Call to extend breast screening

18 November 2010 Last updated at 00:32 ET By Helen Briggs Health reporter, BBC News

Annual screening for women in their 40s with a family history of breast cancer may save lives, research suggests.

The NHS breast screening programme currently offers mammograms to women aged between 50 and 70.

But UK researchers say a pilot study suggests regular mammograms should be given to younger women who have relatives with breast cancer.

A cancer charity said more data was needed to weigh up risks and benefits.

The study, published in the journal Lancet Oncology, looked at women deemed at moderate risk of breast cancer because they have relatives with the disease.

Screening is considered unjustified in women with no family history of breast cancer because of the risk of a false-alarm.

Women at high-risk - because they are thought to have a gene mutation associated with the disease - are already closely assessed, with many given MRI scans or offered early surgery.

False alarms

The study recruited 6,710 moderate risk women across the UK who were given mammograms to check for signs of breast cancer every year for four years.

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"Start Quote

It will be important to weigh up these benefits carefully against potential risks of routine mammography before deciding whether screening really is the best course of action for this group"

End Quote Hazel Nunn Cancer Research UK

These women are not currently included in the main NHS breast screening programme, which offers mammograms to women aged 50-70 every three years.

The researchers, led by Professor Stephen Duffy of Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, compared cancer rates and deaths in this group with women from other trials who were not given annual screening.

They say the women given screening were significantly more likely to be alive 10 years after a diagnosis of cancer than women in the two control groups.

Professor Duffy told the BBC: "It means that annual mammography does reduce the risk of dying of breast cancer in this group of moderate risk women.

"It means they can go and seek medical help knowing that there is something that can be done."

Rough figures suggest that it would probably save an extra 50 lives a year, he added.

"It doesn't sound like much but it means alot to the people who are in that group because they have relatives who have had breast cancer," he explained. "It's not a huge expense to the NHS."

Surveillance

But Hazel Nunn, senior health information manager at Cancer Research UK, said the full picture was not yet clear.

"Since it seems 5,000 women would need to be screened to save one life, it will be important to weigh up these benefits carefully against potential risks of routine mammography before deciding whether screening really is the best course of action for this group," she said.

"We await the results of further research measuring the risks."

The NHS Breast Screening Programme said plans were in place to extend screening to women with a family history of breast cancer in the future.

Assistant Director, Sarah Sellars, said current guidelines for women at risk of breast cancer because of their family history recommend that certain women should be offered surveillance.

She said these services were currently commissioned locally but in the future would be run by them.

"In the future, the NHS Breast Screening Programmes will be taking on responsibility for routinely screening higher risk women under 50," she said.

"Several breast screening sites are currently testing the software to be able to manage these women effectively.

"This service will sit alongside our current breast screening programme for women aged 50 years old and over."

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Kidney zap lowers blood pressure

17 November 2010 Last updated at 09:19 ET By Michelle Roberts Health reporter, BBC News <!-- Embedding the video player --> <!-- This is the embedded player component -->

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Fred Quatromini: Trial treatment "has done something that tablets can't do, to me anyway"

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A short blast of radio waves to the kidneys can help control high blood pressure in patients who do not respond to medication, a study shows.

The pioneering work, described in The Lancet medical journal, selectively severs nerves to the kidney that play a key role in regulating blood pressure.

Although still in the testing phase, experts say the procedure could one day help hundreds of thousands of patients.

Half of patients fail to achieve good blood pressure control with drugs.

This is partly because it can be difficult to remember to take medication every day. But for up to a fifth of patients it is because the drugs simply have no effect.

High blood pressure is an exceedingly common condition, affecting around one in three adults in England.

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This trial opens up a potentially exciting new avenue for the treatment of patients with high blood pressure who do not respond well to current medicines"

End Quote Professor Jeremy Pearson British Heart Foundation

Experts believe the new procedure could help many of these better control their condition, thereby lowering their risk of future strokes and heart attacks.

Promising results

Doctors led by Professor Murray Esler at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, have been testing the safety and effectiveness of the therapy.

To get to the kidneys, the doctors use a long, thin piece of tubing called a catheter that is threaded into an artery in the groin and guided up to the kidney.

Once in place, the catheter is connected to a machine that generates radio waves, known as radiofrequency energy.

In this way, a short burst from the machine can knock out a number of tiny nerves that run in the lining of the arteries of the kidney.

By stopping these nerves from sending signals the treatment lowers blood pressure.

The Australian team, working with 24 centres across the globe, have tested the treatment in trials involving more than 100 patients.

They found the therapy lowered blood pressure by about 10mmHg or more - which although is not enough to return blood pressure to a 'normal' level is enough to reduce some of the associated health risks of very high blood pressure.

And, importantly, there were few side effects if any.

Six months after the treatment, 41 (84%) of 49 patients who underwent the procedure had a reduction in systolic blood pressure of 10mmHg or more, compared with 18 (35%) of 51 controls.

The first patient in the UK received the innovative procedure at Barts and The London NHS Trust a year ago.

