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					Issue 6, Fall 2004

THE VOICE for Women & Families
Lumpectomy or Mastectomy for Early-Stage Breast Cancer: How to Choose?
What’s Inside
Pills that Kill? .............................. 2 Teens and Implants ...................... 4 Supersized Kids ............................ 5 Affiliate Spotlight: GWU .............. 5 Do you Get Enough Sleep? .......... 6 Board Spotlight: Phyllis Katz ...... 7

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Our New Name
We have shortened our name from the National Center for Policy Research for Women & Families to the National Research Center for Women & Families. While we have changed our name, our mission remains: we are dedicated to improving the health and safety of women, children and families, by using research to encourage more effective programs and policies.

hat should I do? That is the question faced by hundreds of thousands of women every year when they first learn they have early-stage breast cancer. When they are diagnosed, women want to make their treatment decisions quickly, but there are many choices. Fear and other emotions may make it especially difficult. How can women get the information they need to decide whether a mastectomy or lumpectomy is the best treatment for them? The National Research Center for Women & Families, in partnership with the National Cancer Institute (NCI) and the National Institutes of Health (NIH), has written a new booklet, Surgery Choices for Women with Early-Stage Breast Cancer. The 22-page booklet was written in a simple, step-by-step format to help women through this difficult process. It clearly defines and compares the three main surgical choices for early-stage patients: lumpecto-

my, mastectomy, and mastectomy with reconstruction. In addition, it answers frequently asked questions about all three procedures. “Once diagnosed, women are often overwhelmed by the decisions in front of them,” explains Dr. Wanda Jones, Director of the Office of Women’s Health at the U.S. Department of Health and Human Services. “This booklet will help them through that process.” It has been almost 15 years since U.S. medical experts came to a consensus, based on scientific evidence, that lumpectomy with radiation is as effective and safe as mastectomy for most women with early-stage breast cancer (DCIS or stages I or II). But today, women around the world, including many in the U.S., still undergo mastectomies that are medically unnecessary. “This new booklet will serve as a valuable resource for patients” says Dr. Vivian Pinn, Director of the Office of Research on Women’s

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POLICY MATTERS
From the President

Pills That Kill? Keeping Kids Safe From Suicide
Diana Zuckerman, Ph.D.

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uicide is the third most common cause of death of adolescents in the U.S., and a recent government study shows that 17% of high school students have made at least one plan to kill themselves. Despite the widespread use of anti-depressants, suicide is killing many children. Did I say despite the antidepressants? Newly revealed research indicates it may be because of the anti-depressants. In September, the FDA asked an advisory committee to examine evidence about the risks of antidepressants for adolescents. The advisers concluded that most popular anti-depressants seemed to double the risk of either attempting suicide or seriously considering it. One raised the risk 800%. A Congressional investigation revealed that the FDA covered up its own scientist’s analysis of the research data, and even urged one company NOT to warn patients about the risks of their anti-depressants for kids. The FDA sat quietly as evidence mounted that the drugs may not be effective OR safe. It was only when Republicans and Democrats joined forces in Congress—a rare event these days— that the FDA finally held a public meeting and provided the evidence that the agency had for months. After examining that evidence, the advisory committee recommended the strongest warning: a black box on the label explaining the increased risk of suicide. They also recommended that every prescription include an information sheet that explains the suicide risks in words that everyone can understand. The FDA hasn’t decided whether to follow the committee’s

