Women Suviving Cancer September 20, 2013 12:45 PM
Being a middle aged Canadian woman, it's nice to learn that Canada
places in the top 3 nations when it comes to surviving cervical and
breast cancer. CAA Health & Dental Insurance
(http://www.caahealth.ca/) reports on their website; "In Canada the five
year survival rate for cervical cancer is 72%, and 87% for breast
The Public Health Agency of Canada (www.publichealth.gc.ca) reported
in their 2012 Canadian Cancer Statistics that death rates in women
caused by cancer of the breast, cervical, non-Hodgkin lymphoma and
stomach have significantly been decreasing since the mid 1990's.
It's nice to hear some good news for a change. I thought it was worth sharing.
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Womens health February 04, 2010 3:09 AM
checkout new section on women's health to know more visit http://www.rx2gostore.com
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September 20, 2007 5:45 PM
Vaccine Protects Against Virus Strains
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September 20, 2007
TRENTON, N.J. (AP) -- New data shows a vaccine against the virus that causes cervical cancer partially blocks infection by 10 strains of the virus on top of the four types the vaccine targets.
That boosts protection -- at least partially -- to 90 percent of strains causing the deadly cancer, according to data presented Wednesday at a medical conference by Merck & Co., maker of Gardasil.
Whitehouse Station-based Merck called it the first evidence of any vaccine providing cross-protection against other strains of the human papilloma virus, or HPV.
Dr. Stephanie Blank, a gynecologic oncologist at the NYU Cancer Institute, said the finding could encourage more widespread use of Gardasil in developing countries, where some of the additional strains are more widespread and women rarely get Pap smears to detect early, curable cancers.
"That could be huge," Blank said.
Gardasil is the only cervical cancer vaccine on the market, approved for sale in 85 countries and pending approval in 40 more; it has racked up about $1 billion in sales since its June 2006 U.S. launch. GlaxoSmithKline PLC is awaiting approval of its own vaccine, Cervarix.
There are more than 60 strains of the HPV virus. About 15 are thought to cause cervical cancer; Gardasil protects against 12 of those, plus another two that cause genital warts but not cancer.
Two strains cause 70 percent of cervical cancer. Merck studies following 17,600 young women for three years found the vaccine to be 99 percent effective in blocking those strains.
New analysis of that data shows the vaccine reduced incidence of HPV-caused precancerous lesions by nearly two-thirds for the three next most common HPV strains in North America. While those three strains are less common elsewhere, together they cause about 11 percent of cervical cancer worldwide.
"There's the potential for an additional 30,000 to 40,000 cancer cases being prevented each year," mostly in developing countries, based on preliminary estimates and widespread vaccination in those regions, said Dr. Eliav Barr, head of Merck's research on infectious disease and vaccines.
There are 9,710 new cases of cervical cancer and 3,700 deaths in the U.S. each year. Worldwide, there are nearly 500,000 new cases and 233,000 deaths a year.
Dr. Jonathan Berek, chairman of obstetrics and gynecology at Stanford University School of Medicine, said he expected Gardasil to provide some protection against HPV strains not directly targeted by the vaccine, but not as much as the data shows.
"It's a reason why we should try to introduce it more broadly around the world," Berek said.
Dr. Michael Segarra of North Brunswick Pediatrics said women still need to get regular Pap smears because the vaccine doesn't cover all HPV strains, but that the extended protection will reduce anxiety in years to come as fewer women get abnormal Pap test results requiring additional testing.
Roughly 2.5 million such follow-up exams and biopsies are done each year in this country, at a cost of about $320 each.
"Any time you can reduce the possibility of getting cancer, it's very significant," added Segarra, who is vice president of the American Academy of Pediatrics New Jersey chapter.
However, Merck took heat for a behind-the-scenes campaign to get states to require sixth-grade girls to get the HPV vaccine to attend school. Merck has since dropped that campaign.
September 07, 2007 9:52 AM
By Jody Ruskamp-Hatz
The goal is to die young, but at a very old age—active and enjoying life up to the very end,” says Dr. Wanda Jones, director of the federal Office on Women’s Health, who touts the triumphs of public health and modern medicine in helping people live longer and healthier.
Her message applies equally to women and men. But for women to live longer, healthier lives they must pay attention to what scientists have been discovering the last two dozen years when they started researching women’s health.
Predominately, men have been medical research subjects and it was believed that except for reproductive organs, women were biologically the same. Doctors looked at women as “small men.” By the 1980s, according to the Society for Women’s Health Research, it was clear that the exclusion of women from clinical research trials compromised the health care they received.
Compared to men, women have different reactions and side effects to certain drugs. Women come out of anesthesia earlier. Women have different symptoms before a heart attack. Women are 2.7 times more likely to acquire an autoimmune disease, such as sclerosis, lupus or rheumatoid arthritis. Adolescent and young adult women are more apt to have eating disorders that lead to death. Women who smoke are far more likely to develop lung cancer at a younger age. Women experience depression at nearly twice the rate as men.
“Women’s health issues are different than men’s, and if we care about overall health we have to look at gender-specific issues,” says Indiana Senator Gary Dillon, a physician and chair of NCSL’s Standing Committee on Health.
In the early 1900s, women in the United States were most likely to die from infectious disease and complications of pregnancy and childbirth. Once women started to live longer, researchers found they have their own versions of chronic conditions such as heart disease, cancer and stroke, which now account for 63 percent of American women’s deaths.
Heart disease is the biggest killer, responsible for more deaths in women than all forms of cancer combined. The condition kills 50,000 more women than men every year. It continues to be the most significant health concern for women in the United States today with nearly 489,000 deaths per year. Cancer is the second major threat to women, with lung cancer being the most common cause of cancer death.
“When a woman’s health is bad, it affects the whole family,” says Oregon Representative Carolyn Tomei. “We have to spend a lot of time with our male counterparts explaining why these women’s health issues are important, not only to them, but to their entire family. Women tend to be the ones who decide when to seek medical advice for other family members.” Tomei is the chair of the Human Services and Women’s Wellness committee and has made women’s health one of her top priorities in the legislature.
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August 30, 2007 8:10 AM
Early Ovarian Surgery Linked to Dementia
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August 30, 2007
NEW YORK (AP) -- Women who have their ovaries removed before menopause run a heightened risk of developing dementia or other mental problems later in life -- unless they take estrogen until age 50, a new study suggests.
Experts said the research needs to be confirmed by further study, but the findings suggest another issue for premenopausal women and their doctors to discuss as they consider ovary removal.
And if they decide to go ahead with surgery, they need to consider the risks and benefits of taking estrogen to age 50, said Dr. Walter Rocca, a Mayo Clinic neurologist and lead study author.
Hormone therapy has been linked to a greater risk of dementia and heart attacks when given to women after age 65. But recent research indicates that when given before menopause or just afterward, it doesn't raise heart attack risk and may protect against dementia.
The study did not include women who had ovaries removed as part of cancer treatment, and Rocca said the results do not apply to such women. The work was published Wednesday in the online edition of the journal Neurology.
Ovaries produce estrogen. Rocca said the likeliest explanation of the study results is that removing ovaries causes a sudden deficiency of that hormone, which in turn affects the brain.
Hundreds of thousands of women have their ovaries removed each year in the United States. In women around age 45, approaching menopause, ovaries are often removed during hysterectomies as a precaution against developing ovarian cancer. In addition, some women at unusually high risk of developing ovarian cancer have ovaries removed without hysterectomies, as do others who have ovarian problems like endometriosis.
Women younger than 45 often take estrogen after ovary removal because of symptoms like hot flashes and concerns about developing osteoporosis, noted Dr. Nancy Chescheir of Vanderbilt University. But older women who have the surgery are less likely to start estrogen therapy, said Chescheir, who didn't participate in the new research.
The new study found the risk of later mental impairment was higher when the surgery was done at younger ages.
The research examined the fates of women who had one or both ovaries removed from 1950-87, and compared them to other women. Interviewers spoke with either the women themselves or somebody who knew them, asking about signs of memory impairment and any diagnosis of dementia or Alzheimer's disease.
Overall, the study found impairment or dementia in 150 of 1,489 women who'd had ovaries removed, versus 98 of 1,472 women who hadn't. That indicates nearly a 50 percent increase in risk.
A second study, which included about 2,300 women who'd had the surgery and about 2,400 who hadn't, found about a 70 percent increased risk for Parkinson's disease symptoms like tremors.
Still, that outcome was far less common than mental impairment, and experts said the evidence behind it was weaker than that provided in the mental-impairment paper. The Parkinson paper finding is "not quite ready for prime time" in terms of affecting patient care, said Dr. JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital. She was not involved with either study.
The mental-impairment paper suggests that a premenopausal woman without a family history of ovarian cancer who has to decide on whether to have her ovaries removed should ask her doctor whether that step is really necessary, she said.
"It's very reasonable and important to have that conversation with her doctor," Manson said.
Chescheir noted that estrogen therapy carries its own risks, such as a higher rate of blood clots and breast cancer, but that ovary-removal patients younger than 50 may want to have a serious discussion of that option after surgery.
Recommended health screenings for women August 14, 2007 3:12 PM
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August 03, 2007 6:58 AM
Simple Method Detects Cervical Cancer
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August 3, 2007
LONDON (AP) -- A cheap method to detect cervical cancer using vinegar, cotton gauze and a bright light could save millions of women in the developing world, experts reported Friday.
The study, published in The Lancet medical journal, found a simple visual screening test to look for the early signs of cervical cancer reduced the numbers of cases by a quarter.
"This is a landmark study," said Dr. Harshad Sanghvi, medical director at JHPIEGO, an international health organization affiliated with Johns Hopkins University that has worked on preventing cervical cancer in poor countries. Sanghvi was unconnected to the Lancet study.
Cervical cancer is largely preventable. It causes about 250,000 deaths every year and is the second-most common cancer in women. Nearly 80 percent of those women are in the developing world.
The visual screening test is done by a nurse or trained health care worker who washes a woman's cervix with vinegar and gauze using a speculum to hold it open. After one minute, any pre-cancerous lesions turn very white and can be seen with the naked eye under a halogen lamp.
Researchers from the International Agency for Research on Cancer in France and their colleagues from Tamil Nadu in India used the technique to screen 49,311 women in Dindigul district, India, from 2000 to 2003. When pre-cancerous lesions were found, health care workers gave immediate treatment to destroy the abnormal cervical tissue.
