This week brought more information for women to consider as they choose whether to alter their lives to decrease the risk of developing breast cancer. As reported in the New York Times, Dr. Wendy Y. Chen and her colleagues evaluated 105,986 women enrolled in the Nurses’ Health Study, which is famous for its long term follow up of the nurses in the United States. This study, “published in the latest issue of The Journal of the American Medical Association, examined the quantity, frequency and age at which women consumed alcohol from 1980 to 2008″ as the Times “Health” section reported.
“The latest study is among the first to assess the effect of relatively small amounts of alcohol over long periods of time, drawing on a large population of women to provide new details about the breast cancer risks associated with different patterns of drinking.”
During the period, of the study, 28 years, ”roughly 7,700 of the women enrolled developed invasive breast cancer. The researchers found that having 5 to 10 grams of alcohol a day, the equivalent of roughly three to six glasses of wine a week, raised a woman’s risk of breast cancer by 15 percent. The effects were cumulative; with each 10-gram increase in alcohol consumption per day, the risk climbed 10 percent.”
Women have been told that some red wine will lower their risk of coronary artery disease and often take that nebulous “some” to one or two drinks a night and more on the weekends. We have discussed the relationship of alcohol consumption and its impact on breast cancer risk, sleep disturbance, cognitive decline, mood disorders and obesity.
Although we can expect this debate over alcohol consumption to continue, it seems prudent to have no more than 1/2 glass of red wine a night—unless one’s appetite for risk is as high as one’s appetite for booze.
This week, Denise Grady of the New York Times wrote about an important new study. It showed that radiation treatment used as part of the treatment for breast cancer significantly lowered cancer recurrence and death rates over a ten-to-fifteen year period. The results, published this week in the journal Lancet, are based on the evaluation of outcome for a large number of women followed over many years.
A report like this, based on an analysis of many studies involving thousands of women treated in many countries, provides a significant answer to an important question: Is radiation useful or harmful in the treatment of women with breast cancer? These findings will guide treatment protocols that will decrease breast cancer recurrence and death from this disease.
Take a look at Grady’s article and let us know what you think.
Internet dating is the 21st century version of the blind date. It has replaced the hook-ups of the eighties, the bar scene of the seventies, the rock festivals of the sixties, and the mixers of the fifties, as the way men and women meet and get together. Statistics show that it’s the third most common way that relationships start in this country. What’s more, one in six new marriages now begin with an Internet connection, according to an article by Nick Paumgarten in the July 4th, 2011, issue of The New Yorker.
And who’s leading the digital dating pack? The New York Times reports that singles 55 and up “are visiting American dating sites more than any other age group.” As a clinical psychologist specializing in relationships and a professional dating coach, I know that many women over 40 are logging on in hopes of finding love. I also know that these women face a special set of issues when considering romance — whether widowed, divorced, or never married.
If you’re considering online dating, you’re likely familiar with at least one of these common obstacles:
Ambivalence, especially after divorce or break-up, is one of the most troubling, tricky, and ubiquitous issues that women face when they resume dating. Research shows that older women recover more slowly from break-ups and are more wary of starting new relationships than younger women. Many times, this is with more than good reason, as the ambivalence about starting over has been born of bitter experience. Their friends and children may urge them to get back in the game. (According to the Times report, children now buy Internet dating memberships for their parents, and vice versa!) But often much time, effort, and healing are required before the triumph of “hope over experience” can be achieved.
Lack of confidence often goes hand in hand with ambivalence, as nothing can shake one’s self-esteem as completely as the end of a relationship. Most women, particularly if they haven’t dated for awhile, feel insecure about “being on the market” at an older age. Unfortunately, the majority of us are acutely aware of our physical flaws at any age, and there are more of them to obsess over now. This feeds into another common difficulty: figuring out how to present oneself. Creating an interesting and accurate profile, choosing an alluring and flattering picture, attracting a like-minded man, and so forth, can be anxiety provoking and challenging to self-esteem.
Uncertainty about the new rules of dating. Much has changed about dating in the years (sometimes decades) that may have passed since an older woman has been “out there.” One issue that comes up often is the question of who picks up the check. As Nora Ephron once quipped, the only real achievement of the feminist revolution seems to be the Dutch treat, but I have known both women and men who have been offended when it is suggested that the bill be split. What does it mean? Just that he/she is modern? Or he’s cheap? He doesn’t like me? She doesn’t respect me, doesn’t want to see me again, she’s after a rich husband? In the old days, there were rules that dictated dating behavior and protected us from all these bewildering questions (at least at first). Now, this simple act requires the skills of a cryptographer!
Fears about sex. I am always reminded of the scene in the movie Sleepless in Seattle, in which Rob Reiner mentions tiramisu to Tom Hanks, who’s about to go on his first date since becoming a widower. Hanks thinks it’s a hip new sexual technique and begs Reiner to tell him about it. Few people are likely to mistake a dessert for a modern addition to the kama sutra, but for couples in their 40s, 50s, and beyond, sex can be a minefield. Consider all the changes in sexual mores that have taken place in the past few decades: First, sex was shameful; then, virginity was shameful; next, sex was dangerous. Menopause, illness, and aging create a new sexual landscape for both sexes, and although freedom from contraception is a plus, the dangers of infection persist. Fears and expectations can be especially difficult in this area, and both men and women feel more trepidation about being physically intimate with a new partner than when they were younger (as if it was always easy then!)
