Still time to have your say on devolution for Cambridgeshire and Peterborough - the deadline for the on-line survey is midnight
There is just under six hours to go on a poll asking the people of Peterborough and Cambridgeshire their views on the future of local government in this area.
Ely is the safest place to live in the county according to latest figures.
"Women who take a common form of HRT are nearly three times as likely to get breast cancer, a major study has found," the Daily Mail reports.
A landmark study in 2001 first linked HRT to an increased risk of breast cancer. But exactly how much of an increase has since been a matter of debate.
Some critics argue the risk was overstated, leading to a "'wasted decade' of suffering since the HRT scare", as we discussed in 2012.
This study aimed to better quantify the size of the risk with the different HRT types by looking at questionnaire data from around 40,000 women in the UK.
Researchers found women taking combined HRT – both oestrogen and progestogen – had just over twice the risk of developing breast cancer compared with women who have never taken HRT.
Women who took the pill for 15 years or more had three times the risk – though this was only seven women in total, meaning the link may have been subject to chance.
Reassuringly, the risk returned to baseline around a year or two after a woman had stopped taking HRT.
Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, advised: "Some women will feel HRT to be a necessity. But in order to minimise the risk of breast cancer … it is recommended that the lowest effective dose is used for the shortest possible time."Where did the story come from?
The study was carried out by researchers from the Institute of Cancer Research and the National Cancer Registration Service, Public Health England, both in the UK.
It was funded by Breast Cancer Now, the Institute of Cancer Research and the Royal Marsden/ICR NIHR Biomedical Research Centre.
The authors declared no conflict of interest.
The UK media's reporting was accurate, acknowledging that it is only the combined oestrogen and progesterone pill that has demonstrated these findings.
The Mail should be given credit for being one of the few sources that made an attempt to put the estimated rise in risk in context.
Headlines stating that the combined HRT "triples the risk of breast cancer", as The Times put it, don't actually provide much useful information unless you know what the initial risk is.
The Mail helpfully summarised the results, saying: "According to the new estimates, 34 women in 1,000 would get breast cancer on combined HRT, an extra 20 than among the group who does not take the drugs."What kind of research was this?
The link between HRT and breast cancer is already recognised. It has also already been observed that most cases have tended to occur in women taking combined HRT.
Women who still have a womb usually need to take oestrogen combined with a progestogen, as oestrogen alone may increase the risk of womb cancer.
Prospective cohort studies, particularly of this size and length, can be useful ways to demonstrate the link between drug use and risk on health outcomes.
However, observational studies cannot prove that one factor – in this case, the combined HRT pill – directly causes another – breast cancer – because other factors may be involved.
For example, obesity, family history and alcohol consumption are all known to be linked to breast cancer risk.What did the research involve?
Researchers used data from a large questionnaire-based study that took place between 2003 and 2015. Assessments were made at recruitment, after 2.5 years and again at six years.
Breast and other cancers were identified from recruitment and follow-up questionnaires, and spontaneous reports to the centre. Diagnoses were confirmed by looking at cancer registries in the UK and accessing the women's medical records.
Women were only included if they had no previous history of breast cancer. The researchers also excluded women who had had a hysterectomy.
Information on HRT use was obtained at recruitment and in follow-up questionnaires. Women were asked the ages they started and stopped use and the name of the drug.
Analysis of HRT use was from when women had been taking the pill for at least a year and continued for a year after they stopped taking it, as this was considered the time women were exposed to the drug.
The researchers took into account a range of confounding variables that may be associated with breast cancer risk.
- family history of breast cancer in first-degree relatives
- socioeconomic status
- age at first pregnancy
- number of children
- alcohol consumption
- duration of breastfeeding
- pre- and post-menopausal body mass index (BMI)
Over the course of the six-year follow-up, 775 (2%) of the total 39,183 women in the study developed breast cancer.
Among current users of HRT, there were reported to be 52 cases among women taking combined HRT, 23 in women taking oestrogen only, and 15 among women taking other or unknown HRT.
This calculated to a more than doubled increased risk of breast cancer in women taking combined HRT for 5.4 years on average, compared with those with no previous HRT use (hazard ratio [HR] 2.74, 95% confidence interval [CI] 2.05 to 3.65).
For more than 15 years of combined HRT, the hazard ratio increased to 3.27 (95% CI 1.53 to 6.99) compared with no HRT use.
There was no increased risk for oestrogen-only HRT (HR 1.00, 95% CI 0.66 to 1.54). However, there was an increased risk for any type of HRT not specified by type (HR 1.95, 95% CI 1.55 to 2.46).How did the researchers interpret the results?
The authors concluded that, "Our results show that risk of breast cancer increases with duration of use of combined MHT up to ≥15 years, and relative risks in most of the published literature are likely to be substantially underestimated.
