Depression ties marital strain to cardiovascular risks in women, not men.

SALT LAKE CITY – Women in strained marriages are more likely to feel depressed and suffer high blood pressure, obesity and other signs of “metabolic syndrome,” a group of risk factors for heart disease, stroke and diabetes, University of Utah psychologists found.

The same study found men in strained marriages also are more likely to feel depressed, yet – unlike women – do not face an increased risk of metabolic syndrome, which is characterized by five symptoms: hypertension, obesity around the waistline, high blood sugar, high triglycerides and low levels of HDL, which is “good cholesterol.”

“We hypothesized that negative aspects of marriages like arguing and being angry would be associated with higher levels of metabolic syndrome,” says the study’s first author, Nancy Henry, a doctoral student in psychology. “We further anticipated that this relationship would be at least partly due to depressive symptoms.”

“In other words, those who reported experiencing more conflict, hostility and disagreement with their spouses would more depressed, which in turn would be associated with a higher risk of heart disease due to metabolic syndrome,” she adds

“We found this was true for wives in this study, but not for husbands,” says Henry, who was scheduled to present the findings Thursday, March 5 in Chicago during the American Psychosomatic Society’s annual meeting.

“The gender difference is important because heart disease is the number-one killer of women as well as men, and we are still learning a lot about how relationship factors and emotional distress are related to heart disease,” she says.

Putting Your Heart into Your Marriage

Does the study suggest women should avoid men to reduce heart disease risks?

“We know they should,” jokes Tim Smith, a psychology professor and study co-author who heads a larger University of Utah study of the role of marriage quality in heart disease. The new study is part of the larger effort.

Smith, turning serious, says: “The reason you have to be careful about ‘what does it mean?’ is that this study is a simple, preliminary test of what might be unhealthy about relationships for women.”

“There is good evidence they [women] should modify some of the things that affect metabolic syndrome – like diet and exercise – but it’s a little premature to say they would lower their risk of heart disease if they improved the tone and quality of their marriages – or dumped their husbands,” he says.

Other data from the larger study indicate “that a history of divorce is associated with coronary disease,” he adds, noting the researchers are pursuing the hypothesis that improving marriage might improve health.

“The immediate implication is that if you are interested in your cardiovascular risk – and we all should be because it is the leading killer for both genders – we should be concerned about not just traditional risk factors [such as blood pressure and cholesterol] but the quality of our emotional and family lives,” Smith says.

In addition to possible health benefits, more immediate benefits include “getting along better and enjoying each other more, improving your mood,” he says.

Some critics have questioned the concept and clinical usefulness of metabolic syndrome – also known as syndrome X or insulin resistance syndrome – and have asserted that it is nothing more than the sum of its parts, namely, a group of five risk factors for heart disease, stroke and diabetes.

“It is defined as a syndrome, but there still is controversy in the medical community – what should be included, how the different factors should be measured, whether all the factors hang together as a distinct syndrome or are they just separate things,” Henry says.

She says she chose to study metabolic syndrome because there is no question its components are risk factors for cardiovascular disease and because the syndrome was a possible explanation for how “psychosocial risk factors” in marriage are related to cardiovascular disease.

“Strained marriages can increase your risk of heart disease, and that may in part be because strained marriages increase the risk of metabolic syndrome and thus heart disease,” Smith says. “The reason strained marriages might be related to metabolic syndrome is that strained marriages can be depressing, and depression is then the link to metabolic syndrome.”

Smith says the endocrinology of depression’s psychological stress may explain why the five risk factors that comprise metabolic syndrome fit together.

He hypothesizes that perhaps “the hormonal effects of stress are why you are depositing fat [around the waist], why your insulin resistance goes up, why your lipids and blood pressure get out of whack. Part of the reason these things may be clumping together is because they are part of an unhealthy body response to stress.”

How the Study Was Performed

Henry and Smith conducted the new study with University of Utah psychologists Jonathan Butner, an associate professor; Bert Uchino, a professor; and Cynthia Berg, a professor and chair of the university’s Department of Psychology.