Another 30,958 women received standard care. They were told to watch for signs and symptoms of cervical cancer and encouraged to visit health care facilities where screening was available. These women were tracked from 2000 to 2006.
There were 167 cases and 83 cervical cancer deaths in the women who received the screening, compared with 158 cases and 92 deaths in those who didn't. That represents 25 percent less cervical cancer and a 35 percent lower death rate among those screened.
All of the women in the study were healthy and between 30 and 59 years old when the study began. The research was funded by the Bill & Melinda Gates Foundation.
Previous research has shown visual screening is almost as effective in catching cancer as Pap smears, a more expensive technique used in the West, which involves scraping cells from the cervix to be examined under a microscope in a laboratory.
"This is the final proof that with an extremely simple test, we can have a dramatic impact on cervical cancer rates," Sanghvi said.
Experts think that the simple, inexpensive technique could be rolled out across the developing world relatively easily. Pilot projects are already under way in a handful of countries in Asia and Africa.
"This study has given us a road map of how we can deliver this kind of screening widely," said Dr. David Kerr, Rhodes Professor of Clinical Pharmacology and Cancer Therapeutics at Oxford University. Kerr was not involved in the study.
Still, the test isn't perfect. It can produce many false positives, so health care workers giving the test must be properly trained. Also, the test cannot be used in post-menopausal women or in women who have had more than two or three children, since pre-cancerous lesions in those women develop in parts of the cervix not normally visible.
But other tests, like Pap smears or those to detect the human papillomavirus, or HPV, which can cause cervical cancer, are too expensive for poor countries to adopt. "The visual screening approach is within our grasp," Sanghvi said. "Visual inspection won't have as dramatic an impact as the sophisticated tests, but will have 70 percent of the impact for a minuscule cost."
Officials are already working on a cheaper version of the cervical cancer vaccine, which currently costs about $360 per dose, for the developing world. Together with stepped-up screening, doctors think that cervical cancer might one day be wiped out as a major health problem.
Good news for breasts! July 20, 2007 11:30 PM
Susan G Komen Breast Cancer Foundation - National Headquarters (Dallas, TX) has earned:
National Breast Cancer Coalition Fund - NBCC (Washington, DC)
National Breast Cancer Foundation - NBCF (Frisco, TX) $100.97
American Breast Cancer Foundation - ABCF (Baltimore, MD)
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July 03, 2007 5:38 AM
Labs Mature Eggs From Girls With Cancer
July 2, 2007
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LYON, France (AP) -- Doctors have removed eggs from young female cancer patients and -- for the first time -- brought the eggs to maturity before freezing them, giving the girls a better chance to one day have children.
Previously, scientists had thought viable eggs could only be obtained from girls who had undergone puberty.
"We didn't expect young girls to have eggs that could withstand the process of maturation," which involves adding hormones, said Dr. Ariel Revel, who led the research at the Hadassah Hospital in Israel.
The research will be presented Tuesday at the annual meeting of the European Society of Human Reproduction and Embryology in Lyon.
In related work, Canadian doctors on Monday announced the first birth of a baby from eggs matured in a laboratory, frozen, thawed and then fertilized -- a key development that holds promise for infertile women.
The year-old baby girl was born to a woman in Canada, doctors told the conference. Three other women are pregnant from eggs that had been matured in a lab, frozen, thawed and then implanted, they said.
The 20 women involved in the study are infertile with an average age of about 30. None have a history of cancer. Until now, doctors did not know whether eggs matured in a lab could withstand the fertilization process, adding that the research is still in early stages.
"It has the potential to become one of the main options for fertility preservation," said Dr. Hananel Holzer, the study's lead author and an assistant professor in the department of obstetrics and gynecology at McGill University in Montreal.
In the study involving young girls with cancer, Revel surgically extracted the eggs and then artificially matured them in a laboratory, with the idea of re-implanting them one day should the patient wish to have children.
To obtain the eggs, Revel and his colleagues performed surgery on 18 patients ages 5 to 20. Of 167 eggs, 41 were successfully matured, including some from prepubescent donors. They were then indistinguishable from those of older women, Revel said.
"Any advance that enables young women to have children one day after having cancer is positive," said Simon Davies, head of Teenage Cancer Trust, a charity based in Britain. Davies was not linked to the research.
But as the extraction of eggs is an invasive operation, Davies said more information was needed about potential risks to young women fighting cancer. There might also be ethical concerns, as the decision to remove eggs from very young girls would likely be made by the parents, not the patient.
Experts think cancer treatments can affect female fertility. Chemotherapy usually affects all body cells, attacking not only the cancer, but other areas including the ovaries -- for which it is often deadly.
Unlike men, who produce sperm throughout their lifetime, women only have a set number of eggs from their birth, which decreases as they age. Young girls who undergo aggressive chemotherapy treatments often experience a sharp drop in the number of their eggs, and some become completely infertile.
The cure rate for childhood cancer can be as high as 90 percent, and doctors are investigating options for preserving patients' fertility. Another experimental method involves removing a thin layer of ovarian tissue for re-implantation later, but trials so far have resulted in only a handful of pregnancies worldwide.
Immature eggs from adult women have previously been matured in the laboratory, but until now, no one had ever tried it with eggs from young girls.
The real test will come when the girls on whom the treatment was performed might be ready to have children. "We will only know the final chapter of this story in about 10 years, when we hope to close the circle of this research," Revel said.
None of the eggs has yet been thawed, and experts are unsure if the process of artificial insemination could result in other problems such as chromosomal abnormalities. Additional surveillance, such as amniocentesis screenings to check the baby's development, probably would be necessary.
June 26, 2007 5:44 PM
Women with Diabetes Left Behind in Drop in Death Rates
June 2007 - A new analysis of data from three large national databases finds that in the 29 years between 1971 and 2000, the death rate of men with diabetes has dropped significantly, in line with the overall decline of the death rate for all Americans. But the death rate for women with diabetes did not decline at all.
Edward W. Gregg, PhD, acting chief, Epidemiology and Statistics Branch of the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC) and lead author of the study, says that the study uncovered the gender disparity in death rates but was not designed to answer its causes.
"The improvements seen in men suggest that the improvements in diabetes care are working on longevity as well," said Gregg. "But the finding in women is concerning and means we may need to explore whether different approaches are needed to improve health outcomes for women with diabetes."
Study authors looked at data from 20,000 people, aged 35 to 74, in one of the National Health and Nutrition Examination Surveys (NHANE I, II, and III and followed participants for up to 12 years to see who was still living and who died.
Researchers found that the death rates from all causes in men with diabetes fell steeply from 42.6 to 24.4 annual deaths per 1,000 people, a 43 percent relative reduction in age-adjusted death rate, while the death rate from cardiovascular disease (CVD), the most common cause of death in people with diabetes, fell from 26.4 to 12.8. In the same period, neither the all-cause nor CVD death rate for women with diabetes declined.
Overall, Americans live longer today than 35 years ago. The study showed that the overall death rate for people who did not have diabetes fell from 14.4 to 9.5 annual deaths per 1,000 people. When the authors analyzed the data by sex and by diabetes status, the startling difference in women with and without diabetes appeared.
In general, people with diabetes have a higher risk of dying earlier than people without the disease. In this study the death rate of men with diabetes remained higher than that of men without diabetes but over the decades it decreased in parallel with the decrease in men without diabetes. These same favorable trends were not present in women with diabetes.
The study did not investigate the reasons for the sex-related difference in death rates.
Dr. Gregg explained, "Some studies have suggested women have had less improvement in heart disease risk factors in recent years. Other studies suggest women receive less aggressive care for heart disease and risk factors. Still other studies suggest that heart disease and diabetes may take a subtly different form in women, and that different types of treatments are needed."
An editorial accompanying the article suggests that part of the reason for the sex differences may be the well-described lower rates of treating cardiovascular risk factors and established coronary heart disease in women.
In the last 35 years, diabetic care has improved, with efforts to maintain tight control of blood sugar, cholesterol and blood pressure levels and with more routine use of flu and pneumonia vaccines and regular exams of eyes feet, and teeth. New drug treatments have come to market.
What can a woman with diabetes do to live as long as possible" The American College of Physicians suggests: Make sure you are under a doctor's care. Have blood sugar, cholesterol levels and blood pressure checked regularly and maintain tight control of these key markers of diabetes and heart health. Get regular checkups of your eyes, feet, and kidney function. If you’re overweight, lose weight. If you smoke, quit. Eat a healthy diet (fewer carbohydrates, sweets and starches that affect blood sugar levels). Take your medications as directed. Be physically active.
The study, "Mortality Trends in Men and Women with Diabetes, 1971-2000," and the editorial "Heightened Cardiovascular Risk in Diabetic Women: Can the Tide be Turned"" appears on the Web site of Annals of Internal Medicine (www.annals.org). It will appear in the Aug. 7, 2007, print edition of the journal
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June 20, 2007 6:38 PM
June 20, 2007
News Review From Harvard Medical School -- Soy Product May Aid Bones
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A soy-based product may help bone density, a study has found. The 389 women in the study had lost some bone. But it was not serious enough to be called osteoporosis. Women were assigned randomly to take either genistein or fake pills. After two years, the genistein group had better bone density than the others. Everyone also took calcium and vitamin D. Genistein comes from soy. It has effects similar to estrogen. The study was published June 19 in the Annals of Internal Medicine.
By Robert H. Shmerling, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
If you're looking for an "all-natural" way to keep your bones strong, soy might be just the answer. At least that's the suggestion of a new study.
In research just published in the Annals of Internal Medicine, 389 women were randomly assigned to one of two groups. The first received calcium, vitamin D and genistein. This is an estrogen-like substance found in soy products. The second group got similar treatment, but took a placebo instead of genistein.
All of these women were past menopause. All had osteopenia. That means their bone density was low, but not as low as women with osteoporosis. After two years, the women taking genistein had higher bone density than those taking the placebo. In addition, blood and urine tests showed that they were losing less bone.
Women receiving genistein complained of digestive symptoms (such as upset stomach or constipation) more often than those receiving placebo. However, they did not have any thickening of the uterus lining. This is a potentially pre-cancerous effect of estrogen.
The results of this research are exciting. They suggest that dietary changes or a simple supplement could be useful to improve bone strength.