advice. So far, they have Feelings that used to be considissued a “Talk Paper” that warns doctors and parents to ered normal and natural are now carefully monitor their being treated with anti-depresdepressed adolescents, whether sants. A pink-colored version of or not they are taking antiProzac is called Serafem and sold depressants. We believe that something for menstrual mood swings. is wrong when our government passes the buck to the parents, instead of providing useful Psychiatrists and drug compainformation so that parents can make ny spokespersons explain that informed decisions. depressed people kill themselves, Doctors across the country are and that is why young people on prescribing anti-depressants for anti-depressants do too. However, everything from moving to a new the testimony shows that kids who school to biting fingernails to menwere never depressed are also taking strual mood swings. Anti-depresthese drugs and then killing themsants are being prescribed for many selves. Feelings that used to be conkids who have never been sidered normal and natural are now depressed. Here’s what parents told being treated with anti-depressants. the FDA’s advisers: In January, 12-year old Candace A pink-colored version of Prozac is called Serafem and sold for menstrustarted taking the anti-depressant al mood swings. Zoloft, prescribed for anxiety she Everyone seems to be looking was experiencing from school work. for the magic pill to make our kids Her mother, Mathy Downing, testifeel better, including physicians who fied that four days later Candace should know better. It didn’t used to hung herself. A week later, a 9-yearold boy in the same community, tak- be this way. Talking with our kids can help with typical adolescent ing Zoloft for obsessive compulsive struggles. Cognitive behavioral therdisorder, started crying and telling apy helps change how people think his mother he was stupid after he about themselves and their shortcame in second in a contest. He ran comings and is an effective strategy to his room and shut the door. His for many depressed children and mother thought of Candace, and adults. Unfortunately, insurance went to check on him—fortunately coverage is often lacking for “talking in time to stop him from hanging therapy,” and so pills are widely himself with his belt. advertised and prescribed as the Maryellen Winter testified that answer for many kids. It seems to be her 22-year old daughter, Beth, I newly graduated from the University the wrong answer. of Rhode Island, was prescribed This article is adapted from Dr. Paxil to help her sleep. Seven days later, she killed herself. “Beth’s death Zuckerman’s op-ed published in several Knight Ridder newspapers in September was a drug-induced suicide caused by Paxil,’’ her mother said. “We think 2004. For information on kids and suicide, go to www.center4research.org. that Beth would want you to know this.’’

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Lumpectomy or Mastectomy
Health at NIH. “With this guide, women can be assured that they are making an informed decision.” Some women do not know that lumpectomy with radiation is an equally safe option for them. “We haven’t had a booklet like this available, so it fills an information gap for many women with early-stage breast cancer,” explains Anna Levy, Deputy Director, NCI Office of Women’s Health. “It will make it easier for these women to understand their options and decide what is best for them.” Lumpectomy with radiation is more expensive than mastectomy, and many insurance plans require co-payments for the 20-40 radiation treatments. As a result, uninsured and underinsured women are more likely to undergo mastectomy. But they are not the only ones having medically unnecessary masteccontinued from page 1

tomies. Older doctors are “Women should not lose a breast more likely to recommend mastectomies, the treatunnecessarily, simply because ment that was standard they didn’t know that they had when they were in medical school. Geography also other equally safe options.” seems to be a factor— — Dr. Diana Zuckerman, President, women in the South and National Research Center Midwest are more likely to for Women & Families undergo medically unnecessary mastectomies. Women treated in university-based hospitals are more likely to undergo lumpecnot told the risks and benefits of tomy, while patients in community radiation or reconstruction. Now, hospitals are less likely. On the regardless of where a woman lives other hand, older women are some- or who her doctor is, this guide will times urged to skip radiation after give her the information she needs.” lumpectomy, which increases the chance of a recurrence of breast Surgery Choices for Women with Earlycancer. Stage Breast Cancer will be available “Women should not lose a for free from the National Cancer breast unnecessarily, simply because Institute and on our web site at they didn’t know that they had www.center4research.org. I other equally safe options,” adds Dr. Diana Zuckerman, our Center’s President. “And, they should not take chances with their health or Information You Can Use peace of mind because they were

A Voice You Can Trust

You Make The Difference
Our Center depends on charitable contributions to fund its work. Without supporters such as you, we would not exist.
I In honor of our 5th anniversary, you can choose up to five friends I Tax-deductible contributions can be sent at anytime. Use the

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to receive our newsletter for a year when you make your annual donation. envelope that we have attached to the newsletter to mail in a gift today. For more information on how to do this, please email us at info@center4research.org or contact us by mail or telephone.

