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Fish oil supplements may decrease breast cancer risk

Women who take fish oil supplements may have a lower risk of developing breast cancer than those who don't, a study published Thursday suggests — though whether the supplement itself bestows the benefit is not yet clear.

In a study of more than 35,000 postmenopausal women, researchers found that those who said they regularly used fish oil supplements were one-third less likely than non-users to develop breast cancer over the next six years.

The lower risk was seen even with a number of known and suspected risk factors for breast cancer taken into account — including older age, obesity, heavy drinking and sedentary lifestyle.

Still, the study is limited in the fact that it is what is known as an "observational" study — where researchers look at the relationship between an "exposure" (like supplement use) and a disease risk.

"There are a lot of cautions with this type of study," said senior researcher Dr. Emily White, of the Fred Hutchinson Cancer Research Center in Seattle. "It cannot show cause-and-effect."

So it is too soon to recommend that postmenopausal women start taking fish oil for the sake of lowering breast cancer risk, White told Reuters Health in an interview.

Further study warranted
Any such recommendations may come if and when evidence from clinical trials supports a benefit of fish oil. "Fortunately, there is going to be a clinical trial," White said.

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She was referring to a Harvard University trial just underway that will look at whether fish oil and vitamin supplements affect the risks of cancer, heart disease and stroke in older men and women.

In that study, which aims to enroll 20,000 U.S. adults, researchers will randomly assign participants to take one or both supplements, or placebo pills, to serve as a comparison. This type of study is considered the "gold standard" for demonstrating cause-and-effect.

Fish oil, a rich source of healthy fatty acids known as omega-3, is best known as a potential boon for heart health. A number of clinical trials have shown that fish oil may help lower triglycerides (a type of blood fat), high blood pressure and the risk of heart attack in people with established heart disease; high fish consumption has also been linked to a lower risk of developing heart disease.

So experts generally recommend that adults aim to eat fish at least twice a week — preferably fattier fish like salmon, mackerel and trout.

But whether fish or fish oil have any effects on cancer risk remains unclear.

The new study, published in the journal Cancer Epidemiology, Biomarkers & Prevention, looked at the question by asking 35,016 women ages 50 to 76 about their current and past use of fish oil and certain other supplements.

The researchers then followed the women for an average of six years to document any diagnoses of breast cancer. During that time, 880 women were diagnosed with the disease.

Among women who developed breast cancer, 5 percent had reported regularly using fish oil at the study's outset. Among women who remained cancer-free, 8 percent had been current fish oil users at the outset.

Anti-inflammatory effects
Overall, fish oil use at the start of the study was related to a one-third lower risk of developing breast cancer compared with non-use — with factors like age, weight, self-reported diet and exercise habits, and family history of breast cancer taken into account.

It is biologically plausible that fish oil could affect breast cancer development, according to White. Fish oil is known to have anti-inflammatory effects, and chronic inflammation in the body is thought to play a role in the growth and spread of cancer cells, White explained.

The pieces of evidence are there, she said, but they have not yet come together into a strong enough whole to recommend fish oil for trimming breast cancer risk.

Dr. Edward Giovannucci, of the Harvard School of Public Health in Boston, agreed.

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"It is very rare that a single study should be used to make a broad recommendation," Giovannucci, a member of the journal's editorial board, noted in a written statement. "Over a period of time, as the studies confirm each other, we can start to make recommendations."

And while fish oil is generally considered safe when taken as directed, it can have side effects, such as stomach upset, heartburn and, at least at higher doses, bleeding.

White's team also found that among a subgroup of women with a history of heart disease, fish oil use was actually related to an increased breast cancer risk versus non-use.

The finding, White said, is surprising and not readily explained. She added, though, that it was based on only a small number of women, and may represent a chance finding rather than a true effect of fish oil.

The current findings cannot hint at whether a fish-rich diet might help lower breast cancer risk. But, White and her colleagues note, two previous large studies did look at the relationship between women's reported omega-3 intake from food and their risk of breast cancer. Neither study uncovered any link.

Health: Acid reflux may disrupt sleep

Chronic acid reflux may frequently wake people up at night, even when it doesn't cause heartburn symptoms, a small study suggests.

The study, of 39 adults with gastroesophageal reflux disease (GERD) and nine GERD-free adults, found that those with the digestive disorder tended to wake up more often during the night -- an average of three times per night, versus just under twice per night for their GERD-free counterparts.

Their sleep disruptions were often related to reflux episodes, as measured by a probe that was placed in the esophagus overnight.

Yet, the study found, most of the awakenings were not spurred by perceived heartburn symptoms; GERD patients reported sensing symptoms in only 16 percent of their sleep disruptions.

The findings, though based on a small group of patients, suggest that GERD may be contributing to poor sleep more often than has been suspected, said senior researcher Dr. Ronnie Fass, chief of gastroenterology at the Southern Arizona VA Health Care System in Tucson.

In an interview, Fass pointed out that when doctors evaluate patients for nighttime GERD problems, they typically ask about symptoms. However, the current findings suggest that "some wakings will be symptomatic, but many will not be," he said.

Fass suggested that people with GERD tell their doctors if they are waking up frequently during the night, even if they do not feel that heartburn symptoms are the cause.

Then they might see whether gaining better control of the GERD improves their sleep, Fass said.

Some ways of managing GERD include weight loss, if needed; avoiding foods that spur symptoms and eating smaller, more frequent meals; and, for nighttime problems, raising the head of the bed 6 to 8 inches using wooden blocks under the bedposts.

Medications for symptom relief include antacids and acid-reducing drugs known as H2 blockers -- such as ranitidine (Zantac) and cimetidine (Tagamet). Another class of drugs, known as proton-pump inhibitors (PPIs), can be prescribed to help prevent acid reflux episodes, particularly in people with more-severe GERD.

The current study, published in the journal Clinical Gastroenterology & Hepatology, was partly funded by Takeda Pharmaceuticals, which makes the PPI medication Prevacid. Fass serves as a consultant and researcher for the company.

The findings are based on 39 middle-aged adults with GERD who had been having at least three heartburn episodes per week for the previous three months, along with nine healthy adults.

All participants underwent overnight sleep monitoring, where a device worn on the wrist recorded their movements and a probe placed in the esophagus measured instances of acid reflux. Those on H2 blockers stopped using the medications at least three days prior to entering the study, and any PPI use was stopped at least three weeks beforehand.

Overall, the study found, 90 percent of GERD patients woke up at least once during overnight monitoring, with the majority of the awakenings (52 percent) being associated with an acid-reflux episode.

In the healthy comparison group, 78 percent woke up at least once, but never in relation to acid reflux.

Fass and his colleagues also found that in GERD patients, the reflux episodes usually came not before, but after they woke up. If the acid reflux usually happened after, and most awakenings were not accompanied by heartburn symptoms, it is not clear why GERD patients tended to wake up more often, according to the researchers.

One possibility, they say, is that nervous-system activity that helps stimulate acid reflux actually rouses people from sleep before the reflux occurs. Why these episodes would so often be symptom-free is also unclear, but one theory is that sleep reduces the sensitivity of the esophagus to stomach acid.

However, Fass and his colleagues note, some past studies have found that the large majority of acid reflux episodes seen in GERD, regardless of the time of day, may actually not trigger clear symptoms. SOURCE: http://link.reuters.com/reb53m Clinical Gastroenterology & Hepatology, online May 31, 2010.