WEDNESDAY, April 9 (HealthDay News) -- A new long-term analysis of breast cancer patient survival suggests it might be time to update the way pathologists test lymph node biopsies.

A team of New York City physicians found about one in four patients originally declared to be free of cancerous cells in their sentinel lymph nodes were actually not cancer-free, and that tiny cancer remnants called micrometastases reduced the women's survival over a 20-year period.

These findings address a long-standing question among breast cancer researchers: Are such micrometastases prognostically significant?

"This is the first study to show that there is a survival impact for the detection of micrometastases," said Dr. Stephen F. Sener, a professor of surgery at Northwestern University Feinberg School of Medicine in Chicago.

The results are published in the April 10 issue of the Journal of Clinical Oncology.

In the study, a team led by Dr. Hiram S. Cody III, a professor of clinical surgery at Memorial Sloan-Kettering Cancer Center in New York City, analyzed a population of 368 patients who were originally diagnosed with breast cancer in the 1970s. At the time, these patients were judged to be free of cancerous cells on the basis of a single tissue slice (standard procedure at that time). As a result of that diagnosis, these patients received no follow-up treatment for their disease.

Each of these patients was then monitored over the following 20 years or so. Cody and his team retrospectively reanalyzed the decades-old tissue samples using modern techniques. They then assessed how many of the slices did, in fact, contain cancerous cells, and whether those stray cancerous cells had affected the women's survival.

"What we found was that among these patients, 23 percent were converted to node-positive [cancer status], and among those who were converted, their survival was worse than among patients who remained node-negative," said Cody.

"The 23 percent number is very significant, because it argues that if pathologists just do one section, you may want to ask them to do more," he explained. "We think the information you get by doing more is significant."

According to Cody, 30 years ago the standard of care for breast cancer patients was complete dissection of the axillary lymph nodes (those found under the armpit) followed by cell-shape analysis using a single tissue slice from each node. Such a surgery would typically collect 15 to 20 nodes, on average. Today, however, a different, less traumatic approach called sentinel node biopsy is used.

In sentinel lymph node (SLN) biopsy, a patient's tumor is injected with a combination of dye and radioactive tracer molecules. The following day, only those lymph nodes to which the tracer molecules migrated (the SLNs) are biopsied and analyzed. So, instead of harvesting 15 to 20 nodes, on average only two are three are collected using the new technique.

That reduction in work per node has a real payoff, because pathologists can delve much deeper into each sample, Cody explained.

"Because you remove fewer nodes, you can study them more carefully, and we argue that the information you get by doing that is prognostically significant," he said.

Current guidelines from the College of American Pathologists recommend analyzing one tissue slice per biopsied lymph node, Cody noted. Yet for years, he said, physicians have known that the more carefully one looks, the more cancerous cells one can find. The problem has always been one of balancing the additional work and expense required against the likelihood of success -- some studies have suggested a pathologist would need to analyze as many as 1,600 additional sections to find a single additional node-positive case.

In the current study, Cody's team took four sections per node, analyzing two each for cell shape (morphology) and the presence of a molecular marker of cancer. Nine percent of patients were found to be node-positive using morphological criteria alone; the other 14 percent were detected using molecular markers. In both cases, survival was poorer than in patients who remained node-negative.

"What we are suggesting is that perhaps the staging system for lymph node metastases should be reevaluated in the next edition of the AJCC [American Joint Committee on Cancer] staging," he said.

Many sites already analyze more than one slice per node, he added. Sener's facility, for instance, uses 10.

According to Sener, the current findings underscore the need for additional systemic therapy, such as chemotherapy, in patients with SLN micrometastases. But he also noted that SLN micrometastases do not necessarily require surgical excision, as most patients with positive lymph nodes do not develop cancer under the arm.

Sener hypothesized that could be because each metastasizing cancer cell has a sort of molecular ZIP code, which governs where it can go. Under this hypothesis, the decreased survivability associated with micrometastases has less to do with the lymph nodes per se, than with what those positive nodes say about metastases elsewhere in the body.

"It may be that the presence of micrometastases in these lymph nodes may be a bystander phenomenon," Sener said, "a surrogate marker for the presence of the lung or liver ZIP code in these cells."

Cody noted one "significant caveat" to this study: Because breast cancer survival and treatment regimens have changed so dramatically over the past 30 years, this study says nothing about the prognostic implication of micrometastases discovered today. That will require prospective studies, several of which are ongoing.