I You can donate your car or old cellular telephone to the Center. I You can include the Center in your will or estate plans as a benefi-

Please call us at (202) 223-4000 with any questions you might have. Thank you again for your support. We are counting on you!

ciary. This gift will be a lasting legacy that will continue to benefit women and children for years to come.

ooking for information about a controversial health issue? Not sure who or what to believe? Companies pay for medical and scientific research to help sell their products. Their ads are persuasive but don’t tell the whole story. Who can you turn to for honest information? The National Research Center for Women & Families is here for you. If you need health information that you can count on, check out our website at www.center4research.org. We make it easy and understandable, and it’s all based on research. We even have an online health hotline, to answer specific questions.

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HEALTH MATTERS
Teens and Breast Implants
logical and physical health Teens may not think about implications on the CBS Early Show in September 2004. She their future financial security, explained how teenagers tend only the immediate gratificato dislike their bodies, but that body image improves as they tion of fixing a perceived get older. problem with their bodies. Teenagers may be naïve about the physical risks involved in breast augmentation, including infection, chronic pain, and the need for more Teens and cosmetic surgery surgery. Young people tend to think was a major focus of our annual bad things won’t happen to them. New York City media luncheon at Are they able to evaluate the risks the Harvard Club this spring. The involved in breast augmentation? luncheon was attended by many Girls also may not realize that they women’s magazines, such as are still growing. Many will gain Glamour, Good Housekeeping, and weight after 18 and so their breasts Latina. We featured Kacey Long, a may get larger. Although the Food graduate student who underwent and Drug Administration approved breast augmentation when she was breast implants only for 19 and had her implants removed women ages 18 and older, when she was 21. there are no legal age Kacey became ill from her restrictions. There are no saline implants within months. She studies on the safety of was diagnosed with rheumatoid breast implants for patients arthritis, fibromyalgia, and chronic under 18. fatigue syndrome. While her health The risks for young has improved since the implants women are not simply were removed, Kacey is still recoverphysical—there are also ing from her reaction to the financial risks. Some implants. And, she is still paying teenagers are taking out back the thousands of dollars she loans to pay for breast owes for her implant and explant implants, and could be sad- surgeries. dled with debt before they Kasey’s implant removal surstart college, buy a car or a gery was featured on MTV’s I Want home, or start a family. a Famous Face—a program that Because breast augmentaexplores the risks of plastic surgery tion often requires addias well as the benefits. Since then, tional surgery within five Kacey has worked with our Center Dr. Diana Zuckerman with Kacey Long at our to ten years, a teenager to provide information to the media New York City Media Luncheon could need at least one sur- and to other young women, and has gery in her 20s, her 30s, been featured in USA Today, US Do teens need to risk injury and every decade after that. Health Magazine, and on several TV news and even death by undergoing med- insurance usually will not pay for programs. She has become an eloically unnecessary surgery for body the treatment or corrective surgeries quent advocate, using her story to sculpting, or are there other ways to for problems that arise. Teens may warn others about the dangers help girls feel better about their bod- not think about their future financial involved. We are proud to work ies and themselves? Dr. Diana security, only the immediate gratifiwith her to educate young women, Zuckerman, our Center’s president, cation of fixing a perceived problem the media, and policy makers. I was interviewed about the psychowith their bodies.

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eenage girls are notoriously selfconscious and insecure about how they look, but thanks to popular television programs like Extreme Makeover and The Swan, many girls think they have found the solution to all of their problems—plastic surgery. And breast augmentation is quickly becoming one of the most popular procedures, with a 24% increase from 2002 to 2003. Some girls are getting breast implants as a high school graduation gift. Clearly some kinds of cosmetic surgery can provide great benefits to many people, including young people. There is no evidence of substantial problems resulting from many plastic surgery procedures. But the same cannot be said of breast implants.

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Supersized Kids?

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t’s becoming increasingly obvious that many children are truly too big for their britches. For some reason, it seems more noticeable when it is someone else’s child. Research shows that 4 out of 5 parents of very overweight young children don’t think their children are even slightly heavy. But most children know if they are fat—if only because other children will tell them. A study of young children in California found that obese kids were the unhappiest kids—with a quality of life comparable to children with cancer undergoing chemotherapy. In addition to the impact on the quality of children’s lives, obesity in childhood carries serious health risks. What used to be called “adult-onset diabetes” has become a national epidemic among children. A diagnosis of diabetes doesn’t scare parents the way some other diseases do, but it can cause a lifetime of serious health problems and a shorter life. The latest research can’t make kids eat better, but it can help parents develop strategies to help everyone in the family—kids and adults—stay at a healthy weight or get back to a healthy weight.
I Cut back on regular soft drinks and sugared fruit drinks.