For their wider study, the psychologists used the Dan Jones & Associates polling firm and newspaper ads during 2001-2005 to recruit 276 couples, who were married an average of 20 years and from ages 40 to 70.

Each couple filled out several questionnaires for both the encompassing study and for Henry’s study. The questionnaires included 10 scales: three to assess positive aspects of marriage quality, such as mutual support, emotional warmth and friendliness, and confiding in each other; three scales to measure negative aspects of marital quality such as arguments, feelings of hostility and extent of disagreement over various topics such as kids, sex, money and in-laws; and four scales to gauge symptoms of depression (not necessarily full-blown clinical depression).

Each couple also went to a university clinic, where their waists and blood pressure were measured and they were given lab tests for “good” cholesterol, fasting glucose and triglycerides. Together, those data determined if a study participant had metabolic syndrome. They also underwent a screening test designed to exclude any couple that already had cardiovascular disease.

The findings:

* Women who reported more marital strain were more likely to also report depressive symptoms, Henry says.

* “Women who reported more marital strain had more metabolic syndrome symptoms, and that association can be explained by the fact they also reported more depressive symptoms,” says Smith.

* “Men in bad marriages also reported more depression, but neither marital strain nor depression was related to their levels of metabolic syndrome,” he adds.

“We know from previous research that women are more sensitive and responsive to relationship problems than men,” Henry says. “The results of this study suggest those problems could harm their health. Understanding the emotional and relationship health of couples can be an important overall factor in understanding physical health. Improving aspects of intimate relationships might help your emotional and physical well-being.”

Source: University of Utah.

The Human Fertilization and Embryology (HFE) Act becomes law in April 2009¹. It promises groundbreaking legislation on assisted reproduction and embryo research², but was its development really a landmark in national scientific decision-making?

With contributions from leading figures in the worlds of science, policy, ethics and the media, the ESRC Genomics Forum³, based at the University of Edinburgh, is holding a conference examining how this new legal framework was determined, and who really makes the decisions related to science policy in Britain.

The event is part of the ESRC’s Festival of Social Science and takes place on Thursday 12th March 2009, 9am-5pm, One Great George Street, Westminster.

Conference speakers include:

* Dr Stephen L Minger, Director, Stem Cell Biology Laboratory King’s College, London
* Phil Willis MP, Chair of the Innovation, Universities, Science and Skills Select Committee
* Dr Katy Berry, Department of Health
* Fiona Fox, Director, Science Media Centre
* Professor Steve Yearley, Director, ESRC Genomics Policy and Research Forum
* Sarah Norcross, Director, Progress Educational Trust

Discussions will explore:

* What was the formal process that ultimately led to the HFE Act?
* What does it mean to make decisions ‘democratically’ in such a controversial area?
* What impact did key stakeholder groups – including scientists, the media and the Church – have on the public debate and legislative outcome?

What can the social sciences bring to our understanding of the public debate and decision-making process?

Source: Economic and Social Research Council

Super-thin films of carbon with exotic properties, now taking the scientific world by storm, may soon mean a new era of brighter, faster, and smaller computers, smart phones, and other consumer electronics. Brighter digital displays that flex like a sheet of paper. Faster computer chips. Smaller computers. That’s the word from an article scheduled for the March 2 issue of Chemical & Engineering News, ACS’ weekly newsmagazine.

In the magazine’s cover story, C&EN Senior Editor Mitch Jacoby notes that these so-called graphene sheets —50,000 times thinner than the width a single human hair — were first isolated by researchers just a few years ago. The nano-size sheets perform better than life-size carbon, with higher strength and the ability to conduct electricity faster. These properties make them attractive for developing new and improved electronic devices, the article notes.

Scientists in academia and industry have stepped up their efforts to improve the performance and manufacture of graphene sheets. At least one company plans to produce the sheets on an industrial scale in ton quantities. Scientists had predicted the existence of these unusual carbon sheets just a few years ago but had not produced actual thin-films until recently. “Graphene is one of the hottest topics in materials science these days,” says one authority in the C&EN article.

