Press releases Monday 8 March to Friday 12 March 2010

Please remember to credit the BMJas source when publicising an article and to tell your readers that they can read its full text on the journal's website (http://www.bmj.com).

(1) Better health associated with more frequent and better quality sex in later life
(2) Obesity and alcohol act together to increase the risk of liver disease
(3) Enabling women to use home test kits could increase HPV detection
(4) Contraceptive pill not associated with increased long-term risk of death

(1) Long waits for radiotherapy linked to increased recurrence of breast cancer
(Research: Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of aging)
http://www.bmj.com/cgi/content/full/340/mar09_2/c810
(Editorial: Sexual activity in middle to later life)
http://www.bmj.com/cgi/content/full/340/mar09_2/c850

People who are in good health are almost twice as likely to be interested in sex compared to those in poor health, according to research published on bmj.com today.

It is already established that sexual activity has health benefits and is linked to living longer. However, this study investigates how general health impacts on the quality of sex.

The study also estimates how many remaining sexually active years healthy men and women have left.

The results reveal that at the age of 30, men have a sexually active life expectancy of nearly 35 years and for women it's almost 31 years. At 55, this figure changes to almost 15 remaining years for men and 10 years for women. This gender difference diminishes for people with a spouse or intimate partner.

While sexually active life expectancy was longer for men, they lost more years of this activity due to poor health than women.

Authors, Stacy Tessler Lindau and Natalia Gavrilova from the University of Chicago, used data from two representative research groups in the US. One group consisted of over 3000 men and women between the ages of 25 and 74 and the other included over 3000 men and women between 57 and 85 years of age.

Participants provided information about their relationship status and rated the quality of their sex lives and how often they had sex. They also rated the level of their general health between poor and excellent.

The results reveal that men are more likely to be sexually active, report a good sex life and be interested in sex than women. This difference was most stark among the 75 to 85 year old group, where almost four out of ten (40%) males compared to less than two out of ten (17%) women were sexually active.

The authors conclude that "sexually active life expectancy estimation is a new life expectancy tool than can be used for projecting public health and patient needs in the arena of sexual health" and that "projecting the population patterns of later life sexual activity is useful for anticipating need for public health resources, expertise and medical services."

In an accompanying editorial, Professor Patricia Goodson from Texas University says Lindau and Gavrilova's research is both refreshing and hopeful. She says: "the study bears good news in the form of hope ... the news that adults in the US can enjoy many years of sexual activity beyond age 55 is promising."

Goodson adds that many unanswered questions remain in the field of older people and sexuality, such as problems with measurement and silence regarding the sexual health of ageing homosexual, bisexual or intersexed people. "They stand as dim reminders of the limitations inherent in applying science to the study of complex human realities, and the cultural values shaping the topics we choose to study, she concludes."

Contacts:

Research: Stacy Tessler Lindau, Associate Professor, University of Chicago, USA
Email: slindau@uchicago.edu

(2) Obesity and alcohol act together to increase the risk of liver disease
(Research: Body mass index and risk of liver cirrhosis in middle aged women in UK: prospective study)
http://www.bmj.com/cgi/content/full/340/mar11_1/c912
(Research: Effect of body mass index and alcohol consumption on liver disease: analysis of data from two prospective cohort studies)
http://www.bmj.com/cgi/content/full/340/mar11_1/c1240
(Editorial: Body fat and increased risk of cirrhosis)
http://www.bmj.com/cgi/content/full/340/mar11_1/c774

Two studies published on bmj.com today show that obesity and alcohol act together to increase the risk of liver disease in both men and women.

Together, these findings have important clinical and public health implications.

Rates of liver disease and obesity are increasing in the UK. While alcohol is a major cause of liver cirrhosis, recent evidence suggests that excess body weight may also play a role.

In the first study, researchers from the University of Oxford examined the link between body mass index (BMI) and liver cirrhosis in 1.2 million middle-aged UK women as part of the Million Women Study.

