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Women with breast cancer who choose to have a preventive mastectomy on their disease-free breast do reduce their risk of cancer in that breast, studies have shown.

But now new research finds that the survival benefit from that preventive surgery is small and not equal among all women.

“The survival benefit was limited to a small subset of all breast cancer patients [studied],” said study author Dr. Isabelle Bedrosian, an assistant professor of surgical oncology at the University of Texas M.D. Anderson Cancer Center, in Houston.

Those most likely to derive a survival benefit, she said, were those younger than 50 who had been diagnosed with early-stage cancers that were estrogen receptor (ER)-negative.

ER-negative tumors don’t require estrogen to grow, as do ER-positive tumors, and the prognosis is poorer for the ER-negative cancers, according to the American Cancer Society.

The study is published online Feb. 25 in the Journal of the National Cancer Institute.

According to Bedrosian and others, experts have long known that women diagnosed with breast cancer have an elevated risk of developing cancer in the opposite breast. Removing that breast as a preventive measure reduces, but does not eliminate, the risk of cancer in that breast.

“But we have never really established the difference it makes in the survival of breast cancer patients,” she said. So, Bedrosian and her colleagues used data from the Surveillance, Epidemiology and End Results (SEER) database, evaluating 107,106 women with breast cancer who had undergone mastectomy for that cancer between 1998 and 2003, along with a subset of 8,902 who had the opposite breast removed as a preventive measure.

After a five-year follow-up, 88.5 percent of those who had the opposite breast surgery were alive, versus 83.7 percent of those who did not, a difference of less than 5 percent. The improved survival was clear for a select group, mostly the women aged 18 to 49 with early-stage, ER-negative tumors, the researchers found.

There was no information from the database on whether the women had genetic mutations to boost breast cancer risk, Bedrosian noted.

After five years, what might happen? “We actually would expect that number [the nearly 5 percent benefit] would increase over time,” Bedrosian said.

The findings makes sense to Dr. Allison W. Kurian, an assistant professor of medicine at Stanford University School of Medicine in Stanford, Calif., who has published research on the topic.

“These results are consistent with other studies,” she said, including her own research published in 2009 in the same journal, which found that the risk for a breast cancer in the opposite breast is affected by a variety of factors, with those having ER-negative tumors in the original breast cancer having a higher risk of getting second tumors in the opposite breast.

Bedrosian said her research suggests most women diagnosed with breast cancer shouldn’t be concerned about the opposite breast: “We cannot demonstrate for most of them a survival benefit [with preventive mastectomy on the opposite breast].”

However, she said, psychological factors should also be taken into account. “There are some patients who may feel they still want to do this,” she said.

Kurian agreed: “This paper does give more information [about the outlook for various women], but it remains a personal decision for women to discuss with their doctor.”

SOURCES: Isabelle Bedrosian, M.D., assistant professor, surgical oncology, University of Texas M.D. Anderson Cancer Center, Houston; Allison W. Kurian, M.D., assistant professor, medicine, Stanford University School of Medicine, Stanford, Calif.; Journal of the National Cancer Institute, online

Getting students to exercise more might not just address obesity issues but also improve their grades with a U.S. study finding physically fit students tend to score higher in tests than their less fit peers.

Test scores dropped more than one point for each extra minute it took middle and high school students to complete a one mile run/walk fitness test, according to Dr. William J. McCarthy and colleagues at the University of California in Los Angeles.

Schools and parents seeking to optimize their students’ academic performance should take heed, McCarthy noted in an email to Reuters Health.

For optimal brain function “it’s good to be both aerobically fit and to have a healthy body shape.”

McCarthy and colleagues compared physical fitness and body weight measures with scores on California’s standardized math, reading, and language tests among 749 fifth-graders, 761 seventh-graders, and 479 ninth-graders who attended schools in Southern California between 2002 and 2003.

About half of the students were girls, 60 percent were white, 26 percent were of Hispanic ethnicity, and about 7 percent each were African American and Asian/Pacific Islander.

Almost 32 percent of the students were overweight and about 28 percent were obese, the researchers report in The Journal of Pediatrics. The researchers estimated students’ aerobic fitness according to their one-mile run/walk time on a flat track. With a 15-minute maximum allowed time to complete the test, the boys averaged slightly less than 10 minutes, while the girls averaged a little less than 11 minutes.

McCarthy’s team found that nearly two thirds of the students (65 percent) fell below the state fitness standard for their age and gender. Compared with these students, students who met or exceeded fitness standards had higher average test scores. Allowing for age, social and economic status, gender, ethnicity, and body size did not significantly alter this association.

Compared with students of desirable weight, overweight and obese students also scored significantly lower on tests, the researchers found.

These findings, McCarthy’s team notes, confirm and extend those of previous investigations. They say further studies are needed to figure out why aerobic fitness may play a role in academic performance.

If future studies confirm a cause-and-effect link between lower fitness and reduced academic performance, “schools will have to reverse their recent disinvestment in physical education ostensibly for the purposes of boosting student achievement,” they concluded.

(Reporting by Joene Hendry of Reuters Health, Editing by Belinda Goldsmith)