Source: American Chemical Society

Scientists in Germany are reporting development of a new, more effective method to determine whether milk marketed as “organic” is genuine or just ordinary milk mislabeled to hoodwink consumers. Their report appears in the current edition of ACS’ Journal of Agricultural and Food Chemistry, a bi-weekly publication.

In the study, Joachim Molkentin and colleagues point out that organic milk has soared in popularity in many countries. Sales in Germany, for instance, rose by almost one-third between 2006 and 2007. Consequently, crooks may take advantage of the situation by marketing increasing quantities of fake organic milk. That situation created a need for better tests to detect the fraud.

To address the issue, the scientists developed a test based on an analysis of milk fat for the ratio of stable isotopes of carbon. They used it to identify milk samples from cows raised on feed containing a higher ration of maize. Such a feeding regimen is typical of conventional milk production. Organically raised cows are fed less maize but more pasture feed. In addition, the team identified a significant difference in the alpha-linolenic acid content of milk fat between organic and conventional milk samples. Organic milk typically has a higher alpha-linolenic acid content than conventional milk. -MB

Source: Federal Research Institute of Nutrition and Food, American Chemical Society.

“This is one of the first images made using near-infrared interferometry,” says lead author Jean-Baptiste Le Bouquin. Interferometry is a technique that combines the light from several telescopes, resulting in a vision as sharp as that of a giant telescope with a diameter equal to the largest separation between the telescopes used. Achieving this requires the VLTI system components to be positioned to an accuracy of a fraction of a micrometre over about 100 metres and maintained so throughout the observations — a formidable technical challenge.

When doing interferometry, astronomers must often content themselves with fringes, the characteristic pattern of dark and bright lines produced when two beams of light combine, from which they can model the physical properties of the object studied. But, if an object is observed on several runs with different combinations and configurations of telescopes, it is possible to put these results together to reconstruct an image of the object. This is what has now been done with ESO’s VLTI, using the 1.8-metre Auxiliary Telescopes.

“We were able to construct an amazing image, and reveal the onion-like structure of the atmosphere of a giant star at a late stage of its life for the first time,” says Antoine Mérand, member of the team. “Numerical models and indirect data have allowed us to imagine the appearance of the star before, but it is quite astounding that we can now see it, and in colour.”

Although it is only 15 by 15 pixel across, the reconstructed image shows an extreme close-up of a star 100 times larger than the Sun, a diameter corresponding roughly to the distance between the Earth and the Sun. This star is, in turn, surrounded by a sphere of molecular gas, which is about three times as large again.

T Leporis, in the constellation of Lepus (the Hare), is located 500 light-years away. It belongs to the family of Mira stars, well known to amateur astronomers. These are giant variable stars that have almost extinguished their nuclear fuel and are losing mass. They are nearing the end of their lives as stars, and will soon die, becoming white dwarfs. The Sun will become a Mira star in a few billion years, engulfing the Earth in the dust and gas expelled in its final throes.

Mira stars are among the biggest factories of molecules and dust in the Universe, and T Leporis is no exception. It pulsates with a period of 380 days and loses the equivalent of the Earth’s mass every year. Since the molecules and dust are formed in the layers of atmosphere surrounding the central star, astronomers would like to be able to see these layers. But this is no easy task, given that the stars themselves are so far away — despite their huge intrinsic size, their apparent radius on the sky can be just half a millionth that of the Sun.

“T Leporis looks so small from the Earth that only an interferometric facility, such as the VLTI at Paranal, can take an image of it. VLTI can resolve stars 15 times smaller than those resolved by the Hubble Space Telescope,” says Le Bouquin.

To create this image with the VLTI astronomers had to observe the star for several consecutive nights, using all the four movable 1.8-metre VLT Auxiliary Telescopes (ATs). The ATs were combined in different groups of three, and were also moved to different positions, creating more new interferometric configurations, so that astronomers could emulate a virtual telescope approximately 100 metres across and build up an image.

“Obtaining images like these was one of the main motivations for building the Very Large Telescope Interferometer. We have now truly entered the era of stellar imaging,” says Mérand.

