Smoking doesn’t boost breast cancer risk

A new study has suggested that there is a significant link between smoking and breast cancer risk in postmenopausal women, but it depends on their body weight.

A significant association between smoking and breast cancer risk was observed in non-obese women, but not in obese women.

The results from an analysis of the Women’s Health Initiative observational study were similar regardless of whether obesity was defined by body mass index (BMI) or waist circumference.

Juhua Luo, assistant professor in the department of community medicine at West Virginia University, and colleagues examined the relationship between obesity, smoking and breast cancer risk.

“We found an association between smoking and breast cancer risk among non-obese women, which is understandable because tobacco is a known carcinogen,” she said.

“However, we did not find the same association between smoking and breast cancer risk among obese women. This result was surprising.”

The study included 76,628 women aged 50 to 79 years old who had no previous history of cancer. Participants were part of the Women’s Health Initiative observational study. They were recruited between 1993 and 1998 at 40 U.S. centers and were followed until 2009.

Obesity was measured by BMI and by waist circumference, and the results were adjusted for other breast cancer risk factors.

The study results indicated that non-obese women with a BMI less than 30 who had a history of smoking had a significantly higher risk for breast cancer. Those who smoked from 10 to 29 years had a 16 per cent excess risk; those with a 30- to 49-year history of smoking had a 25 per cent excess risk; and those with 50 or more years of smoking had a 62 per cent excess risk. However, this same association was not found among women with a BMI over 30.

The researchers then examined the data according to waist circumference to determine if the type of fat distribution – general compared with abdominal obesity – affected the results. When obesity status was defined by a waist circumference greater than 88 cm, similar results were found.

Despite the study’s finding that smoking did not affect breast cancer risk among obese postmenopausal women, Luo emphasized that she does not want to give the public the wrong message. Previous research has established that obesity alone is a risk factor for postmenopausal breast cancer.

“Smoking and obesity are among the leading causes of morbidity and mortality, both of which have substantial consequences on health,” she said.

“This is only the first study to examine the interaction between smoking, obesity and breast cancer risk. The main conclusion from this research is that more studies are needed to confirm these results,” she added.

The findings were presented at the AACR 102nd Annual Meeting 2011.

Is the NFL Bad For Women’s Health?

Just prior to the Super Bowl in 1993, a news conference was held by a coalition of women’s groups informing reporters of substantial evidence that domestic violence rose significantly (as much as 40 percent) on Super Bowl Sunday. The subsequent flurry of media attention resulted in this news becoming a “fact” (you’ll see why I have added the quotes shortly) in the psyches of professional football fans and detractors alike. It also led many people to affirm their belief, however inaccurate, that football fans were a bunch of knuckle-dragging misogynists who, out of frustration at seeing their team lose, beat their wives and girlfriends. However, several investigations reported by the urban-legend-debunking web site snopes.com demonstrated that “the claim that Super Bowl Sunday is ‘the biggest day of the year for violence against women’” was simply not true.

Now move ahead 18 years and a new scientifically rigorous study conducted by two economists offers compelling evidence that there is a significant link between the outcomes of professional football games and family violence (not the Super Bowl specifically), though only with certain game outcomes. Let me explain.

The researchers compared data compiled from the National Incident Based Reporting System of crime statistics from 750 law enforcement agencies with more than 900 NFL regular season game scores involving six teams (Carolina Panthers, Denver Broncos, Detroit Lions, Kansas City Chiefs, New England Patriots, and Tennessee Titans) over an 11-year period . But they went behind just wins and losses. They also looked at which team was favored, whether the opposing team was a traditional rival or in playoff contention, and whether the game was at home or away.

The results are disturbing, though not that surprising. The study reported that, in games that ended in an “upset loss” (the home team was favored to win by four or more points by the Las Vegas point spread), domestic violence spiked by ten percent. When the upset winner was a rival, domestic assault calls rose by 20 percent. These researchers are obviously real data hounds because they also reported that the rise in violence occurred when the fans’ teams were in playoff contention, were penalized significantly, and when the quarterback was sacked more than three times. Moreover, increases in reported violence occurred within a window of a few hours following the conclusion of the game.

Close games, away-game upset losses, and “upset wins” (when the home team wasn’t expected to win) didn’t have any impact on the rate of domestic violence. And there were no increases in violence by women against men.

I should note that this ten percent spike domestic violence is not nearly as high as that occurs on major holidays (New Year’s Day shows the greatest increase at 31 percent) and is about the same as occurs on hot days, another high point (or should I say low point) of family violence.

The researchers assert that emotional cues caused by the outcomes of NFL games have a significant effect on domestic violence, specifically the emotional shock and frustration that male fans experience when their team loses a game that it was expected to win. Additionally, they posit that the loss of control that occurs following their team’s unexpected loss can further trigger violent behavior. Though not addressed in the study, it’s also likely that the consumption of alcohol, a well-documented behavioral disinhibitor (sorry for the psych-speak), and the testosterone and adrenaline that often saturates the viewing environments of football games (sorry for the stereotype) may very well contribute to the increase in domestic violence.

