We all know that Bacchus was a man. Based on gender stereotypes, most of us assume that women are less likely to excessively imbibe alcohol then men. (For the sake of transparency, the Superbowl was playing while I wrote this and all that celebrated testosterone caused me to make that last statement). But not necessarily so… According to a recent CDC report in “Vital Signs,” more than 14 million US women binge drink about three times a month and consume an average of six drinks per binge. This number includes one in eight women and one in five high school girls! The report states that binge drinking is most common in young women, women who are white or Hispanic, and among women with household incomes of $75,000 or more. Oh…and half of all high school girls who drink alcohol report binge drinking.

A woman’s ability to metabolize alcohol differs significantly from that of a man. When we drink alcohol it is absorbed more quickly, deactivated by enzymes less efficiently, and gets to the brain faster. (Well, we always knew that our brains have rapid and superior circulation. ) We generally weigh less than men so we are also less likely to dilute the stuff. As a result, one drink for a women has the impact of two for a man.

The definition of binge drinking for a woman is consumption of four or more alcohol drinks on an occasion. And an occasion is considered to be 2 to 3 hours. Although binge drinking in high school or college can lead to a higher incidence of alcoholism in later life, most binge drinkers are non-alcoholics and not alcohol dependent. The CDC reports that drinking too much (which of course includes binge drinking) results in about 23,000 deaths in women and girls each year and increases the chances of breast cancer, heart disease, sexually-transmitted diseases, unintended pregnancy as well as other health problems. If a woman binge drinks while pregnant, she risks exposing her baby to high levels of alcohol during its development which can lead to miscarriage, low birth weight, sudden infant death syndrome (SIDS), attention deficit/hyperactivity disorder (ADHD), and fetal alcohol syndrome (facial disfigurement and mental deficiencies). This is where I’m supposed to say it’s not safe to drink alcohol any time during pregnancy.

Aside from giving warnings, the CDC and its Guide to Community Preventive Services recommend certain strategies for preventing excessive alcohol consumption.. These include:  

*Increasing alcohol taxes.

*Reducing the number and concentration of stores that sell alcohol in a given area.

*Continuing government controls over alcohol sales.

*Maintaining or reducing the days and hours of alcohol sales.

*Enhanced enforcement of laws prohibiting sales to minors.

*Electronic screening and counseling for excessive alcohol use.

I know some of this sounds excessive and may go against our sense of what the government should and should not do. (There are no blue laws in California, and according to that wonderful series Boardwalk Empire, prohibition doesn’t work!) To help avoid teenage binging, the best plan might be to make sure that our teens can’t get into our liquor closet and of course, maintain zero tolerance for alcohol use before, during and after school parties. And then we should listen to the anti-binge advice ourselves. Remember abstaining from that second and certainly the third drink may lessen our risk for breast cancer, heart disease, stupid behavior, and worse yet, the wrong sexual and reproductive decisions. We just don’t need that extra glass of wine, cocktail or beer to enjoy the game, the dinner or the party. The salute ” Le Chaim” (translated, for those of you who need it) to “To Life” need not be accompanied by 4 drinks…one is healthier and should suffice.

A quick personal note: I am traveling to Mozambique next week with several women to see the school we built through the LA Associates of Save the Children. I will be happy to share pictures and stories upon my return.

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I no longer have to take exams (except for recent on-line traffic school), nor do most of my contemporaries. But we all have to maintain our learning and memory skills in order to live our daily lives and to perform adequately or hopefully, better than adequately, in our professions. Even if we don’t have to take academic tests, our children and grandchildren do. And we all stay up for hours in front of our computers, iPads and tablets trying to get our work done, making sure we have not forgotten something or are not behind in our virtual lives. It seems that everyone crams, often at the expense of sleep. Well, it turns out that the best way to study for an exam, prepare for that next day’s task or keep the necessary data going in our brain’s memory is to get a good night’s sleep. Studies have shown that even a little sleep loss may impair our memory and learning skills.

