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Though the use of fertility drugs does not seem to generally increase uterine cancer risk, a Danish study identified small increases in risk from certain fertility drugs used for longer duration.

Dr. Allan Jensen, with the Danish Cancer Society in Copenhagen, and colleagues identified higher uterine cancer risk among women who used follicle-stimulating hormone and human menopausal gonadotropin (hMG) for more than 10 years.

They saw similar risk among women who ever took six or more cycles of clomiphene, an established treatment for women not ovulating normally, or when clomiphene did not work, when women were injected with six or more cycles of human chorionic gonadotropin (hCG).

In each of these scenarios, uterine cancer risk seemed about two times the usual risk, Jensen and colleagues report in the American Journal of Epidemiology.

Even so, “the absolute risk of developing uterine cancer is still not very high,” Jensen emphasized in an email to Reuters Health.

From a group of 54,362 women treated for infertility between 1965 and 1998 and followed for 16 years on average, Jensen’s team compared the use of fertility drugs among 83 who developed uterine cancer and 1,241 of similar age who did not develop cancer of the uterus.

Overall, 51 and 50 percent of the women who did and did not develop uterine cancer, respectively, used fertility drugs. Those with uterine cancer ranged from 28 to 67 years old (50 years on average) when diagnosed.

In analyses that allowed for number of births, the investigators did not find significant differences in uterine cancer risk.

Differences in risk, as noted, became evident in analyses of specific fertility drugs used and the length of use. These risks remained when the investigators further allowed for number of births, use of a single or multiple fertility drugs, causes of infertility, and any history of oral contraceptives.

The researchers are continuing to monitor the study group to more definitively assess ties between fertility drugs and uterine cancer risk.

They caution, however, that any unfavorable effects from fertility drugs need to be balanced against the physical and psychological benefits of pregnancies that may only be possible with the use of fertility drugs.

One percent of U.S. drivers — 1.9 million people — have had accidents or near-misses over the past year because they were driving while sleepy, a new survey finds.

Also, more than half of drivers surveyed admitted that they’ve driven over the last year while feeling drowsy, and 28 percent said they drive while sleepy at least once a month, according to the survey sponsored by the National Sleep Foundation.

“People underestimate how tired they are and think that they can stay awake by sheer force of will,” Thomas Balkin, chairman of the National Sleep Foundation, said in a news release about the 2009 Sleep in America poll. “This is a risky misconception. Would there be 1.9 million fatigue-related crashes or near misses if people were good at assessing their own ability to drive when fatigued?” he asked.

“The problem is that although we are pretty good at recognizing when we feel sleepy, we do not recognize the process of actually falling asleep as it is happening,” Balkin said. “The process robs us of both self-awareness and awareness of our environment. All it takes is a moment of reduced awareness to cause a crash.”

Research has suggested that not sleeping for more than 20 hours can make people as impaired as if they were drunk. Sleepiness slows reaction times, makes people less aware and impairs their judgment, researchers say.

What do the experts suggest? The National Sleep Foundation recommends that you watch out for these warning signs:
Difficulty focusing, heavy eyelids and difficulty avoiding daydreams
Nodding, forgetting the last few miles you’ve driven, and repeated yawning
Restlessness and irritability

If you do feel sleepy on the road, turn the wheel over to a buddy and take a nap.

Caffeinated beverages or caffeinated gum can keep you more alert for a few hours. You could even drink a caffeinated beverage and take a quick nap — 20 to 30 minutes — before it kicks in.

But remember, caffeine is no replacement for sleep. You’ll still need to get some shuteye.

Analyzing individual breast tissue for specific structural characteristics may more precisely determine a woman’s risk for developing breast cancer.

In the Oct. 5 online issue of the Journal of Clinical Oncology, researchers report that the more acini a woman has — these are the sacs that produce milk — and the larger her breast lobules, the higher the chance she will get breast cancer.

“A tremendous number of women get breast biopsies from abnormal mammograms. They number 1 to 2 million people a year in the U.S. alone,” said study co-author Derek Radisky, an assistant professor of biochemistry at the Mayo Clinic in Jacksonville, Fla. “Of these, about one-quarter have positive findings of cancer while the rest could immediately benefit from this kind of assessment.”