But it's too soon to know whether eating more soy products or taking genistein is a good idea. Here's why:
- A relatively small number of women were studied.
- The study lasted only two years. It will take many more years to know whether genistein significantly improves bone strength.
- The treatment in this study was a supplement found in soy, not a dietary source. Eating more soy-containing foods might not provide as much genistein as the study subjects received.
- Although increased bone density usually leads to a lower fracture risk, this study did not assess whether genistein could lower fracture rates.
- The safety of genistein cannot be proven by a small study lasting only two years.
It's important to note that all of the women in this study were taking supplements of calcium and vitamin D. Even if more research confirms the benefits of soy for bone health, soy is unlikely to accomplish much if your diet does not contain enough calcium and vitamin D. Even though genistein is a "natural" approach, it may be far less effective (and could even be riskier) than other available options for the prevention of osteoporosis and fractures.
What Changes Can I Make Now?
You can make changes to improve bone density and reduce your risk of bone fracture. Here are some of the most important:
- Get enough calcium and vitamin D. For adults, current guidelines recommend 1,000 to 1,200 milligrams of calcium and 200 to 400 units of vitamin D each day. Talk to your doctor about your dietary intake and whether you may need even more than the guidelines suggest.
- Increase your weight-bearing exercise.
- Don't smoke.
- Moderate your alcohol intake. A common recommendation is for women to have no more than one drink a day and for men to have no more than two drinks daily.
- Talk to your doctor about screening tests for osteoporosis, including a measure of bone mineral density.
- Consider taking medicine to increase bone density and lower fracture risk. Examples include alendronate and risedronate. To help with this decision, talk to your doctor about your screening test results and other factors that affect your risk.
- If you take thyroid medication, be sure to have regular tests to make sure that your dose is just right. A dose that is higher than needed may increase osteoporosis risk.
- Talk to your doctor about ways to avoid falling. For example, medicines, muscle weakness and poor lighting in the home can increase the risk of falls. But these problems often can be fixed.
It's not yet clear that increasing dietary soy will help your bones. On the other hand, it's an excellent source of protein, a good alternative to high-fat, high-calorie foods, and unlikely to cause side effects. That's why I'd encourage soy intake even without this latest research.
What Can I Expect Looking to the Future?
Researchers are already working hard to find better ways to detect bone loss and prevent fractures. Look for more research on the risks and benefits of soy-containing foods or supplements such as genistein. Future research may find the ideal dose of supplements or the best combination of soy-based foods and drugs to safely improve bone health. You can expect long-term studies of genistein among women with normal bone density or osteoporosis, not just osteopenia.
June 14, 2007 2:14 PM
Experts List Signs of Ovarian Cancer
June 13, 2007
ATLANTA (AP) -- For the first time, cancer experts are advising women of certain symptoms that might alert them to ovarian cancer, a disease that is hard to spot early and one of the deadliest cancers.
Suddenly experiencing weeks of bloating, the need to frequently urinate, eating changes and abdominal or pelvic pain -- either one of these or a combination -- could be a tip-off to early ovarian cancer, according to several groups of cancer experts.
The American Cancer Society and other groups released a consensus statement Wednesday listing the symptoms. Historically, doctors have believed there are no early symptoms of ovarian cancer, which is expected to kill about 15,000 U.S. women this year.
There is no screening test for the condition and so symptom recognition; regular pelvic examinations are considered the main ways to detect the cancer early.
"Unfortunately, until now there has been no agreement on common symptoms, allowing women to go undiagnosed, despite visits to the doctor, until it was too late," said Dr. Barbara Goff, a University of Washington gynecologic oncologist, in a prepared statement.
The Cancer Society put together the consensus statement along with the Gynecologic Cancer Foundation and the Society of Gynecologic Oncologists.
The experts say women should see their doctor if they suffer, for at least three weeks, one or more of these symptoms daily:
-Pelvic or abdominal pain.
-Difficulty eating or feeling full quickly.
-Frequent or urgent urination.
But the guidelines are problematic, said Debbie Saslow, the cancer society's director of breast and gynecologic cancer.
More women with one or more of the symptoms are more likely to have irritable bowel syndrome than ovarian cancer, she said. Also, there are no highly accurate tests to clearly confirm ovarian cancer in women who have the symptoms, she added.
That means recognizing the symptoms may not lead to helpful tests or saved lives. Indeed, pursuing the symptoms as a harbinger of ovarian cancer may, in some cases, lead to biopsies and other treatments that will cause more harm than benefit.
"That was the frustration with this," Saslow said. But experts decided to issue the statement anyway, because important recent studies by Goff have indicated the sudden onset of the symptoms in healthy women may be an important indicator.
"We can't not tell women there are any symptoms just because we're not sure what to do" in terms of definitive diagnosis and treatment, Saslow said
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May 23, 2007 8:44 PM
News Review From Harvard Medical School -- Skipping Your Period, Every Month
Several new products expected to be approved soon will make it possible for women to avoid having menstrual periods for a long time, the Associated Press (AP) reported May 22. With Seasonale, available since 2003, a woman has just four periods a year. New products awaiting U.S. Food and Drug Administration approval include a birth control pill, Lybrel, designed to be taken indefinitely and an implanted contraceptive, Implanon, AP reported. Both stop menstruation for most women.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Newly packaged versions of the birth control pill and other hormone-based birth control methods are allowing women to make their periods less frequent, or they are stopping menstrual bleeds altogether. Most women are delighted with the prospect of eliminating their periods. But a woman wonders, is there any possible danger involved with having few or no periods?
This is a good question. We may not yet have the final answer, particularly in the area of cancer concerns.
Some doctors worry that monthly shedding of the uterus lining is an important way that the body protects itself against cancer. Uncontrolled growth in the lining of the uterus might lead to cancer of the uterus or to fibroid tumors (benign tumors), these doctors argue, if the lining isn't shed regularly.
Other doctors point out that birth control pills (at least, those with monthly bleeds) are linked to a substantially lower rate of cancer in the uterus overall. This lowered risk is possibly related to the balance of hormones in the pills.
The protection provided by the hormones in birth control pills might be more important than the possible risk from less frequent shedding of the lining. So far, studies of suppressed menstruation have occurred over too short a term to give us a final answer to the cancer question.
So far, using hormonal birth control in a way that can suppress your periods has only a few clearly known drawbacks:
- Some women have breakthrough (unpredictable) spotting or bleeding. This is more common for women taking pills with a period every three months, rather than every month.
- An unplanned pregnancy could be discovered less quickly. With average patterns of use (and average forgetfulness), roughly one out of every 30 to 50 women who use the pill will become pregnant in a typical year of use.
- The hormones in birth control cause a small increased risk of a stroke or heart attack, and a more substantial risk of a clot in a leg vein or in the lung (pulmonary embolus). Taking hormone medicine during four weeks instead of three weeks out of each month is likely to increase this risk by one-third.
- Using pills without a break usually costs more per month, a cost offset by less need to purchase tampons or pads.
Suppressing your periods can be beneficial. Here are some advantages:
- The inconvenience of having a period does not occur, or occurs less frequently.
- Less blood loss means a lower chance of developing anemia.
- Fewer migraine headaches occur in women who develop these at the onset of their periods.
- Fewer menstrual cramps and less bloating occur, particularly for women with endometriosis.
Use of birth control pills lowers the risk of ovarian cancer and appears to have a minimal effect on breast cancer risk in women who are in their reproductive years. It is not known whether use of birth control hormones during four weeks of the month will change these risk patterns in a significant way.
Keep in mind that if you are not taking birth control hormones, then a regular monthly period is a sign of good health and is not optional. See a doctor if your periods are not occurring naturally.
What Changes Can I Make Now?
Overall, I think it is reasonable for women to engineer less frequent bleeding if they take birth control pills or another form of hormonal contraception. Since it is not yet clear whether an increased risk of cancer or other complications might arise after long-term suppression, I recommend periods every three months for my own patients who want to suppress menstruation, instead of eliminating periods altogether.
If you choose to have less frequent menstruation on hormone-based birth control, there are several ways you can achieve this:
- Women on any combined oral contraceptive can decrease the frequency of their periods by using only the first three weeks of pills in each pack before beginning the next pack's pill supply. This will cause a skipped period.
- Women may use the brand Seasonale to have a planned menstrual period once every three months.
- Women using the NuvaRing (vaginal ring) or the birth control patch (Ortho Evra) may replace the ring or patch every three weeks, without waiting a week in between.
Some women can't take hormone-based birth control safely. Women over age 35 who smoke have an increased risk of stroke while taking birth control pills or other hormone-based birth control. Also, women with breast cancer (or any estrogen-sensitive cancer), liver disease or a previous history of stroke can't take birth control pills safely. Women who react to birth control pills with high blood pressure that is not easily controlled also must avoid hormonal birth control.
What Can I Expect Looking to the Future?
Several new birth control preparations that offer reduced menstrual frequency probably will become available within the next year. These medications are likely to be approved by the U.S. Food and Drug Administration, but they will have passed only short-term tests of safety. Only with time and experience will we know for sure whe
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May 21, 2007 10:18 PM
FDA Set to OK Period Suppression Pill
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May 21, 2007
TRENTON, N.J. (AP) -- Women looking for a simple way to avoid their menstrual period could soon have access the first birth control pill designed to let women suppress monthly bleeding indefinitely.
The U.S. Food and Drug Administration is expect to announce approval Tuesday for Lybrel, a drug from Wyeth which would be the first pill to be taken continuously.
Lybrel, a name meant to evoke "liberty," would be the fourth new oral contraceptive that doesn't follow the standard schedule of 21 daily active pills, followed by seven sugar pills -- a design meant to mimic a woman's monthly cycle. Among the others, Yaz and Loestrin 24 shorten monthly periods to three days or less and Seasonique, an updated version of Seasonale, reduces them to four times a year.
Gynecologists say they've been seeing a slow but steady increase in women asking how to limit and even stop monthly bleeding. Surveys have found up to half of women would prefer not to have any periods, most would prefer them less often and a majority of doctors have prescribed contraception to prevent periods.
"I think it's the beginning of it being very common," said Dr. Leslie Miller, a University of Washington-Seattle obstetrician-gynecologist who runs a Web site focused on suppressing periods. "Lybrel says, 'You don't need a period.'"