Getting duped, or hurt, or worse. Decoding men’s profiles, reading between the lines, recognizing red flags, while at the same time learning not to overlook the occasional “diamond in the rough” requires patience and, usually, a lot of sorting out. Everyone has (many) more misses than hits. Almost every man claims to be “athletic and fit,” and it’s very common for men (and women) to lie about their age, and worse. Women are especially fearful about being deluded, or, of course, romanced by someone dishonest or dangerous. As one woman said to me, relieved when she finally met a man she had been talking to online, “He seems to be who he says he is.” The man in question was that and more: a good match. Like her, he was widowed after a happy marriage, and though she’s still hesitant, so far they’re enjoying being together. It took a long time for her to overcome her fears and worries about dating in general and Internet dating in particular, and though nothing much has happened yet, she’s thanked me for helping her at least five times. To paraphrase E.M. Foster, it can be good to “only connect.”
Her name was Constance Laibe Hays. She had several beats at The New York Times and while working as a reporter there wrote an important and exhaustive book about Coca-Cola that was published by Random House, The Real Thing: Truth and Power at the Coca-Cola Company. She was brilliant. She was quiet. She was the understated woman who always had the best haircut. She ran track while studying toward her cum laude degree at Harvard. She spoke Mandarin. She made crème brulee at dawn so the youngest of her three children could bring it to school for one of the hundreds of occasions made more special by her thoughtfulness. She had a knitting circle and a book group and a dozen other regular gatherings with friends whom she honored with commitments of time and energy. She did all of this and much more while holding that full-time job at the paper and anchoring her extended family and being the woman who solved the problems of every shopkeeper in her neighborhood. She once kept me company by walking the New York City Marathon with me.
She died in 2005 at age 44.
She lives on as the departed do—in the hearts of all who loved her. And today when Jill Abramson’s appointment as executive editor of The Times was announced I could hear her cheer. Connie wasn’t given to conventional sentimentalities, but she knew a revolutionary act when she saw one and believed in their elegance and importance.
Though Abramson’s ascension to the loftiest height at the world’s most powerful news organization happened after Connie was gone, I know the professionalism, intelligence, dignity, diligence, savior faire, and clear-eyed practicality of my friend gave women at The Times a very good name. I believe she forged more than one secure rung on the endless ladder that any woman would have to climb to get to the top.
It’s a great day for women in journalism. It is no wonder I thought of one of the greats when I heard about it. Congratulations to Jill Abramson. From me and Connie and all the women who knew this day would come.
Jill Abramson, managing editor for news for The New York Times, will succeed Bill Keller as executive editor, becoming the first female executive editor in the newspaper’s 160-year history, The Times announced Thursday morning. The appointment is effective Sept. 6.
Keller, who has been executive editor since 2003, is returning to writing full time.
After the publisher, Arthur Sulzberger Jr., made the announcement to staff members crowded onto the third floor of the newsroom, Abramson said the appointment was like “ascending to Valhalla.”
For a number of years, Abramson, a former investigative reporter and Washington bureau chief, had been widely considered a candidate for the job when Keller stepped down. Among other contenders believed to have been in the running for the position was Dean Baquet, the newspaper’s Washington bureau chief and former editor of The Los Angeles Times. Baquet was named managing editor for news. John Geddes, who has been managing editor for operations, will continue in that post.
“Without question, Jill is the best person to succeed Bill in the role of executive editor,” Sulzberger said. With him, she steered the newsroom through one of the most challenging periods in recent history, both economically and culturally.
“Over the past year, she has immersed herself in our digital strategy and led the effort to fully integrate the newsroom. This Web integration has made us a better news organization, able to maintain our high journalistic standards while adjusting our approach to the dissemination of news.
“An accomplished reporter and editor, Jill is the perfect choice to lead the next phase of The Times’ evolution into a multiplatform news organization deeply committed to journalistic excellence. She’s already proven her great instincts with her choice of Dean Baquet to serve as managing editor.”
Abramson said that becoming the first woman to lead the newsroom was “meaningful to me” but added that she stood on the shoulders of women who came before her in the news organization.
“I am absolutely thrilled for Jill and for The Times,” Golden Behr, who was in the newsroom for the announcement, told WVFC this afternoon. “It’s high time for a woman to hold the baton in a newsroom that’s long been filled with strong women journalists. She and Dean Baquet – and John Geddes – are a very strong team. It bodes well for the company.”
Golden Behr, who is now executive director of scholarshipplus.org, noted that at the announcement no on actually said that Abramson would be the first woman to be executive editor. “There was a good feeling in that room – great leadership for the tough years ahead,” she said, adding that there was a positive attitude from the crowd “and great pride and belief in The Times as an amazing and vital institution.”
Abramson has already proved that she can handle tough challenges. She became managing editor for news after Howell Raines and Gerald Boyd were ousted as executive editor and managing editor in the wake of a 2003 scandal in which it was revealed that a reporter, Jayson Blair, was fabricating news stories. Staff morale was low as the newspaper fought to regain its credibility.
In 2007, she was hit by a truck and suffered a broken femur and fractured hip, but continued reading the paper with a sharp eye and handling news responsibilities as she recuperated.
Now she takes over the newsroom at a time when the news industry is wrestling with the question of keeping revenue coming in even as more and more news is distributed at no charge to readers on the Internet. The Times recently added a paywall to its website, charging readers after they reach a certain number of pageviews.