“We have recognized for a long time that the cancer risk-assessment models we have are not perfect, particularly for individual patients, so certainly this is an approach that’s very interesting. But it’s not going to change anything for a woman who walks in the clinic for the next year,” said Dr. Angela Bradbury, director of the Margaret Dyson Family Risk Assessment Program at Fox Chase Cancer Center in Philadelphia. “But it’s exactly this type of paper, this type of research that, two to three years down the road, may actually play out in the clinic. Anything that improves on our risk assessment will be useful.”

Currently, factors such as family history of breast cancer, number of pregnancies and age at first pregnancy are helpful in predicting how often breast cancer will arise in a larger population.

But these same tools are poor indicators of individual risk.

“They’re terrible on an individual basis, so there’s no individualized ability to say whether a person is likely to get cancer or not,” Radisky said.

Other than family history and genetics, the best tool experts have to predict individual breast cancer risk is the Gail model, which takes into account age and number of previous biopsies, as well as family history and pregnancy history.

But, the authors stated, the Gail model is “only slightly better than chance alone.”

This is not the case in cervical or colon cancer, where pathologists can tell from physical characteristics of actual tissue how likely a person is to get that type of cancer.

Breast cancer originates in the breast lobules. The lobules are supposed to disappear as a woman ages, reducing her breast cancer risk, but this doesn’t always happen.

The authors analyzed tissue from 85 women with breast cancer (as well as earlier tissue samples taken before they developed the cancer) and 142 control samples from women who had had benign breast disease.

The more acini per lobule a woman had and the larger the lobule, the higher her risk for developing breast cancer, the researchers found.

This new technique proved more accurate than the Gail model.

The study was a relatively small one by breast cancer standards. More research will not only have to have more women, it will also need to incorporate additional risk factors and will need to be tested in a separate set of women, Radisky said.

Still, he said, the current results “look very good” and he would be “pretty shocked if [more findings] were not consistent.”

If more studies do replicate these initial findings, the procedure might find its way into clinical practice fairly easily and quickly.

“That’s the real power of this. It’s not high tech. It could be done anywhere that takes tissue and has a microscope,” Radisky said. “It could be done anywhere once we build the model, using factors that are available to the physician just from asking the patient and taking tissue, which could be evaluated by any pathologist in any town in America.”

People with nerve pain respond better to a combination treatment using the anticonvulsant gabapentin and antidepressant nortriptyline than to treatment with either drug alone, according to Canadian researchers.

The study findings suggest that combination treatment could be used to help people who only partially respond to one drug or the other.

Nerve, or neuropathic, pain — which affects 2 to 3 percent of the population — is “initiated or caused by a primary lesion or dysfunction in the nervous system,” according to a news release from The Lancet, which is publishing the study online Sept. 29. Conditions that cause neuropathic pain include nerve problems in the spine, diabetes-related nerve damage and postherpetic neuralgia (PHN), which is nerve pain caused by the varicella zoster virus that can follow an outbreak of shingles.

The study included 56 people with PHN or diabetic nerve disease who had a daily pain score of at least 4 on a scale of 0 to 10. They were randomly selected to be given gabapentin alone, nortriptyline alone, or both drugs. Everyone received each type of treatment, with each treatment period lasting six weeks.

At the start of the study, the average daily pain level among the participants was 5.4. At maximum tolerated doses, average daily pain levels were 3.2 while people were taking gabapentin, 2.9 for while taking nortriptyline and 2.3 while taking the combination treatment, the researchers reported.

“This trial shows that combination of an antidepressant and an anticonvulsant drug seems to be superior to monotherapy for neuropathic pain,” wrote study author Ian Gilron, director of clinical pain research at Queen’s University and Kingston General Hospital in Ontario, and colleagues.

“Although development of more effective and better-tolerated monotherapies is much anticipated, our findings suggest that drug combinations represent the most effective strategy for many patients with neuropathic pain,” the researchers concluded. “On the basis of our results, we recommend combined gabapentin and nortriptyline for patients who have a partial response to either drug alone and seek additional pain relief.”