This was the conclusion of research presented at the Society for Neuroscience meeting in New Orleans this past week, reported in JAMA. A team of researchers from Pennsylvania studied the effects of a single night of lost sleep on 22 healthy adults who agreed to stay in the lab for five days and undergo brain imaging and memory testing. (I’m not sure how anyone could sleep in a lab but hey, research of this nature requires consenting adults who agree to have sleep-overs in strange places.) The participants  were tested after a normal night of sleep and then after a night of sleep deprivation and then once more after two nights of “recovery sleep”. Lo and behold, the participants didn’t perform well on memory tasks after a sleepless night. And when imaging tests were done, their sleep deprived brains had decreased connectivity between the hippocampus (where memory is stored) and other areas of the brain necessary for performance of memory tests and tasks. It was as though parts of their brains had gone to sleep (or strike), in protest of the forced state of sleep deprivation.

The good news is that needed memory connectivity was not lost for long after a night of lost sleep. In the study, the brain connections and the participants’ performance on memory tasks were back to normal after a couple of nights of recovery sleep.

Bottom line: If you get a good night’s sleep you’ll be more likely to remember what you just read and what you should do with the information the next day…I usually write articles telling you to eat right, exercise, maintain a healthy weight, get the appropriate diagnostic tests, therapies, medications and immunizations. This time my advice should be somewhat more relaxing… sleep well.

It’s amazing to realize that it was just 10 years ago that the Women’s Health Initiative results were released with extraordinary media brouhaha, causing as many as 70% of women who were taking menopausal hormone therapy (usually Prempro) to cease and desist…and in many instances flush, flash and lose sleep. But with time, additional studies and empathy, the experts (members of the North American Medical Society, gynecology department heads at major universities, and editors of the American Society for Reproductive Medicine and The Endocrine Society to name just some) now agree on key points regarding the safety and efficacy of hormone therapy in menopause. And since the following is generally what I tell my patients, I am delighted to recap the recommendations just published in several of the major journals.

In a overview, they agree that systemic therapy is an “acceptable” option for relatively young (up to 59 or within 10 years of menopause) and healthy women who are troubled by moderate to severe menopausal symptoms. There is no one therapy fits all, and consideration should be given to a woman’s quality- of- life priorities as well as her risk factors such as age, time since menopause risk of blood clots, heart disease, and stroke and breast cancer. Their consensus then deals with individual issues

Hormone Therapy Risks

Vascular risks Although both estrogen and estrogen with progestogen increase the chance of clots (deep vein thrombosis and pulmonary embolism as well as certain types of strokes) the risk is rare in the 50- to 59- year old age group. Moreover, observational studies have found that transdermal estrogen therapy ( with patches, creams, and sprays) and lowdose oral estrogen therapy have been associated with lower risks of these type of clot caused events.
Breast cancer
An increased risk of breast cancer is seen within 5 years or more of continuous estrogen and progestogen therapy. The risk is not great and risk declines after hormone therapy is discontinued. There is even less risk for women who have had a hysterectomy and don’t need to add progestogen to their estrogen therapy. Use of estrogen alone for a mean of 7 years does not seem to increase risk of breast cancer.
Duration of therapy

This is where everyone sites the same sentence: ” The lowest dose of therapy shouldbe used for the shortest anoint of time to manage menopausal symptoms.” they thenadd that duration should be individualized. I add that if more or longer therapy is neededto achieve quality of life, the patient and her physician should discuss this laststatement. And estrogen therapy alone, allows more flexibility in duration. There arereports of increased risk after 10 or 15 years of use in large observational studies.
Additional information

Evidence is lacking that custom compounded bio identical hormone therapy is safe oreffective. Many medical organizations and societies agree in recommending againsttheir use, particularly given concerns regarding content, purity and labeling. Finally thereis a lack of safety data supporting the use of estrogen or estrogen and progestogentherapy in women who have had breast cancer.

Conclusion

Leading medical societies devoted to the care of menopausal women agree that the decision to initiate hormone therapy should be for the indication of menopause-related symptoms.

Bottom line: there is no question that hormone therapy plays an important role in
managing the symptoms so many women experience during menopause. As usual, we
all recommend that therapy be individualized. So talk to your doctor!