Each woman was tracked for an average of 6.2 years, and risks were adjusted for factors such as age, alcohol consumption, smoking, socioeconomic status and physical activity.

Compared to women of a healthy weight, women who were overweight or obese had an increased relative risk of liver cirrhosis. Although this relative risk did not differ significantly by alcohol consumption, the absolute risk did.

For example, among women who reported drinking an average of about a third to half a drink a day, 0.8 in 1000 will be admitted to hospital with or will die from liver cirrhosis over five years if they are of healthy weight compared with 1 in 1000 women who are obese.

However, among women who reported drinking an average of two and a half drinks a day, 2.7 in 1000 will be admitted to hospital with or will die from liver cirrhosis over five years if they are of healthy weight compared with 5 in 1000 women who are obese.

In the second study, researchers from the Universities of Glasgow and Bristol investigated the joint effects of BMI and alcohol consumption on liver disease in more than 9,000 men in Scotland. Participants were tracked for an average of 29 years.

Both factors were related to liver disease and, more importantly, the combination of high BMI and alcohol consumption was greater than the additive effect of the two separate factors.

For example, obese men who reported drinking 15 or more units per week had the greatest risk of liver disease: almost 19 times higher than underweight or normal weight non-drinkers. The authors suggest that lower, BMI specific "safe" limits of alcohol consumption may need to be defined for people who are overweight. Preventive efforts are also needed to limit the affordability and availability of alcohol and to increase physical activity, they say.

Both studies conclude that, from a public health perspective, strategies to jointly reduce both excessive alcohol consumption and excessive body weight should lead to a reduction in the incidence of liver disease.

In an accompanying editorial, Professor Christopher Byrne at the University of Southampton and Dr Sarah Wild from the University of Edinburgh say that future research must focus on better diagnosis and treatment of non-alcoholic fatty liver disease (a build-up of fat in the liver caused by obesity, high alcohol intake and diabetes, which can lead to cirrhosis).

In the meantime, the old adage of "prevention is better than cure" remains pertinent, they write. "Reducing alcohol consumption and obesity are, at present, our only weapons against non-viral liver disease. The progression of non-alcoholic fatty liver disease to end stage liver disease can now be added to the list of the undesirable consequences of modern lifestyles."

Contacts:

Research (via University of Oxford press office): Jonathan Wood, Press Officer, Medical Sciences, University of Oxford, UK
Email jonathan.wood@admin.ox.ac.uk
Research (via University of Glasgow press office): Stuart Forsyth, Media Relations Officer, University of Glasgow, UK
Email s.forsyth@admin.gla.ac.uk
Editorial: Christopher Byrne, Professor of Endocrinology and Metabolism, Institute of Developmental Sciences, University of Southampton, Southampton General Hospital, Southampton, UK
Email cdtb@soton.ac.uk

(3) Enabling women to use home test kits could increase HPV detection
(Research: HPV testing on self collected cervicovaginal lavage specimens as screening method for women who do not attend cervical screening: cohort study)
http://www.bmj.com/cgi/content/full/340/mar11_1/c1040

More high risk cases of human papilloma virus (HPV) could be detected by offering home testing kits to women who do not come forward for cervical screening, according to research published on bmj.com today.

While cervical cancer screening programmes in Western countries have contributed to a decrease in deaths from cervical cancer, one of the major drawbacks remains the number of women who do not come forwards for smears.

Researchers in the Netherlands, led by Professor Chris Meijer from the VU University Medical Centre, investigated whether home testing kits would improve HPV detection rates. It has long been established that some strains of HPV are found in most cases of cervical cancer so early discovery is important.

As part of the Dutch cervical screening programme, PROHTECT, the authors identified 28,073 women who had not responded to two invitations for screening.

Meijer and his team invited 27,792 of these women to use the Delphi Screener device to collect a cervical fluid sample at home and return it to the researchers. The remaining 281 women were recalled for a conventional cervical screening test.