A perfect illustration of this is another VLTI image showing the double star system Theta1 Orionis C in the Orion Nebula Trapezium. This image, which was the first ever constructed from VLTI data, separates clearly the two young, massive stars from this system. The observations themselves have a spatial resolution of about 2 milli-arcseconds. From these, and several other observations, the team of astronomers, led by Stefan Kraus and Gerd Weigelt from the Max-Planck Institute in Bonn, could derive the properties of the orbit of this binary system, including the total mass of the two stars (47 solar masses) and their distance from us (1350 light-years).
Source: ESO

ATHENS, Ohio – In the Mesozoic Era, 70 million years before birds first conquered the skies, pterosaurs dominated the air with sparrow- to Cessna-sized wingspans. Researchers suspected that these extinct reptiles sustained flight through flapping, based on fossil evidence from the wings, but had little understanding of how pterosaurs met the energetic demands of active flight.

A new study published today in the journal PLoS ONE by researchers from Ohio University, College of the Holy Cross and the University of Leicester explains how balloon-like air sacs, which extended from the lungs to inside the skeleton of pterosaurs, provided an efficient breathing system for the ancient beasts. The system reduced the density of the body in pterosaurs, which in turn allowed for the evolution of the largest flying vertebrates.

“We offer a reconstruction of the breathing system in pterosaurs, one that proposes the existence of a mechanism with the same essential structure to that of modern birds — except 70 million years earlier,” said study co-author Leon Claessens, an assistant professor of biology at the College of the Holy Cross.

The system would have facilitated the necessary gas exchange to enable sustained activity, added co-author Patrick O’Connor, an assistant professor of biomedical sciences at the Ohio University College of Osteopathic Medicine.

Claessens and O’Connor were inspired to conduct the study after David Unwin of the University of Leicester, then curator at the Natural History Museum in Berlin, showed them an extraordinarily preserved pterosaur in 2003. The scientists thought the specimen might finally shed light on how the animals powered sustained flight.

“The shape and size of the rib segments that articulate with the sternum indicate that the ribcage was mobile, contrary to previous ideas,” Claessens said.

Unique and previously unrecognized projections on the ribs provided important leverage for the muscles that power lung ventilation, he added.

Because fossils rarely preserve soft tissues, the research team conducted a comparative study that included pterosaurs, birds and crocodilians in order to get a better understanding of the relationships among air sacs, lung structure and the skeleton. By using X-ray movies and CT scans, the group characterized how the skeleton works to move air through the lungs in living animals, and also how to identify the signature traces left on bones that have been invaded by air sacs.

Not only do the extinct pterosaurs show evidence that their bones that were invaded by air sacs, but patterns of pneumaticity throughout the entire skeleton of different pterosaur species parallel trends identified in many living bird groups. For example, there is a direct relationship between the proportion of the skeleton invaded by air sacs and the absolute body size of an animal.

“Whereas small-bodied pterosaurs and birds typically pneumatize only a restricted part of the backbone, larger-bodied species routinely pneumatize most bones of the body, including the wing skeleton out to the ends of the fingers,” O’Connor said.

Such modifications of the skeleton would have reduced bone density and resolved a major problem with sustaining flight in large-bodied pterosaurs: the energetic cost of keeping a heavy body up in the air. Density reduction of the skeleton in pterosaurs may have been beneficial, particularly so in the aerial giants—just as it appears to be in the largest flying birds today.

Air sacs in birds also serve other purposes, such as for visual displays and the production of sound, the researchers said. The existence of an analogous air-sac system in pterosaurs highlights new areas of research in which paleobiologists can explore aspects of pterosaurian biology.

Source: Ohio University.

CHICAGO, IL–After installing an extensive network of monitoring stations in Costa Rica, researchers have detected slow slip events (also known as “silent earthquakes”) along a major fault zone beneath the Nicoya Peninsula. These findings are helping scientists understand the full spectrum of motions occurring on the fault and may yield new insights into the events that lead to major earthquakes.