Affiliate Spotlight:
Women’s Studies at GWU

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I Don’t eat or drink while watching TV. Studies show it’s

It’s just common sense to avoid supersized drinks, but even moderate size drinks can add up to undesirable flab. A new study published in the Journal of the American Medical Association found that drinking one or more soft drinks each day was linked to weight gains of 10 pounds a year, compared to drinking only one per week a bad habit that is common among overweight children (and adults). This is what happens: when you eat you want to watch TV, and when you watch TV you will want to eat. Break the cycle! Don’t allow eating while watching TV. If it’s hard to go “cold turkey” in your house, then just allow eating during certain programs or only allow healthy foods that you want to encourage, like milk or fresh fruit. Cut back gradually if you need to, but sometimes clear rules are easier to enforce than more flexible ones. 70 lbs! That might be faster, more convenient, or better exercise for parents, but kids that size should be walking on their own unless they have a physical disability. Let kids walk or ride their bikes to school or to visit friends if it is safe and close enough. It’s a great form of exercise, it fosters kids’ sense of confidence and independence, saves money on gas, and can even give parents more time to do other things. I

I Walk. Stores are now selling strollers for kids up to

ounded in 1972, the Women’s Studies Program at George Washington University (GWU) is one of the oldest in the country. The program offered the first interdisciplinary M.A. degree in Women’s Studies in the United States. Given its location in Washington, DC, students tend to focus on public policy. The curriculum stresses a strong foundation in feminist theory, while encouraging student internships and related research projects. “We want students to be involved in direct action, not just sitting in the classroom,” explains Professor Dan Moshenberg, Director of the Women’s Studies Program. “We train graduates to change the social policies that have constrained women’s lives.” The program encourages students to become actively involved on the local, state, federal, and global levels. Upon graduation, many students work for community-based programs and nonprofit organizations. “It’s been great having the GW Women’s Studies Program affiliated with us,” says Michelle Nawar, our Center’s Director of Policy and Communications. “Several graduate students from the program have interned with us, helping us prepare for an FDA hearing, drafting articles, and researching public health problems. It’s terrific experience for the students, and one of the many ways that affiliates can benefit from our expertise and we can benefit from theirs.” As the world becomes increasingly interlinked, the GW Women’s Studies Program wants to extend its policy work to include looking at how globalization affects women. When protesters descended on Washington for the pro-choice March for Women’s Lives in April, it was the same weekend that protesters were in town for anti-globalization demonstrations at the World Bank meetings. As part of its Public Intellectual/Public Controversies Lecture Series, the program brought together pro-choice activists and anti-globalization activists to discuss the intersection of globalization and women’s issues. The Women’s Studies Program hopes to partner with academic institutions in El Salvador, Chile, South Africa, and other countries to explore these important issues. By working with and learning from researchers around the world, GWU students and faculty can gain a better understanding of how I global policies affect women world-wide.

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RESEARCH NETWORK
Do You Get Enough Sleep?

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ind it hard to get out of bed in the morning? As part of our monthly lunch discussion series, Terri Weaver, PhD, RN, an expert in sleep research, spoke to a room full of oftenexhausted women leaders from the Washington, DC area. Dr. Weaver is a new member of our Research Network and an Associate Professor at the University of Pennsylvania School of Nursing and School of Medicine. Dr. Weaver started by asking audience members when and how often they dozed off during various daily activities. Based upon the results, Weaver concluded that half of the audience was pathologically sleep-deprived—an average number, according to Dr. Weaver.

