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Belgian transplant surgeons are reporting a medical first: They coaxed a donor trachea to grow its own network of blood vessels before transplantation by first embedding it for months in the recipient’s arm.

The innovative approach not only brought the patient a healthy, functional trachea (windpipe), but it did so without the need for taking lifelong immunosuppressive drugs, as is common with most transplant operations.

“This is very new,” said study author Dr. Pierre Delaere, a professor of otolaryngology at University Hospital Leuven. “People with airway problems can stay alive with tracheal cannula [tubing]. However, a tracheal cannula can give serious breathing and speech difficulties. This new technique may lead to improved quality of life for this group of patients.”

Delaere and his colleagues describe the new procedure in the Jan. 14 issue of the New England Journal of Medicine.

Though many body parts, including kidneys, lungs and other organs, are relatively amenable to transplant, a complex structure like the trachea is not.

“You can’t just transplant the trachea because it doesn’t have a distinct blood vessel supplying it,” explained Dr. Megan Sykes, a transplant immunologist at Harvard Medical School and the author of an accompanying commentary. “You can’t just hook it up to the recipient’s blood vessels.”

But life for people with severely damaged trachea can be very difficult. The patient described in the study was a 55-year-old woman whose windpipe was seriously injured during an emergency tracheotomy after a car accident 25 years earlier. The woman could breathe only with the aid of implanted tracheal stents that caused her to cough continuously and left her vulnerable to a series of infections, including bronchitis and pneumonia.

The Belgian team tried an experimental form of transplant to help the woman. They first found a donor trachea from a deceased man with the same blood type, but the problem of maintaining a blood supply remained.

To get around that problem, the team opened up the woman’s lower left arm and created a kind of pocket for the 3.5-inch-long donor trachea beneath the skin. The trachea “lived” within the woman’s arm forearm for four months. During much of this time, she received standard anti-rejection drugs.

Placing the trachea within the blood- and nutrient-risk environment of the forearm “allowed a process called neovascularization to take place,” wherein the donor windpipe grew a vital network of blood vessels, Sykes explained.

But something else happened, too. The surgeons knew that once anti-rejection drugs were discontinued, the woman’s immune system would attack and destroy the soft mucosal (inner) tissue of the donor trachea. So, a month into the process they opened up the forearm and grafted a piece of soft mucosal lining from the recipient’s mouth onto the donor trachea.

Once immunosuppressive drugs were stopped, the mucosal tissue from the donor was gradually destroyed — as expected — but the transplanted mouth tissue from the patient grew to replace it. In the meantime, the hard cartilage rings of the donor trachea — which give the windpipe its structure — were not rejected, Sykes said, because cartilage is a special kind of tissue that seems to be protected from the immune system.

“So, what was left from the donor — the cartilage in the tracheal rings — is still donor-derived,” said Sykes, who is also associate director of the Transplantation Biology Research Center at Massachusetts General Hospital.

After four months of being embedded in the woman’s forearm, the trachea — now made up of cells from both the recipient and donor — was carefully removed, along with its new blood vessels, and transplanted into her neck.

CT images taken after the operation “showed that the airway had been restored by the tracheal transplant,” the researchers said, and “since the removal of the airway stents, the patient has had no further episodes of bronchitis or pneumonia.”

One year later, the woman remains “satisfied with the outcome” and has no need for anti-rejection drugs, the team said.

According to Delaere, it’s tough to say just how many patients could benefit from this type of procedure in the future. However, because of its high level of safety and the lack of need for immunosuppressive therapy, “this procedure may become the standard of care,” he said.

Sykes noted that transplant specialists have toyed in the past with the notion of boosting the vasculature of transplanted tissue beforehand, “but the idea of doing that in one place [on the body] and then implanting it in another — that’s really new.”

The procedure is “a breakthrough in the context of tracheal reconstruction,” Sykes said. “It’s a way of repairing large tracheal defects that couldn’t be repaired before.”

SOURCES: Megan Sykes, M.D.,, professor, surgery and medicine, Harvard Medical School, and associate director, Transplantation Biology Research Center, Massachusetts General Hospital, Boston; Pierre Delaere, M.D., Ph.D., professor, otolaryngology, University Hospital Leuven, Leuven, Belgium;

Daily supplements of calcium and vitamin D reduce the risk of fractures in women and men of all ages, even if they’ve suffered previous fractures, but vitamin D supplements alone don’t offer significant protection, a new study has found.