"These results provide further information to allow women to make informed decisions about the potential risks and benefits."Conclusion
This study shows a link between the use of combined oestrogen and progesterone HRT and breast cancer risk, particularly among women who take the pill for a long period of time. But this is not the entire story.
The study included a large cohort of women. The risk increase for combined HRT is based on only 52 of the 39,183 women taking the combined pill who developed breast cancer.
Of these, only seven women had been taking the pill for more than 15 years. Therefore, the analysis was based on a very small number, which may mean the risk associations are not completely accurate.
Assessments were based on self-report questionnaires, so there is a possibility of recall bias. For example, some information about use of HRT pills was collected from women after their breast cancer diagnosis. As the combined HRT pill has been linked to breast cancer, women may have recalled their use differently from those who didn't develop cancer.
Although the researchers took into account a wide range of factors, it's possible that some unaccounted factors influenced the link. One of these factors the authors note is BMI, which should be taken into consideration, particularly when comparing results between studies.
These findings will be of concern to women taking combination HRT. But there are a few extra points to put this into perspective.
The baseline risk of developing breast cancer with combined HRT is still quite small. This research found no link with the oestrogen-only pill.
But we still can't conclude with complete certainty that it's only the combined pill that carries a breast cancer risk – particularly when the analyses combining all types of HRT found an increased risk. For now, it has to be considered that any type of HRT could carry a small increased risk of breast cancer.
HRT can also increase the risk of developing other types of cancer. Oestrogen-only HRT can increase the risk of womb cancer and is normally only used in women who've had a hysterectomy – women who were excluded from this study.
This means we cannot conclude that all women taking combined HRT should switch to oestrogen-only – they could be increasing their risk of another type of cancer.
Other potential risks of HRT include ovarian cancer and blood clots. Whether or not the benefits outweigh the risks therefore has to be considered on an individual basis.
The authors call for women to be provided with more information to make informed decisions about the potential risks and benefits of HRT overall, and by the specific type: combined or oestrogen-only.
There is no one-size-fits-all recommendation when it comes to whether a woman should take HRT. Your GP should be able to provide more detailed information about your own individual circumstances.
Links To The Headlines
Women who take a common form of HRT are 'nearly THREE times as likely to get breast cancer'. Daily Mail, August 23 2016
HRT triples the risk of breast cancer, biggest ever study shows. The Daily Telegraph, August 23 2016
British study finds combined HRT nearly triples risk of breast cancer. The Guardian, August 23 2016
Hormone Replacement Therapy TREBLES the risk of women developing breast cancer. Daily Mirror, August 23 2016
Taking HRT 'triples risk of breast cancer'. ITV News, August 23 2016
HRT can triple risk of breast cancer. The Times, August 23 2016 (subscription required)
Links To Science
Jones ME, Schoemaker MJ, Wright L, et al. Menopausal hormone therapy and breast cancer: what is the true size of the increased risk? British Journal of Cancer. Published online July 28 2016
Kingfishers Bridge in Wicken is holding its first public open day this Saturday (August 27).
"Simple test can now reveal which heartburn patients are at risk of oesophageal cancer," is the hopeful headline in the Daily Mail, reporting on a new study from researchers at Queen Mary University of London.
The researchers have been investigating whether a test for patients with Barrett's oesophagus may be able to predict the likelihood of the condition progressing to oesophageal cancer.
Barrett's is linked to gastro-oesophageal reflux disease (GORD), where acid leaks from the stomach back up into the throat. Stomach acid can aggravate the cells, so there is the potential for this condition to turn cancerous.
It's hard to precisely estimate cancer risk with this condition, however. The current thinking is around 1 in 10 people with GORD will develop Barrett's. Out of these people, around 1 in every 10 to 20 people will go on to develop oesophageal cancer.
So while the overall risk is small, it can still be distressing because of the uncertainty of outcome for people with Barrett's.
This latest research involved taking oesophageal cell samples from a sample of patients with Barrett's about three years apart to look at what factors predicted progression.
The researchers found progression was mostly linked to the degree of genetic diversity in the cells. Or, in the words of the lead researchers, some cells were just "born to be bad".
The follow-up time in this study is short, and it's not clear whether other risk factors were accounted for in the analysis or whether there are steps people can take to reduce their risk of cancer.
No doubt further larger studies of this technique are now being planned.
Where did the story come from?
The study was carried out by researchers from a number of institutions, including Queen Mary University of London and the University of Amsterdam.
Funding was supported by the Dutch Cancer Foundation, the Netherlands Organization for Scientific Research, Fonds NutsOhra, the European Research Council, the Gut Club Foundation, and Abbott Molecular.
The Mail's reporting was accurate, providing information on oesophageal cancer, risk factors for the disease, and a description of Barrett's oesophagus.What kind of research was this?
This prospective cohort study aimed to assess whether a test performed on patients with non-cancerous Barrett's oesophagus may be able to predict whether the condition will progress to oesophageal cancer.