Nevertheless, he said, "because we don't know the results of those studies yet, studies like our own may be the best available evidence at present, and our study suggests these micrometastases are prognostically significant."

More information

For more on breast cancer, visit the U.S. National Cancer Institute.

WEDNESDAY, April 9 (HealthDay News) -- The osteoporosis drug raloxifene is safe and effective for women with mild to moderate chronic kidney disease (CKD), a condition that increases osteoporosis risk, according to a new study.

The use of osteoporosis drugs in women with CKD has been controversial because it wasn't known if the drugs were safe for these women.

In this study, Dr. Areef Ishani, of the Minneapolis VA Medical Center and University of Minnesota, and colleagues analyzed data on 7,705 postmenopausal women with osteoporosis who took part in the Multiple Outcomes of Raloxifene Evaluation (MORE) trial.

The authors examined raloxifene effects over three years on the rate of bone mineral density, incidence of fractures, and adverse effects in women with and without CKD. They found that women with and without CKD had a greater increase in spine bone mineral density and a reduction in vertebral fractures than women taking a placebo. Women taking the drug -- especially those with mild to moderate CKD -- also had increased hip bone mineral density.

The findings were published online Wednesday and were expected to be published in the July print issue of the Journal of the American Society of Nephrology.

The study authors said their findings have significant clinical relevance, because many postmenopausal women have unidentified CKD. This study shows that raloxifene is safe and effective in women with decreased kidney function, information that will help doctors provide better care for these patients.

The study was released during National Women's Health Week, which includes initiatives to encourage women to make their health a top priority and to take steps to have a longer, healthier and happier life. The ways they can achieve this include physical activity, nutritious diet and preventive health screenings, such as bone density tests.

More information

The American Academy of Family Physicians has more about chronic kidney disease  .

TUESDAY, April 8 (HealthDay News) -- Exercise does a body good -- two bodies when the one exercising is a pregnant woman.

A new study shows that when a mom-to-be works out, her fetus reaps cardiac benefits. The benefits show up as lower fetal heart rates, according to the finding to be presented this week at the Experimental Biology 2008 annual meeting in San Diego.

"This study suggests that a mother who exercises may not only be imparting health benefits to her own heart, but to her developing baby's heart as well. As a result of this pilot study, we plan to continue the study to include more pregnant women," study co-author Linda E. May, of the Department of Anatomy at Kansas City University of Medicine and Biosciences, said in a prepared statement.

Ten women participated in the study, half of whom were exercisers and the other half who weren't. Fetal movements such as breathing, body and mouth movements were monitored and recorded from 24 weeks into pregnancy to term.

The researchers found significantly lower heart rates among fetuses that had been exposed to maternal exercise throughout the study period. The heart rates among the fetuses not exposed to exercise were higher, regardless of the fetal activity or the gestational age.

More information

The U.S. Department of Health and Human Services has more about prenatal care.

THURSDAY, April 3 (HealthDay News) -- Women who are victims of male partner violence suffer a wide range of physical and mental health problems, says a World Health Organization study that included 25,000 women in 11 countries.

The women, aged 15 to 49, came from Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and the United Republic of Tanzania. The study found that having ever experienced physical or sexual partner violence was associated with poor health overall, and with specific health problems in the four weeks prior to being interviewed: pain, memory loss, dizziness, vaginal discharge and difficulty walking or doing daily activities.

In addition, women who'd experienced partner violence at least once in their lives had more emotional distress, or suicidal thoughts or attempts, than women who'd never suffered abuse by a male partner.

Differences in age, education or marital status did not seem to be factors in the association between partner violence and these physical and mental health problems in women.

The study findings, published in this week's issue of The Lancet, suggest that the effects of this kind of violence linger long after the actual violence has ended, the researchers said.

"In addition to being a breach of human rights, the high prevalence of partner violence and its associations with poor health -- including implied costs in terms of health expenditures and human suffering -- highlight the urgent need to address partner violence in national and global health-sector policies and programs," the study authors concluded.

In an accompanying commentary, Riyadh K. Lafta, of the Mustansiriya Medical School in Baghdad, Iraq, stated: "Accurate and comparable data on violence against women are needed to strengthen advocacy efforts, help policy makers understand the problem, and guide design of preventive interventions."

However, efforts to collect data are hampered by several factors including: the influence of social and cultural views in determining what constitutes violence; the settings of interviews, the type of target population, and the way questions are asked, Lafta noted.

More information

The American Bar Association offers a domestic violence safety plan  .