On January 4, 2007, I wrote about Joann Ferrara, a very special physical therapist whose work has been of great interest to me. Today, she speaks for herself. —Elizabeth Hemmerdinger, WFVC Board Member
As a physical therapist watching the events of the past two weeks unfold, I can’t help but think of the road that lies ahead for Congresswoman Gabrielle Giffords. From all accounts, under the best of circumstances, she has a long journey—and by these same accounts, the personality and will to meet the challenge. In his opinion piece in the New York Times on January 25, 2011, Richard Sloan speaks of the lack of documented evidence that a “fighting spirit” will improve health and wellbeing. While this may be true with regard to clinical medicine, I beg to differ when speaking of the challenges of rehabilitation. As a physical therapist for more than thirty years, I have witnessed time and again patients who surpass their expected potential due to their sheer willpower and “fighting spirit.”
I reflect upon forty girls who were born with physical and medical challenges, some so severe they require a tube to take each breath. And I marvel at their determination as I teach them at a special dance program each week called Dancing Dreams. Watching the dancers delight in accomplishing a movement we take for granted makes me realize that whatever I am giving them, I am gaining back in inspiration and introspection. Every girl teaches me by example. As they move their bodies, each in her own way, toward the ultimate goal of dancing onstage at our recital, I am reminded that each of us has at least one unique challenge in our lives that we can choose to overcome.
The last month has been a test of my own willpower.
For the last twenty three days, I have been harassing and yes, downright annoying at times, as I cajole people to “vote” for our program in a contest. We have made the finals of the Pepsi Challenge. By January 31, we must accumulate enough votes to be among the top ten vote-getters in order to receive a $50,000 grant.
First thing each morning, I send a “reminder” email to our contacts. And frankly, some days I feel like I have hit the wall and can’t possibly come up with another new and exciting way to convince people to vote that day. Then I think about the dancers, what this grant means to them and their families. The Challenge is set up so we know only our ranking—we have no idea how many votes we have received or how far we are from the leaders. We have moved from #343 to #59, and have only four days left. I won’t give up—after all, I am the “leader” of the program—and how can I not put forth my absolute best effort? How can I not teach by my example that even if we do not win—if we are not perfect—it is okay as long as we don’t give up?
Winning would allow our program to expand, allowing more children and families to experience the pride in their accomplishments that goes along with performing onstage. But win or lose this particular challenge, I have more faith than ever in the “fighting spirit.”
Late last year, a new health controversy grabbed the media spotlight: a report questioning the need for two supplements that have been longstanding nutritional touchstones for women past 40: calcium and vitamin D. We asked Naina Sinha, a member of the WVFC Medical Advisory Board and an endocrinologist specializing in metabolic bone diseases, to weigh in. Here’s her take on the topic.
On November 30th, the Institute of Medicine released guidelines about the intake of calcium and vitamin D. It is important to note that these guidelines were developed without the rigorous clinical research studies that are the gold standard in medicine. It is customary with medications that are being developed that studies are performed to closely examine safety, quality and efficacy prior to FDA approval. The FDA is not involved in regulation of supplements, and this is why, in this case, the research that is needed before making any sound recommendations is lacking.
To maintain healthy bones, we need enough calcium and vitamin D in our diet. The best way to get calcium is through food sources. Adults typically need 1200 to 1500 mg daily, which must be taken in three doses, as the body can only absorb 500-600 mg of calcium at a time.
In people with bone loss, it is especially important to get enough calcium every day, because if they don’t, the bone loss will be accelerated. If enough calcium can be absorbed through the diet, then no additional calcium supplements are needed. But it’s difficult to consume this much calcium on a daily basis, since it requires taking in a significant amount of dairy products. In these cases, a calcium supplement will be very beneficial to bone health. But it is important not to take too much calcium, as more than 2,000 mg a day can increase the risk of developing kidney stones. So it’s important to stay within the range of 1,200-1,500 mg per day.
Vitamin D is more difficult to get through diet than calcium is. It is mainly found in fatty fish like salmon, mackerel, and cod. We are able to make vitamin D in our skin upon exposure to sunlight, but if we’re wearing SPF and body lotions or if it’s wintertime, then the amount of vitamin D produced by the skin is far less. To get the daily dosage we need—roughly 800-2,000 units every day—a vitamin D supplement is needed. For people with bone loss, vitamin D is necessary to prevent further bone loss. Vitamin D can also help maintain good immune function and insulin function, which is especially important in people with diabetes. Vitamin D also plays a role in maintaining healthy mucosal surfaces. Just as with calcium, too much vitamin D can be harmful and can increase the risk of fractures and high blood calcium levels.
The new recommendations are better than the old ones (which recommended even less calcium and vitamin D). But it’s important that these guidelines serve as a launching pad for rigorous research studies. These must be performed to obtain the data that’s needed to make recommendations based in actual science. It is time the FDA got involved in evaluating supplements for the safety of us all.
A “historian’s dream” and a “diplomat’s nightmare.” British historian and columnist Timothy Garton Ash succinctly framed the duality inherent in the latest data dump of over 250,000 classified American diplomatic cables. WikiLeaks, an organization dedicated to exposing official secrets, announced it will release them in stages over the coming months. The first week saw the publication of 800-plus documents. At this rate, it will take over five years before we have them all.
We’ve seen but a very small fraction of the State Department’s confidential communications, yet a great debate is raging between those who condemn WikiLeaks and its founder, Julian Assange, for destroying the trust and credibility of the foreign service to America’s peril, and others, such as Secretary of Defense Robert Gates, who believe the exposure may be embarrassing and awkward, but not significant, because very little has been published that wasn’t either known or assumed before.