While that can be done easily -- sometimes more cheaply -- by skipping the sugar pills or replacing birth-control patches or vaginal rings sooner, doctors say the trend is fueled mainly by advertising for the new options. They expect plenty for Lybrel's July launch, although Madison, N.J.-based Wyeth says it will market to doctors first.
Analysts have estimated Lybrel sales could reach $40 million this year and $235 million by 2010. U.S. sales of Seasonique, launched last August, hit $6.1 million in the first quarter of 2007. Predecessor Seasonale, which got cheaper generic competition in September, peaked at about $100 million. Yaz, launched last August, had first-quarter sales of $35.6 million; Loestrin 24, launched in April 2006, hit $34.4 million in the first quarter.
Still, some women raise concerns about whether blocking periods is safe or natural. Baltimore health psychologist Paula S. Derry wrote in an opinion piece in the British Medical Journal two weeks ago that "menstrual suppression itself is unnatural," and that there's not enough data to determine if it is safe long-term.
Sheldon J. Segal, a scientist at the nonprofit research group Population Council, wrote back that a British study found no harm in taking pills with much higher hormone levels than today's products for up to 10 years.
"Nothing has come up to indicate any unexpected side effects," said Segal, who co-authored the book "Is Menstruation Obsolete?"
Most doctors say there's no medical reason women need monthly bleeding and that it triggers health problems from anemia to epilepsy in many women. They note women have been tinkering with nature since the advent of birth control pills and now endure as many as 450 periods, compared with 50 or so in the days when women spent most of their fertile years pregnant or breast-feeding.
Dr. Mindy Wiser-Estin, an obstetrician-gynecologist in Little Silver, N.J., has long advocated menstrual suppression.
She has seen a big increase in the last year in patients asking about it, but has one concern that leads her to encourage younger women to take a break every 12 weeks. About 1 percent of oral contraceptive users become pregnant each year, and young women taking continuous pills who have never been pregnant may not recognize the symptoms, she said.
"They may not know it in time to do something about it," Wiser-Estin said.
Barr Pharmaceuticals of Woodcliff Lake, N.J., whose subsidiary Duramed already is developing a lower-estrogen version of Seasonique, said its research with consumers and health care providers indicates they feel four periods a year is optimal, said spokeswoman Amy Niemann.
Wyeth obviously thinks otherwise.
"It allows women to put their menstrual cycle on hold" and reduces 17 related symptoms, from irritability to bloating, based on one small study, said Dr. Amy Marren, director of clinical affairs for Wyeth Pharmaceuticals.
Marren said Lybrel contains the lowest dose of two hormones widely used in birth-control pills, ethinyl estradiol and levonorgestrel.
That might cause too much breakthrough bleeding, already a problem with some newer pills with low hormone doses, said Dr. Lee Shulman, a Chicago obstetrician-gynecologist who chairs the board of the Association of Reproductive Health Professionals.
In testing of Lybrel, 59 percent of women ended up with no bleeding after six months, but 18 percent of women dropped out of studies because of spotting and breakthrough bleeding, according to Wyeth.
"You're now basically trading scheduled bleeding for unscheduled bleeding, and I don't know whether American women will buy into that," Shulman said.
May 14, 2007 12:28 PM
Women and Men: Ten Differences that Make a Difference
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When it comes to health, there are many crucial health differences between men and women. Yet many women do not know that they react differently to some medications, are more vulnerable to some diseases, and may have different symptoms. The Society for Women's Health Research brought attention to sex differences in initiating the groundbreaking 2001 Institute of Medicine report, Exploring the Biological Contribution to Human Health: Does Sex Matter? The report underscored the need to better understand the importance of sex differences and translate that knowledge into improved medical practice and therapies.
Following are some quick but vital facts about sex differences in health care that you probably did not know.
- Heart Disease – Heart disease kills 500,000 American women each year — over 50,000 more women than men — and strikes women, on average, 10 years later than men. Women are more likely than men to have a second heart attack within a year of the first one.
- Depression – Women are two-to-three times more likely than men to suffer from depression in part because women's brains make less of the hormone serotonin.
- Osteoporosis – Women comprise 80% of the population suffering from osteoporosis, which is attributable to a higher rate of lost bone mass.
- Smoking – Smoking has a more negative effect on cardiovascular health in women than men. Women are also less successful quitting smoking and have more severe withdrawal symptoms.
- STDs – Women are two times more likely than men to contract a sexually transmitted disease, and more likely to experience significant drops in body weight, which can lead to wasting syndrome.
- Anesthesia – Women tend to wake up from anesthesia more quickly than men — an average of seven minutes for women and 11 minutes for men.
- Drug reactions – Even common drugs like antihistamines and antibiotic drugs can cause different reactions and side effects in women and men.
- Autoimmune Disease – Three out of four people suffering from autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis, and lupus, are women.
- Alcohol – Women produce less of the gastric enzyme that breaks down ethanol in the stomach. Therefore, after consuming the same amount of alcohol, women have higher blood alcohol content than men, even allowing for size differences.
- Pain – Some pain medications (known as kappa-opiates) are far more effective in relieving pain in women than in men.
May 14, 2007 12:27 PM
Women: Stay Healthy At Any Age
Checklist For Your Next Checkup
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What can you do to stay healthy and prevent disease? You can get certain screening tests, take preventive medicine if you need it, and practice healthy behaviors.
Top health experts from the U.S. Preventive Services Task Force suggest that when you go for your next checkup, talk to your doctor or nurse about how you can stay healthy no matter what your age.
Screening Tests: What You Need And When
Screening tests, such as mammograms and Pap tests, can find diseases early when they are easier to treat. Some women need certain screening tests earlier, or more often, than others. Talk to your doctor about which of the tests listed below are right for you, when you should have them, and how often.
The Task Force has made the following recommendations, based on scientific evidence, about which screening tests you should have.
- Obesity: Calculate your body mass index (BMI). BMI is a measure of body fat based on height and weight.
- Mammograms: Have a mammogram every 1 to 2 years starting at age 40.
- Pap tests: Have a Pap test every 1 to 3 years if you have ever been sexually active or are between the ages of 21 and 65.
- Cholesterol: Have your cholesterol checked regularly starting at age 45. If you are younger that 45, talk to your doctor about having your cholesterol checked if you smoke, have diabetes, have high blood pressure or if heart disease runs in your family.
- Blood Pressure: Have your blood pressure checked at least every 2 years.
- Colorectal cancer: Have a test for colorectal cancer starting at age 50. Your doctor can help you decide which test is right for you. If you have a family history of colorectal cancer, you may need to be screened earlier.
- Diabetes: Have a test to screen for diabetes if you have high blood pressure or high cholesterol.
- Depression: If you've felt "down," sad, or hopeless over the last 2 weeks or and have felt little interest or pleasure in doing things, talk to your doctor about whether he or she can screen you for depression.
- Osteoporosis: Have a bone density test at age 65 to screen for osteoporosis (thinning of the bones). If you are between the ages of 60 and 64 and weigh 154 lbs. or less, talk to your doctor about whether you should be tested.
- Chlamydia and other sexually transmitted diseases: Have a test for Chlamydia if you are age 25 or younger and sexually active. If you are older, talk to your doctor about being tested. Also, ask whether you should be tested for other sexually transmitted diseases.
Should You Take Medicines to Prevent Disease?
- Hormones: Do not take hormones to prevent disease. Talk to your doctor if you need relief from menopausal symptoms.
- Breast cancer drugs: If your mother, sister, or daughter has had breast cancer, talk to your doctor about the risks and benefits of taking medicines to prevent breast cancer.
- Aspirin: Talk to your doctor about taking aspirin to prevent heart disease if you are older than age 45 and have high blood pressure, high cholesterol, diabetes, or if you smoke.
- Immunizations: Stay up-to-date with your immunizations:
- Have a flu shot every year starting at age 50. If you are younger than age 50, ask your doctor whether you need a flu shot.
- Have a pneumonia shot once at age 65. If you are younger than age 65, ask your doctor whether you need a pneumonia shot.
What Else Can You Do To Stay Healthy?
- Don't smoke. But if you do smoke, talk to your doctor about quitting. Your doctor or nurse can help you. And, you can help yourself. Make a plan and set a quit date. Tell your family, friends, and co-workers you are quitting. Ask for their support. You can also take medicine and get counseling to help you quit. If you are pregnant and smoke, quitting now will help you and your baby.
- Eat a healthy diet. Emphasize fruits, vegetables, whole grains and fat-free or lowfat mild and milk products; include lean meats, poultry, fish, beans, eggs and nuts. Eat foods low in saturated fats, trans fats, cholesterol, salt and added sugars.
- Be physically active. Walk briskly, mow the lawn, dance, ride a bike or do any other physical activity you enjoy. If you are not already active, start small and work up to 30 minutes or more of moderate physical activity most days of the week.
- Stay at a healthy weight. Balance calories from foods and beverages with calories you burn off by your activities. To prevent gradual weight gain over tiem, make small decreases in food and beverage calories and increase physical activity. Remember to watch portion sizes. Talk to your doctor if you have questions about what or how much to eat.
- Drink alcohol only in moderation. If you drink alcohol, have no more than one drink a day. (A standard drink is one 12-ounce bottle of beer or wine cooler, one 5-opunce glass of wine or 1.5 ounces of 80-proof distilled spirits. If you are pregnant, avoid alcohol.
National Women's Check-up Day May 14, 2007 12:25 PM
Take care of your health
•Cancer •Eating Disorders
Though breast cancer grabs the headlines, there are other types of cancer you should be aware of.
Eating disorders range from a single, mild illness in adolescence to a lifelong disorder, which is either persistent or fluctuates. •Fibromyalgia
Fibromyalgia is a chronic condition of pain, stiffness and usually fatigue. •HIV Infection And Women
The number of women with HIV infection and AIDS in the United States is steadily rising. Read more about this important health concern, from the National Institute of Allergy and Infectious Diseases. •Osteoporosis
In the United States, osteoporosis causes more than 1.3 million fractures annually. It is much more common in women than in men. •Reproductive Health
Disorders of the female reproductive system can be very troublesome to women. What are the most common disorders, and are you at risk? •Screening: Domestic Abuse
Learn the warning signs of domestic abuse. •Thyroid Disease
Approximately one woman in eight will develop some type of thyroid disorder during her lifetime. Find out more about these diseases. •Urinary Tract And Bladder Conditions
Disorders affecting the urinary tract and bladder include infections, incontinence and urethritis. •Women And Depression
Women are disproportionately affected by depression, experiencing it at roughly twice the rate of men. Research continues to explore how the illness affects women. •Women And Heart Disease
Heart disease is no longer considered a "man's" disease, but many women remain unaware of the extent of their risk. How can you prevent heart disease?
