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The timing and type of hormone replacement therapy women take to relieve menopausal symptoms seem to determine the degree of breast cancer risk they face, a new French study suggests.

Overall, starting estrogen-progestagen therapy soon after menopause appears to boost the risk of breast cancer, even when only used for short periods of time, according to the study, which was published in the Sept. 14 online issue of the Journal of Clinical Oncology.

Women who began the therapy in the three years after menopause and took it for two years or less had a 54 percent higher risk of breast cancer compared to those who never used the therapy, said study co-author Francoise Clavel-Chapelon, a researcher at the Institut Gustave Roussy in Villejuif, France.

However, they found an exception.

“This 54 percent increase in risk is an average, but does not seem to apply to estrogen-progesterone menopausal hormone therapy, for which no increased risk was observed when used two years or less, even close to menopause,” she said. But she noted the risk may still be present, and it was simply not found in the study due to such factors as lack of statistical power.

Many types of progestagens were taken by the women in the study; the finding that progesterone may be safer needs to be confirmed, she stressed.

The new study adds to a growing body of research that is sorting out the risks and benefits of hormone replacement therapy. Until the end of the 1990s, the therapy was viewed as largely beneficial, the authors noted. But with the release of the Women’s Health Initiative trial in 2002, research began to show the therapy boosted the risk for blood clots and breast cancer, and did not protect against heart disease, as originally believed.

Later on, some researchers hypothesized that the timing of therapy might affect patients’ heart disease risk. The French researchers decided to see if timing might affect breast cancer risk.

They turned to a large French study in which 1,726 invasive breast cancers were diagnosed among 53,310 postmenopausal women from 1992 through 2005.

They took into account hormone use, types of hormones, when the therapy was started and how long it was taken, along with comparing users and non-users.

In addition to finding a 54 percent increased risk for those who took hormone therapy for two years or less within three years of the start of menopause, they also found that short-term treatment of two years or less that was started more than three years after the beginning of menopause didn’t increase breast cancer risk. However, longer duration of use elevated risk, no matter when the therapy was begun.

The new study should serve as a warning, said Leslie Bernstein, director of the division of cancer etiology at the City of Hope National Medical Center in Duarte, Calif., who wrote an accompanying editorial.

“The missing piece is, ‘How safe is it to take right after menopause in terms of breast cancer risk?’” Bernstein said.

The French study provides some answers, but more research is needed, she said. The regimens typically taken in France are different than those taken by most U.S. women, Bernstein noted. And French women often use skin patches, not oral pills.

Any woman who is taking hormone replacement therapy should check with her doctor to see what hormone formulation is involved if she wants to more accurately assess her breast cancer risk.

While noting that the 54 percent elevated risk found by the French researchers is “worrisome,” Bernstein pointed to another study finding — that once a woman stops hormone therapy, her risk over time declines to that of the general population.

“I see this paper as a warning,” Bernstein said. “You want to take a conservative approach.”

People whose jobs bring them in regular contact with pesticides may be at increased risk for Parkinson’s disease, a U.S. study finds.

Researchers asked 519 Parkinson’s patients and 511 people without the disease about their work history and exposure to toxins, including pesticides and solvents. Working in agriculture, education, health care or welding wasn’t associated with Parkinson’s disease, nor was any other specific occupation after the researchers adjusted for other factors.

But the study found that 44 (8.5 percent) of Parkinson’s patients reported pesticide exposure, compared with 27 (5.3 percent) of those without the disease. The finding suggests an association between work-related pesticide exposure and increased risk of Parkinson’s.

“Growing evidence suggests a causal association between pesticide use and parkinsonism. However, the term ‘pesticide’ is broad and includes chemicals with varied mechanisms,” wrote Dr. Caroline M. Tanner of the Parkinson’s Institute in Sunnyvale, Calif., and colleagues. “Because few investigations have identified specific pesticides, we studied eight pesticides with high neurotoxic plausibility based on laboratory findings. Use of these pesticides was associated with higher risk of parkinsonism, more than double that in those not exposed.”