The cables’ contents range from the almost trivial (candid and unflattering characterizations of foreign leaders) to the worrisome, confirming our suspicions (the colossal extent of Afghan corruption), to the downright alarming: China, contrary to expectation, may not have enough clout in North Korea to tamp down its nuclear aspirations.
When Secretary of State Hillary Clinton was attempting to soothe ruffled feathers and repair some of the damage done by the leaks, a foreign counterpart told her not to worry: “you should see what we say about you.” The cables described Libyan Leader Muammar al-Qadhafi as acrophobic and dependent, German chancellor Angela Merkel as “risk averse and rarely creative” but also undisputed leader of Europe, French president Nicolas Sarkozy as “brilliant, impatient, undiplomatic, hard to predict, charming, innovative, and summit-prone.”
The administration, however, deems the leaks serious enough to scramble the diplomatic corps, high-ranking military, and intelligence agents with assignments in different embassies, assuming their safety may be at risk and their missions compromised. It’s clear that American diplomacy has suffered a substantial blow.
Yet advocates of transparency criticize the U.S. government for trying to suppress information that’s already out there, because there’s no way to put the genie back in the bottle. The government is exerting pressure on the American business world to inhibit publication. So far, the documents are no longer hosted by Amazon’s server; PayPal will no longer relay donations to WikiLeaks; Tableau, whose software creates graphics from data, has yanked its charts and analytics from the WikiLeaks Cablegate page; and the domain wikileaks.org no longer exists. The government has also forbidden federal employees to access the data (as if they didn’t have their own computers at home).
This heavy-handedness is very troubling. How much difference is there between the American reaction—the attempts to suppress information about the workings of the government from its citizens—and China’s Great Firewall, which prevents the Chinese from reading documents that have the potential to expose abuse, lies and corruption in their government?
This is not to say that a degree of confidentiality isn’t essential to conduct business or diplomacy. George Packer argues that a veil of secrecy is necessary in all sensitive transactions, not only in the State Department but for “[l]awyers, judges, doctors, shrinks, accountants, investigators, and—not least—journalists” to do even the most basic tasks. People often say things in confidence that they would never admit publicly. Is it right to lay bare these communications and so intensify the mistrust and disdain of America in places like Turkey and Yemen? To jeopardize the restoration of American standing among our allies after former Secretary of Defense Rumsfeld’s “old Europe” insults? To imperil the fruition of painstaking diplomacy?
Arthur Brisbane, Public Editor of the New York Times, defends his paper’s decision to publish the cables—with names of informants and other information that could result in real harm, not just embarrassment—redacted. Americans have a right to be informed by responsible journalists who “ferret out and publish information — most especially information that government, business and other power centers prefer to conceal,” he argues. Brisbane reminds his readers that government secrecy, which proliferated in the Bush administration, has continued to mushroom unchecked under President Obama.
The intent of the leakers of the cables seems to be primarily to embarrass the U.S. while inflicting collateral damage along the way. We don’t yet know what the remaining huge cache of cables will reveal. In whose interest is it to expose so much confidential material? Given that China has launched several successful hacking attacks on the U.S. government and private businesses, and that the cables reveal its determination and ability to hack into Google’s servers in China, it isn’t idle speculation to theorize that the Chinese may have had a hand in this, and may even have planted an inflammatory false document or two among the many genuine ones.
Despite the blows dealt to the U.S. and the inevitable setbacks in international cooperation, the argument that these cables may actually enhance the world’s perception of Americans and their foreign policy is increasingly being made. What the cables reveal, writes Leslie Gelb, a former New York Times columnist and senior government official, is
A United States seriously and professionally trying to solve the most dangerous problems in a frighteningly complicated world, yet lacking the power to dictate solutions. U.S. policymakers and diplomats are shown, quite accurately, doing what they are supposed to do: ferreting out critical information from foreign leaders, searching for paths to common action, and struggling with the right amount of pressure to apply on allies and adversaries. And in most cases, the villain is not Washington, but foreign leaders escaping common action with cowardice and hypocrisy.
Washington, however, will have to come to terms with the new reality of the modern information age: leaks are unavoidable, and they can’t be efficiently plugged. Nor should they be by a society that values its freedom.
If you were alarmed by the recent New York Times article, “Breast Cancer Seen as Riskier with Hormone,” you’re not alone. The day it came out, my computer crashed with hundreds of emails from worried women wanting clarification, validation, and the straight scoop, all summed up in one question: “What does this mean?”
It means a few things. It means we have some additional data from an old study that mostly confirms our knowledge that hormones can increase the risk of occurrence and the severity of breast cancer. But it also means that we need to take our morning news with a dose of perspective. The alarmist media we associate with politics these days seems to be spreading to medicine. And as in politics, this report is not what you’d call fair and balanced. Now that I’ve had a few days to read and discuss the findings with other experts in the field, I am certainly less alarmed than the average reader of the Times.
Here’s the straight story.
The Women’s Health Initiative (WHI) is the most rigorous study into the impact of hormone therapy on the cardiovascular health of post menopausal women. The latest followup of WHI Secondary Outcomes was just published in the Journal of the American Medical Association. And, I might add, released to the media several days before it reached practicing physicians.