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May 10, 2007 3:18 PM
Study: Cervical Cancer Vaccine Less Effective in Sexually Active
May 10, 2007
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(USA TODAY) -- A vaccine designed to prevent cervical cancer significantly cut the risk of precancerous changes in women who had not already been infected with the cancer-causing virus types targeted by the vaccine, a study reports today.
The Gardasil vaccine, which has been sold in the USA since last summer, was not as effective in women who had been infected with human papillomavirus (HPV) types 16 or 18, thought to cause 70% of cervical cancer cases.
HPV is the most common sexually transmitted infection in the USA, so that finding suggests that sexually active women might not be getting their money's worth out of the vaccine, which also targets two other HPV types thought to cause 90% of genital warts cases.
"Just like any vaccine, it's not going to be effective in people who already have the disease," Emory obstetrician/gynecologist Kevin Ault says.
About 93% of the more than 12,000 women ages 15 to 26 who participated in the international study, published in The New England Journal of Medicine, were not virgins upon enrollment.
Before they received the vaccine or placebo, participants were checked to see whether they had ever been infected by any of the four HPV types targeted by the vaccine. Fewer than 1% had been infected by all four, but 27% had been infected by at least one. But the HPV test available in doctors' offices reveals only whether women are currently infected with any HPV type, not what type or whether they've been infected before.
"It's important that women understand if they're sexually active, there's a chance they won't receive full benefit from the vaccine," says University of Washington epidemiologist Laura Koutsky of the trial's study group, which followed women for three years.
More than 90% of HPV infections clear up on their own. Once that happens, Koutsky says, studies suggest most women are protected against those HPV types. Lasting infection with cancer-causing HPV types can lead to cervical cancer, which is expected to kill 3,670 women in the USA this year.
Gardasil is approved for girls and women ages 9 to 26. The Centers for Disease Control and Prevention recommends vaccinating girls at age 11 or 12, before most are sexually active. Many states are considering the controversial step of requiring HPV vaccination for girls entering sixth grade.
University of California-San Francisco OB/GYN George Sawaya, co-author of an editorial accompanying Koutsky's study, says he's not sure what to tell sexually active patients who ask about the vaccine. "An easy answer is 'CDC recommends it,'" Sawaya says. "I've been very clear with my patients that it's hard for me to counsel them about risks and benefits."
It's not known what proportion of vaccine recipients were sexually active before receiving the three-shot regimen, which costs $360. Jennifer Allen of Gardasil maker Merck says the company has not yet broken down recipients by age, which could serve as a marker for sexual activity.
Allen says Merck does not yet know the total number of girls and women who have received the vaccine, but, she says, 5 million doses were distributed from last June through March 31
March 27, 2007 10:09 AM
Aspirin Shows Benefit in Older Women
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March 27, 2007
CHICAGO (AP) -- Aspirin in low to moderate doses may lower the risk of death in women, particularly those who are older and prone to heart disease, a 24-year study of nearly 80,000 women suggests.
However, experts cautioned that the results are not definitive and that women should not take aspirin as a health preventive without talking to their doctor.
In this long-running study of nurses who were middle-aged and older, women who took aspirin had a 25 percent lower risk of death compared to those who never took it. Aspirin-takers had a 38 percent lower risk of death from cardiovascular disease and a 12 percent lower risk of death from cancer.
Many doctors advise people who've had heart attacks and strokes to take a daily 81-milligram baby aspirin, costing less than 50 cents a week. The new study suggests aspirin may help healthy women, too.
No benefit was found for high doses, which the study defined as two or more standard 325-milligram aspirin tablets a day.
"This confirms what we already know: Aspirin is good for you, whether you're a man, whether you're a woman," said Dr. Jeffrey Berger of Duke University Medical Center who studies aspirin's effects. He was not involved in the new research and receives no money from aspirin makers.
However, since aspirin can cause ulcers and bleeding, Berger said, women should talk to their doctors before taking it to prevent disease.
"It's not a little vitamin; it's not a sugar pill," he said.
Most of the best-designed studies have not found that aspirin lowers the risk of death. But they have found that aspirin helps to prevent heart attacks in men and strokes in women.
Aspirin is thought to prevent heart attacks and strokes by blocking platelets from forming blood clots. Its anti-inflammatory properties may also play a role in preventing cancer.
The average age of the women was about 46 at the start of the study and about 70 by its end. The women at risk for heart attacks and strokes, and older women, got the most benefit.
The size and length of the new study, appearing in Monday's Archives of Internal Medicine, make the results compelling. But the research, based on data from the long-running Nurses Health Study, was observational, meaning the women chose whether to take aspirin, rather than being randomly assigned to take it -- a gold standard in research.
The aspirin-takers could have been healthier than other women for reasons the researchers didn't take into account. The aspirin-takers also could have been more zealous about how they took other medicine, for example.
"We cannot prove a cause-and-effect relationship and the results should be interpreted with caution," said study co-author Dr. JoAnn Manson at Harvard-affiliated Brigham and Women's Hospital. "We don't want people hearing about the study and beginning to take aspirin long-term without having a discussion with their doctor."
The researchers matched 9,477 women who died between 1980 and 2004 with women who didn't die. They looked at which women reported taking aspirin and took into account other risk factors such as high blood pressure, diabetes, smoking and weight.
Cancer was the leading cause of death in the study. The researchers said they'd expect more deaths from heart attacks and strokes if the women in the study had been older. Cardiovascular disease is the leading cause of death in American women.
February 28, 2007 6:29 PM
Feds Say 20 Million Have Form of HPV
February 28, 2007
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CHICAGO (AP) -- One in four U.S. women ages 14 to 59 is infected with the sexually transmitted virus that in some forms can cause cervical cancer, according to the first broad national estimate.
The figure is mostly in line with previous assessments. The highest prevalence -- nearly 45 percent -- was found in young women within the age range recommended for a new virus-fighting vaccine, according to a report from the federal Centers for Disease Control and Prevention.
Researchers have estimated that 20 million Americans have some form of HPV. The study concluded that 26.8 percent of U.S. women are infected, a figure that is comparable to earlier estimates using smaller groups.
"We expected the prevalence of any HPV infection would be high and that's what we found," said CDC researcher Dr. Eileen Dunne, the study's lead author.
Just 3.4 percent of the women studied had infections with one of the four HPV strains that the new vaccine protects against. But that doesn't mean the vaccine should be written off, said Dr. Yvonne Collins, an assistant professor of gynecologic cancer at the University of Illinois at Chicago.
For one thing, Collins said, that relatively small percentage corresponds with a lot of women -- about 3 million, according to the report. And it does not include those with past infections that have cleared up.
The number of women with HPV strains targeted by the vaccine was lower than in some previous, less comprehensive estimates. And the overall HPV prevalence among the youngest women studied, 14- to-24-year-olds, was substantially higher than in previous estimates, 7.5 million versus 4.6 million.
Dunne attributed those variations to different study populations and different HPV detection methods. She said the results should not be interpreted to mean infection prevalence has changed in recent years.
The new nationally representative report is based on vaginal swab specimens from 1,921 women tested in 2003-04.
The report appears in Wednesday's Journal of the American Medical Association.
There are dozens of strains of HPV. Low-risk forms can cause genital warts and non-cancerous changes in cells in the cervix, and often clear without treatment. Several high-risk forms have been linked with cervical cancer.
Dunne said HPV prevalence is thought to be high in men as well, but none were studied.
An estimated 11,150 U.S. women will be diagnosed this year with cervical cancer, and about 3,670 will die from it. Numbers are much higher worldwide, especially in developing countries where Pap tests to detect cervical cancer are not routine.
The new vaccine, Merck's Gardasil, was approved last June for girls and women aged 9 to 26. It protects against two HPV strains believed responsible for about 70 percent of cervical cancer cases, and two other strains that cause 90 percent of genital wart cases.
Other vaccines are in the works to protect against other HPV strains, Collins said.
Women aged 20 to 24 had the highest overall HPV prevalence in the study, 44.8 percent. Prevalence increased each year from ages 14 to 24, then dropped off gradually, confirming that young, sexually active women face the greatest risk of infection.
The study underscores the need for young women to get vaccinated, and to get routine Pap tests, said Dr. Howard Jones, a gynecologic cancer specialist at Vanderbilt University.
February 26, 2007 6:31 PM
Study: Hormone Patch Safer Than Pill
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February 26, 2007
(The Associated Press) -- For women who have struggled with the symptoms of menopause but are fearful of taking risky hormone pills, there is at last a bit of hope.
Hormone skin patches and gels, it seems, are far less likely than pills to cause dangerous blood clots. At least that was the finding from a recently published French study.
Patches and gels are already known to be effective for relieving the hot flashes and sleep-interrupting night sweats that plague many women. No one knows whether they will prove safer than pills in terms of breast cancer, heart attack or stroke risk. A large study currently under way may answer that.
But if they do, it may soften some of the backlash against hormones since a landmark study in 2002 frightened many women away from their use. Critics of that study have long contended that it is the type of estrogen or progestin, the dosage, and the method of taking the hormones that may affect the health risks.
The French study, while not the final word, is the strongest proof yet that this may be true, said Dr. JoAnn Manson, chief of preventive medicine at Harvard-affiliated Brigham and Women's Hospital in Boston. She has no financial ties to hormone drugmakers and just published a book giving women advice on hormone use.
Evidence is mounting that the method of taking a drug and possibly the dose are important factors, she wrote in an editorial accompanying the study in the journal Circulation.
Millions of women abandoned hormone pills after the Women's Health Initiative study reported in 2002 higher rates of stroke among those taking estrogen, and of stroke and breast cancer with estrogen-progestin use.
The study tested Wyeth's Prempro and Premarin, which contain synthetic estrogens made from the urine of pregnant horses. Some people believe that estrogens from plant sources are closer to what the human body naturally produces and may be safer. The plant forms are in many competitors' pills and also in patches, creams and gels.
The French researchers compared 271 women ages 45 to 70 who suffered blood clots to 610 similar women without clots. Women taking various hormone pills were more than four times more likely to suffer clots than women not taking hormones or receiving them through patches, gels or creams.
