CHICAGO—Women who report regular use of aspirin appear to have a reduced risk of breast cancer, according to a study in the May 26 issue of the Journal of the American Medical Association (JAMA).

While cancer epidemiology and prevention have traditionally focused on the identification and modification of lifestyle factors that may increase or decrease the risk of various cancers, much recent attention has been centered on chemoprevention, the use of chemical agents to prevent or inhibit the carcinogenic process, according to background information in the article. Use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with a decrease in the risk of several cancers, including breast cancer. Given the importance of estrogen in the pathogenesis of breast cancer, the ability of aspirin and other NSAIDs to protect against breast cancer could vary according to hormone receptor status.

Mary Beth Terry, Ph.D., of Columbia University, New York, and colleagues conducted a study to determine the association between the frequency and duration of use of aspirin and other NSAIDs and breast cancer risk and whether any observed association is more pronounced for women with hormone receptor-positive breast cancers. The study, which included in-person interviews, was conducted during 1996-1997. There were 1,442 breast cancer cases and 1,420 controls.

The researchers found that ever use of aspirin or other NSAIDs at least once per week for 6 months or longer was reported in 301 cases (20.9 percent) and 345 controls (24.3 percent) with a 20 percent lower risk of breast cancer for ever use vs. nonusers. "The inverse association was most pronounced among frequent users [7 or more tablets per week, 28 percent lower risk]. The results for ibuprofen, which was used by fewer women on a regular basis, were generally weaker [22 percent lower risk for less than 3 times per week vs. 8 percent lower risk for 3 times or more per week]. Use of acetaminophen, an analgesic that does not inhibit prostaglandin synthesis, was not associated with a reduction in the incidence of breast cancer. The reduction in risk with aspirin use was seen among those with hormone receptor-positive tumors [26 percent lower risk] but not for women with hormone receptor-negative tumors," the authors write.

CHICAGO—Having information on the other illnesses a patient with cancer has can help in determining appropriate treatments and possible outcomes, according to a study in the May 26 issue of the Journal of the American Medical Association (JAMA).

For more than 40 years, cancer patients have been staged by the size of their tumor while ignoring how sick they are from the tumor and considering other medical conditions, according to background information in the article. The present system of cancer classification does not consider patient-based prognostic factors, such as the general health of the patient, defined as the number and severity of coexisting diseases, illnesses, or conditions. These conditions and diseases, which exist before cancer diagnosis and are not adverse effects of cancer treatment, are generally referred to as comorbidities. Comorbidity may impact treatment decision-making, prognosis, and quality of care assessment.

Jay F. Piccirillo, M.D., of Washington University School of Medicine, St. Louis, and colleagues assessed whether comorbidity information obtained by cancer registrars during their usual chart abstraction process could provide important prognostic information.

Comorbidity data were collected by trained hospital-based cancer registrars and obtained through medical record review using the Adult Comorbidity Evaluation 27, a validated chart-based comorbidity instrument. The study included a total of 17,712 patients receiving care between January 1, 1995, and January 31, 2001, for the primary diagnosis of new cancer of the prostate, lung (nonsmall cell), breast, digestive system, gynecological, urinary system, or head and neck.

"Our results demonstrate that hospital-based cancer registrars can collect comorbidity information, which provides important prognostic information," the authors write. "Comorbidity information was prognostically relevant in all cancer sites while the exact contribution varied from site to site. Comorbidity information was more important among the cancers with longer mean survival (prostate and breast) and prognostically least informative in the cancers with the worst survival (lung). In addition, we showed that comorbidity and extent of tumor spread or stage are prognostically complementary."

CHICAGO—A study in the May 26 issue of the Journal of the American Medical Association (JAMA) suggests that prenatal cocaine exposure was not associated with lower full scale IQ scores, or verbal or performance IQ scores at age 4 years. However, the study also found that prenatal cocaine exposure was associated with specific cognitive impairments and a lower likelihood of an above average IQ, but that home environments could make a difference for better outcomes for some children.

"Cocaine readily crosses the placental and fetal brain barriers and has a direct effect on the developing fetal brain..." the authors provide as background information in the article. The authors add that "a number of methodologically sound studies have found a relationship between fetal cocaine exposure and negative child developmental outcomes in the first years of life, although others have not."

In this study, Lynn T. Singer, Ph.D., from Case Western Reserve University, Cleveland, and colleagues assessed the effects of prenatal cocaine exposure and the quality of the caregiving environment on cognitive outcomes. The participants included 376 children (190 cocaine-exposed and 186 non-exposed) from a high-risk population who were enrolled in a longitudinal study from birth (September 1994 - June 1996). They were screened for drug exposure as infants, assessed at 6, 12 and 24 months of age and then tested at 4 years old for cognitive developments.

The researchers found that prenatal cocaine exposure was not related to lower full-scale IQ scores (cocaine exposed 80.7 vs. nonexposed 82.9), summary verbal (cocaine exposed 79.9 vs. nonexposed 81.9) or performance IQ measures (cocaine exposed 85.5 vs. nonexposed 87.5) at age 4 years. "However, there were specific effects of prenatal cocaine exposure on several subscales, with cocaine-exposed children having lower information, arithmetic, and object assembly scores than nonexposed children," the researchers report. "Prenatal cocaine exposure was also associated with a lower likelihood of achievement of IQ above normative means."

The researchers continue, "Comparisons indicated that cocaine-exposed children in foster or adoptive care lived in more stimulating home environments and their caregivers had better vocabulary scores than those of cocaine-exposed children in biological maternal or relative care and nonexposed children. In addition, cocaine-exposed children in foster or adoptive care had verbal, performance, and full-scale IQs equivalent to nonexposed children, while cocaine-exposed children in biological maternal or relative care had lower full-scale and performance IQ scores than nonexposed children, despite the fact that children in foster or adoptive care had twice the severity of cocaine exposure as measured by maternal report of the average numbers of 'rocks' of cocaine used weekly over the pregnancy. Moreover, the duration of placement in foster or adoptive care was positively related to full-scale IQ," the authors note.

PRENATAL COCAINE EXPOSURE DAMAGING, BUT NOT AS DEVASTATING TO BRAIN DEVELOPMENT AS PREVIOUSLY THOUGHT