Women's Health Archive

Women whose breasts appear dense on mammograms have a higher risk for some aggressive breast cancers.

One of the strongest known risk factors for breast cancer is high breast density — that is, relatively little fat in the breast and more connective and glandular tissue, as seen on a mammogram. Now, a study has found that higher breast density in postmenopausal women increases the risk of specific types of breast cancer, including some that have a relatively poorer prognosis.

Can gentle vibration improve bone density and prevent fractures after menopause?

Soon you may be hearing a lot about low-intensity vibration therapy for strengthening bones and reducing the risk of fractures. Two low-intensity oscillating devices designed for home use are coming onto the market, and the Agency for Healthcare Research and Quality (AHRQ), which advises the federal government on health care matters, is expected to issue a report highlighting the evidence as well as the many unanswered questions about this unique approach to bone health.

A study provides one more reason to carve out time every day for a brisk walk or similar exercise, especially if you have vascular disease or are at risk for developing it. Vascular disease, including heart disease and other conditions that affect blood vessels, increases the risk of age-related problems with memory and thinking, known as cognitive decline. Many studies indicate that exercise has a protective effect on cognitive function, but most have focused on generally healthy populations. The study suggests that a 72-year-old woman with vascular problems (or vascular risk factors) who exercises at least 30 minutes a day may be, on average, as cognitively sharp as a 65-year-old woman. Results were published in the Archives of Internal Medicine (July 25, 2011).

The study. The investigation involved 2,809 women ages 65 years and over who were part of a larger study, the Women's Antioxidant Cardiovascular Study. All of them had vascular disease or at least three risk factors for heart disease, such as diabetes, high blood pressure, or a body mass index (BMI) of 30 or higher. Researchers periodically asked the women about their exercise habits, including activities such as swimming, biking, and aerobic dance, as well as walking and stair climbing. They also conducted telephone interviews to assess participants' cognitive function using five tests, including memory tests of 10 words and a "category fluency" test that asked participants to name as many animals as possible in one minute. Most of the women (81%) completed at least three assessments at two-year intervals. The researchers classified the women into five groups, or quintiles, based on their reported activity levels an average of 3.5 years before their initial cognitive assessment.

Q. I'm 75 years old and healthy. My doctor is still recommending annual Pap tests for me. I have no history of any problems in this area and have had normal Pap tests for years. Is this necessary at my age?

A. If you've had routine normal Pap tests up to now, you're unlikely to need further screening, as your risk for cervical cancer is very low. The three organizations that set guidelines for cervical cancer screening generally agree on this matter. The American Cancer Society recommends that Pap test screening be discontinued at age 70 in women who have had at least three normal Pap tests in the past 10 years and are not at increased risk for cervical cancer. The United States Preventive Services Task Force says that women at average risk for cervical cancer can stop Pap test screening at age 65. And according to the American College of Obstetrics and Gynecology, women at average risk can stop screening between the ages of 65 and 70.

Not all women have the same risk for developing breast cancer over a lifetime. Certain factors increase a woman’s risk, and some have a bigger impact on risk than others. However, having several risk factors doesn’t mean you’ll inevitably develop breast cancer. Likewise, having few risk factors doesn’t mean that you’ll never develop it.

Many risk factors, such as age and gender, are not within our control. Others, especially those related to personal behaviors, can be modified.

About 10% of women who have heart attacks seem to have clear, unblocked arteries. They don’t, really. Instead, they have a problem inside tiny arteries supplying the heart muscle, called microvessels. Traditional diagnostic tests can’t “see” into microvessels. In larger coronary arteries, the buildup of cholesterol-filled plaque creates distinct bulges that narrow the vessel at a particular spot, reducing blood flow. In microvessels, plaque uniformly coats the inner layer. This reduces the space for blood flow and makes the arteries stiff and less able to expand in response to exercise or other stress. Researchers are still trying to determine the best ways to diagnose and treat microvessel disease. Talking to cardiologists at Harvard-affiliated Brigham and Women’s Hospital, Dr. C. Noel Bairey Merz said that the erectile dysfunction drug Viagra (sildenafil), which was originally developed to improve blood flow to the heart, is being tested as one possible therapy.

Do these heavily promoted hormones justify the claims made for them?

"Bioidentical" hormones have been promoted as safer and more effective than FDA-approved hormones. The exaggerated claims go beyond relief of menopausal symptoms, suggesting they are a veritable fountain of youth.

It's understandable that women would be interested in a different approach now that long-term use of conventional hormone therapy (HT) does not prevent cardiovascular disease as researchers had hoped.

Annual screening for ovarian cancer with the CA-125 blood test and transvaginal ultrasound (TVUS) does not reduce a woman’s risk of dying from the disease, according to the results of a large clinical trial sponsored by the National Cancer Institute. Ovarian cancer is 90% curable when treated early, but most cases are diagnosed late, when the five-year survival rate is less than 30%. Nearly 14,000 women die from the disease every year.

As part of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, researchers at the University of Utah evaluated whether yearly screening could lead to earlier detection and reduce mortality. Results were presented at the American Society of Clinical Oncology meeting in Chicago and published online in The Journal of the American Medical Association on June 4, 2011.

Q. Could you discuss the benefits of creatine supplements for older, postmenopausal women? Are there any drawbacks?

A. Creatine is a substance made in our bodies from the amino acids arginine, glycine, and methionine. Amino acids are the chemical building blocks of protein; we get them from dietary protein. The body makes 1 to 2 grams of creatine a day, and we also get creatine from certain foods, such as fish and meat. Most (95%) of the body’s creatine is located in muscle, though some is found in other tissues, including the brain and retina.