun and may actually intensify the sun’s rays. The typical “tanning oil” has an SPF of 2 to 4, which provides very minimal protection from damaging UV radiation.

Q: What are the misconceptions and tips you would like to highlight?

AW: Unfortunately, there is a lot of misinformation out there about the use of sunscreen, leading individuals to avoid its use or to flock to “natural” or “herbal” sunscreens that have not been tested by the FDA. 

This is very risky and it’s important for individuals to be well-informed and to discuss these decisions with their dermatologist. Seeking shade, wearing protective clothing or hats and avoiding peak UV hours are always recommended.

Outdoor athletes are at increased risk for skin cancer due to long hours of exposure, often during peak hours of UV exposure. In addition, sweating may increase photodamage by intensifying the skin’s sensitivity to ultraviolet radiation and the risk of sunburn.

While melanoma is the deadliest skin cancer, non-melanoma skin cancer is exceedingly more common. One in four Americans will develop some form of non-melanoma skin cancer in their lifetime. 

Every year in the United States, there are three to four times as many non-melanoma skin cancer cases compared to all other cancers combined. Anything new, growing, changing, bleeding or not healing on the skin should be evaluated by a board-certified dermatologist.

8 THINGS WOMEN SHOULD KNOW ABOUT BREAST CANCER

White and black women in Los Angeles County are the most likely to be diagnosed with breast cancer, but Asians are slowly catching up

 

August 22, 2016--The Los Angeles Cancer Surveillance Program (CSP), a state-mandated database managed by the Keck School and the USC Norris Comprehensive Cancer Center, provides scientists everywhere with essential statistics on cancer.

Newswise — Asian women living in Los Angeles County are experiencing more breast cancer now than they faced nearly four decades ago, according to a recently released cancer report card administered by USC.

When compared to other Asian groups, Filipino women face the most breast cancer diagnoses in the county, but their risk is on the decline. The diagnoses went down 6 percent in the seven years between 2005 and 2012.

In contrast, Korean women are on the bottom of the list but are experiencing a steep and continuous increase in breast cancer rates, nearly quadrupling in the 32 years between 1980 and 2012.

The data comes from “Cancer in Los Angeles County: Trends by Race/Ethnicity 1976-2012.” Released on Aug. 15, the book is based on all cancers diagnosed among Los Angeles County residents over the past 37 years — more than 1.3 million cases.

Breast cancer is the most common cancer in women regardless of race or ethnicity and the most common cause of cancer death among Hispanic women, according to the Centers for Disease Control and Prevention. It is the No. 2 cause of cancer death among white, black, Asian and Pacific Islander women.

An estimated 246,660 women will be diagnosed with invasive breast cancer in 2016, and about 40,450 women will die from the disease this year, according to the American Cancer Society.

Christy Russell, director of the Harold E. and Henrietta C. Lee Breast Center at USC Norris Cancer Hospital and an associate professor of clinical medicine at the Keck School of Medicine of USC, has treated breast cancer patients for 30 years. Russell shares what has she gleaned from all that oncology experience.

Q: Although fewer Korean women develop breast cancer than any other ethnicity, their breast cancer risk has soared in the past 37 years. Why are more Korean women developing breast cancer?

CR: Presumably, they have taken on more “American lifestyle” choices, which would mean earlier puberty, later menopause, fewer pregnancies, less breastfeeding, perhaps less physical activity, higher body weight and possibly alcohol. Extensive epidemiologic studies need to be done to figure out which, if any, of these factors attributes to the rising rate of breast cancer risk in Korean women.

Q: Why do Filipino women have the highest breast cancer risk among Asians? What might be causing a decline in this group’s breast cancer occurrence?

CR: I can’t answer this question. Epidemiologic studies would need to be done to assess the timing of their adoption to the “American lifestyle.”

Q: If adopting a more American lifestyle could be the culprit, why has the rate of breast cancer among white and black women begun leveling off in the past decade?

CR: The risk of breast cancer in white and black women is likely leveling off because of their steady use of screening mammography. Additionally, during the time frame when their risk of breast cancer is developing, they probably continue to have similar lifestyle habits as those in years past, such as age at first full-term pregnancy, length of breastfeeding, use of hormone replacement therapy, exposure to alcohol and total body weight.

Q: What causes breast cancer?

CR: Breast cancer is related to lifetime exposure of the breast tissue to uninterrupted estrogen and progesterone. The ovaries produce these hormones. Anything that prolongs the exposure to these hormones will increase a woman’s lifetime risk of breast cancer.

Once a woman begins her ovarian function during puberty, there are limited things she can do to reduce her risk of developing breast cancer. Interruptions in the menstrual cycle will reduce risk. The earlier and the more frequently she interrupts her menstrual cycle, the greater reduction in risk of breast cancer. This includes full-term pregnancy, prolonged breast feeding, steady and continuous physical activity, and maintaining a low and healthy body weight.

Q: What role does alcohol play?

CR: More than 100 epidemiologic studies have consistently found that alcohol use is related to the risk of developing breast cancer, and there is no “safe” amount. The more alcohol consumed, the higher the risk.