As with the initial findings, this follow-up report confirms a slight—and I do mean slight—increase in the incidence of breast cancer in women on combined continuous estrogen plus progestin therapy (PremPro), as compared to women who were given no hormone therapy at all (the placebo group). The absolute numbers: 385 cases of breast cancer in the hormone treatment group versus 293 cases in the control group, out of a total of 16,608 women.
The original study did not report separately on breast cancer deaths. In this new WHI data, there were 25 deaths related to breast cancer in the hormone treated group and 12 deaths from breast cancer in the placebo group, from the start of the study (November 15, 1993) through this most recent review (August 14, 2009).
So we’re talking 2.6 deaths on hormone treatment versus 1.3 deaths on no treatment, per 10,000 women per year.
That’s really only one more woman who developed breast cancer. Per 10,000—ten thousand—women.
Not exactly a headline grabber, is it?
Many critics of the WHI still argue that the interpretation of the latest observational data—now 17 years out from the start—is plagued by an important flaw: at the start of the study, the median age of the participants was 63, more than a decade past the average age of menopause. Older women were chosen because, the reasoning went, they wouldn’t have menopausal symptoms and as a result would be less likely to know if they were on the hormonal medications or the placebo.
The median age of these women now is well over 70. Increasing age is known to be one of the most significant risk factors in the development of breast cancer. So in terms of gauging the risks of hormone therapy, findings for older women—already at risk for breast cancer based on age alone—has been extrapolated to the treatment of much younger women.
Even so, we need to give the WHI study its due. Over the years, it has clearly shown that postmenopausal hormone therapy has risks and rewards. From this data, we’ve learned that hormone therapy shouldn’t be used to prevent coronary artery disease or decrease heart attacks and strokes. And it’s clear that no woman should use it as a specious attempt to avoid aging, to keep a youthful complexion, or from an inappropriate fear that menopause will ruin her life.
On the other hand, there are times when hormone therapy can be appropriate. Women with severe symptoms of menopausal syndrome are few, but for them, it’s hard to look at anti-depressants and sleeping pills as the only recourse. I do feel that women who are not functioning and who find that they are “themselves again” with hormone therapy deserve the option of short-term therapy without constant anxiety from overblown headlines.
Bottom line: Women who have significant menopausal symptoms should evaluate the risks and benefits of hormonal treatment with their health care providers. If they choose to use systemic hormone therapy, they should use the lowest dose for the shortest period of time consistent with their needs. In the meantime, maybe what we need is a health advisory for media headlines. The media need news that will alarm their readers, and they need to be the first with the scoop on the bad news of the moment. They are not as concerned with balance as they should be, nor are they concerned with the anxiety and fear that their lead sentences will produce in their readers. Maybe the New York Times should have a black-box warning around these alarming health articles: “Check With Your Doctor Before Reading This.” And keep your speed dial on 911.
Over the past few weeks, conflicting reports about the effectiveness of screening mammography in breast cancer prevention have hit the media spotlight. As Breast Cancer Awareness Month continues, we asked surgical oncologist Alisan B. Goldfarb, M.D., F.A.C.S., a member of our WVFC Medical Advisory Board, to evaluate the coverage of recent studies in this area. Here, she weighs in on two New York Times articles on the topic. –Ed.
Why is it that the New York Times has a fixed attitude about screening mammography? On September 23, 2010, the headline on a front page story read: “Mammogram’s Value In Cancer Fight At Issue.” The article reported on a study that would appear in the New England Journal of Medicine the following week and gave a very opinionated review of it. Then on September 30, buried on the bottom half of page 24, an article appeared for which the headline was: “Mammogram Benefits Seen For Women In Their 40s.” In print almost as large as the headline, a call-out in the middle of the article read: “A Swedish study found fewer cancer deaths but other experts disagreed.”
What I don’t understand is why, in the news portion of the paper, there is so much opinion being expressed–particularly by one writer, who authored both articles. The first study comes from Norway and takes advantage of the fact that, before the 1990s, there was no coordinated breast cancer care, and breast cancer screening had not yet been established. The coordinated care of breast cancer was established throughout that country just prior to 1996; that year, they began doing screening mammography for women between 50 and 69 on a once-every-two-years basis. But not all the counties in Norway began screening at once. This allowed them to compare, within in the same county, the death rate from breast cancer over a ten-year period, starting long before there was coordinated breast care and after such care was in place. They could also compare the combination of coordinated breast care and mammography with a similar control group from the same area.
The findings were not a real surprise. A substantial decrease in deaths from improved cancer treatment was seen almost immediately and, since the follow-up period was very short, that was a good thing. The follow-up period was as little as two years in many patients, and less than nine years in the whole group. The addition of screening did improve the breast cancer survival rate during that short follow-up period, but not as dramatically as the increased care. The Times article goes on to note that it’s clear that mammography is not as useful as we thought because of the great new treatments available, and therefore, it’s not necessary to find breast cancers early.
Their conclusion is, of course, not correct. In order to see the impact from screening mammography, we would have to wait much longer than the short follow-up period in the Norway study. This has been very well-shown in many of the earlier studies on screening.
We also have to remember that the goal of the screening mammogram is to find small cancers, maybe even pre-invasive cancers, so that patients can be treated for cure without chemotherapy. The notion that these small cancers would never amount to anything, and that we are treating people who do not need treatment, is often mentioned when talking about the downside of screening.