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There are three ailments that most of us fear as we get older: losing our mental capacities, cardiovascular disease and cancer. In deference to reading time and latest articles, I am only going to deal with one, dementia. As I perused this month’s issue of the Journal Menopause (did I ever mention that its cover is bright red?), I found an article that summarized much of the data on dementia. Over a century ago, Dr. Alois Alzheimer, a German physician, reported on his treatment and subsequent autopsy examination of a female patient (Frau August Deter… there were no HIPAA regulations regarding names at that time) who developed dementia in midlife. Among her symptoms: hallucinations, paranoia, hostility, severe memory impairment, diminished cognition and language disturbance. She rapidly deteriorated, becoming bedridden, incontinent and completely helpless. At autopsy, Dr. Alzheimer found dramatic atrophy of her brain and on microscopic exam the neurons were surrounded by deposits of protein and had degenerated. We now know that the disease named after Dr. Alzheimer (AD) is the preeminent cause of dementia and is one of the most serious public health issues facing baby boomers as we age.

The development of Alzheimer’s disease is now thought to be influenced by many factors that include inherited gene susceptibility, environmental exposures, midlife health status, education and lifestyle choices. We also know, however, that the “older” brain has the ability to form new neurons and improve on the connection of old ones; in other words our brains have “placidity” and “cognitive reserve”. Alzheimer’s is the end result of a spectrum of mental declines and begins with mild cognitive impairment. So are there ways to prevent or delay that decline? And what can we do to maintain our brain fitness? (And if you remember, this is the intent of my somewhat cute website title.)

Here are some of the factors and prevention activities reported in the article:

Cognitive training: We’ve been told in books, magazine articles and PBS specials to engage in stimulating activities. Studies have been done which show that learning to play musical instrument lessons, memory games and learning a second language demonstrate some promise in early AD, but overall the effectiveness of these activities is, according to the authors, equivocal. They point out, however, that it can’t hurt…. (By the way, those of us who are bilingual are less likely to develop AD and lifelong bilingualism appears to delay the onset of dementia by approximately 4 years!)

Social engagement: Here is where I can add that volunteering activities have been found in some research to improve cognitive functions and mental health in seniors.

Health factors: The decidedly negative factors that increase risk of AD are the usual issues every doctor tries to help treat: obesity, atherosclerosis, high cholesterol, hypertension, smoking and diabetes. Diagnosing and treating them at an early stage should help prevent the mental consequences.

Diet: A diet rich in nuts, fish, fruits and vegetables – the so-called Mediterranean diet – is associated with a reduced risk of dementia and AD. One study that is cited in the review found that the dietary pattern that was significantly associated with reduced AD risk was a diet rich in omega-3 and omega-6 polyunsaturated acids, vitamin E, and folate and low in saturated fatty acids and vitamin B12. To get the brain-right nutrients we have to have a diet rich in dark and leafy vegetables, salad dressing, nuts, fish, tomatoes, poultry, cruciferous vegetables, and fruits, while refraining as much as possible from high-fat dairy, red meat organ meat and butter. And although it might seem easier to just take dietary supplements containing antioxidants or the omega fatty acids, know that most randomized controlled studies comparing nutrient supplements with placebo have not consistently found that they protect against cognitive decline. Apparently, we need to actually eat the foods in order to get an interaction of their nutrients to support our brains.

Physical exercise: Greater amounts of physical activity over the course of one’s lifetime are associated with a reduced risk of dementia. And it seems that there are positive effects of exercise in later life. In one study, 130 older adults (mean age 67.7 years) without dementia were randomly assigned to either an aerobic exercise training group of 30 minutes of brisk walking three times a week for 1 year or stretching in the control group. Exercise training actually increased the volumes in certain areas of the brain and memory scores on tests in the exercisers, while the control group had a decrease in the same areas in their brains and a decline in their memory scores over just the 1 year study period. I think that the data on exercise and brain health is extraordinarily convincing. And yes, I went to the gym today!