After menopause, alcohol, higher body weight and hormone replacement therapy all increase the risk of breast cancer. These are all related to continued exposure of the breast to either estrogen alone or estrogen plus progesterone in the case of hormone replacement therapy.

Q: Girls are reaching puberty earlier nowadays — sometimes starting at age 8. What does early puberty mean for breast cancer risk?

CR: Initiation of puberty is related to a young woman attaining a specific height and weight. Presumably, the body knows when it is capable of childbearing and thus puberty begins. Populations in the world with greater health and nutrition during childhood will decrease the age at which their girls start puberty.

Reaching puberty earlier increases the amount of estrogen and progesterone a young woman receives in her lifetime, so earlier puberty increases her risk of developing breast cancer.

Q: Should menopausal women abstain from hormone replacement therapy to limit their breast cancer risk?

CR: The use of hormone replacement therapy is a very personal decision and should be based on the extent of menopausal symptoms such as hot flashes, sweats and sleep disturbance. The use should be limited in terms of number of years and should be discontinued as early as possible to reduce the subsequent increased risk of breast cancer. The longer a woman is exposed to hormone replacement therapy, the greater her risk of developing breast cancer.

However, that being said, the majority of breast cancer risk is related to one’s lifetime exposure to estrogen and progesterone and is not just related to what happens after menopause.

Q: When are most women diagnosed with breast cancer?

CR: Even though the majority of female breast cancer risk is established during the years between puberty and menopause, breast cancer generally occurs in older women. The median age for the appearance of breast cancer in women is mid-sixties.

REPLACING JUST ONE SUGARY DRINK WITH WATER COULD SIGNIFICANTLY IMPROVE HEALTH, VIRGINIA TECH RESEARCHER FINDS

Choosing drinks with fewer calories can help reduce excess weight and improve dietary choices.

Newswise, August 17, 2016 — Think one little sugary soda won’t make a difference on your waistline? Think again.

If people replace just one calorie-laden drink with water, they can reduce body weight and improve overall health, according to a Virginia Tech researcher.

“Regardless of how many servings of sugar-sweetened beverages you consume, replacing even just one serving can be of benefit,” said Kiyah J. Duffey, an adjunct faculty member of human nutrition, foods, and exercise in the College of Agriculture and Life Sciences and independent nutrition consultant.

 Consuming additional calories from sugary beverages like soda, energy drinks, and sweetened coffee can increase risk of weight gain and obesity, as well as Type 2 diabetes and cardiovascular disease.

Duffey’s findings, which were recently published in Nutrients, modeled the effect of replacing one 8-ounce sugar-sweetened beverage with an 8-ounce serving of water, based on the daily dietary intake of U.S. adults aged 19 and older, retrieved from the 2007-2012 National Health and Nutrition Examination Surveys.

Duffey, along with co-author Jennifer Poti, an assistant professor of nutrition at the University of North Carolina at Chapel Hill, showed that this one-for-one drink swap could reduce daily calories and the prevalence of obesity in populations that consume sugary beverages.

The 2015 Dietary Guidelines for Americans recommend that no more than 10 percent of daily calories come from added sugar and that calorie-free drinks, particularly water, should be favored.

“We found that among U.S. adults who consume one serving of sugar-sweetened beverages per day, replacing that drink with water lowered the percent of calories coming from drinks from 17 to 11 percent,” Duffey said.

 “Even those who consumed more sugary drinks per day could still benefit from water replacement, dropping the amount of calories coming from beverages to less than 25 percent of their daily caloric intake.”

As Duffey found, a reduction in the amount of daily calories coming from sugary drinks also improves individual scores on the Healthy Beverage Index – a scoring system designed to evaluate individual beverage patterns and their relation to diet and health based on standards set forth by the Beverage Guidance Panel and the Dietary Guidelines for Americans.

Duffey developed this index in 2015 with Virginia Tech nutrition researcher Brenda Davy, a professor of human nutrition, foods, and exercise in the College of Agriculture and Life Sciences and a Fralin Life Science Institute affiliate.

Their preliminary data showed that higher scores correlate to better cholesterol levels, lowered risk of hypertension, and in men, lowered blood pressure.

The broader goal of the index is to help people identify what and how much they drink each day, as drinking habits can impact eating habits.

Higher calorie drinks, such as sweetened soda and high-fat milk, have been associated with diets rich in red and processed meats, refined grains, sweets, and starch, according to a 2015 review study by Duffey, Davy, and Valisa Hedrick, an assistant professor of human nutrition, foods, and exercise in the same college at Virginia Tech.

Lower-calorie drinks, such as water and unsweetened coffee and tea, were associated with alternative diets rich in fruits, vegetables, whole grains, fish, and poultry.

Diet drinks are also healthier alternatives to sugary drinks, explained Duffey, but other research has shown that people who drink water over low-calorie alternatives still tend to eat more fruits and vegetables, have lowered blood sugar, and are better hydrated.

The initial study was funded by the Drinking Water Research Foundation, an independent not-for-profit organization that supports research in areas related to consumer- and drinking-water-industry interest.