Commenting on the findings, Professor Jeremy Pearson of the British Heart Foundation said: "This trial opens up a potentially exciting new avenue for the treatment of patients with high blood pressure who do not respond well to current medicines.

"Further studies are needed to see if this invasive procedure will be acceptable to patients and produce long-lasting effects that are safe and reduce future cardiovascular events."

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Professor Graham MacGregor, chairman of UK charity the Blood Pressure Association, said: "This is exciting research which could play a part in tackling the massive issue of high blood pressure, which affects 16 million UK adults and is a major killer through the strokes and heart attacks it causes."

But he said most people would not need to undergo such invasive treatment as, for the majority, high blood pressure can be successfully controlled through prescribed medicines and a healthier lifestyle.

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Ministers &#39;broke midwife pledge&#39;

17 November 2010 Last updated at 03:09 ET <!-- Embedding the video player --> <!-- This is the embedded player component -->

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Cathy Warwick: "The government is not delivering on its pre-election pledge...we are incredibly disappointed"

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The Royal College of Midwives (RCM) has accused the government of backing down on a pre-election pledge to increase midwife numbers in England.

It says mothers and babies will suffer unless the 3,000 extra midwives it says were promised are delivered by 2014.

RCM general secretary Cathy Warwick will tell its annual conference there are too few to cope with a rising birth rate and increasingly complex births.

The Tories said the rise was now not needed as the birth rate was stable.

Speaking ahead of Wednesday's conference in Manchester, Ms Warwick told BBC Radio 5 live ministers had gone back on their word.

Vacant posts

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"Start Quote

There is a need for more consultants to deal with the increase in the number of high-risk pregnancies"

End Quote Dr Tony Falconer Royal College of Obstetricians and Gynaecologists

She said: "Just before the election, both the prime minister and the deputy prime minister told us that they would commit to continuing the previous government's promise to give us more midwives.

"We've just done a survey of all the heads of midwifery and they've got vacant posts but they're having difficulty filling them."

The RCM survey of 83 out of 194 heads of midwifery suggested maternity units were already seeing budget and staffing cuts.

Some 30% said their budgets had fallen over the past year, while a third had been asked to reduce staff.

And two-thirds surveyed said they did not have enough midwives to cope with demand.

Meanwhile, the number of live births in England has risen by 19% between 2001 and 2009, to 670,000 a year.

The RCM said births over the same period had become more complex, with obese pregnant women and older or teenage women needing extra support.

The Royal College of Obstetricians and Gynaecologists (RCOG) said maternity services were facing many challenges.

President, Dr Tony Falconer, said: "As well as need for more midwives, there is a need for more consultants to deal with the increase in the number of high-risk pregnancies."

A Conservative Party spokesman said: "The commitment to 3,000 midwives made in opposition was dependent on the birthrate increasing as it has done in the recent past. It was not in the coalition agreement because predictions now suggest the birthrate will be stable over the next few years.

"People can be absolutely clear that our commitment to meet the needs of expectant mothers remains, and we will continue to train new midwives to meet the demands arising from the births."

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Placenta key to pregnancy length

16 November 2010 Last updated at 20:27 ET By Neil Bowdler Science reporter, BBC News

The placenta may play a key role in determining the gestation period of humans and other mammals, according to a new study.

The research links growth rates of mammals inside the womb to the structure of the placenta and the way it connects mother and baby.

This, as well as mammal size, may explain variations in gestation times.

While a human pregnancy is nine months long, a meadow mouse gives birth after just three weeks.

Finger-like

The placenta plays a fundamental role in reproduction in mammals, transferring nutrients and oxygen from mother to foetus and removing waste from the foetus.

The structure of the placenta, however, varies enormously from species to species. This new study suggests these variations may play a role in the length of the pregnancy.

The researchers analysed 109 mammal species. What they found was the more complex and folded the placenta of a mammal, the shorter the gestation time appeared to be.

What they believe is happening is that more folded placentas are able to deliver more nutrients to the infant, spurring growth, and so reducing gestation times.

More complex placenta were found in mice, which have a gestation period of some three weeks, dogs (two months) and leopards (three months).

But humans and other primates such as baboons were seen to have simpler placentas where fewer nutrients were passing into the foetus, resulting in slower growth rates and longer gestation times.

"In humans, the placenta has simple finger-like branches with a relatively limited connection between the mother's tissues and those of the foetus," said Dr Isabella Capellini of Durham University, the lead author on the study.

"Whereas in leopards, the placenta forms a complex web of interconnections that create a larger surface area for the exchange of nutrients."

The study is published in the journal American Naturalist.

Mother vs baby

There are of course many other factors involved in gestation times, not least the size of the mammal, with larger mammals tending to have longer pregnancies.

Natural selection is also thought to determine at what stage of maturity an animal is born.

An antelope or a sea turtle must be born ready to escape predators, while mice or squirrels are born with their eyes closed and without fur, and must be guarded further by their mothers.