Bottom line (finally): Keep your brain engaged with mental challenges, don’t let yourself become isolated and if you have free time, volunteer (call me about Save the Children). Moreover, don’t smoke, try to maintain an appropriate weight, make sure you get your cholesterol and glucose levels down to optimal levels, get your brain nutrients through the right kind of diet (don’t rely on supplements to do it), and make exercise a vital part of your daily routine. All this may help prevent loss of a piece or peace of mind.

Greetings Patients and Friends, I will not have the usual medical related article this week.

Last Saturday my father passed away peacefully. He was 92.

Israel Sentizky was a brilliant physicist, violinist and most importantly a devoted husband and phenomenal father. He taught me advanced math (before I was emotionally advanced enough to appreciate it) and spent hours driving his two daughters to daily dance classes in NYC. When asked how long he wanted to live, he replied “Long enough to take care of my wife.” She passed away in January… My sister, his grandchildren and I will always miss him.

Certain songs play over and over again in our minds…One that haunts me was written by Charles Fox and sung by Roberta Flack; “Killing Me Softly with His Song”. I was humming it while reading an article in the journal Menopause. (Please don’t laugh.) The article was a met- analysis  of studies that measured the mean difference in age of natural menopause between smokers and nonsmokers. Menopause occurred 1.12 years earlier in smokers than nonsmokers, and that difference was significant. Hence the heading for my article this week.

Menopause is defined as a permanent cessation of periods for 12 months. And if wis use this 12 month definition, the only way to date menopause is to do so retrospectively. Before our ovaries run out of the follicles that produce the estrogen and progesterone needed to instigate our periods, they “sputter”. The follicles that have not been used up during our teens through our mid forties are the rejects and they simply do not put out (hormonally) as they should. This period of approaching follicular extinction is termed the menopausal transition. On average it begins at age 47 and lasts 4 years. During this transition, even though periods may come and go, symptoms such as hot flashes, sleep disturbances, vaginal dryness and pain with intercourse can occur.

There are more than 3000 chemicals inhaled in cigarette smoke. Many of them are detrimental to the health and well being of the follicles and can contribute to their early demise. The concerns about early menopause do not solely relate to symptoms. Early menopause increases the risk of cardiovascular disease, venus thrombosis (clots) and osteoporosis. Overall it increases the risk of mortality by approximately 2% per year. And to add insult to smoke injury, the combination of earlier loss of estrogen and current smoking further increases a woman’s risk of cardiovascular disease and death!

For this and so many other reasons, quitting smoking is the best thing a smoker can do for her health. Now would putting a picture of ovaries with a big red X over them help to convince women to stop smoking? I’m not sure … But it can’t hurt to add this to all the other warnings.

I’m sure anyone who has read a newspaper in the past few months is aware of the fears that are engulfing (of should I say filling) the French women who have received silicone implants. A company in France produced a popular (and apparently not too expensive) implant termed the Poly Implant Prothese (otherwise known as PIP). It was sold in 65 countries throughout the world over the last decade and used for breast augmentation or reconstruction in more than 300,000 women. The company that made the implants was shut down by the French government for fraud in 2010. It turns out that they had been using industrial grade silicone that was (obviously) not approved for medical use. The concern was (aside from the fact that no woman wants her breasts augmented with the same stuff they use in building or road construction) that these implants were far more likely to rupture…. apparently of the 30,000 French women who have had these implants, 1,000 experienced a rupture or leak. The French are advising those women who still have PIP implants to have them removed. Other countries are deciding what to suggest and many are simply suggesting that the women discuss “what to do” with their physician.

Why has this not been a problem here in the USA? This timely question was addressed in an article in the January 14th issue of Lancet titled “Silicone breast implants: lessons from the USA.”

The silicon-gel implants that are used in our country have been FDA approved after a long and arduous history. Currently the FDA assures us that they are safe. Their approval has allowed 150,000 American women to get silicone-gel implants for breast augmentation and 46,000 women to get them for breast reconstruction in the last year alone. In 2010 after 2 days of public testimony from silicon implant manufacturers, surgeons and scientists, the FDA concluded that American women can “consent with confidence to procedures involving silicon implants, which are considered safe but with acceptable risk of local complications (rupture, tissue hardening, pain, inflammation, and infection).” (Note the same complications occur with non-silicone, i.e. saline implants.) And just to be more precise the FDA published a 63 page report assuring the safety of silicon-gel implants.