Three compounds — an organic (2,4-dichlorophenoxyacetic acid), an herbicide (paraquat), and an insecticide (permethrin) — were associated with a more than threefold increased risk of Parkinson’s, the study found. Laboratory tests have shown that all three compounds have effects on dopaminergic neurons, which are affected by Parkinson’s disease.

“This convergence of epidemiologic and laboratory data from experimental models of Parkinson’s disease lends credence to a causative role of certain pesticides in the neurodegenerative process,” Tanner and colleagues concluded. “Other pesticide exposures, such as hobby gardening, residential exposure, wearing treated garments or dietary intake, were not assessed. Because these exposures may affect more subjects, future attention is warranted.”

Older men diagnosed with prostate cancer who choose watchful waiting are doing better these days than in the era before screening with a test for prostate-specific antigen (PSA) became common, a new study finds.

“The most important message is that the long-term outcome for patients who don’t have surgery or radiation is pretty good,” said study author Dr. Grace L. Lu-Yao, an associate professor of medicine at the University of Medicine and Dentistry of New Jersey. Her report appears in the Sept. 16 issue of the Journal of the American Medical Association.

That message applies only to men over 65 when prostate cancer is diagnosed. Lu-Yao and her colleagues analyzed data on 14,516 such men whose diagnoses were made between 1992 and 2002, at an average age of 78, and who did not have surgery or radiation in the next six months. The researchers followed them for an average of 8.3 years.

The study separated men by their Gleason score, which measures the degree to which the prostate gland has lost its orderly structure. Greater disorder indicates greater danger from the cancer.

The 10-year death rate from prostate cancer was 8.3 percent for men with the least disordered tumors. Their death rate from all other causes was 59.8 percent. For men with moderately disordered tumors, the 10-year prostate cancer-specific death rate was 9.1 percent, compared to a 57.2 percent death rate from all other causes. The prostate cancer death rate for men with the most disordered tumors was 25.6 percent, compared to 56.5 percent for all other causes.

The cancer survival numbers are much better than for the pre-PSA screening era, possibly because “patients now are diagnosed at a much earlier stage compared to patients 10 and 20 years ago,” Lu-Yao said. Earlier detection translates to apparent longer survival simply because the cancer has a longer time to grow.

But the information in the study shouldn’t be applied to younger men, Lu-Yao stressed. The best available data indicate better survival with treatment for men under 65, she said.

So, the study might send the wrong message about PSA testing to those men, said Dr. Richard Greenberg, chief of urologic surgery at the Fox Chase Cancer Center in Philadelphia.

“My concern is that 50-year-old men with family histories of prostate cancer will be listening to these statements that there is too much screening, so they won’t have screening because they think it isn’t necessary,” Greenberg said.

He is skeptical about watchful waiting, except in carefully selected cases. “I don’t think anyone under 60 is a great candidate for watchful waiting unless they have another condition that is going to do them in within 10 years,” Greenberg said.

Every man diagnosed with prostate cancer should understand that watchful waiting is one possible option, he said. “But you have to individualize the decision for every patient,” Greenberg said. “If they have an aggressive cancer, they should be treated aggressively. You need to be very selective when you say when a conservative approach is appropriate.”

Treatment or watchful waiting for cancer in men 70 and older “is an important question, but probably not the most important question,” said Dr. Martin Sanda, director of the prostate cancer center at Beth Israel Deaconess Hospital in Boston.

Sanda recently reported a study of younger men whose average age when they were diagnosed with prostate cancer was about 60. That study indicated that “lower-risk tumors probably can be managed with watchful waiting in men anywhere from the 40s to the 70s,” Sanda said, but the key issue is the nature of the tumor.

“For patients with poorly differentiated tumors, there is a fair amount of cancer deaths unless they are treated aggressively,” he said.