I would like to know what these lesions are. I have not seen, in 30 years, a small cancer that I could guarantee would not go on to become a problem in the future, nor have I ever been unhappy to find a cancer that could be adequately treated without chemotherapy. We should not have to wait until lesions are big enough to feel in order to diagnose them, because that condemns even the less aggressive tumors to a course of chemotherapy and, for the most aggressive tumors, we will probably lose our opportunity to cure those patients.
The most aggressive cancers can spread very early and both chemotherapy and radiation therapy are what we call burden-dependent therapies. They are much more likely to be successful if there’s a minimal amount of disease present. I must strongly say that I’m completely at odds with the interpretation of the data as the New York Times presented it, which I will also point out is not how the author summed up the article. The author stated that having coordinated care and modern treatment have had a larger short-term effect on the mortality rate, but that screening mammograms are still making a considerable contribution.
The study reported in the Times on September 30 is one that has not yet been published but will appear in the journal Cancer. This research, done in Sweden, again takes advantage of the fact that some counties introduced screening mammography for women starting at the age of 40 and others did not. The researchers were able to follow the change in the mortality rate; they noticed a 26 percent lower rate in the counties with screening. Instead of simply reporting this, the Times again editorialized and got opinions from other researchers, who took exception with the findings. Those other researchers said that the analysis was flawed because the mortality rate would not be affected by finding and treating the cancers that would, in the future, have been harmless.
Once again, the notion that cancer can be harmless if left alone is one that has never been shown to be true. Until we find a way to prevent breast cancer at the molecular level, or find a test which is more sensitive and more specific than a mammogram, mammography remains our single best tool for early detection which, if followed for the long-term, will result in a much lower mortality rate from breast cancer.
As medical students, we are told that in reading medical literature, never to read just the conclusions of the author, but to read through the paper to see what data was looked at and how those conclusions were drawn. I must express great disappointment that in both articles, the journalist was not even accurately reporting the conclusions of the research that she was reporting on. I am reminded that, perhaps, a newspaper is not the best place to obtain medical information and advice.
Elizabeth Roper Marcus, an… I was going to say old friend, but… a friend since first grade, emailed me last month. I hadn’t heard from her in ages, but just her initials were enough to send me on a little travel through time. Nice to know there are some places you can still go that don’t involve an airport security officer peering through your belongings on a TV screen.
Liz and I go back all the way to Howdy Doody, watched on a tiny black-and-white TV screen (much like the ones that those security officers gaze at endlessly). Except, as I remember, her parents didn’t allow her to watch TV – until PBS was born.
Liz paid attention. I was a philistine. How do I know? We went to the same orthodontist, Dr. Sved. One day, braces all tightened up and throbbing, we did the Awful. We didn’t return directly to school. We went… (shhhh) we went to…. (seriously, don’t tell anyone)… to the Guggenheim Museum.
It was new. Extraordinary. A silo full of art with a breathtaking ramp that made my heart race. Or maybe that can be attributed to the fact that I had never done anything wrong—on purpose, anyway. I was the good girl and here I was with my best friend, playing hooky. Looking at art. ART! We rode the elevator to the top of the ramp, we started down.
I was terrified we’d get caught and wanted to race down, get it over with. Liz was oblivious. She stopped at almost every painting. And identified each picture without looking at the little sign. Klee. Mondrian. Modigliani. Pollock. Picasso. You know the group. But I didn’t.
“Yeah-but… how do you know?” I kept asking.
“These boxes, those lines, that long face…”
Back in school at that very moment, Mrs. Corby would be teaching Ninth Grade History. Like this: 20 nice girls sitting compliantly at tidy desks as she dictated outlines. Yup. That’s it. For four years. And it was a good school for which our parents paid dearly.
Yet here we were, two children: a committed teacher, a stunned student.
I was scared of Liz’s father. He banned all the good TV shows. He told me once, when I was even younger and Liz’s guest at their weekend house, that I had not been Liz’s first choice of guest—the other girls were busy. He was also my dentist. He wore Mickey Mouse space shoes and I can hear him saying, “Don’t move; you don’t want me to hurt you with the drill.” He was honest, you’ve got to give him that. He gave Liz a way to look at the world and clearly she loved him.
Here’s what Liz wrote to me last month. ”I have a little piece in Tuesday’s New York Times Science Section that I thought you might enjoy, given that you knew the subject so well. Here is the link.”
I hope that someday, no matter how difficult I appear to them, my children will write so fondly of me.
In this past weekend’s “Wellness Issue” of the New York Times Magazine (April 19, 2010), Cynthia Gorney, a journalist in her 50s, wrote a passionate essay about the suffering experienced by some women during the perimenopausal transition.
The voice in this essay is not objective or dispassionate. Ms. Gorney and other women whom she interviewed suffered from perimenopausal depression and/or cognitive dysfunction as the primary symptoms of their menopausal syndrome. Gorney apparently began hormone therapy almost a decade ago and is now struggling with the decision that nearly all women who begin hormone therapy must confront: When do I stop this treatment? What will happen when I don’t use hormone therapy?
Gorney has used her investigative skills to search for the holy grail of menopausal syndrome management. This time, it seems it might be found in “the timing hypothesis.” Scientists and physicians who have long been interested in estrogen research are conducting a number of studies that, over the next few years, will begin to give us clues about the impact of hormone use on many clinical aspects of the lives of women who are symptomatic during some part of the menopausal transition. Many of these studies will focus on when hormone therapy should be started in those cases where a woman needs treatment for symptoms she feels are destructive to her quality of life. The “timing hypothesis” focuses on the positive impact that estrogen has been demonstrated to have scientifically on the brain when hormone therapy is given early in the menopausal transition.