A slow slip event involves the same fault motion as an earthquake, but it happens so slowly that the ground does not shake. It can be detected only with networks of modern instruments that use the Global Positioning System (GPS) to measure precisely the movements of the Earth’s crust over time.

Susan Schwartz, a professor of Earth and planetary sciences at the University of California, Santa Cruz, leads a team that has installed a permanent network of 13 GPS monitoring stations and 13 seismic stations on Costa Rica’s Nicoya Peninsula.

“At least two slow slip events have occurred beneath the Nicoya Peninsula since 2003,” Schwartz said. “When we recorded the first one in 2003, we had only 3 GPS stations. By 2007, we had 12 GPS stations and over 10 seismic stations, so the event that year was very nicely recorded.”

The National Science Foundation (NSF) has funded the work by Schwartz and others to install monitoring equipment in Costa Rica. Schwartz, who directs UCSC’s Keck Seismological Laboratory, has been working in the region since 1991. At the annual meeting of the American Association for the Advancement of Science (AAAS) in Chicago, she will describe results from the past decade of fault-zone monitoring in Central America.

“The newest discovery is the occurrence of these slow slip events. But there has been a decade of focused effort in this area that has significantly advanced our knowledge of the Central America seismogenic system,” Schwartz said. “Initially, we focused on areas of the fault that are locked up, which slip in an earthquake. The slow slip is occurring in regions that are not strongly locked, and a big question is whether that is loading the locked area, making it more likely to break, or relieving stress on the fault.”

Schwartz said she does not think slow slip events significantly increase the likelihood of a major earthquake on a locked portion of the fault. She noted, however, that scientists are still at an early stage in terms of understanding the implications of different kinds of fault motion and translating that information into earthquake hazard assessments.

Flanked by active tectonic margins on both the Pacific and Caribbean coasts, Costa Rica is one of the most earthquake-prone and volcanically active countries in the world. Just off the west coast is the Middle America Trench, where a section of the seafloor called the Cocos Plate dives beneath Central America, generating powerful earthquakes and feeding a string of active volcanoes. This type of boundary between two converging plates of the Earth’s crust is called a subduction zone–and such zones are notorious for generating the most powerful and destructive earthquakes.

The slow slip phenomenon was first observed at subduction zones where hundreds of GPS and seismic instruments are deployed: the Cascadia fault zone (off the coast of Washington and British Columbia) and Japan’s Nankai Trough. At these and most other subduction zones, the part of the plate boundary where earthquakes originate, called the seismogenic zone, lies beneath the ocean. But in Costa Rica, the seismogenic zone runs right beneath the Nicoya Peninsula.

“It’s a perfect opportunity to study the seismogenic zone using a network of land-based instruments,” Schwartz said.

The 2007 slow slip event in Costa Rica involved movement along the fault equivalent to a magnitude 6.9 earthquake. But it took place over a period of 30 days rather than the 10 seconds typical for an earthquake of that size, and such slow motion does not radiate the seismic energy associated with normal earthquakes. The instruments did pick up seismic tremor, however, which Schwartz likened to a lot of very small earthquakes. Tremor activity is also associated with slow slip events in Japan and Cascadia, but there are some differences in Costa Rica, Schwartz said.

“Costa Rica has a different type of subduction zone from the well-studied ones in Japan and Cascadia,” she said. “One thing that makes it interesting is that the temperature is much cooler at the depth range where slip occurs, and that is helping us work out the role of fluids in generating slow slip.”

Ultimately, the goal of this research is not only a better understanding of subduction zones, but also better assessments of earthquake hazards. Schwartz said her Costa Rican colleagues have been working to educate the population of Nicoya about earthquakes and related hazards. With a growing population along the coast, the region faces a potential tsunami threat as well as the possibility of a major earthquake, she said.

Source: University of California – Santa Cruz

If you’re looking for bargain air travel, a new study finds that you should look at more than just the ticket price. Instead, a researcher at North Carolina State University who co-authored the study says that consumers need to consider the quality of the flights being offered in order to get the best “price efficiency.”