Researchers analyzed data from 68,517 people, average age 70, who took part in seven studies that looked at the effect vitamin D or vitamin D plus calcium had on reducing fractures.

The analysis revealed that vitamin D given alone in doses of 10 micrograms to 20 micrograms per day doesn’t prevent fractures. However, calcium and vitamin D given together reduce the risk of hip fractures, total fractures and possibly vertebral fractures.

The study, published online Jan. 12 in BMJ, called for additional studies of vitamin D, especially vitamin D given at higher doses without calcium.

There’s a growing consensus that a combination of calcium and vitamin D is more effective than vitamin D alone in preventing nonvertebral fractures, Opinder Sahota, of Queen’s Medical Center in Nottingham, England, wrote in an accompanying editorial.

Further research is need to determine the most effective dose, treatment duration and method of taking the calcium/vitamin D combination, Sahota said.

Is soy food helpful or harmful for women with breast cancer? Studies have yielded mixed results. A new study published today suggests that breast cancer survivors may benefit from eating moderate amounts of soy products.

In a large group of breast cancer survivors in China, researchers found that a higher intake of soy food — up to 11 grams daily — was associated with a lower risk of death or recurrence of breast cancer during follow up. (For comparison, a slice of bread generally weighs between 30 and 40 grams.)

“The key take home message from our study is that moderate amount of soy food intake is safe and may reduce risk of mortality and recurrence among women with breast cancer,” Dr. Xiao Ou Shu, of Vanderbilt University Medical Center in Nashville, Tennessee noted in an email to Reuters Health.

Soy foods are rich in compounds called isoflavones — a major group of plant-derived phytoestrogens possessing both estrogen-like and anti-estrogen actions.

Eating soy has been linked to a reduced of risk of breast cancer in some studies, while other studies have suggested that soy may help breast cancer cells grow and multiply, the study team explains in Wednesday’s issue of the Journal of the American Medical Association.

To investigate further, Shu and colleagues analyzed the dietary habits of more than 5,000 women aged 20 to 75 years who were diagnosed with breast cancer between March 2002 and April 2006 and were followed up through June 2009 as part of the Shanghai Breast Cancer Survival Study.

Among 5,033 women who had surgery to remove the breast cancer, 444 women died and 534 had recurrences or breast cancer-related deaths during a median of 3.9 years.

Women who ate the most soy protein had a 29 percent lower risk of dying during the study period, and a 32 percent lower risk of having their cancer return compared to women who ate the least amount of soy protein.

At 4 years, death rates were 10.3 percent and 7.4 percent for women with the lowest and highest intakes of soy protein, and recurrence rates at 4 years were 11.2 percent and 8.0 percent, respectively.

The benefits of soy food intake on death and breast cancer recurrence peaked at 11 grams per day, the researchers note. “No additional benefits on mortality and recurrence were observed with higher intakes of soy food,” they wrote.

Eating soy was beneficial regardless of whether the women’s breast tumors were driven by estrogen (that is, estrogen-receptor positive breast cancer) or were “estrogen receptor-negative.”

The benefits of soy were also seen in both users and nonusers of tamoxifen, a drug commonly used to treat and prevent breast cancer. Prior studies have suggested that soy isoflavones may interact with tamoxifen, and both beneficial and possibly harmful interactions have been reported.

The authors of a commentary on the study caution that while it provides important information, there are several concerns, including differences in the quality, type and quantity of soy food intake between Chinese and American women.

For one thing, the average isoflavone intake in Chinese women is 47 milligrams per day compared with 1 to 6 milligrams per day for American women, Dr. Rachel Ballard-Barbash, of the National Cancer Institute, Bethesda, Maryland and Dr. Marian L. Neuhouser, of the Fred Hutchinson Cancer Research Center, Seattle, point out.

Larger studies, they say, are needed to understand the effects of these foods among diverse subsets of women with breast cancer.

In the meantime, they add, women with breast cancer should know that “soy foods are safe to eat and that these foods may offer some protective benefit for long-term health.”

“Patients with breast cancer can be assured that enjoying a soy latte or indulging in pad thai with tofu causes no harm and, when consumed in plentiful amounts, may reduce risk of disease recurrence,” Ballard-Barbash and Neuhouser advise.

