Breast screening advice updated amid controversy over harms

Women invited for breast cancer screening in the UK are to be given more information about the potential harms of being tested.

An independent review was set up to settle a fierce debate about whether the measure did more harm than good.

It showed that for every life saved, three women had treatment for a cancer which would never have been fatal.

The information will be included on leaflets to give women an "informed choice", the government said.

Cancer charities said women should still take up the offer of screening.

Controversy
 
Screening has been a fixture in diagnosing breast cancer for more than two decades. Women aged between 50 and 70 are invited to have a mammogram every three years. It helps doctors catch cancer early so treatment can be given when it is more likely to save lives.

However, the national cancer director Prof Sir Mike Richards said it had become "an area of high controversy".

The debate centres around the concept of "overdiagnosis", that is screening which correctly identifies a tumour, but one which would never have caused harm. It leads to women who would have lived full and healthy lives having treatments - such as surgery, hormone therapy, radiotherapy and chemotherapy - which have considerable side-effects.

There is no way of knowing which tumours will be deadly and which could have been left alone.

The review, published in the Lancet medical journal, showed that screening saved 1,307 lives every year in the UK, but led to 3,971 women having unnecessary treatment. From the point of view of a single patient they have a 1% chance of being overdiagnosed if they go for screening.

The independent review panel was led by Prof Michael Marmot, from University College London. He said screening had "contributed to reducing deaths" but also "resulted in some overdiagnosis".

He said it was "vital" women were told about the potential harms and benefits before going for a mammogram.

Prof Richards said: "My view is that the screening programme should happen, we should invite women to be screened and give women the information to make their own choice."

He said the leaflets on breast cancer screening sent to women would be updated in the "next few months" to "give the facts in a clear, unbiased way".

Current advice does not highlight the scale of the risk.

To screen?
 
Cancer charities have unanimously argued that women should still choose to be screened.

A joint statement by Breakthrough Breast Cancer, Breast Cancer Campaign and Breast Cancer Care said: "We encourage all women to attend their screening appointments."

It said the review provided "much-needed clarity" that screening saves lives, but women must be given "clear and balanced information" to highlight the harms.

Cancer Research UK, which commissioned the review alongside the Department of Health, said that "on balance" it thought that women should go ahead with screening.

Its chief executive Dr Harpal Kumar said: "Because we can't yet tell which cancers are harmful and which are not, we cannot predict what will happen in an individual woman's case.

"Research is advancing at pace and we hope that in the future there will be a number of new techniques that we can use alongside the screening programme to make it more sophisticated and reduce the numbers of women having unnecessary treatment."

Richard Winder, the deputy director of the NHS Cancer Screening Programmes, said: "This was a robust review and we appreciate the rigour and efforts of the panel in conducting it.

"We are pleased that the panel concluded the NHS Breast Cancer Screening Programme confers significant benefit and should continue.

"Where they have made recommendations, we will work with all partners to take these forward."

Analysis: Debate over?

The national cancer director described the findings as the "best data" available on the issue. However, this is unlikely to be the final word on breast cancer screening.

One of the lead voices questioning screening, Prof Peter Gotzsche from the University of Copenhagen, has told the BBC he has "serious reservations" about the findings.

His previous research suggested 10 women were treated unnecessarily for every life saved and questioned whether screening had any overall benefit.

He said "the estimate of the balance [of benefit vs harm] is still too positive" in this study.

He criticised the independent panel for using old data and ignoring more recent studies showing no benefit of screening.

He will be publishing a response in a medical journal soon.

Screening in numbers

• More than two million women are screened each year in the UK
• Women between 50 and 70 are screened every three years.
• 48,000 women are diagnosed each year.
• One in eight women will develop breast cancer at some point in their lives.
• More than 11,000 women die from breast cancer each year

Stress-Busters For Better Sleep - Part II

Start A Worry Journal 

Before you get into bed, spend 10 minutes or so writing down what's really troubling you in a journal or on a piece of paper -- anything from work and family concerns to some issue or question that's really bugging you, Ojile says. "The reality is that writing it down in a worry journal isn't going to solve the problem," he says. But what it can do is give you a place to put down your thoughts and let them go until tomorrow.