Barrett's oesophagus is a condition where damage from the stomach acid eventually causes the cells in the lining of the oesophagus to change abnormally. It is often caused by acid reflux.
The abnormal cells are at an increased risk of becoming cancerous in the future, although this risk remains small. It's estimated 1 in every 10 to 20 people with Barrett's oesophagus will develop cancer within 10 to 20 years.
This type of study is useful for investigating links with factors that may be associated with cancerous change.What did the research involve?
The researchers recruited adult patients with Barrett's oesophagus from an academic medical centre and six hospitals in The Netherlands.
Participants had to be aged 18 years or over and have endoscopy evidence of Barrett's oesophagus and no features of active oesophageal cancer.
All patients that developed cancerous change or oesophageal cancer within six months from the initial endoscopy were excluded from the study.
Endoscopic examinations with cell biopsy were carried out at the start of the study and then about every two to three years.
The researchers carried out laboratory tests on the biopsy samples to identify potential genetic markers and other disease features associated with progression.What were the basic results?
A total of 320 people with Barrett's oesophagus were included in the study, and were followed for an average period of 43 months.
During this time 20 (6.3%) people progressed, while eight people developed high-grade cancerous change and 12 developed oesophageal cancer.
The researchers found participants with little genetic diversity in their cell samples were unlikely to progress to cancer.
However, the opposite is true when genetic diversity is present. The researchers claim some cells are "born to be bad".How did the researchers interpret the results?
The researchers concluded that genetic diversity correlates with the risk of Barrett's oesophagus progressing to cancer.
They say the level of genetic diversity over time does not appear to have an effect on the risk of progression to cancer – it seems to be predetermined by the baseline level of diversity.Conclusion
This prospective cohort study aimed to see whether a test performed on patients with non-cancerous Barrett's oesophagus may be able to predict whether the condition progressed to oesophageal cancer.
Overall, they found genetic diversity in the oesophageal cell samples at the start of the study seemed to be linked to the risk of cancer progression.
However, the research has limitations to consider:
- By design, this study is only able to draw links – it does not propose treatment or lifestyle steps to be taken to reduce risk.
- The sample of patients in this study is small, so we cannot rule out that any associations seen are down to chance.
- The length of follow-up it not sufficiently long to see how many of the participants went on to develop cancer, as this can take 10 to 20 years.
- It is unclear whether the researchers have taken into account other risk factors for oesophageal cancer, such as smoking, drinking too much alcohol over a long period of time, being overweight or obese, and having an unhealthy diet.
The future aim of such a test could be to reduce the need for regular monitoring in patients at low risk of going on to develop cancer. But more research is needed to confirm the use of such a test.
Links To The Headlines
Simple test can now reveal which heartburn patients are at risk of oesophageal cancer. Mail Online, August 19 2016
Links To Science
Martinez P, Timmer MR, Lau CT, et al. Dynamic clonal equilibrium and predetermined cancer risk in Barrett's oesophagus. Nature Communications. Published online August 19 2016
Fresh appeal after latest inquest hearing to solve the 10 year riddle of what happened to Wisbech man Terry McSpadden
The family of a father who went missing almost 10 years ago is hoping an inquest into his death will answer their questions before the end of the year.
At 1.44am on Saturday (20) crews from Cottenham and Sutton were called to a fire in the open in Twentypence Road, Wilburton.
Viva’s production of ‘Made in Dagenham’ wows critics and sell-out crowds at Ediburgh Fringe Festival
“Not a weak link in sight” with “a lot of strong performances” is how critics viewed Viva’s production of ‘Made in Dagenham’ as it took its place on the bill at the world-famous Edinburgh Fringe Festival.
Villagers showed off a range of talents at the 44th Mepal Produce and Craft Show.
Mainly whisky and brandy was stolen in a £1,000 theft of alcohol from an Ely supermarket.
Chatteris legion members and their visit to the Menin Gate and service commemorate the Battle of the Somme at the Thiepval Memorial
Chatteris branch of the Royal British Legion once more set of on a visit to the Menin Gate for the last post ceremony and the service to commemorate the Battle of the Somme at the Thiepval Memorial.
Wildlife and play park officially opened in Welney as campaigners pledge to fight on to save Sandgate Meadow for future generations by having it designated as a village green
Conservationist Tony Juniper officially opened Welney’s new wildlife haven watched by around 80 villagers.
Lithuanian teenager living in Wisbech jailed for life after stabbing fellow countryman ‘in a drunken temper’ during late afternoon argument
A Lithuanian teenager living in Wisbech has been jailed for life after being found guilty stabbing a man to death “in a drunken temper”.
Wisbech councillor demands answers over threat to minor injuries units while MP Steve Barclay urges public to attend consultation meetings
Questions will be asked and answers expected by Wisbech independent councillor Virginia Bucknor at a consultation meeting to discuss the proposed closure of the area’s minor injuries units.