The study compared flights and “price efficiencies” from several Internet travel agent Web sites. Because each site offers widely different flights – some flights might have lengthy layovers or multiple connections -it is unwise to simply compare prices. Instead, author Dr. Sangkil Moon, an assistant professor of marketing at NC State, explains that researchers must account for both price and the quality of the flight. Dr. Wagner Kamakura of Duke University and Moon used a statistical model named the stochastic frontier model to account for the value of individual components of a flight – such as a direct flight, or a convenient departure time – and to estimate the theoretical lowest price of each flight.

The researchers then compared the theoretical price to the actual market price of the flight, or the price that online retailers are charging for the flight. The ratio of the theoretical lowest price and the market price is called the price efficiency.

In other words, the flight with the best price efficiency is the best deal: consumers are getting the most quality for their buck given a number of alternative flight tickets. However, Moon concedes that the procedure used in their research is not readily available to most average consumers because of its technical complexities. But Moon says the new study does give consumers some help in finding the best travel deals.

For one thing, Moon notes that none of the major Internet travel sites consistently provided the best price efficiency – so shopping around is important. Moon says savvy customers should look at a variety of tickets that differ in price and quality rather than trying to find the cheapest flights first and then looking at quality as a secondary factor. Consumers that focus exclusively on price may pay less to get from point A to point B, Moon says, but they will probably have a worse quality flight – and that could mean multiple connecting flights, lengthy layovers and/or red-eye flight times.

In addition, Moon says, consumers who are Internet savvy about identifying quality flights can target better value flights by using travel Web sites that display only the outbound flights first and then display multiple inbound flights corresponding to the selected outbound flight on a subsequent page. Moon explains that this allows the retailer greater flexibility in terms of the variety of flights it can offer. Rather than offering round trips that simultaneously show one departure time and one return time on the same screen, retailers show multiple return times for each departure time.

Source: North Carolina State University

Arab-American women living in southeast Detroit whose conservative dress limits their exposure to sun should be taking a vitamin D supplement to boost their dangerously low serum levels, according to a study published by Henry Ford Hospital researchers.

Researchers found that all 87 women involved in a small study showed vitamin D levels averaging 8.5 ng/mL (nanograms per milliliter) for those who wore western dress to 4 ng/mL for those who wore the hijab, modest dress with a headscarf. A healthy vitamin D level is 30 ng/mL or higher.

Also, the women consumed little dietary sources of vitamin D. Forty-seven women reported drinking any milk on a weekly basis, but the amount they consume isn’t significant enough to boost their vitamin D levels, researchers say.

The study is published in the January/February issue of Endocrine Practice. It is believed to be the largest study on the prevalence of vitamin D deficiency in one of the largest concentrations of Arab Americans in southeast Michigan.

Raymond Hobbs, M.D., a Henry Ford Internal Medicine physician and lead author of the study, described the vitamin D deficiency in the women as “much greater than we would have thought.”

“When people live where the weather is colder and they are more covered with clothing, they depend on their diet for their vitamin D,” Dr. Hobbs says. “Unfortunately, most food with the exception of oily fish and vitamin D fortified milk has very little vitamin D. The women in our study drank very little milk, fortified orange juice and had decreased sun exposure because of their dress.”

Low levels of vitamin D are linked to increased risk of cancer, diabetes and Crohn’s disease, Dr. Hobbs says. Vitamin D is needed to maintain normal blood levels of calcium and phosphorus. It also helps in the absorption of calcium, helping to form and maintain strong bones.

“Our findings are consistent with those of similar studies in other parts of the world and underscore the point that there are pockets of individuals who are at risk for culturally mediated health problems,” Dr. Hobbs says. “We need to raise their awareness of this deficiency and to offer them options for increasing their vitamin D levels. A vitamin D supplement is a start.”

More than 490,000 Arab Americans reside in southeast Michigan, the largest population anywhere outside the Middle East. For the study, researchers looked at Arab-American women in the city of Dearborn, a southeast Detroit suburb in which Arab Americans comprise one third of the 100,000 population.

Sunlight exposure is the single most important factor in producing vitamin D in the body. For example, sun bathing for a period of time will produce 10,000- 20,000 international units, a measure of vitamin potency, or the equivalent of 100 glasses of fortified milk.

