Preventive Mastectomies Could Reduce Risk of Breast Cancer

TIMES MEDICAL WRITER

Preventive mastectomies can reduce the risk of breast cancer in women genetically susceptible to the disease, according to a new Dutch study.

Women with the genes, called BRCA1 and BRCA2, have a high lifetime risk of developing breast cancer, perhaps as high as 85%. The new research confirms an earlier American study showing that prophylactic mastectomies--complete removal of both breasts--can sharply reduce that risk. But researchers fear that cancer could still occur in residual tissue left behind after the mastectomy.

Dr. Jan Klijn and colleagues at the Erasmus University Medical Center in Rotterdam studied 139 women carrying either of the genes, but who had not yet developed cancer. The women were given counseling about their options, and 76 chose to have both breasts removed. The remaining 63 elected to have only intensive monitoring, including regular mammograms and magnetic resonance imaging to detect tumors.

The team reported in the July 19 New England Journal of Medicine that eight of the women undergoing only monitoring developed breast cancer, while none of those who received mastectomies did so.But experts cautioned that the women had been monitored for an average of only about three years and that the situation could change over time.

A 1996 study by researchers at the Mayo Clinic had shown that prophylactic mastectomies reduced the risk of breast cancer by 90%, but that was a retrospective study, which is not thought to be as reliable.

Lung Surgery Frequency and Success Are Linked

A new look at lung cancer surgery reaffirms the old adage that practice makes perfect. As has previously been found for a variety of surgical procedures, the new study found that hospitals that perform the most lung cancer surgeries have the best outcomes.

Dr. Peter P. Bach and his colleagues at Memorial Sloan-Kettering Cancer Center in New York City studied 2,118 patients who had surgery for non-small-cell lung cancer--the most common form--at 76 U.S. hospitals.

Surgeons at the 34 lowest-volume hospitals averaged only one to eight of the surgeries per year, while those at the two highest-volume hospitals did 67 to 100 annually.

Bach's team reported in the July 19 New England Journal of Medicine that, among those treated at the highest-volume hospitals, 44% survived five years and only 3% died within 30 days. Among those treated at the lowest-volume hospitals, however, only 33% lived five years and 6% died within 30 days. Moreover, 44% of the patients at the lowest-volume hospitals suffered complications, compared with 20% at the highest-volume facilities.

Study: Painkillers Not Linked to Kidney Damage

A new study calls into question the prevailing idea that regular, moderate use of over-the-counter painkillers can cause kidney damage. As many as six studies have suggested that they can, but none has been conclusive.

Dr. Kathryn Rexrod and her colleagues at Brigham and Women's Hospital in Boston studied 11,032 men who used as many as 500 pills a year for an average of 14 years. The painkillers used included aspirin, acetaminophen (Tylenol), naprosyn (Alleve) and ibuprofen (Motrin, Advil). The men were ages 40 to 84 when the study began.

The team reported in the July 18 Journal of the American Medical Assn. that it found no evidence of damage to the kidneys of the men in the study. Kidney function was determined by two blood tests. One measured the levels of creatinine, a waste product normally cleared by the kidneys. The other measured how quickly and efficiently the kidneys were able to remove creatinine.

The study was paid for by the National Institutes of Health and the manufacturer of Tylenol.

Procedure to Monitor Heart May Be Too Risky

An invasive procedure used to monitor the heart during major operations has no obvious benefit and may even be dangerous to the patient, according to a new study.

The procedure is right heart catheterization, in which a thin, flexible tube is inserted into a neck vein and guided into the right side of the heart. It can be used to monitor fluid pressure within the heart, oxygen content and other characteristics.

Dr. Thomas Lee and his colleagues at Harvard Medical School studied 215 patients who had right heart catheterization during major surgery and an equal number of closely matched patients who did not.

All were older than 50 and underwent elective non-cardiac operations at Brigham and Women's Hospital between 1989 and 1994.

The researchers reported in the July 18 Journal of the American Medical Assn. that they found no benefit from the procedure and that those who had it had three times the risk of heart attacks and other cardiac complications.

It is unclear whether the procedure itself causes problems or whether information provided by the monitoring leads to overaggressive corrective action, Lee said. The National Heart, Lung and Blood Institute is now conducting two other studies on use of the technique.

Surgery Soon After Heart Attack Poses a Stroke Risk

Having bypass surgery within two weeks after a heart attack is probably not a good idea, according to a new study by researchers at McMaster University in Hamilton, Canada.

Patients who underwent a bypass operation--in which a piece of blood vessel from the leg is used to circumvent clogged heart arteries--within the first two weeks after a heart attack are twice as likely to suffer a stroke as those who have a later bypass, researchers found. They are four times as likely to have a stroke as those who did not have a bypass at all.

The team also reported in the July 16 issue of Circulation: Journal of the American Heart Assn. that patients who had an angioplasty had no increased risk of stroke. In angioplasty, a small balloon is threaded into the artery and inflated to compress blockages and reopen arteries.

Dr. Shamir Mehta and his colleagues studied the records of more than 18,000 patients who had suffered heart attacks between 1995 and 1998. Only 1.3% of the patients had strokes within the next six months, but about one-fifth of the strokes were fatal.

During bypass surgery, blood clots can form, circulation of blood can be compromised, and bleeding can occur. All such events increase the risk of a stroke.

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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.

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