There is quite a chronicle that preceded this. Silicon-gel implants were available in the US since the early 1960’s, but not until 1976 were they regulated by the FDA. In 1988, the FDA classified them as devices (duh) that needed their safety and efficacy to be proven in order to stay on the market. They gave the manufacturers 30 months to provide the necessary data. Apparently they could not. In 1991, it was deemed that the data did not fully assess the risks and in 1992 (this s a history lesson!) the FDA imposed a moratorium on silicon-gel implants. They were only to be used for reconstruction (after mastectomy for breast cancer or redoes of bad previous implants) and not electively for augmentation until their safety was proven. Then all hell broke loose (at least litigiously) and in 1995 the biggest US class action lawsuit took place, for $4.3 billion. Subsequently, publications in peer-reviewed journals and a 400-page report of the Institute of Medicine failed to link systemic disease with silicon breast implants. The ban was lifted in 2006 and since then 2 manufacturers; Mentor and Allergan have supplied the US market. They have promised to conduct ongoing post-approval studies and are following 40,00 women for 10 years,

So right now we feel (sorry about the use of this word) that our silicon-gel implants are safe. The authors conclude with the statement that “some critics argue that the FDA’s approval process is too slow and bureaucratic” But they add “but at what cost to safety?”

I agree with them. We should expect no less.

The saying that politics makes for strange bedfellows took on a new low when Michelle Bachman came out with her ridiculous statement against HPV vaccination. (In case you didn’t get the pun…HPV infection is most frequently transferred in a bed … or for that matter in any place that allows for sexual contact.)  So I’ll skip the part where we ask why a responsible parent would not want to help diminish the chance that her daughter would get cervical cancer or genital warts. (Yes, their may be parents out there who think that their daughter will not be sexually active with anyone but the man she marries, but what guarantees do they have that the young man she commits to did not have partners before or after he proposed to and married her.) Long-term large studies have shown negligible side effects from HPV vaccination. Sudden “mental retardation” which of course is a truly nonmedical and impolitic term, cannot suddenly occur from a vaccine given to an adolescent girl! (I have given hundreds of shots in my office and at most have seen a few “ouches” at the site of injection.) Okay, I have to stop now and become scientific. Here are the facts I promised in the heading of this week’s newsletter:

There are more than 40 types of human papilloma viruses or HPV’s that infect the general tract; approximately 15 types have been linked with cancers and are classified as carcinogenic or high risk. We now know (or at least the scientists who do the testing know) that 99.7%of cervical cancer specimens, as well as their precancerous predecessors, test positive for at least one of these high risk HPV’s. (Just in case you want to complete your viral numerical knowledge…they are HPV-16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 72.) The most common onset of infection occurs in the first years of sexually activity. Thankfully most of the infections in young women and men resolve within 2 years. In a small proportion of women however, HPV infection persists. If this happens, the virus may enter the DNA of cervical cells and cause mutations, which over time can result in precancerous lesions that progress to cancer.  HPV viral infections are extremely contagious. (Put bluntly, a touch of a penis harboring the virus will pass it on.) And there are usually no lesions that signify viral presence. It’s a “down there” scenario akin to that portrayed in the movie Contagion; but with HPV, the consequences of the viral infection occur years later. If a woman has sex with someone, she essentially has a viral contact with everyone he or she has had sex with and everyone those individuals have had sex with… etc., etc.

So it’s not surprising that at least 80% of women will, at some time in their lives, have an HPV infection…most commonly when they are young or when they are exposed to the virus through new or non monogamous partners. In most young women, the virus will clear. In the few in whom infection persists, it takes at least 2 to 3 years for potential progression to a precancerous lesion and more time until it can cause cancer. So adolescents and young adults have a very low risk of developing cervical cancer.