Does it matter?
Who cares if you occasionally doze while reading or watching a movie? Unfortunately, sleep deprivation can have serious health effects and can decrease everyday performance. To demonstrate, Dr. Weaver described a fascinating study in which participants were given eight, six, or four hours of sleep, or none at all, over several nights. Participants were asked to respond to a flashing light by pressing a button as quickly as they could—the kind of quick responses that can save your life while driving. For those with 8 hours of sleep, performance remained steady. Not surprisingly, those with no sleep or only 4 hours did less well as the days went on. But what about adults given 6 hours of sleep per night, an amount many of us would consider normal? Their performance deteriorated over the two weeks—as if they had pulled one all-nighter. That’s because we all need at least 8 hours of sleep per night.

Over 100,000 motor vehicle accidents per year are attributed to lack of sleep. There are lots of accidents in the middle of the night, but also between 2:00 pm and 4:00 pm, when the body’s natural circadian rhythm makes us sleepier. Dr. Weaver noted that the catastrophes of Chernobyl, Bhopal, and the Exxon Valdez were all officially linked to sleep-related errors in judgment. With sleep deprivation, cognitive processing and short-term memory deteriorates. Insufficient sleep is also linked to insulin resistance, obesity, and depression. For teens, the price of too little sleep can be high. Teens are notorious for wanting to sleep late in the morning and, as it turns out, their biology is partly responsible. The internal biological clock of teenagers makes them naturally stay up late and sleep later in the morning. When teens have to get up early for school without getting 8 hours of sleep, their school performance, driving, and judgment while making important decisions will suffer. They will be less patient and more moody with teachers or family members. That’s why some school districts are starting high school an hour later— around 8:30 a.m.

How can we get more sleep?
Going to bed earlier is essential, but here are some other tips Dr. Weaver suggests for a better night’s sleep:
I Keep to a regular sleep

I Make your bedroom cool,

schedule, especially a regular wake-up time. You can catch up on your sleep over the weekend, but if you sleep very late on Sunday morning, it will be difficult to fall asleep early enough to get a good night’s sleep Sunday night. dark, and quiet.

I Use the bed only for sleepI Limit routine naps to 30

ing (or sex), not reading or watching TV. minutes.

I Avoid stimulants like cafI Set aside a “worry time” I Although alcohol seems to

feine and nicotine.

during the day, so you won’t do it at night.

Why are we getting less sleep?
People are working longer hours. Caffeinated foods and drinks are flooding the market. Computers and all-night TV options keep us up late. Hot flashes disrupt the sleep of many menopausal women. Four out of ten children have TVs in their bedrooms, and those kids go to bed an average of 20 minutes later than other children. Remember: most people who need more sleep don’t know it. They feel fine. If you doze off during the day, even during a boring meeting, it’s a sign that you are sleep deprived. I

I Don’t eat, exercise, or work

make you sleepy, it actually prevents the deeper stages of sleep as it wears off.

I If you do wake up in the

right before bed. Give yourself a couple of hours after a large meal or exercise, and an hour after finishing work, before you try to fall asleep.

middle of the night and can’t fall back to sleep, GET OUT OF BED. Get up and eat a snack or read, waiting to feel tired before getting back in bed.

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BOARD SPOTLIGHT
Dr. Phyllis Katz: Fighting Prejudice
Board of Directors

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rejudice can have a devastating impact on the health of children and families. Fortunately, research can help us understand and change those attitudes. Founding Board member Phyllis Katz, PhD, has done just that and influenced a generation of researchers. In the early 1970’s, Dr. Katz and her colleague Dr. Sue Zalk showed kids photographs of children of various races, and varied viewing conditions. Some of the children were told to look at the photos briefly, others were told to look at them carefully, and one group was told to learn the children’s names. This last condition was effective in changing children’s racial attitudes. “It is amazingly easy to influence kids’ attitudes and behaviors,” Dr Katz tells us. “The kids that learned the names of the children of a different race started to see them as individuals. Their attitudes changed as a result of this simple task, and their behaviors did too.” How was prejudice measured? The researchers took photographs of boys and girls who were white or African American in ambiguous school settings. Each photo had at least two children, one of each race, with their names in large letters on their shirts. The kids being tested were asked which child in the photo “spilled the paint” or “got the spelling prize” or some other good or bad thing. The kids were told nothing about the children— they based their opinion only on what the child looked like. Kids were considered more prejudiced if they thought the African American child did the “bad” thing, or the white child did the “good” thing. Around the same time, Dr. Katz started research on gender stereotypes. The same photos that