They point out, however, that any potential benefits are from soy foods. Inferences should not be made about the risks or benefits of soy-containing dietary supplements.

Certain dietary supplements appear to affect the development of colorectal cancer or its recurrence, two new studies suggest.

In one study, researchers from the U.S. National Institute for Environmental Health Sciences found that eating a diet high in omega-3 fatty acids cut the risk of developing colorectal cancer by nearly 40 percent. In the other study, from cancer researchers in Italy, consumption of a dietary supplement containing selenium was found to reduce the chances of having polyps recur by a similar amount.

Both studies were to be presented Dec. 7 in Houston at a conference on cancer prevention sponsored by the American Association for Cancer Research.

In the selenium study, 411 people, 25 to 75 years old, who’d had one or more colorectal polyps removed took either a supplement or a placebo. The supplement, described as an antioxidant compound, contained 200 micrograms of selenomethionnine (a combination of selenium and methionnine), 30 milligrams of zinc, 6,000 international units of vitamin A, 180 milligrams of vitamin C and 30 milligrams of vitamin E.

Participants had a colonoscopy one year, three years and five years after starting the regimen.

Polyps recurred in 4.2 percent of those taking the supplement, compared with 7.2 percent of the placebo group. Overall, the study found, people taking the supplement had about a 40 percent reduction in risk for a return of polyps.

The researchers estimated that, after 15 years, about 48 percent of those taking the supplement would still be free of polyps, versus about 30 percent of those not taking the supplement.

Polyps, or adenoma, are benign growths on the large bowel. Though only a small proportion progress to become cancer, about 70 to 80 percent of colorectal cancer cases begin as polyps, according to the American Association for Cancer Research. About one in four people, most older than 60, will have at least one adenoma.

Selenium is found in soil, and human consumption comes by eating plants that have absorbed the nutrient or fish or animals that have eaten plants as part of their diet. “The content of selenium in the food depends on the soil content of this trace element, and in the same country there are areas at high, adequate or low content of selenium in the soil,” said the study’s lead author, Dr. Luigina Bonelli, head of the unit of secondary prevention and screening at the National Institute for Cancer Research in Genoa, Italy.

Earlier research had suggested that selenium can inhibit cell proliferation in the colon and rectum, Bonelli said.

Michele Forman, a professor of epidemiology at the M.D. Anderson Cancer Center in Houston, said that, though the findings are interesting, it’s impossible to tell if the benefit was attributable to the selenium or to the other vitamins and minerals included in the supplement.

“You really don’t know if it’s the selenium or some combination that reduces risk of recurrence,” Forman said.

In addition, the daily dosages of vitamins A and E taken by the participants were higher than the recommended daily allowances, Forman added. High levels of such vitamins can be detrimental, she said.

In the omega-3 study, U.S. researchers surveyed 1,509 whites and 369 blacks about their dietary habits in the past year. About half of the participants had colorectal cancer.

Among the white participants, those whose diets were in the highest fourth of omega-3 fatty acid consumption were 39 percent less likely to have colorectal cancer than those in the lowest fourth. However, for reasons the authors said they did not know, no association was noted between omega-3s and a reduction of colorectal cancer risk among black participants. The disease occurs at a higher rate among blacks than whites.

“Our finding clearly supports the evidence from previous experimental and clinical studies showing that long-chain omega-3 fatty acids inhibit tumor growth,” said the study’s lead author, Sangmi Kim, a postdoctoral fellow at the U.S. National Institute of Environmental Health Sciences in Research Triangle Park, N.C.

Kim said the research supports boosting omega-3 intake through diet or perhaps by taking an omega-3 supplement. Omega-3 fatty acids are found in fish, especially oily fish such as salmon, mackerel, herring, anchovies, sardines and tuna. Plant-based sources include flax and flaxseed oil, Brussels sprouts, soybeans and soybean oil, canola oil, spinach, walnuts and kiwi.

Previous studies have suggested that omega-3 fatty acids act as anti-inflammatory agents and help prevent cancer. But in the new study, Forman noted, participants were asked about their diets after they had been diagnosed with colorectal cancer so it’s possible that their recollections were not fully accurate.

In addition, she said, it’s possible that the benefit was not the result of omega-3s. Those who ate more fish might have had a healthier diet overall, she said.