The study was paid for by the French government and partly by hormone drug and patch makers.
Why the difference in risk?
"Part of the reason we think oral estrogens do cause clots is that they pass through the liver and can cause some clotting factors to be produced," said Dr. Karen Bradshaw, director of women's health and an endocrinology specialist at UT Southwestern Medical Center.
Hormones through skin patches are directly absorbed into the bloodstream, and therefore can be given in far lower doses to be effective, she explained.
"This study, like others, may change things" in terms of what hormones women and doctors are willing to use, Bradshaw said. Before the Women's Health study, Prempro and Premarin accounted for half of the hormones she prescribed. Now they account for about one-fourth, and much of that is the lower dose of Prempro that Wyeth began selling in 2003, a year after the Women's Health study.
Premarin and Prempro remain top sellers in the United States, according to IMS Health, a drug marketing information firm.
A Wyeth physician, Dr. Eileen Helzner, noted that the French study did not randomly assign some women to get patches and some to get pills -- the most rigorous scientific test. At least two previous, smaller studies reached differing conclusions on the clot risk, and more research is needed before definitive conclusions can be made, she said.
She also noted that the federal Food and Drug Administration has not changed its Internet advice that all forms of hormone therapy "have the same risk profile."
However, some women already have moved to patches.
Barbara Isaac, a research nurse and women's health study coordinator at Albert Einstein College of Medicine, switched to Vivelle, sold by Novogyne Pharmaceuticals, after years of taking Prempro and Premarin.
"It's a tiny little patch. It's the size of a small postage stamp. You put it on your belly and change it twice a week," she said.
Although she is 63 and has used hormones for more than a decade, she is not willing to quit.
"I have a very busy life. My sleep is important to me," she said. Before starting on hormones she had "drenching, drenching sweats -- you could just wring me out," she said.
"My doctor who prescribed this for me is 70 or 71 and she still uses it," she added.
Isaac and Manson are helping conduct the Kronos Early Estrogen Prevention Study, or KEEPS, which is directly comparing pills and patches.
Ironically, some hormone patches seem to carry greater risks of blood clots than pills when used for birth control. The FDA recently required new warnings on one such contraceptive patch -- Ortho-McNeil Pharmaceutical's Ortho Evra.
Also, women should tell their doctors about any other drugs, vitamins or supplements they are taking. The herbal supplement St. John's wort can decrease blood-estrogen levels, undermining the relief any hormone treatment can give. So can certain antibiotics and other drugs.
January 24, 2007 7:17 PM
Advisers Nix New Birth Control Rules
January 24, 2007
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WASHINGTON (AP) -- Birth control pills sometimes fail, but setting limits on how often that could happen would put newer, low-dose contraceptives off limits to women, federal health advisers said Wednesday.
The lower-dose pills are less effective at preventing pregnancy than the first oral contraceptives approved beginning in 1960. Yet the newer drugs offer other health benefits or cause fewer side effects. That has split federal health officials on the need to define a pregnancy or failure rate that would be unacceptably high for next-generation pills.
Throughout the 1960s, the earliest birth control pills to win Food and Drug Administration approval failed just once per 100 woman-years of use. That is, for every 100 women taking the pills for a year, there was fewer than one pregnancy on average among them.
Today, newer pills contain less estrogen and progestin. Those pills can reduce the risk of blood clots, stroke and other sometimes deadly side effects. But as the hormone content of the pills has dipped, failure rates have climbed.
Over the last decade, the FDA has approved some pills with failure rates that exceed two pregnancies per 100 woman-years of use, according to agency documents. That is twice the rate considered acceptable in the 1960s.
But allowing the less effective pills on the market can increase the options for women and their doctors, said Dr. Charles Lockwood of Yale University, acting chairman of FDA's reproductive health drugs advisory committee.
"We don't want an arbitrary number to be ascribed," Lockwood said after the panel declined to define a pregnancy rate that would be considered unacceptable.
While most women take the pill to prevent pregnancy, others rely on hormonal contraceptives to regulate their monthly periods or curb acne.
The FDA scheduled meetings both Tuesday and Wednesday with its outside experts to gather advice on future guidelines that drug makers could follow in seeking approval for new hormonal contraceptives.
The FDA is looking at how well studies done prior to approval of new birth control pills reflected their "real-world" use. Typically, that use is less consistent and reliable than it is in clinical studies.
Also, newer versions of the pill aren't being tested on women who reflect the broader population. The women in clinical trials are younger, skinnier and healthier than are U.S. women on average, panelists and other experts said.
The more clinical trials can mimic real-world use, the more confident women will be that the pills both work and are safe, Kirsten Moore, president of the Reproductive Health Technologies Project, a nonprofit advocacy group, told panelists.
"When expectations don't match up to reality, women are more likely to discontinue their contraceptive use and possibly expose themselves to unwanted pregnancies," Moore said.
The exclusion of smokers, obese and older women from clinical trials also underscores the need for large follow-up studies that assess the real-world safety and effectiveness of the oral contraceptives, advisers said. Who would fund those studies remains unclear.
For instance, the risk of pregnancy and blood clots both can rise in obese women who take the pill, Amy Allina, program and policy director with advocacy group National Women's Health Network, told the panel. The pills also appear not to work as well in overweight women, according to the FDA.
The FDA acknowledged its own staff is split over whether to establish an acceptable failure rate for pills and, if so, what that rate should be. The FDA isn't required to follow the advice of its advisory committees, but usually does.
Several panelists suggested that any birth-control pill that isn't highly effective or offers some other benefit simply wouldn't sell, making the issue moot.
"If a new product isn't as good as what's out there, clinicians aren't going to prescribe it -- unless there's something there," said Lorraine Tulman, of the University of Pennsylvania's School of Nursing and the panel's consumer representative.
Nearly 12 million U.S. women were on the pill as of 2002, making it the nation's leading method of contraception, acco
January 12, 2007 6:45 PM
Scientists Map Gene of STD Parasite
January 11, 2007
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WASHINGTON (AP) -- The tiny parasite undulates under the microscope like some creature from a sci-fi movie, but this one is all too real, latching onto the sexually unwary with tentacle-like probes. Now scientists have mapped the genes of the nasty little bug that causes one of the world's most common, and arguably least recognized, sexually transmitted infections, one with the tongue-twisting name of trichomoniasis.
Researchers hope the work will bring new attention to a parasite estimated to infect 170 million people a year worldwide, including 8 million in North America -- and one emerging as a player in the spread of the AIDS virus.
"There are a huge number of people infected out there, but they don't know it so you don't know it," warned Dr. Jane Carlton, a parasite specialist who led the four-year effort by The Institute for Genomic Research to crack the bug's genome.
The work is published in Friday's edition of the journal Science.
Most sexually transmitted infections are caused by viruses or bacteria. A microscopic, single-celled protozoan named Trichomonas vaginalis causes this one.
The good news: "Trich," as it's short-handed, is easily curable, with a drug called Flagyl. The bad news: Many people go undiagnosed and thus continue spreading trich, plus the parasite is starting to develop resistance to the drug.
Both men and women can be infected, although trich is more common in women. But men usually suffer no symptoms, while about half of women do, reporting such problems as vaginal itching and a fishy-smelling frothy discharge.
During pregnancy, trich can cause premature birth or low-weight babies. It's linked to pelvic inflammatory disease.
But trich's real threat is that it quietly increases women's vulnerability to HIV, by altering the lining of the vagina so that it's easier for the AIDS virus to sneak in. Trich also seems to increase the chances that people who already have HIV spread it, enhancing that virus in different ways.
"It is a bad actor," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which funded the genome work.
The genetic mapping "is a very strong step in the right direction with regard to a parasite we still have not fully appreciated," he added.
The genome - which turned out to be 10-fold larger than researchers had predicted - highlights this bug's predatory nature, says Carlton, now at New York University School of Medicine.
First, it shifts from the shape of a pear to flatten and cover as much of the vaginal surface as possible. Then it sends tendrils under that surface to latch on. And then it gobbles up the vagina's good, anti-infective bacteria even as it secretes proteins that can erode holes in cells in the vaginal lining.
"We think it's a very voracious parasite," Carlton said.
December 19, 2006 9:49 AM
Study: Black Cohosh No Help in Menopause
December 18, 2006
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PHILADELPHIA (AP) -- A popular herbal treatment called black cohosh is practically ineffective at relieving hot flashes and night sweats in women going through menopause, a study found.
The findings were disappointing news for women seeking alternatives to estrogen-progestin hormone supplements, which have been linked to breast cancer and heart problems.
The yearlong study of 351 women suffering from hot flashes and night sweats found that those given black cohosh got about the same amount of relief as those who took a placebo. And those groups saw nothing close to the improvement in women on hormones.
"It's safe and not effective, so therefore it doesn't have any utility whatsoever," said Barrie Cassileth, an alternative-medicine researcher at Memorial Sloan-Kettering Cancer Center in New York, who was not involved in the study.
The study was conducted at Seattle-based Group Health, a health plan, and was published Monday in the Annals of Internal Medicine.
Black cohosh -- an herb that is a member of the buttercup family and is commonly given to ease menopause symptoms -- is available in pill or liquid form and is sold over the counter in many health food stores and over the Internet.
In the study, some participants were given black cohosh, while others received hormone supplements, a placebo or a botanical treatment that included black cohosh, alfalfa, licorice and ginseng.
Women taking the herbal treatments reduced hot flashes by only about half an episode per day when compared with those taking the placebo, the study found. Those who got hormone therapy reduced their hot flashes by about four episodes per day when compared with the placebo.
"It's disappointing news," said Katherine M. Newton, an epidemiologist who helped lead the study, funded by the National Institute on Aging and the National Center for Complementary and Alternative Medicine. "It would be nice to offer something safe and effective."
Menopausal women can still make behavioral changes such as dressing in layers, sleeping in a cooler room and avoiding possible triggers such as very hot liquids and alcohol, Newton said. The study also shows that symptoms decreased over the course of the 12-month period and that they nearly always go away on their own.
The findings come less than a week after researchers reported a dramatic decline in U.S. breast cancer cases, a drop doctors attributed partially to fewer women using hormone therapy to treat menopause. Breast cancer rates fell more than 7 percent in 2003, with about 14,000 fewer women diagnosed than were expected.