Take A Bath

The benefits here are twofold. First, water tends to be soothing psychologically, Ojile says, which can help ease built-up stress from the day. But it can also benefit our sleep: The act of cooling the body, like that which happens when you get out of a warm tub, makes us feel tired.

 Don't want the fuss of taking a bath? Sipping a cup of warm, non-caffeinated green tea can trigger that same cooling response in the body, Ojile explains.

Say A Prayer (Or Meditate!) 

If your mom told you to say your prayers before bed, she was on to something. No matter what you believe in, the act itself can help quiet your brain.

"In order to pray or to meditate in a very effective way, you've got to let go of those things in life that are the same ones that keep you from sleeping," Ojile says. Both prayer and meditation can quiet the brain, which will ultimately keep you from tossing and turning in bed. And the act of repetition, like saying the rosary prayers in order, for instance, seems to be especially powerful, he adds.

Take A Walk 

While some might find that strenuous exercise too close to bedtime only makes sleep more elusive, taking a leisurely walk a couple of hours before turning in can actually help.

 "An evening walk is a really helpful to help get rid of some of those stresses and strains from the day," Ojile says. "You always feel better after a walk."

Relax Your Muscles 

 One old-fashioned technique that can trigger sleep is called progressive muscle relaxation, which Ojile describes as almost a form of meditation and yoga. Here's how it works: Start down at your feet and work your way up the body, focusing on relaxing each part, one at a time. When you get to your core, take some deep breaths. "As you get to the deep breathing, you're by nature going to be ready for sleep," he says. "You're naturally feeling more calm and relaxed."

Cuddle Up 

Spending some time cuddling with a partner before bed stimulates the kind of emotions that are, by nature, calming, Ojile explains. And that means better sleep. Having sex can also help (we bet you won't say no to that assignment). "It may prevent sleep immediately," he says, "but ultimately it promotes sleep and relaxation.

Stress-Busters For Better Sleep - I

That looming work deadline you're not close to meeting. Your crazy mother-in-law. The election.
Stress. We all have it -- and aside from being uncomfortable during the waking hours, it could be keeping you up at night. In fact, a full 65 percent of Americans report losing sleep because of stress, according to findings from the Better Sleep Council.

"[Stress] is the single most common thing that causes people to have trouble getting to sleep," says Joe Ojile, M.D., founder and CEO of the Clayton Sleep Institute in St. Louis, Mo. and a board member of the National Sleep Foundation.

But the good news, according to one new study, is that spending time undoing the day's stress before bed can help actually you sleep better. The findings, presented at the CHEST 2012 conference earlier this week, suggest that a 10-minute stress-reduction technique can help to alleviate stress and improve sleep quality.
Researchers from the Walter Reed National Military Medical Center in Bethesda, Md. taught 334 study participants a bedtime technique involving deep breathing and imagery, which they dubbed a "tension tamer." Sixty-five percent of the volunteers reported decreased stress after trying out the new method -- and that group also reported better sleep.

"A novel stress reduction technique, the 10-minute Tension Tamer, can reduce perceived stress levels in a majority of subjects resulting in improved sleep quality, decreased sleep latency and improved fatigue," the authors wrote in their abstract.

While the findings have not yet been published in a peer-reviewed journal (meaning we should consider them preliminary), working to cut back on stress before bed is a great way to help you sleep better, Ojile explains. And while this study focused on imagery and deep breathing, that's definitely not the only effective option.

"The act of doing it is a much more important issue than which thing is done," he says. So we asked Ojile to talk through a few other 10-minute techniques worth trying. But first it's worth noting what not to do: Skip reading work emails from bed, which will only agitate you, and keep the television in another room. "The bedroom should be completely devoid of any stimulus," he says.