What is particularly interesting, and perhaps controversial, is that they assert that “any difference between the rate of family violence following a win or loss as a causal effect (italics added by me) of the outcome of the game.” The researchers aren’t simply arguing that this relationship is just coincidental or correlational, rather they’re saying that the results of professional football games are the direct cause of the increase in domestic violence. They do, however, suggest that any activity that triggers strong emotional reactions, such as getting a speeding ticket, would have a similar effect. In conjunction with the theories they form the foundation of their analysis, they postulate that these scenarios increase the chances of such assaults occurring in families in which conflict is already present.

So what conclusions can we draw from this unsettling study? First, and I say this in dead seriousness, football fans need to get a grip and get a life. What causes the aforementioned emotional cues to have such a significant impact on fans is that they are so heavily invested in their teams. I studied fan violence a number of years ago and found that the line between fan and fanatic is crossed when fans “over-identify” with their teams, meaning their self-esteem becomes inextricably linked to the successes and failures of their team. Indications of this overinvestment may be in evidence when, for example, fans talk about “my” team or how “we” are doing, when their emotional reactions are out of proportion to the impact the team has on their lives, and when, I suppose, fans paint their houses the team colors.

I’m all for rooting for the home team. Following a favorite team is an exciting and bonding experience. And reveling vicariously in the team’s victories and mourning their defeats can be equally engaging. But when the line between being a fan and being a fanatic is crossed, that level of fandom strikes me as being pretty darned unhealthy. It should, at a minimum, be a sign to such fans that they may need step back, take a hard look in the mirror, and reflect on the role that watching football plays in their lives. At a maximum, these fans might consider finding fulfilling activities in which they can actually participate rather than just spectate.

Before I move on, I want to make it clear that I am not an authority on domestic violence, so the following suggestions are simply offered as common-sense steps for a very sad situation. Women whose husbands and boyfriends (or, for that matter, fathers, brothers, and uncles) are prone to violence should take this research to heart and ensure that they aren’t home for that short window of time following upset losses. It sure seems unfair that the onus has to be on the potential victims (e.g., find out who the team is playing, check the point spread, etc.) to avoid such egregious behavior; they shouldn’t have to live in fear of their significant others’ inexcusable behavior. But better control and proaction than falling victim to domestic violence.

Ob-Gyns And Midwives Seek To Improve Health Care For Women And Their Newborns

The American College of Nurse-Midwives (ACNM) and The American College of Obstetricians and Gynecologists (The College) are pleased to announce the publication of a new “Joint Statement of Practice Relations between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives.” The landmark document highlights key principles to facilitate improved communication, working relationships, and seamlessness in the provision of maternity care and other vital women’s health services.

“Health care is most effective when it occurs in a system that facilitates communication across care settings and among providers,” according to the joint statement. “Ob-gyns and CNMs/CMs are experts in their respective fields of practice and are educated, trained, and licensed, independent providers who may collaborate with each other based on the needs of their patients. Quality of care is enhanced by collegial relationships characterized by mutual respect and trust, as well as professional responsibility and accountability.”

The College and ACNM affirmed their shared commitment to the following:
- Support of evidence-based practice
- Promotion of the highest standards for education, national professional certification, and recertification
- Accredited education and professional certification preceding licensure as essential to ensure skilled providers at all levels of care across the United States
- Recognition of the importance of options and preferences of women in their health care
- Ob-gyns and CNMs/CMs must have access to affordable professional liability insurance coverage, hospital privileges, equivalent reimbursement, and support services in order to establish and sustain viable practices
- Ob-gyns and CNMs/CMs must have access to a system of care that fosters collaboration among licensed, independent providers to ensure highest quality and seamless care

The joint statement is part of an ongoing ACNM and College initiative to promote collaborative practice between obstetrician-gynecologists and certified nurse-midwives and/or certified midwives. Through The College’s 2011 Issue of the Year, “Successful Models of Collaborative Practice in Maternity Care,” The College and ACNM jointly called for papers describing sustainable models of collaborative practice involving both groups, noting that, “The impending maternity care workforce crisis necessitates focusing on best practices across the United States.” More than 60 papers were submitted for consideration; winning papers will be announced at The College’s upcoming Annual Clinical Meeting, April 30-May 4, in Washington, DC, and winners will also be honored at the ACNM 56th Annual Meeting, May 24-28, in San Antonio, TX.

“CNMs and CMs and ob-gyns are with women in some of the most important moments in their lives,” said ACNM president Holly Powell Kennedy, PhD, CNM, FACNM, FAAN. “By strengthening the way our independent professions work together, we believe that we can more effectively provide the highest quality care that women expect and deserve. We anticipate that this historic document will usher in a new era of enhanced cooperation between our professions.”

“Ob-gyns working collaboratively with midwives is a way to address the gap between the supply of ob-gyns and the demand for women’s health care services,” said Richard N. Waldman, MD, FACOG, president of The American College of Obstetricians and Gynecologists. “As a result, access to health care will be greatly improved.”

With roots dating to 1929, ACNM’s mission is to promote the health and well-being of women and newborns within their families and communities through the development and support of the profession of midwifery as practiced by certified nurse-midwives and certified midwives. Midwives believe every individual has the right to safe, satisfying health care with respect for human dignity and cultural variations.