For the study, researchers recruited women who attended an ethnic supermarket in Dearborn during the course of two Saturdays in April 2007 to search for correlations with dress, diet, use of vitamin D-fortified foods and vitamin supplements. They were interviewed to assess dress, medical history, medication use, clinical symptoms associated with vitamin D deficiency, consumption of fortified milk or fortified orange juice and vitamin supplements. Blood samples also were taken onsite and analyzed for levels of vitamin D and parathyroid hormone and other minerals.

Dr. Hobbs says Henry Ford is launching an awareness campaign to educate the Arab American community in Dearborn about the prevalence of vitamin D deficiency and offer options for addressing the problem.

Researchers theorize that Arab American women avoid milk because of reported higher incidence of lactose intolerance in their population.

“Our goal is to help them understand that by taking these preventive measures now, they can avoid serious health problems in the future,” Dr. Hobbs says.

Source: Henry Ford Health System

SEATTLE – Updated guidelines for physicians that represent best practices for using magnetic resonance imaging (MRI) to newly diagnose breast cancer and to make treatment decisions for breast cancer were published today in the Journal of the National Comprehensive Cancer Network. Breast radiologists and surgeons at the Seattle Cancer Care Alliance (SCCA) and the Roswell Park Cancer Institute in Buffalo, N.Y. authored the paper upon which the guidelines are based.

The SCCA breast imaging program led by Connie Lehman, M.D., has established itself as a national leader in breast MRI based on pioneering research it has published in the past few years. Lehman is corresponding author of today’s journal paper, “Indications for Breast MRI in the Patient with Newly Diagnosed Breast Cancer.” The study summarizes an extensive review of published, peer-reviewed studies.

Among the key recommendations:

• MRI is not a substitute for screening or diagnostic mammography and, when indicated, diagnostic breast ultrasound. MRI supplements the use of these standard imaging tools in appropriately selected clinical situations.
  
• For women with diagnosed breast cancer, MRI provides enhanced detection in both the breast known to have cancer and the opposite, or “contralateral,” breast.
  
• Surgical decisions should not be based solely on MRI findings because not all suspicious lesions on MRI are cancer. Suspicious lesions should be biopsied before a surgery plan is devised in order to avoid surgical overtreatment.
  
• In the rare instances where cancer is found in the lymph nodes but not the breast, an MRI can find the location of cancer in the breast in nearly 60 percent of women.

“Exciting research over the past decade makes it clear that breast MRI finds cancers that are missed by mammography and ultrasound,” said Lehman, who is the director of radiology at the SCCA and a professor at the University of Washington School of Medicine. “The next phase of research is to understand more completely the impact of this improved cancer detection on treatment outcomes.”

The journal is published by the National Comprehensive Cancer Network, a non-profit alliance of 21 of the country’s leading cancer centers. Cancer guidelines published by the NCCN are the most widely used in oncology practice throughout the world. The SCCA is a member.

Co-author of the study is Benjamin Anderson, M.D., a professor of surgery at the University of Washington and director of the SCCA’s Breast Health Clinic.

“Health care policy decisions regarding the use of important but expensive technology must be based upon evidence that these tools are providing measurable benefit to patients,” Anderson said. “This study provides that evidence for breast MRI.”

Breast MRI is a relatively new clinical tool for detecting breast cancer and techniques for using the sensitive equipment vary by site. Lehman and colleagues urge that clear standards for technical parameters be established, as well as performance measures at clinical sites that offer MRI.

The MRI guidelines adopted by the NCCN state that MRI examinations should be performed and interpreted by an expert breast-imaging team working in concert with a multidisciplinary diagnosis and treatment team. Breast MRI exams require dedicated equipment and breast-imaging radiologists who are familiar with the technical details for image interpretation. The NCCN guidelines also say that imaging centers need to have the ability to perform MRI-guided needle biopsy sampling of lesions detected by MRI to properly evaluate possible abnormalities.

Source: Fred Hutchinson Cancer Research Center