THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 545.5 Guest: Dr. Joann Zujewski, Research Oncologist, Nat'l. Cancer Institute Topic: Women's Health Initiative Producer/Host: Steve Girard

NEMA: Researchers have an intricate and arduous task: gauge the effects of food, air and water on a complicated, bio-mechanical system. Sometimes, studies can come up with meaningless data, sometimes they provide a breakthrough idea, but most times...researchers are happy if the study points out a direction, a place to go with what they find out. We're talking with research oncologist Joann Zujewski of the National Cancer Institute. Joann, we talked about a recent study which seems to show no link between dietary fat intake and breast cancer, contradicting earlier information showing there is a connection...

ZUJEWSKI: Because of that kind of information, the National Cancer Institute actually launched a large study, "The Women's Health Initiative", which addresses several problems. The dietary modification part is only one part of a larger trial. But they're specifically looking at health issues in women, and it's post-menopausal women, between the ages of 50 and 79. The study actually has two components: there's a randomized component and there is an observational component. People in the observational study will answer questionnaires about their lifestyle, their health and their risk factors...and we'll follow them over a period of time to see if one group over the other has different health outcomes. In the randomized portion, which is somewhat smaller, about 65 thousand women - so still rather a large trial - they're looking at three major interventions. And one is a dietary modification, they're going to evaluate the group who they're going to ask to follow a low fat, high fruit, fiber and grain diet on the prevention of breast and colon cancer, and heart disease.....from other participants who had followed their usual diet. Part of that trial also involves hormone replacement therapy. They're going to look for the effect of hormone replacement therapy on the prevention of heart disease and osteoporosis, as well as any associated risk for breast cancer. And then, the final component of the Women's Health Initiative is the calcium and vitamin D component. And they'll evaluate the effect of calcium and vitamin D supplementation on the prevention of osteoporosis and colon cancer.

NEMA: We've just done a story about the effect of estrogen on two health problems that affect mainly women....osteoporosis and Alzheimer's disease...both are supposedly helped by taking estrogen supplements, but that may increase risk of breast cancer...of actually feeding a tumor...

ZUJEWSKI: With any supplement, you have to evaluate both the risks and the benefits, and so, estrogen replacement therapy may increase your risk of breast cancer, but it's thought that you'd have to be on the estrogen replacement therapy for a longer period of time. Current users tend to have a higher risk compared to past users or never users. But again, because what you're really looking for is the net health benefit, at the present time, each individual will have to look at their own particular risk factors. For example, women who have had breast cancer in the past, we usually do not recommend estrogen replacement therapy. Whereas a member of the general population might consider estrogen replacement therapy particularly if they were in a family with a high incidence of heart disease. What something like the Women's Health Initiative will do is allow women who are undecided to participate in a study which will help tell us exactly how much it will affect one or the other health parameters.

NEMA Dr. Joann Zujewski says the Women's Health Initiative is ongoing... they'll be accruing subjects through January of 1998. There are forty clinical centers nationwide accruing patients to the trial... And the period of following is about 15 years...such detail, such patience. I'm sure glad there's someone out there doing the work. Next...Dr. Zujewski returns with a look at a study on breast cancer prevention. I'm Steve Girard.