CHICAGO—Young women with Hodgkin disease (HD) who had been treated with chest radiation alone have an increased risk for breast cancer, according to a study in the July 23/30 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, second cancer is the leading cause of death in long-term survivors of HD, with exceptionally high risks of breast cancer among women treated at a young age. Quantitative associations between radiotherapy dose delivered to the breast at ages 30 or less and administered chemotherapy have not been reported to date in large series, nor has the influence of ovarian exposures on subsequent risk. Increased rates of breast cancer have been generally attributed to chest irradiation for HD, consistent with the known sensitivity of the breast to ionizing radiation at young ages.

Lois B. Travis, M.D., of the National Cancer Institute, National Institutes of Health, Bethesda, Md., and colleagues analyzed the risk of breast cancer among 3,817 women diagnosed with HD at age 30 or younger (between June 1965 and December 1994) and provided estimates of relative and absolute excess risk in terms of radiation dose delivered to the breast and the number of alkylating-agent (certain types of drugs that inhibit cell division and growth and are used to treat some cancers) cycles.

In an international investigation, the researchers studied 105 patients with HD who developed breast cancer and matched them with 266 patients with HD but without breast cancer. "A radiation dose of 4 Gy [gray, a measurement of radiation] or more delivered to the breast was associated with a 3.2-fold increased risk, compared with the risk in patients who received lower doses and no alkylating agents. Risk increased to 8-fold with a dose of more than 40 Gy. Radiation risk did not vary appreciably by age at exposure or reproductive history. Increased risks persisted for 25 or more years following radiotherapy [2.3-fold increased risk]," the authors write.

Treatment with alkylating agents alone resulted in a reduced risk (40 percent) of breast cancer, and combined alkylating agents and radiotherapy in a 1.4-fold increased risk. Risk of breast cancer decreased with increasing number of alkylating agent cycles. Risk also was low (60 percent reduced risk) among women who received 5 Gy or more delivered to ovaries compared with those who received lower doses.

"In summary, young women with HD may receive treatments that both increase their risk of breast cancer (i.e., radiation dose delivered to the breast) and treatments that decrease their risk of breast cancer (i.e., selected alkylating-agent chemotherapy; radiation dose delivered to the ovary). The overall increase in risk may be due in part to the result of mutational changes that, after prolonged hormonal stimulation, develop into breast cancer. The decrease in risk is likely due to a reduction or cessation of ovarian function and accompanying diminution in hormonal stimulation of breast tissue," they write.

CHICAGO—A short-term study suggests that a specific type of low-saturated-fat, vegetarian diet may reduce cholesterol levels as much as cholesterol-lowering medications (statins), according to a study in the July 23/30 issue of The Journal of the American Medical Association (JAMA).

David J.A. Jenkins, M.D., from the University of Toronto, Canada, and colleagues, studied a group of adults with high cholesterol levels to determine whether a specific type of diet that includes plant sterols (naturally occurring components of all plants mainly found in vegetable oils, vegetables and fruits) and viscous fibers (oats, barley, psyllium) would reduce cholesterol levels as much as a cholesterol-lowering drug (a statin).

According to background information provided by the authors, dietary changes have had modest cholesterol reductions in the past, from 4 percent to 13 percent. "In contrast, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) repeatedly have been shown to reduce mean serum low-density lipoprotein cholesterol (LDL-C) concentrations by 28 percent to 35 percent in long terms trials, with corresponding reductions in cardiovascular death of 23 percent to 32 percent in both primary and secondary prevention trials." Recently, the Adult Treatment Panel (ATP III) of the National Cholesterol Education Program has recommended the addition of plants sterols (2 grams/day) and viscous fibers (10 - 25 grams/day) to the diet. The American Heart Association has also raised awareness about the possible benefits of soy proteins and the potential value of nuts for the primary prevention of cardiovascular disease.

In this short-term (4 week) study, 46 healthy, hyperlipidemic (high cholesterol) adults (25 men and 21 postmenopausal women) with an average age of 59 and body mass index of 27.6 were recruited from a Canadian hospital affiliated nutrition research center and the community from October through December 2002. The participants were randomly assigned to one of three groups for the clinical trial: a diet very low in saturated fat, based on milled whole-wheat cereals and low-fat dairy foods, such as skim milk, fat-free cheese and yogurt, (n=16; control); the same diet plus lovastatin, 20 mg/day (n=14); or a diet high in plant sterols (1g/1,000 kcal), soy protein (21.4g/1,000kcal), viscous fibers (9.8 g/1,000kcal), and almonds (14g/1,000 kcal) (n= 16; dietary portfolio group). Lipid and C-reactive protein levels, obtained from fasting blood samples were measured at the start of the study, and on the second and fourth week. Blood pressure and body weight were also measured at those intervals. The food for the diets was provided to the participants, except for the fresh fruit and vegetables.

"The control, statin, and dietary portfolio groups had mean [average] decreases in low-density lipoprotein ["bad"] cholesterol of 8.0 percent, 30.9 percent, and 28.6 percent, respectively," the authors report. Respective reductions in C-reactive protein were 10.0 percent, 33.3 percent, and 28.2 percent. The significant reductions in the statin and dietary portfolio groups were all significantly different from changes in the control group."

CHICAGO—Infection with West Nile virus can cause short and long term neurologic effects, including headaches, memory loss, movement disorders and polio-like paralysis, in a small percentage of patients, according to a study in the July 23/30 issue of The Journal of the American Medical Association (JAMA).

Most human infections with West Nile virus (WNV) are subclinical or manifest as a mild febrile (feverish) illness, but a small proportion of patients (less than 1 percent) develop acute neurologic illness, according to background information in the article. The U.S. outbreak of WNV in 2002 presented an opportunity to prospectively assess specific neurologic manifestations, laboratory and neurodiagnostic findings, and long-term outcome associated with WNV infection.

James J. Sejvar, M.D., of the National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, and colleagues conducted the study from August 1 to September 2, 2002, in St. Tammany Parish, La., among patients with suspected WNV infection. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNV-seropositive patients were reassessed at 8 months.

The researchers found that 16 (37 percent) of 39 suspected cases had antibodies against WNV; five had meningitis, eight had encephalitis, and three had poliomyelitis-like acute flaccid (relaxed) paralysis. Movement disorders, including tremor (n=15), myoclonus (n=5; one or a series of sustained muscle contractions), and parkinsonism (n=11), were common among WNV-seropositive patients. One patient died. At 8-month follow-up, fatigue, headache, and myalgias (muscle aches) were persistent symptoms; gait and movement disorders persisted in six patients. Patients with WNV meningitis or encephalitis had favorable outcomes, although patients with acute flaccid paralysis did not recover limb strength.

LONG TERM EFFECTS OF WEST NILE VIRUS INCLUDE HEADACHES, MEMORY LOSS, MOVEMENT DISORDERS AND POLIO-LIKE PARALYSIS