In 2002, a government study found a higher risk of breast cancer and heart problems occurred among women taking estrogen-progestin pills. Millions of women stopped taking the supplements. Doctors urged women with serious menopausal symptoms to use the lowest dose for as short a time as possible.
The latest study, conducted between 2001 and 2004, could hurt hopes for herbal remedies.
"We hope that this is not it," said Dr. Susan D. Reed, another of the study's authors. "However, there's not much that appears promising that is currently on the horizon."
The news may not all be bad. Since women who took a placebo saw some improvement, experts say there is hope that some could get relief through meditation or self-hypnosis.
"If you can relax your mind appropriately, you can also relax your body," Cassileth said. "If 30 percent of women could lose hot flashes because their mind made them do it, that's fantastic."
December 08, 2006 6:36 PM
Study: New Moms Face Mental Health Risk
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December 5, 2006
CHICAGO (AP) -- New moms face increased risks for a variety of mental problems, not just postpartum depression, according to one of the largest studies of psychiatric illness after childbirth.
New dads aren't as vulnerable, probably because they don't experience the same physical and social changes associated with having a baby, the researchers and other experts said.
The study, based on medical records of 2.3 million people over a 30-year period in Denmark, found that the first three months after women have their first baby is riskiest, especially the first few weeks. That's when the tremendous responsibility of caring for a newborn hits home.
During the first 10 to 19 days, new mothers were seven times more likely to be hospitalized with some form of mental illness than women with older infants. Compared to women with no children, new mothers were four times more likely to be hospitalized with mental problems.
New mothers also were more likely than other women to get outpatient psychiatric treatment.
However, new fathers did not have a higher risk of mental problems when compared with fathers of older infants and men without children.
The prevalence of mental disorders was about 1 per 1,000 births for women and just .37 per 1,000 births for men.
Mental problems included postpartum depression, but also bipolar disorder, with altering periods of depression and mania; schizophrenia and similar disorders; and adjustment disorders, which can include debilitating anxiety.
The study underscores a need for psychiatric screening of all new mothers and treatment for those affected, according to an editorial accompanying the study in Wednesday's Journal of the American Medical Association.
"Mental health is crucial to a mother's capacity to function optimally, enjoy relationships, prepare for the infant's birth, and cope with the stresses and appreciate the joys of parenthood," the editorial says.
Two of the editorial's three authors reported financial ties to the psychiatric drug industry. The study researchers said they had no financial ties to the industry.
They examined national data on Danish residents from around 1973 to July 2005. About 1.1 million participants became parents during the study.
A total of 1,171 mothers and 658 fathers -- none diagnosed with any previous mental problems -- were hospitalized with a mental disorder after childbirth.
Lead author Trine Munk-Olsen, a researcher at Denmark's University of Aarhus, said similar risks for psychiatric problems likely would affect new parents in other developed nations including the United States. However, differences in screening practices and access to health care might influence whether parents elsewhere are hospitalized, she said.
Physical changes after childbirth might partly explain why women are vulnerable, including fluctuating hormone levels, Munk-Olsen said. These, alone or combined with sleep deprivation and the demands of breast-feeding could trigger mental problems, she said.
Hard data on the number of women worldwide affected by postpartum mental illness are scant, but postpartum depression alone affects about 15 percent of U.S. women.
The condition made headlines last year when actress Brooke Shields acknowledged taking antidepressants after her first child was born -- and Tom Cruise publicly criticized her for it.
It also has been cited as a factor in shocking cases of mothers killing their children, including Andrea Yates' drowning of her five children in Texas in 2001.
Dr. Nada Stotland, a psychiatry professor at Rush Medical College in Chicago, said gender differences in postpartum mental illness are not surprising.
Mothers generally bear the brunt of sleep deprivation, and many new mothers are socially isolated or live far from relatives who could provide support, Stotland said.
She said the study likely will provoke mixed reactions.
"There may be people who say, 'My mother raised eight children and she never needed to have mental health care,' and others will say, 'Finally somebody has noticed just how stressful this is and what people go through,'" Stotland said
November 20, 2006 3:43 PM
Ban on Silicone Breast Implants Lifted
November 20, 2006
WASHINGTON (AP) -- The government ended a 14-year virtual ban on silicone-gel breast implants Friday despite lingering safety questions, making the devices available to tens of thousands of women who have clamored for them.
The Food and Drug Administration approved the implants for women 22 and older, or those undergoing breast reconstruction surgery, but warned that patients probably would need at least one additional operation because the implants don't last a lifetime.
The decision clears implants made by two California manufacturers, Inamed Corp. -- now part of Allergan Inc. -- and Mentor Corp.
"There is reasonable assurance that Allergan and Mentor silicone-gel breast implants are safe and effective, and there is adequate information to enable women to make informed decisions," said Dr. Daniel Schultz, the FDA's medical device chief.
Mentor called the decision a "historic moment." Allergan said it created new options for women.
However, Dr. Sidney Wolfe, a longtime opponent, called the implants "the most defective medical device FDA has ever approved." And a lawmaker called on Congress to investigate the FDA's approval process.
The twin approvals came with conditions, including a requirement that the companies complete 10-year studies on women who have already received the implants to study leaks, as well as begin new decade-long studies of the safety of the devices in 40,000 women. The FDA set the age minimum because women's breasts aren't fully developed before then.
Schultz called the implants "one of the most extensively studied medical devices."
FDA warned that the implants are not without risk and that women may not immediately know if their implants break. That means women with the implants will need to undergo regular MRIs to catch those so-called "silent ruptures." Such MRIs typically cost several hundred dollars -- a cost not always covered by insurance.
Patients will have to be given special brochures that explain these risks.
The FDA decision opens the implants to much wider use by women seeking to reconstruct or augment their breasts. Since 1992, the silicone implants had been available only as part of research studies.
Silicone-gel breast implants first went on the market in 1962, before the FDA required proof that all medical devices be safe and effective. Thirty years later, they were banned amid concerns about their safety.
At the time, there were worries about a possible connection to a variety of diseases, including cancer and lupus. Alarming cases of ruptures added to the concern.
Since then, most studies have failed to find a link between silicone breast implants and disease.
The rupture issue persists. An Institute of Medicine report in 2000 found rupture rates as high as 77 percent. The FDA's Dr. Donna-Bea Tillman said women should expect them to last for the "reasonably foreseeable future," without elaborating.
Rep. Rosa DeLauro, D-Conn., called on Congress to investigate the FDA's decision-making process to make sure it is "based on science and not on corporate and political considerations."
"From a scientific standpoint, the decision we are making tonight is in the best interests of American women," Schultz responded.
Women whose silicone implants ruptured have reported years of pain, swelling, numbness and other symptoms that they blame on the devices. Leaked silicone gel can migrate throughout the body, forming lumps. Implants also can cause infection and form hard, painful scar tissue that can distort the shape of a breast.
Some researchers also worry that the platinum used to manufacture the implants can seep into the body and cause harm. The FDA says there is no evidence of that.
Proponents say silicone-gel implants look and feel more natural than do those filled with saline, or salt water. Those implants are sold without restrictions.
"It's a hugely positive piece of news for plastic surgeons and for patients and for the company -- all three -- because it really allows us to turn a page and to work with what we have believed for a long time is a better technology and better device," said Dr. Scott Spear, head of plastic surgery at Georgetown University Hospital and an Allergan consultant.
Last year, the FDA told both companies their implants could be approved once they met additional, undisclosed conditions. Federal advisers had narrowly recommended that Inamed's implants not receive FDA approval, citing concerns about the long-term durability. The same advisers endorsed Mentor's implants.
In October 2003, FDA advisers had recommended allowing the implants to be sold again. The agency overruled that recommendation.
Breast implants have become more popular, despite a history of lawsuits. Last year, 291,000 women had their breasts surgically enlarged in the United States, a 37 percent increase since 2000, according to the American Society of Plastic Surgeons.
The popularity of implants for reconstructive surgery shrank over the same five-year period by 29 percent, to 58,000 procedures, according to Society statistics. Last year, 39,000 women had their implants removed.
Overall, the use of breast implants has grown since 1992 despite the FDA's de facto ban on silicone-gel implants.
Just three years later, Dow Corning Corp., once the major manufacturer of silicone breast and other implants, faced 19,000 lawsuits, pushing it into Chapter 11 in 1995. The company emerged from Chapter 11 in 2004, after setting aside $2.35 billion to settle claims.
Allergan Inc. shares rose $1.76, or 1.6 percent, in trading that was almost double its average volume to close at $112.50 on th
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October 06, 2006 11:02 PM
Study: Drug Prevents Postpartum Bleeding
October 6, 2006
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LONDON (AP) -- A drug normally used to treat ulcers was effective in preventing excessive postpartum bleeding for women in poor areas -- a discovery that may save the lives of thousands who die annually from complications of childbirth, a British medical journal reported Friday.
The study, which appeared in The Lancet, showed the drug, misoprostol, reduced the likelihood of having such hemorrhages by 50 percent over the three-year period during which the research was conducted in rural India.
An estimated 500,000 women die annually from complications during pregnancy and childbirth -- and the most common cause of death is postpartum bleeding.
"This trial offers a very dramatic proof of an opportunity to reduce this toll on women's lives," said Nancy Moss, of the National Institutes of Health in Bethesda, Maryland, who oversaw the study. "When mothers die in the developing world or in low-resource settings, children often die as well. ... So we're saving not only mother's lives, we're saving children's lives as well."
In developed countries, where most births take place in hospitals and emergency care is available, deaths from such hemorrhages are rare.
But in rural India, where the study was conducted between September 2002 and December 2005, about half of all births occur without a doctor, and poor families often lack the means and the transport to take a woman to the hospital in an emergency.
The estimated maternal death rate in India is 407 per 100,000 births, with postpartum hemorrhage responsible for about 30 percent of those fatalities, the study said. In the United States, that number is about 10 per 100,000, with such hemorrhages accounting for only 17 percent of the deaths.
Though other, more expensive drugs are used to prevent excessive bleeding in the developed world, misoprostol costs as little as 14 cents per pill and requires no refrigeration and no special training to administer.
The drug stops bleeding in the uterus by causing it to contract.
"In areas where access to care is so limited, we need to look to other methods to prevent and treat postpartum hemorrhage," said Dr. Kirsten Cleary, an assistant professor of obstetrics and gynecology at New York-Presbyterian Hospital/Columbia University who was not involved in the study. "This seems like a really viable one."