“Were they eating a salmon-and-broccoli diet or a hamburger-and-french-fry diet?” Forman asked. “We don’t know enough to say that it’s truly the effect of the omega-3s.”

High-flow oxygen appears to be an effective treatment for cluster headaches, British researchers have found.

People with cluster headaches can have as many as eight per day in bouts that last for weeks or months. The current treatment is injection with the drug sumatriptan, but frequent use of the drug isn’t recommended because of the risk of adverse effects. High-flow oxygen is also used to treat cluster headaches, but its use is limited because of a lack of good quality controlled studies.

This new study included 76 adult patients, aged 18 to 70, with either episodic cluster headache (57) or chronic cluster headache (19). During four cluster headache episodes, the patients alternatively received high-flow oxygen (inhaled oxygen at 100 percent, 12 liters per minute, delivered by face mask, for 15 minutes at the start of the attack) or placebo (high-flow air).

The study found that 78 percent of patients reported being pain-free or having adequate relief within 15 minutes of receiving high-flow oxygen, compared with 20 percent of patients after they received high-flow air. High-flow oxygen also provided better pain relief at 30 and 60 minutes.

No serious harmful side effects were reported after high-flow oxygen treatment, according to the report published in the Dec. 9 issue of the Journal of the American Medical Association.

“To our knowledge, this is the first adequately powered trial of high-flow oxygen compared with placebo, and it confirms clinical experience and current guidelines that inhaled oxygen can be used as an acute attack therapy for episodic and chronic cluster headache,” wrote Anna S. Cohen, of the National Hospital for Neurology and Neurosurgery in London, and colleagues.

“This work paves the way for further studies to optimize the administration of oxygen and its more widespread use as an acute attack treatment in cluster headache, offering an evidence-based alternative to those who cannot take triptan agents,” they concluded.

Could the music of the 18th century classical genius Wolfgang Amadeus Mozart help tiny infants born today?

Yes, suggests an Israeli study that found that listening for just 30 minutes a day helped premature babies use less energy, which may help them grow faster.

“Within 10 minutes of listening to Mozart music, healthy infants [born prematurely] had a 10 percent to 13 percent reduction of their resting energy expenditure,” the study authors wrote. “We speculate that this effect of music on resting energy expenditure might explain, in part, the improved weight gain that results from this Mozart effect.”

The findings were published online Monday in Pediatrics, and are slated to appear in the January print issue of the journal.

In the 1990s, researchers released a small study that found that when adults listened to a Mozart sonata they performed better on intelligence tests. Numerous studies have been done since, including studies on premature infants that have found the “Mozart effect” can decrease the heart rate, lower stress hormone levels and ease distressed behavior in premature infants, according to background information in the new study. Babies exposed to music have also shown an increase in their levels of oxygen and weight gain.

However, none of these studies have been able to look at how the music might be causing these changes.

To get an idea of how Mozart’s music might help weight gain, the researchers designed a prospective, randomized trial that included 20 healthy babies who were born prematurely. The babies weren’t eating on their own, but instead were being tube-fed consistent quantities of food.

The babies were randomly assigned to listen to no music or to Mozart for 30 minutes for two consecutive days.

During the first 10 minutes, the resting energy expenditure was similar in both groups. But during the next 10 minutes, the researchers noted a change in the babies who were exposed to Mozart — their resting energy expenditure decreased, and the effect continued through the next 10-minute period as well. Overall, there was a 10 percent to 13 percent drop in resting energy expenditure.

“When you’re born early, lots of the pathways in the brain are still being laid down and developing, and then babies are put in an environment where there are lots of unfamiliar sounds and other stimuli, which may cause sensory overload. Music may help decrease those noxious influences,” said Dr. Cheryl Cipriani, director of the neonatal intensive care unit at Scott & White Memorial Hospital, in Temple, Texas. “It’s an area that needs further explanation.”

Dr. Beverly Brozanski, clinical director of the neonatal intensive care unit at Children’s Hospital of Pittsburgh, said that “developmental inputs, whether music or touch or something else, are very important to infant brain development.”

Both experts said that while this study’s results are intriguing, it’s only a small pilot study, and that no definitive conclusions can be drawn from it.

Whether the effect seen in this study is exclusive to Mozart or could be replicated with other music is also unknown. The researchers suggest that the effect may be unique to Mozart because his music tends to repeat the melody more than music of other composers.