were designed to study racial prejudice were useful for studying gender bias—did the girl or the boy spill the paint? Which one got an “A” on the test? She found that gender bias is even more prevalent in young children than race bias. “A lot of great research was being conducted on sex prejudice and stereotypes, but there was no place to publish it,” Dr. Katz explains. “So I started a new journal, Sex Roles, in 1974.” It was the first interdisciplinary journal in the field. In 1976, she founded the Institute for the Study of Social Problems. Since then, she has continued her research and remains dedicated to reducing gender and racial bias among children. Dr. Katz’s work is nationally known and respected. In her current research, Dr. Katz is investigating when children become aware of gender and race cues, and how that affects their behavior. She found that children with bedrooms decorated in sex-stereotypic ways tend to have stereotypic views of girls and boys. She also found that even when parents are open-minded, 5and 6-year-olds can be quite biased. The more diversity of people there are in their lives, however, the less prejudiced they are. As a founding Board member and now member of our National Advisory Board, Dr. Katz has earned a reputation as a wonderful researcher, strategist, and advocate. We asked her how parents can help their kids be less prejudiced. “Talk about race to young children,” Dr. Katz suggests. “Expose kids to a socially heterogeneous environment. Attitudes are there, and there early, but not deep-seated. Get them young if you want to change I those attitudes.”

Arthur L. Caplan, Ph.D., Director, Center for Bioethics, University of Pennsylvania School of Medicine Bonnie Bazilian Finkel, J.D., Finkel Consulting Mary G. Hager, M.A., Writer Judith L. Harris, J.D., Managing Partner, Reed Smith

Roberta F. Havel, President, A Family Friend Richard Lupfer, America Online Patricia N. Olson, D.V.M., Ph.D., Director, Morris Animal Foundation Joy Mair Taylor, MBA

Amir Pasic, Ph.D., Johns Hopkins University Diana Zuckerman, Ph.D., President, National Research Center for Women & Families

National Advisory Board
Judy Woodruff, Prime Anchor and Senior Correspondent, CNN Michael Weitzman, M.D., American Academy of Pediatrics

The Honorable Olympia Snowe, U.S. Senator, Maine Shari Miles, Ph.D., Executive Director, Society for the Psychological Study of Social Issues Mary McDonough, Actress and Director

Joy Simonson, President, Clearinghouse on Women’s Issues

Lisa Lopez, J.D., V.P., Haemonetics Corporation Irene S. Levine, Ph.D., Nathan S. Kline Institute for Psychiatric Research

Rebecca Klemm, Ph.D., President, Klemm Analysis Group

Phyllis A. Katz, Ph.D., Director, Institute for Research on Social Problems Patricia Hendel, Former President, National Association of Commissions for Women

Mark Frankel, Ph.D., American Association for the Advancement of Science Iris Chang, Author

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In this issue of The

VOICE

WE WELCOME YOUR SUPPORT!
You can donate to us online or by check. We gratefully acknowledge these recent supporters of our work: Agency for Healthcare Research and Quality (AHRQ) American Legacy Foundation Bloomingdale’s National Cancer Institute NIH Office of Research on Women’s Health Office on Women’s Health, U.S. Department of Health and Human Services Reed Smith Susan G. Komen Foundation Tides Foundation Verizon Foundation

Lumpectomy or Mastectomy for Early-Stage Breast Cancer: How to Choose?
Page 1

Pills that Kill ?
Page 2

Teens and Breast Implants
Page 4

Supersized Kids
Page 5

and more!
For more information on health, programs, and policies that affect women and families every day, visit www.center4research.org.

Special thanks to our Women’s Health lunch seminar supporters: Baja Fresh, Preferred Office Club, Reed Smith and Turner Strategies.

NONPROFIT ORGANIZATION U.S. POSTAGE PAID PERMIT NO. 2442

NRC FOR WOMEN
& FAMILIES
National Research Center for Women & Families www.center4research.org 202-223-4000 1901 Pennsylvania Ave., NW Suite 901 Washington DC 20006


				
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