Read through these suggestions, then tell us: What do you do when you're too stressed to sleep?

Breakfast Eaters...

...Are Leaner

A 2003 study in the American Journal of Epidemiology showed that people who skip breakfast are 4.5 times more likely to be obese than those who take a morning meal.

The study, which included 499 people whose diets were tracked over a year-long period, also showed that eating out for dinner and breakfast are linked with obesity risk
.

Are All-Around Healthier 

A study presented in 2003 at the American Heart Association's annual conference showed that not only are breakfast-eaters less likely to be obese, they're also more likely to have good blood sugar levels and less likely to be hungry later on in the day, BBC News reported.

 "Our results suggest that breakfast may really be the most important meal of the day," study researcher Dr. Mark Pereira, of Harvard Medical School at the time, told BBC News. "It appears that breakfast may play an important role in reducing the risk of Type 2 diabetes and cardiovascular disease."

...Feel More Energized 

Eating a breakfast that's high in fiber and carbohydrates could help you feel less tired throughout the day, according to a 1999 study in the International Journal of Food Sciences and Nutrition.

 Researchers found that when people ate a high-fat, low-carb breakfast, they had more energy throughout the day compared with people who ate a high-fat breakfast, WebMD reported.

…Have Better Cholesterol Levels 

A study in the American Journal of Clinical Nutrition showed that breakfast-skippers are more likely to have worse cholesterol levels and insulin sensitivity than breakfast-eaters.

 The study also showed that the breakfast-eaters consume about 100 fewer calories a day, compared with people who skip their morning meal, CBS News reported.

...Remember Better 

Eating high-energy foods for breakfast could help to boost short-term memory, according to a study of 319 teens (between ages 13 and 20) in the Journal of Adolescent Health.

Researchers also found that eating a high-calorie breakfast actually seemed to hinder concentration.

...Consume More Nutrients 

People who rarely eat breakfast consume more fat and fewer nutrients -- like calcium, potassium and fiber -- than regular breakfast-eaters and "often" breakfast-eaters, according to a 2011 study in the journal Nutrition Research and Practice.

…Have An Excuse To Eat Healthy Breakfast Foods 

Breakfast-eaters have an excuse to consume healthy breakfast-time foods like oatmeal, eggs, grapefruit and coffee.

Oatmeal has been shown in many studies to be good for cholesterol levels, and research has also shown that it could help improve children's memory and attention skills when eaten for breakfast, compared with ready-to-eat cereals.

 Grapefruit is high in vitamins C and A, and has also been shown in a Clinical Cancer Research study this year to boost the beneficial effects of cancer drugs, HealthDay reported.

Eating eggs for breakfast has been linked to increased satiety and less food consumed later in the day, compared with eating bagels for breakfast, according to a 2005 study in the Journal of the American College of Nutrition. (The study was funded by the Egg Nutrition Center.)

And coffee, of course, has been linked to a whole host of health benefits, from a decreased risk of depression to a lower risk of some cancers and Type 2 diabetes.

Skipping Breakfast Could Make You Want More High-Calorie Foods, Study Suggests

If skipping breakfast has ever left you with a craving for some high-calorie mac and cheese or a big, juicy burger, a small new study might explain the reason why.

Researchers at the MRC Clinical Science Centre at Imperial College in London found that there is more brain activation in response to high-calorie items when a person has skipped breakfast, compared with when a person has had their morning meal.

"Through both the participants' MRI results and observations of how much they ate at lunch, we found ample evidence that fasting made people hungrier, and increased the appeal of high-calorie foods and the amount people ate," study researcher Dr. Tony Goldstone, M.D., Ph.D., said in a statement.

The study included 21 male volunteers who were asked not to eat anything before coming in for the study for two visits. On one visit, they were fed a 750-calorie breakfast before undergoing an MRI brain scan where they looked at images of high-calorie foods. They were then fed lunch.