Brozanski said that she suspects that lullaby-type music that contains a soothing repetition would probably produce similar effects.

Cipriani said she doesn’t know if playing different music would change the outcome, but like Brozanski, she suspects the repetition probably is key. “The baby is used to hearing a beat before it’s born — the whoosh of the blood, the heartbeat — and it may be that certain types of music do a better job of soothing them and reminding them of the womb,” she said.

The chemical acrylamide, which is classified as a probable cancer-causing agent, does not appear to increase overall risk for mouth, throat, voice box, or thyroid cancers, with one possible exception, study findings hint.

Besides a possible link to an increased risk of mouth cancer among non-smoking women, Dr. Leo J. Schouten at Maastricht University, and colleagues observed no link between low to high levels of dietary acrylamide and other head-neck or thyroid cancers among 120,852 Dutch people followed for more than 16 years.

However, the small number of mouth cancer cases in the group calls for further investigation to determine “whether there is a real association or just a chance finding,” Schouten noted in an email to Reuters Health.

Acrylamide is found in some starchy foods cooked at high temperatures such as French fries and potato chips, baked goods and coffee. Animal studies have indicated acrylamide may cause cancer, and in 2005 the World Health Organization called for lower levels of acrylamide in food. However, studies of any link to human cancers have produced variable results.

Using food frequency surveys obtained when participants’ were 55 to 69 years old, Schouten’s team estimated the men’s and women’s average daily acrylamide intake at 22.5 and 21.1 micrograms, respectively, they report in the American Journal of Epidemiology.

Coffee accounted for about 47 percent of this intake. Dutch spiced cake, cookies, French fries, and potato crisps accounted for another 15, 13, 8, and 2 percent, respectively.

Besides the noted exception among non-smoking women, there was no link between acrylamide and head/neck and thyroid cancers in analyses that allowed for age, gender, smoking status, number of cigarettes smoked, and number of years spent smoking, as well as other demographic and dietary factors.

Considering that acrylamide molecules are small, water soluble, and, have the potential to reach nearly every organ and tissue in the body, the current findings are generally “reassuring,” Schouten said.

He reiterated, however, that further investigations need to confirm or refute these findings.

In the mean time, Schouten and colleagues advise limiting acrylamide intake, particularly in foods with minimal or no health benefits, such as French fries and potato crisps.

More than just a bad bout of stomach flu, some food-borne illnesses can cause long-term consequences, especially for young people, a report released on Thursday has found.

Researchers at the Center for Foodborne Illness Research & Prevention in Pennsylvania studied the five most common food-borne diseases and found they can cause life-long complications including kidney failure, paralysis, seizures, hearing or visual impairments and mental retardation.

“It’s not just a tummy ache,” the center’s Tanya Roberts told a news briefing.

An estimated 76 million Americans become sick each year from food-borne illness, 325,000 are hospitalized and 5,000 die, according to the U.S. Centers for Disease Control and Prevention. About half are children under 15.

Since 2006, outbreaks have been linked to peanuts, peppers, ground beef, spinach and other common foods.

Diarrhea and vomiting are the most common symptoms of food-borne illness, and typically last only a few days.

But in 2 to 3 percent of cases, food-borne disease can cause serious long-term health problems, according to the U.S. Food and Drug Administration.

For the report, the team studied campylobacter infection, E. coli O157:H7, Listeria monocytogenes, Salmonella and Toxoplasma gondii.

In addition to diarrhea, fever, abdominal cramps, nausea, and vomiting, campylobacter infection can cause Guillain-Barre syndrome, the most common cause of paralysis in the United States. It can also trigger arthritis, heart infections, and blood infections.

E. coli O157:H7 infection can cause hemolytic uremic syndrome, the leading cause of acute kidney failure in children in the United States.

Listeria has been linked with infections of the brain and spinal cord, resulting in serious neurological dysfunctions or death. It kills about 1 in 5 people.

Salmonella bacteria can cause reactive arthritis, a painful form of arthritis that can interfere with work and quality of life.

And infants whose mothers were infected with toxoplamosis, caused by a food-borne parasite, can develop mental retardation, crossed-eyes and in some cases blindness in one or both eyes.

“It’s not just these five,” Roberts said. “There’s over 200 pathogens that have different kinds of consequences and these consequences can be prevented,” she said.