More definitive information about watchful waiting versus treatment of prostate cancers is expected from a study recently started in Canada and now being done in medical centers there and in the United States, Greenberg said. But results of that study are not expected for at least 10 years, he noted, and meanwhile men and their doctors need to make treatment decisions based on each man’s characteristics.

“We need to individualize these decisions, even in the elderly,” Sanda said.

Old people who are physically active are apt to live longer than their couch-potato peers, and are more likely to maintain their independence, new research from Israel shows.

And people who had been sedentary but became active — even those who started when they were well into their 80s — cut their risk of dying and lengthened the amount of time they were able to live on their own, Dr. Jeremy M. Jacobs of Hebrew University Hadassah Medical School in Jerusalem and his colleagues found.

“The take home message is that even among the very old, it never is too late to start exercising,” Jacobs noted in an email to Reuters Health. He and his colleagues report the findings this week in the Archives of Internal Medicine.

While the benefits of exercise are clear, there has been little research on physical activity in very old people, Jacobs and his team note. To investigate, they looked at 1,861 people 70 to 88 years old who had been followed for up to 18 years. Those who got at least 4 hours of exercise each week were classified as physically active, while those who got less were considered sedentary.

Among active 70-year-olds, Jacobs and his colleagues found, 15 percent died over the next 8 years, compared to 27 percent of sedentary 70-year-olds. Eight-year mortality was 26 percent for active 78-year-olds, and 41 percent for their sedentary peers. Among 85-year-olds, 3-year mortality was roughly 7 percent for active individuals and about 24 percent for sedentary people.

Being active also increased the likelihood that a person would be able to continue to perform activities like bathing, dressing and eating by themselves; people who were active when they were 78 were nearly twice as likely to maintain independence in their activities of daily living when they reached 85.

The differences remained significant after the researchers adjusted for health problems, how well people functioned independently, and how people rated their own health.

While it’s clear that healthier people would also be more likely to be active, Jacobs and his colleagues controlled for several factors related to longevity, such as smoking, heart disease, diabetes, and functional status, the researcher noted.

“Although the list is not exhaustive, it does include the major risk factors, and controlling for these factors allowed us to isolate physical activity as an independent factor in mortality, and not just an indicator of the overall health of the subjects,” he said.

The message of his findings for older people, Jacobs said, is to start being active today if you aren’t already. “The beauty of our finding is that the benefits of activity were seen with as little as 4 hours a week of gentle activity. That’s just over 30 minutes a day.”

To stay safe people should start slowly and rest as needed, he added, and anyone with a history of falls or who is concerned that they are unsteady on their feet should seek medical advice before starting to exercise. It’s also important, he added, to watch out for traffic and avoid extremes of temperature.

“Walking is my first choice,” Jacobs said. “In addition to the physical benefits, the act of getting outside daily, meeting people, interacting with the outside world and changing seasons are all ingredients of successful aging.”

Breathing polluted air for even two hours can boost blood pressure, potentially raising the risk of cardiovascular disease in those exposed to smog, a new study suggests.

Although the increase may not mean much for healthy people, “this small increase may actually be able to a trigger a heart attack or stroke,” study author Dr. Robert D. Brook, an assistant professor of medicine at the University of Michigan, said in a university news release.

An estimated nearly one in three Americans suffer from high blood pressure, meaning the heart is straining to push blood through the circulatory system.

In the study, which appears in a recent issue of Hypertension, researchers tested 83 people as they breathed levels of air pollution similar to those in an urban city near a roadway.

“We looked at their blood vessels and then their responses before and after breathing high levels of air pollution,” study co-author Robert Bard, a University of Michigan clinic research coordinator, said in a news release.

The air pollution caused diastolic pressure — the lower number in a blood pressure reading — to rise within two hours. Blood vessels were impaired for as long as 24 hours.

Tests showed that microscopic particles in the air, rather than ozone gases, caused the rise in blood pressure and impaired blood vessel function.

“If air pollution levels are forecasted to be high, those with heart disease, diabetes or lung disease should avoid unnecessary outdoor activity,” Brook said.