The second visit, they weren't fed any breakfast before undergoing the brain scan where they looked at high-calorie foods. After the brain scans, they were fed lunch.

Researchers found that activity in the orbitofrontal cortex -- the part of the brain that plays a part in reward and pleasantness from food -- was different when the participants were fed breakfast, compared with when they fasted from breakfast.

Specifically, researchers found that the orbitofrontal cortex was more activated when the participants hadn't eaten breakfast.

The study was presented at the annual meeting of the Society of Neuroscience; because it has yet to be published in a peer-reviewed journal, its findings should be regarded as preliminary.

The findings back up prior research on negative ways skipping breakfast can affect your body and brain.

Take a Breath

How many times have you heard someone say that to you? Angry? "Take a breath." Confused? "Take a breath." Frustrated? "Take a breath." I think this is one of the greatest things we can do for our own mental and physical health. But how do you remember to take a breath when you're angry, confused or frustrated?

I've been teaching myself and others for more than 50 years, and in that time, a sort of user's manual for living a life on the earth has formed in my mind. I've spoken in thousands of seminars, written more books than I can count, and now here's this blog: a distillation of useful suggestions for living a life that fully expresses who each of us is.

OK, how do you remember to breathe? And why should you have to remember -- isn't it automatic? Like you, in times of stress I habitually hold my breath when I'd be better off putting my attention there rather than on what's bothering me. Focusing on my breath helps me relax so I can choose the next thing I need to do to handle the stress.

One time, swimming in a lake, I developed a cramp that was so severe that I had great difficulty staying on top of the water, much less swimming toward shore. I went down and came up. On about the fifth trip up for air, I realized that I really might drown. The intensity of that realization and the desire for life and for that next breath moved my consciousness in a way it had never been moved before. I focused my attention on staying alive. I remembered to breathe into the cramp, which allowed me to get moving. Then it was almost as if the shore reached out and pulled me in. I recognized the tremendous force of life that was within me and the great desire to continue with that life.

There's the formula. Focus on what you want; practice the habit of conscious breathing. Since that lake swim, I've practiced breathing, which is to say I've worked on building a habit of the kind of breathing that expands me, that relieves stress, focuses my mind and brings me immediately present.

Try it for yourself. Sit quietly for a moment. Let your body relax, take a slow, deep breath and feel the air gently filling your lower belly. Follow your breath in your imagination as it moves in and out. In a few moments you may begin to feel yourself "being breathed," with no effort on your part. You'll find more peace. Calm will be present in your life and likely, your awareness of the connection between breath and your essence -- spirit -- will increase.

Women who quit smoking live decade more

Smoking and women: Women who smoke nearly triple their risk of premature death, but women who quit the habit by age 40 eliminate most of that excess risk -- a difference that amounts to about an extra decade of life, a large new study shows.

Quitting even earlier is better and quitting later still helps. Bottom line: It's always a good time to stop smoking. (TIME)

Pharmacy crackdown: Massachusetts officials are cracking down on compounding pharmacies -- operations that mix their own medicines -- as a result of an outbreak of fungal meningitis linked to one such operation. In the latest development, the state closed down Infusion Resource in Waltham after an inspection found unsanitary conditions. No illnesses have been linked to that pharmacy. (NBC News)

Flu vaccine benefits: A flu vaccine prevents flu but may also prevent some heart attacks, new research suggests. One reason is that the flu may trigger heart attacks in some vulnerable people. (HealthDay)

Today's talker: One Texas mom has managed to feed hundreds, if not thousands, of premature babies -- by donating a record 86.8 gallons of breast milk to a milk bank, says Guinness World Records. Alicia Richmond pumped and donated the milk between June 2011 and March of this year, while also feeding her son. She said she got the idea when she ran out of room in her freezer. (New York Daily News)