The results show that over a quarter (26%) of the self-sampling group fulfilled the request, compared with only 1 in 7 (16%) of the recall group.

Participants in both groups whose samples were HPV positive were referred for further tests.

The authors conclude that using home testing kits for detecting HPV is an effective way to target women who do not attend for cervical screening and that it would lead to twice as many cases of cervical cancer being diagnosed compared with the regular screening programme.

Contact:

Chris Meijer, Department of Pathology, VU University Medical Centre, Amsterdam, Netherlands
Email cjlm.meijer@vumc.nl

(4) Contraceptive pill not associated with increased long-term risk of death
(Research: Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners' Oral Contraception Study)
http://www.bmj.com/cgi/content/full/340/mar11_1/c927

Women in the UK who have ever used the oral contraceptive pill are less likely to die from any cause, including all cancers and heart disease, compared with never users, according to research published on bmj.com today.

The results show a slightly higher risk in women under 45 years old who are current or recent users of the pill. The authors stress that the effects in younger women disappear after about 10 years. Furthermore, the benefits in older women outweigh the smaller excess risks among younger women.

The study continues to find a higher rate of violent or accidental death among oral contraceptive users compared with never users. The authors are unable to explain this persistent finding.

In May 1968, the Royal College of General Practitioners' (RCGP) began the RCGP Oral Contraception Study, one of the world’s largest continuing investigations into the health effects of oral contraceptives.

Early reports from the RCGP study suggested an increased risk of death among oral contraceptive users, mainly due to an excess of strokes or other vascular problems among older women or those who smoked. Although a later report suggested that these effects disappear once the pill is stopped, at the time there were relatively few cases of different types of cancer.

These latest results, led by Professor Philip Hannaford from the University of Aberdeen, relate to the 46,000 recruited women, followed for up to nearly 40 years, creating more than a million woman-years of observation.

The results show that in the longer term, women who used oral contraception had a significantly lower rate of death from any cause, including heart disease and all cancers (notably bowel, uterine body and ovarian cancers) compared with never users.

This equates to 52 fewer deaths per 100,000 woman-years.

Slightly higher rates were found among younger women who had used oral contraception, with 20 more deaths per 100,000 among those younger than 30, and four more deaths per 100,000 among 30-39 year olds.

But by the age of 50, the benefits outweighed these modest risks, with 14 fewer deaths per 100,000 among 40-49 year olds; 86 fewer deaths per 100,000 for 50-59 year olds; 122 fewer deaths per 100,000 for 60-69 year olds; and 308 fewer deaths per 100,000 for 70+ year olds.

Hannaford says: "Many women, especially those who used the first generation of oral contraceptives many years ago, are likely to be reassured by our results. However, our findings might not reflect the experience of women using oral contraceptives today, if currently available preparations have a different risk than earlier products."

The authors conclude that their results, derived from a relatively healthy UK study group, show that "oral contraception is not significantly associated with an increased long-term risk of death . . . indeed a net benefit was apparent." However, they point out that "the balance of risks and benefits may vary globally, depending upon patterns of oral contraception usage and background risk of disease."

Contact:

Philip Hannaford, Centre of Academic Primary Care, University of Aberdeen, Scotland
Email p.hannaford@abdn.ac.uk

For more information please contact:

Emma Dickinson
Tel: +44 (0)20 7383 6529
Email: edickinson@bma.org.uk

Press Office telephone : 020 7383 6254 (Weekdays : 0900hrs - 1800hrs)
British Medical Association
BMA House, Tavistock Square, London WC1H 9JP

and from:

the EurekAlert website, run by the American Association for the Advancement of Science (http://www.eurekalert.org)
[[$FOOTER]] http://intranet.bmj.com/departments/dept-bmj/bmj-team-resources/web-team-resources/General_blogging_principles.doc