Hormone research is once again in a very productive phase, even though we are unlikely to ever see a study as large or as ambitious as the Women’s Health Initiative (WHI), initiated in 1991. We now know that this study was deeply flawed in design and delivery of results. It answered the questions of that time regarding the wholesale promotion of hormone therapy to prevent cardiovascular disease. It clearly showed that women who were not symptomatic and who were on the average 63 years of age should not take hormone therapy to prevent heart disease.
The WHI showed that women above the age of 59 who were treated with hormone therapy had an increase in cardiovascular events, blood clots, stroke, and breast cancer as compared to a control group given a placebo. When monitored over time, an even older group started on hormone therapy was found to have an increase in dementia compared to the placebo group. The results were delivered to the media and to women before the information was given to physicians. The media message was as blunt as the one appearing on cigarette packages: “Hormone therapy is hazardous to your health.”
Because findings from this study were released to the public before they had been properly discussed in the medical community, near-panic occurred. Women stopped hormone therapy overnight, including many who needed it to function. Now that we understand the flaws in the WHI study, we know that women who have no risk factors for hormone therapy, and who need it for management of disabling symptoms, can in fact use hormone therapy—in low doses for a short period of time—as long as the risk/benefit relationship is well understood.
Gorney nicely dissects the results of this study while looking for clues that will help her understand her hormone therapy choices. What choice must I make that is safe enough? This is the question that drives this very personal essay, “The Estrogen Dilemma.”
Questions of benefit and risk in the use of hormone therapy will always be a part of the treatment decisions that the patient and doctor must make throughout the medical management of menopausal symptoms. There will never be an easy answer. There will never be a right answer.
But the conversation has been enlivened by Gorney’s investigation into current hormone research and years of personal experience with the use of hormone therapy for the treatment of perimenopausal depression.
Dear Dr. Pat,
I just read Michelle Slatalla’s New York Times column about her menopause and hot flashes, and felt that I was reading about myself. I’m also 48 years old, and the nightly hot flashes and sweats are driving me crazy. Like her, I end up kicking the covers off, jumping out of bed to throw the windows open, and fanning myself desperately. Then my skin turns clammy and I’m freezing. I run back to bed and grab the covers. (My husband complains like hers, too.)
What’s going on? My body and I have always been friends. Why is it turning against me like this? How long will it last? What can I do?
I hear you. No one wants their sleep interrupted night after night by hot flashes and night sweats. Or the daytime exhaustion, memory loss, and mood changes that go with it, all of it caused by significant temperature disruption.
What you need is an action plan. Or I should say, a ‘less action’ plan.
For starters, it’s best not to think of hot flashes in terms of ‘action verbs:’ kick, jump, throw, fan desperately, fly or grab. That kind of thinking stimulates your adrenal glands to produce massive fight-or-flight chemicals that add fuel to the fire: palpitations, more anxiety, agitation, and recurrent hot flashes.
Here’s what I suggest:
- Before you get into bed, put a thermos of ice water on your bedside table, along with a small glass and a bowl with a dry washcloth in it. You’ll use them each time you have a hot flash.
- Create a quiet time before you go to sleep each night. Acknowledge that you’ll have hot flashes but remind yourself that you have a plan to address each episode in a calm way. Be positive about your ability to return to sleep. Then do two minutes of breathing exercises before going to sleep. Remember to use this simple meditation each time you’re wakened by a temperature surge.
- When you have a hot flash, don’t throw the covers off. Just breathe in a meditative fashion, sit up in bed, and pour a small amount of ice water into the glass and onto the washcloth in the bowl. Place the cool cloth on the back of your neck, drink one ounce of ice water, and do the meditative breathing for two minutes. Your body temperature will decrease and you know that you’ll return to sleep.
Here’s the thing: If you’re convinced that you’ll be tortured by hot flashes and temperature disruptions, then you certainly will be. But if you’re disciplined about taking the steps I’ve described, you’ll have non-medical tools to diminish the impact of the hot flashes.
“The neurobiology of hot flashes is not completely understood,” says Gyatri Devi, clinical associate professor of neurology at NYU’s School of Medicine. “But it surely arises from an errant hypothalamus—our brain’s thermostat.” Hormonal changes affect the normal ability of this temperature regulator. We do know that there is a circadian rhythm tied to the increase in hot flashes at night, but we do not yet know why. In other words, hot flashes are often much worse at night. Drugs that modify the sympathetic activity from the hypothalamus may have some benefit. Obviously, hormone therapy works to prevent this problem.
No one can tell you how long the hot flashes will continue. It is not uncommon to have hot flashes for several years before the last menstrual period, the time of medical menopause, then for a few years after this.
Roberta, menopause is a universal experience, but it’s one that each woman experiences uniquely. Some women find they cannot function without drug support during this time. Others are able to manage their symptoms through non-medical means. It’s important to find both a doctor who is interested in menopause and information from other sources that may be helpful.
Each generation of women has to find its way anew in terms of how it will cope with the menopausal transition. I suggest that you look for mentors and role models who are a decade or so older and ask them what worked. Seek out women who are functioning well, and find what works for you.
Dr. Patricia Yarberry Allen, director of the New York Menopause Center, is publisher of Women’s Voices for Change.
“This menopause business is not turning out the way I’d hoped,” writes Michelle Slatalla this week in the New York Times.