Obviously many young women will initially harbor one of the HPV viruses and as a result may also have some mild changes in a Pap smear screening. If these changes are found and pronounced abnormal, they (and their moms) will go through a lot of unnecessary anxiety over something that usually clears up… and even worse they may go through unwarranted surgical procedures that can scar the cervix and impact their future ability to conceive or have a normal vaginal delivery.

To help avoid unwarranted concern and cut down on unnecessary procedures, the American College of Obstetricians and Gynecologists (ACOG) has released guidelines that should make us all relax with regards to screening. They state that Pap smears should begin no earlier than age 21. And from 21 to 29 women should be screened every 2 years. (But this does not negate the need for annual pelvic exams and, if necessary Chlamydia and other STD testing should be done more frequently.) It’s recommended that by age 30 all women should undergo screening with HPV testing as well as a Pap smear. If both tests are negative and the woman has no new partners, she can then be tested every 3 years. (But again a yearly pelvis exam should be done, and if a woman has a new partner or if she is not sure of the monogamy of her current partner, testing should be more frequent.) All women in high-risk groups (women with HIV, those on immunosuppressive medications, women exposed to DES in utero and women who test positive for high risk HPV or who have been treated for cervical precancerous or cancer) should be screened frequently.

The current vaccines protect against 2 types of high-risk HPV infections that cause 70% of cervical cancers. These vaccines will not cure or get rid of HPV infections that are already present. Hence the best way to help prevent cervical cancer is to vaccinate young women (and ideally young men) before sexual activity occurs. In medical parlance this is when the young person is “sexually naïve”. Because other high-risk HPV’s, which are not covered by the vaccines, can still cause 30% of cervical cancers,  young women who receive the vaccine will still need to begin cervical cancer screening when they reach the age of 21. But when administered at the right time the vaccine will insure that the majority of cervical cancers won’t occur. What’s political about that!

As you know when you come for your annual gynecologic visit, the receptionist requests that you update your information, sign a confidentiality form, and she checks on your insurance. The nurse then hands you a small plastic cup and asks you to give a urine sample. So there you are in a cramped bathroom trying to aim the stream into what now seems like an impossibly narrow container and thinking: (a) this is humiliating, (b) why is this necessary, I have no problems with my bladder? and possibly (c) I can’t go, so what am I supposed to do now?

A new article in the Journal Obstetrics and Gynecology aptly titled “In the Trenches” emphasizes the importance of checking your urine.

An immediate urine test can be performed with a “dipstick”, a strip of paper that is specially treated to check for white cells (often present if there is an infection) red blood cells or RBC’s (and the rest of this newsletter will deal with this… if blood is present in the urine, the medical term is hematuria), protein (if elevated, a sign of kidney or even systemic disease), glucose (present in urine if blood levels are high), ketones (elevated with kidney problems or dehydration), bilirubin (elevated in liver disease) and pH (acidity).

The journal article dealt specifically with microscopic hematuria in women. “Microscopic” simply means that there is blood (or red blood cells) in urine but the urine doesn’t look bloody to the naked eye or toilet paper…(I realize this is getting a bit gross!) According to the American Urological Association, “significant microscopic hematuria” means there are three or more red blood cells (RBC’s) per high power field (magnified 40 times) on microscopic examination from two to three properly collected urinalysis specimens. To get a proper sample, the first drops of urine should not be included, just the midstream…all the more difficult to get into that cup. If you have your period, recently exercised vigorously, just had sex or vaginal trauma, obviously blood cells in the urine will not count and the test should be repeated another time.

Once a dip stick test is positive for RBC’s …I (or any doctor) will probably send the urine out for a complete urinalysis. The urine is spun down and the sediment is examined for the number of RBC’s, white cells, and/or bacteria. Often we also do a urine culture to rule out infection. (Most women, however, do know when they have a bladder infection…. they have urinary urgency, frequency and burning.)