But the role of the placenta may go some way to explaining why gestation times can vary between mammals of similar weight.

A European porcupine, which has a highly folded placenta, has a gestation of two months. A baboon, which will grow to a similar weight, has a simpler placenta, and a gestation length of six months.

Scientists have long seen the organ as a battleground where mother and child compete for nutrients.

The new research suggests that while the offspring of mice may be winning that war, in humans, there may be a more evenly balanced contest between mother and child.

"Parent-offspring conflict is universal," said Professor Robert Barton, of Durham University, who co-authored the report.

"From the moment of conception, the physiologies of mother and baby are adapted to achieve slightly different goals in terms of how fast the baby grows."

According to Professor E Wildman of Wayne State University in Detroit, US, who reviewed the study, the research provides strong evidence of the role placenta structure plays in gestation times.

He said the work showed that "the oven was being turned up a bit" in some mammals, with more nutrients leading to faster growth rates.

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Garlic &#39;remedy for hypertension&#39;

16 November 2010 Last updated at 20:48 ET By Helen Briggs Health reporter, BBC News

Garlic may be useful in addition to medication to treat high blood pressure, a study suggests.

Australian doctors enrolled 50 patients in a trial to see if garlic supplements could help those whose blood pressure was high, despite medication.

Those given four capsules of garlic extract a day had lower blood pressure than those on placebo, they report in a scientific journal.

A UK heart charity said more research was needed.

Garlic has long been though to be good for the heart.

Garlic supplements have previously been shown to lower cholesterol and reduce high blood pressure in those with untreated hypertension.

In the latest study, researchers from the University of Adelaide, Australia, looked at the effects of four capsules a day of a supplement known as aged garlic for 12 weeks.

They found systolic blood pressure was around 10mmHg lower in the group given garlic compared with those given a placebo.

Researcher Karin Ried said: "Garlic supplements have been associated with a blood pressure lowering effect of clinical significance in patients with untreated hypertension.

"Our trial, however, is the first to assess the effect, tolerability and acceptability of aged garlic extract as an additional treatment to existing antihypertensive medication in patients with treated, but uncontrolled, hypertension."

Experts say garlic supplements should only be used after seeking medical advice, as garlic can thin the blood or interact with some medicines.

Ellen Mason, senior cardiac nurse at the British Heart Foundation, said using garlic for medicinal purposes dates back thousands of years, but it is essential that scientific research proves that garlic can help conditions such as raised blood pressure.

She said: "This study demonstrated a slight blood pressure reduction after using aged garlic supplements but it's not significant enough or in a large enough group of people to currently recommend it instead of medication.

"It's a concern that so many people in the UK have poorly controlled blood pressure, with an increased risk of stroke and heart disease as a consequence. So enjoy garlic as part of your diet but don't stop taking your blood pressure medication."

The study is reported in the journal Maturitas.

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Clot drug to help heart patients

15 November 2010 Last updated at 11:02 ET

Hundreds of thousands of heart patients would benefit from new type of blood thinning drug to cut their risk of stroke, say UK experts.

Patients with atrial fibrillation (AF), a fast and erratic heartbeat, can reduce their risk by a fifth when taking rivaroxaban rather than the most popular existing treatment, warfarin.

The data comes from a study of 14,000 patients and was presented at the American Heart Association conference.

AF affects around 800,000 UK people.

One in five people over the age of 70 is likely to be diagnosed with an irregular heartbeat, which can lead to blood clots and cause strokes.

Continue reading the main story

"Start Quote

This important study adds rivaroxaban to the increasing list of new drugs that seem to be at least as good as warfarin - the current standard therapy to prevent strokes in AF"

End Quote Professor Peter Weissberg Medical director of the BHF

Disease prevention

Both rivaroxaban and warfarin work by thinning the blood to reduce the risk of clots.

Patients treated with warfarin are half as likely to have a stroke compared with those taking no treatment or aspirin.

However, the dosage needs to be closely monitored - in some cases once a week. Too high a dose can lead to internal bleeding, which can prove fatal, and too low a dose increases the risk of stroke.

Unlike warfarin, levels of the new drug do not need to be monitored as intently and the necessary dosage is not affected by certain foods or alcohol.

Rivaroxaban is already recommended on the NHS to prevent blood clots in people undergoing hip and knee replacement surgery.

Professor Keith Fox, British Heart Foundation professor of cardiology at the University of Edinburgh, who led the research, said: "Our study showed that rivaroxaban is simpler to administer and patients taking it have fewer strokes and blood clots.

"We now have an effective alternative to warfarin for patients with irregular heart beats and one that reduces complications and is easier to administer."

Professor Peter Weissberg, medical director at the British Heart Foundation, said: "This important study adds rivaroxaban to the increasing list of new drugs that seem to be at least as good as warfarin - the current standard therapy to prevent strokes in AF."

But he said: "The rate at which these new drugs are introduced into routine clinical practice will be determined by the extent to which regulators believe their benefits justify their additional cost."

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