How many of us have said that?
In fact, it’s what inspired this website.
Women’s Voices for Change is about life before, during, and after menopause—emphasis on ‘life.’ There’s info about menopause and women’s health here, for sure, but more, too: news, opinion, culture, tech, and other hot-button topics from the perspective of women over 40, along with personal reflections about the pleasures and challenges of this time of life.
Amid the sizzling accounts of her body’s haywire thermostat, Slatalla writes: “If there’s any happy surprise, it’s that’s menopause doesn’t suddenly turn you old. I’m still me, albeit with annoying physical symptoms, but without any of Edith Bunker’s grandmotherly demeanor.”
That’s the way we see it, too.
Welcome to Women’s Voices for Change. We’d love to hear your thoughts, and suggestions for topics to cover or features to add. And we invite you to take a moment to sign up for email updates (in the upper right corner of this page), become a Facebook fan, or follow us on Twitter. We’re looking to rethink menopause and what it means for women today, and we’re thrilled for you to join us.
(Many observant WVFC readers are already fans of Julia Kay, who first told us of her Daily Portrait Project a year ago and this fall shared vivid memories of many Septembers. Since then, one of her portraits was in a Chicago show featured in the New York Times, and she keeps discovering new meanings of the word “portrait.” We’re thrilled that Julia has now agreed to check in with us once a month with a new selection from her project, chosen just for WVFC, and to let us know what new directions continue to grow out of her process. — Ed.)
No one paid any attention while I made January 5′s self-portrait (left), even though I was standing right in front of Roland Petersen’s “The Wedding Feast With Five Figures” (right) at the Juicy Paint exhibition at the San Jose Museum of Art. No one paid any attention because there were no paints, no brushes, no dropcloth.
I drew it with my finger on my iPod Touch using Inspire, one of dozens of drawing and painting apps (programs) for the iPhone and iPod Touch. No one paid attention because there’s nothing unusual these days about someone staring intently at a small electronic device.
When my partner first gave me an iPod Touch — essentially, a small computer like the Apple iPhone but without the phone — the device had no drawing programs. Back then, there were no independently developed programs at all, no commercials saying “There’s an app [application] for that.”
It didn’t matter: I mostly wanted to be able to have my portfolio in my pocket. When someone asked, “What kind of art do you make?” rather than inviting them to my studio or Website to see my work, or trying to explain the variety of media and subjects I’ve encompassed over time, I could answer the question with pictures. I was so thrilled that I immediately made a self-portrait in watercolor holding my iPod Touch, with the Touch displaying my portfolio.
But when the first drawing app, No. 2 , was launched in 2008, I downloaded it immediately and made my first such drawing, “iTouch” (left), despite it being an extremely limited program with a clunky interface, in which you could only make a thin black line on a white background. Since color wasn’t available, I printed it onto art paper and painted over it in watercolors to make “Worrying About My Friends” (right).
Since then, dozens more drawing and painting programs have been developed, with improved interfaces and constantly updated features. Some are general purpose, and some have a very specific capability such as drawing with type or making paint splatters a la Jackson Pollack. Many have their own groups online, mostly on the flickr.com photo Website, where users of their programs share the art they are making.
Although I’ve long had a presence on the Internet (my first Website loaded in 1998, I’ve had a blog since 2007), I had only used the Flickr photo Website to share my travel photos from abroad. With the impetus of seeing how other people were drawing on similar devices, I started uploading my Daily Portrait Project pieces, both those done on my iPod Touch and those in traditional media. It turned out there’s a fantastic community of artists out there, and soon I was following the work of artists all around the world, from China to France, Portugal to Italy, USA to Canada. I became engaged in conversations about color, media, narrative, process—in short, all aspects of making art.
I found compelling work that was like mine, and work that I loved although it was not like mine at all. One of the people whose work I started to follow was Jerry Waese, a Canadian artist who draws dynamic and engaging pictures of – traffic (see image at left). Omnibuses and taxies veer across intersections, pedestrians flow together and apart, bicycles and motorbikes converge, and skies are criss-crossed with electric lines for trams, towering traffic lights and leering street posts. All this and more is to be found in his drawings. Traffic, never a subject that interested me, was suddenly fascinating. Since Waese draws in traditional (non-digital) media, there’s always the potential of something lost in the process of scanning and uploading, in the space between the actual drawings and their digital representations.
When I discovered, quite by accident, that Waese had several pieces in a group show in San Jose, about an hour from where I live in San Francisco, I decided to drive down and see the show. It was fun to hold Waese’s actual drawings in my hands, and to wander the compact downtown of San Jose afterward, visiting galleries and museums.
And that’s how I ended up at Petersen’s “Wedding” at the San Jose Museum of Art’s Juicy Paint show, where I made another drawing on my iPod Touch (full size below). Standing in front of Petersen’s painting, I was able to imagine myself in the scene and make what I imagined real. It was far easier than I ever could have done before while standing in a museum, all thanks to having an entire, full-color art studio at my fingertips, an art studio that did not attract the attention of the other visitors or the security guards.
Julia Kay’s Daily Portrait Project is now heading toward its third anniversary, and Julia hasn’t yet missed a single day. The series of self-portraits can be viewed in its entirety at http://studiojuliakay.com/portraitproject. A broad overview of her work can be seen on her website at http://studiojuliakay.com, and her most recent work, portraits and non-portraits alike can be seen in her flickr photostream.