So why is it so important to detect microscopic hematuria? Before I relate the possible causes and consequences listed in the journal article, I’ll tell the tale of a patient that I saw a few weeks ago. She was menopausal, had no signs of vaginal bleeding or urinary problems, but a routine urine dipstick test was positive for RBC’s. Her urine was sent out for culture (it was negative) and complete urinalysis. The latter confirmed the presence of a significant amount of RBC’s.. I asked her to repeat the test 2 weeks later and once more it showed RBC’s. I then referred her to a urologic specialist for a complete workup.. This ultimately consisted of cystoscopy and a CT scan of her pelvis and kidneys. She was found to have bladder cancer. It was resectable and curable.. This simple urine test probably saved her life.

The two most frequent causes of microscopic hematuria in non-pregnant women (46% of women do have hematuria during their pregnancy) are cystitis (bladder infection) and kidney stones. Additionally, some women seem to shed RBC’s in their urine without any pathology. But the cause that should be ruled out, especially in women over 40, is cancer. Bladder cancer is the 17th most common cancer in women worldwide. In the United States in 2008 there were 17,770 new cases of bladder cancer diagnosed and 4,270 deaths …that means that there were more deaths annually from bladder cancer in women than from cervical cancer! (A personal aside…. many years ago my paternal grandmother died from bladder cancer.)

The risk factors for urologic cancers in women include age over 40, smoking, a history of exposure to chemicals or dyes, a history of gross hematuria (the “gross” here is a medical term and means that urinary blood is visible), analgesic abuse and a history of pelvic radiation. And here is a fact that seems to appear whenever we discuss most cancers: up to 35% of female bladder cancer cases may be attributable to cigarette smoking!

The recommendations put forth in the article state that a complete work up of microscopic hematuria should include an evaluation of the lower urinary tract (the bladder) and upper urinary tract (the ureters and kidneys) in any “high-risk” patient. Once more, you are at risk if you are over 40, have smoked, have had chemical exposure (hair stylists), have a family history of bladder cancer (I guess that’s me) and/or recurrent urologic disease. The work up should include cystoscopy, x-rays with dye and CT scans.

We all know about the need for Pap smears. It turns out that a urine test is just as important. So please don’t bewail that request to pee in a cup.

I’ve written several newsletters about potential side effects of bisphosphonates medications used to treat osteopenia and osteoporosis (Fosomax, Boniva, and Actonel….just to remind you of some brand names). This time I want to share some potentially good news about this bone density enhancing class of medications. And I am especially happy to share the report because it comes from a study conducted in Israel. (As many of you know, I have taught and worked there and indeed will be in Tel Aviv when this article appears.)

The Israeli researchers conducted a study entitled The Molecular Epidemiology of Colorectal Cancer. It was supported by the National Cancer Institute and published in the February issue of the American Journal of Clinical Oncology. (I hope I haven’t lost most of my readers by this point…just bear with me. So many of you or your relatives take bisphosphonates so that your skeletons can successfully bear your weight without an osteoporetic fracture)

They found that postmenopausal women who had taken an oral bisphosphonates longer than one year had a 59% reduced risk of colorectal cancer. Like the Scandinavian countries, pharmaceutical records in Israel are extremely well documented. (All the citizens have health insurance and most of their prescription medications are covered…I wish I could say the same for us!) The researchers used computerized pharmacy records and identified almost 2000 women who had colorectal cancer.

They found that in these women, compared to controls who were matched for age, weight, and religion, the use of bisphosphonates longer than 1 year, but not less than 1 year, reduced the risk of colorectal cancer by half, even when they adjusted for other factors that could perhaps lower colorectal cancer risk. (Here is where I list these factors to remind you that they too count in our “war on colorectal cancer”…as does screening. They include vegetable consumption, physical activity, and weight control, use of low-dose aspirin, statins, vitamin D and postmenopausal hormones.)

Ongoing research indicates that oral bisphosphonates may exert a cancer-protective effect (including breast and prostate cancer.)  Clearly this study is not large enough to persuade the FDA to approve any official indication that this class of medication will diminish colorectal cancer. So I’ll end with the phrase that is used in the conclusions of most medical articles: “Further studies are needed”. I felt , however, that a bit of good news about the medications that can lower the huge toll of osteoporotic fractures in women (and men) is welcome.