Sandra Eskin, director of the Food Safety Program at the nonprofit Pew Health Group, said she hopes the report will prompt action on legislation pending in Congress to reform food safety in the United States.

“We started 2009 with a major food-borne illness outbreak linked to peanut butter and peanut butter products. It ultimately resulted in nine deaths and sickened more than 700 people in 46 states,” Eskin said. “Families should not have to wait another year for safer food.”

Constipation occurs when it becomes difficult or painful to have regular bowel movements. What’s “regular” varies by person, however.

Some people have three bowel movements per day, while others have three movements per week, the American Academy of Family Physicians says.

Here are the academy’s suggestions for staying regular:
When you feel the need to have a bowel movement, don’t put it off.
Schedule time each day to have a bowel movement, such as after a meal.
Boost your fiber intake.
Drink plenty of water — aim for eight glasses each day.
Don’t rely on laxatives, as taking them too frequently can worsen constipation.
Get regular exercise.
Avoid sugary and high-fat foods that can contribute to constipation.

Declining use of hormone replacement therapy may be driving down rates of a condition called “atypical ductal hyperplasia,” a known risk factor for breast cancer, new research suggests.

This is the first time a link has been found between atypical ductal hyperplasia — abnormal cells in the breast’s milk ducts — and hormone therapy, said Diana Miglioretti, senior author of a paper published in the November issue of Cancer Epidemiology, Biomarkers & Prevention.

“It sounds like another reason not to take hormones,” said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge.

“This is part of a pattern that combined use of hormone therapy with both estrogen and progesterone does something to a woman’s breast that predisposes them to atypical ductal hyperplasia, which is felt to be a precursor to certain types of malignancies,” Brooks added.

If atypical ductal hyperplasia does turn out to be a precursor to breast cancer, this link would be a good indicator of how use of hormone therapy — often used for menopausal symptoms such as hot flashes — can help spur malignancy.

The findings are in keeping with other recent research showing a decline in breast cancer rates since the release of results from the Women’s Health Initiative, a major trial that caused many women to stop taking combined (estrogen plus progesterone) hormone therapy.

The Women’s Health Initiative was halted in July of 2002 after researchers found higher risks of heart attacks and breast cancer in women taking the hormone supplements compared with placebo.

Since that time, use of hormone replacement therapy (HRT) has experienced a precipitous decline.

According to experts, women diagnosed with atypical ductal hyperplasia have a three to five times increased risk of developing breast cancer, either in the same breast or the opposite breast.

Atypical ductal hyperplasia “is a benign condition but it is a risk factor for breast cancer. It’s not clear if it’s a precursor to breast cancer,” said Miglioretti, who is a senior investigator with the Group Health Research Institute in Seattle. “This sheds light on more of the breast process, how HRT affects breast cancer.”

Miglioretti and her co-authors analyzed almost 2.5 million screening mammographies from samples provided by the Breast Cancer Surveillance Consortium. The mammograms were done between 1996 and 2005.

In 1999, atypical ductal hyperplasia was found in 5.5 per 10,000 mammograms but by 2005 had declined to only 2.4 per 10,000, a drop of more than half. This occurred despite an increase over time of rates of mammography, which tend to pick up the abnormality.

Meanwhile, breast cancer cases in women with atypical ductal hyperplasia declined from 4.3 per 10,000 mammograms in 2003 to 3.3 per 10,000 mammograms in 2005.

And postmenopausal use of hormone therapy dropped from 35 percent to 11 percent.

The study also revealed that cancers associated with atypical ductal hyperplasia tend to be less aggressive, lending support to the theory that less aggressive and more aggressive cancers develop differently, the authors stated.

One breast cancer expert said the new study dovetails with recent trends in breast cancer incidence.

“The finding they report is consistent with [previous] observations that suggested there was a drop in incidence of breast cancer in about 2003 and it coincided with when the Women’s Health Initiative reported that estrogen-plus-progesterone use was associated with an increased risk of heart attacks as well as a slight increased incidence of breast cancer risk,” said Dr. James Liu, chairman of obstetrics and gynecology at MacDonald Women’s Hospital, Case Medical Center, University Hospitals in Cleveland. “The association caused many women to either question their need to be on [hormone therapy] or stopping it.”

But, cautioned Liu, “the data is not strong enough to say this observation was caused by [a decline in hormone use] but it is a very strong association.”