The study involved 1,620 women in rural India. About half received the drug, while the other half received a placebo.
Those who took misoprostol were 50 percent less likely to experience acute hemorrhage -- which the study defined as about one to two pints (500 milliliters to 1,000 milliliters) of blood.
"Saving five out of 10? That's a big number," said Dr. Abdulla Al-Khan, of the Hackensack University Medical Center in New Jersey. Al-Khan, the hospital's director of perinatal diagnostics and therapeutics, was not involved in the study.
The study was funded by the Global Network for Women's and Children's Health research, a partnership between the U.S. National Institute of Child Health and Human Development and the Bill and Melinda Gates Foundation.
Researchers from the University of Missouri, India's Jawaharlal Nehru Medical College and the NIH participated.
September 25, 2006 6:10 PM
Birth-Control Patch Label Warns of Risk
September 20, 2006
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WASHINGTON (AP) -- Women were warned Wednesday that their risk of blood clots in the legs and lungs may be higher if they use the birth-control patch instead of the pill.
The Food and Drug Administration said it updated the label on the Ortho Evra birth-control patch to reflect the results of one study that found women using the patch faced twice the risk of clots than did women on the pill. However, a second study found no difference in risk between the two forms of birth control.
"Even though the results of the two studies are conflicting, the results of the second epidemiology study support FDA's concerns regarding the potential for Ortho Evra use to increase the risk of blood clots in some women," the FDA said in a notice published on its Web site.
The risk of clots in women using either the patch or pill is small. Even if it doubled for those on the patch, perhaps just six women out of 10,000 would develop clots in any given year, said Dr. Daniel Shames, of the FDA's Center for Drug Evaluation and Research.
Initial results of the two studies were made public in February by the patch's manufacturer, Ortho Women's Health & Urology. The Raritan, N.J.-based company is owned by Johnson & Johnson.
Last year an investigation by The Associated Press, citing federal death and injury reports, found higher rates of blood clots in women using the patch.
The FDA recommended that women with concerns about clots and use of the patch talk to their doctors.
"We cannot conclude there is in fact a greater risk," Shames said. "We are however concerned enough about this information and we think it is important enough information that it should be given to consumers and to health-care providers so they can make better choices."
In November, the FDA updated the label on Ortho Evra to alert women that using the patch exposes them to about 60 percent more estrogen than using birth-control pills.
Johnson & Johnson previously has said clots remains rare and that they have been reported as a potential risk of all hormonal contraceptives.
Ortho Women's Health & Urology said in a statement that data will continue to be collected for both studies. Shames said the studies, which rely on insurance claims information on upward of 500,000 women, would last another 18 to 24 months.
The company also said it would continue to provide new information to the FDA.
The company reported in filings made last month that Ortho Evra sales have declined significantly following the previous label revision and a spate of media coverage of the clot issue. Since the patch went on sale in 2002, more than 4 million women have used it.
The company also disclosed that approximately 500 people have filed lawsuits or made claims related to injuries they allegedly suffered from the Ortho Evra patch.
The investigation by The Associated Press found that patch users die and suffer blood clots at a rate three times higher than women taking the pill. About a dozen women died in 2004 from blood clots believed linked to use of the patch, the AP reported. Dozens more suffered strokes and other clot-linked problems.
Health officials warn that women who smoke should not use the patch, since smoking increases the risk of stroke and heart attack. Researchers believe estrogen may promote coagulation of the blood.
September 05, 2006 7:12 PM
Hormone Therapy May Damage Hearing
September 5, 2006
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WASHINGTON (AP) -- Older women taking certain hormone replacement therapy may suffer hearing damage, scientists report.
A study of 124 postmenopausal women found that those taking hormone replacement therapy that included progestin had poorer speech understanding than women who were not taking hormones or who were using estrogen only.
The findings, by a team led by Dr. Robert D. Frisina at the University of Rochester Medical Center in Rochester, N.Y., are reported in Tuesday's issue of Proceedings of the National Academy of Sciences.
The team previously had reported indications of hearing problems associated with hormone therapy and their new study says progestin is the likely culprit.
The research found problems in the inner ear and in some measures of brain function affecting hearing in women using hormone therapy with progestin, Frisina said in a telephone interview.
Since hearing problems can affect quality of life, including family and business activities, he urges increased hearing testing for women using this therapy.
"We feel this should be added to the list of possible side effects, so when a woman and her doctor make their decision she can weigh this," Frisina said, adding it may be a particular concern for women who already have some hearing loss.
"I tell women to have their hearing tested if they are going to start" hormone replacement therapy, and to have it rechecked every six months, he said. If it starts getting worse they may want to reconsider the dosage or the use of progestin, he said.
Many birth control pills also contain progestin and Frisina said he is not aware of any studies to determine if that has an effect on women's hearing. "It should be studied," he said.
Meanwhile, his next step is to look at women who stop using progestin and see if the hearing damage is reversible.
Not everyone is convinced of the findings, however.
"The jury is still out" on the effects of hormone replacement therapy on hearing, says Dr. Karen S. Helfer of the University of Massachusetts at Amherst.
Helfer, who said she has done similar research on a smaller scale, said, "There are a number of reasons to suspect that (hormone replacement therapy) would have either a positive or a negative effect on hearing. Subtle differences in auditory abilities can be demonstrated during different phases of the menstrual cycle. There are also a number of animal studies that show either positive or negative hormonal influences on hearing."
And Dr. Wendy S. Klein of Virginia Commonwealth University Medical Center noted that the study included only 32 women treated with progestin, which she said makes it difficult to generalize from the results. Thirty were taking estrogen only and 62 were not using hormones.
The study looked at women aged 60 to 86 who had received hormone treatment from five to 35 years. "If you asked an older patient what medications they had taken over the course of a lifetime, they may not remember with accuracy," she said.
"Although the analyses regarding hearing loss was clearly done with careful attention to measurement of hearing, and to biostatistics ... I find it very difficult to draw any significant conclusions about causality from this study," concluded Klein.
Klein and Helfer were not part of Frisina's research team.
The study was funded by the National Institute on Aging, National Institute on Deafness and Communications Disorders and the International Center for Hearing and Speech Research in Rochester.
August 30, 2006 12:16 PM
New Cervical Cancer Shot in Short Supply
August 29, 2006
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CHICAGO (AP) -- Many parents hoping to get their daughters a new cervical cancer vaccine at their back-to-school checkups are winding up disappointed.
The expensive shots -- while recommended by a panel of experts -- are often hard to find or not yet covered by insurance.
At her 14-year-old daughter's checkup last month, Lisa Abolt learned that while her doctor strongly recommends the vaccine, she hadn't ordered supplies. The pediatrician, Dr. Aleta Clark, said that's because of uncertainty over whether many health insurers will cover the $360 cost of the three-shot series. Clark recommends patients return in January, when she believes most insurers will be on board.
"I'm trying not to stick families with the bill," she said.
Abolt wants the shots for her 11-year-old daughter, too, and said getting both girls vaccinated is a no-brainer.
"If there's something out there that could protect against something down the line, why wouldn't you get the vaccine?" Abolt said. "I want to get it as soon as it becomes available -but I would also like insurance to cover it."
The vaccine, Merck & Co.'s Gardasil, has been hailed by many doctors as a breakthrough in cancer prevention. It prevents infections from four strains of the sexually transmitted human papilloma virus, or HPV, which can cause cervical cancer, other genital lesions and genital warts.
About 6 million Americans are diagnosed each year with HPV, which is among the most common sexually transmitted diseases. It infects men and women, but because cervical cancer is the most serious consequence, the vaccine currently is recommended for women and girls only.
Chicago pediatrician Dr. Donald Brown said patients and parents who have seen television ads and other consumer marketing about the shots "have been asking about this like no other vaccine that I can recall."
Brown said he's offering it despite insurance uncertainties, and is billing insurers, not patients, with his fingers crossed.
"We don't know about the insurance, but it's good medicine," he said.
"This is a big school season, kids are coming in to get high school physicals and college physicals, and if we don't catch them now we'll have to wait a year," Brown said Monday.
The vaccine was approved in early June for use in girls as young as 9, up to age 26. A government advisory panel's recommendations later that month said that ideally the vaccine should be given before girls become sexually active; for those already exposed or infected by one HPV strain, the vaccine can offer protection against other strains.
Some major health insurers including Aetna, Cigna and Wellpoint say they already offer coverage for Gardasil. Others have said they will but are waiting for the federal Centers for Disease Control and Prevention to adopt the advisory panel's recommendations -- something that's expected to happen in November, said Mohit Ghose, spokesman for America's Health Insurance Plans, a trade group for insurers.
Still, it could take insurers and doctors several months to work out contracts and reimbursement issues for the expensive vaccine, Ghose said.
Gardasil is at least twice as expensive as three-shot vaccines for other diseases. That's because of research and development costs and its value as a public health tool, said Merck spokeswoman Kelley Dougherty. She said the vaccine is available in all 50 states but would not discuss the amount ordered or already shipped to doctors' offices.
Some doctors, Planned Parenthood offices and community clinics are waiting to order the vaccine when it becomes available for uninsured youngsters through the government's Vaccines for Children program. Some, too, are waiting until it is recommended by the American Academy of Pediatrics, which is expected to follow the CDC's lead.
While a lag between approval and official government policy on vaccines is normal, the delays have lasted months with several recent shots, creating "a kind of limbo" for many doctors, said Dr. Jonathan Temte of the American Academy of Family Physicians.
Temte said his group plans to discuss speeding up its own recommendations instead of waiting for the CDC.
August 28, 2006 9:56 PM
FDA Eases Limits on Morning-After Pill
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August 24, 2006
WASHINGTON (AP) -- Women can buy the morning-after pill without a prescription, the government declared Thursday, a major step that nevertheless failed to quell the politically charged debate over access to emergency contraception.
The manufacturer, lawmakers and other advocates said they will press the government to allow minors to purchase the pills over the counter.
The Food and Drug Administration said that women 18 and older -- and men purchasing for their partners -- may buy the Plan B pills without a doctor's note, but only from pharmacies.
Girls 17 and younger still will need a prescription to buy the pills, the FDA told manufacturer Barr Pharmaceuticals Inc., in ruling on an application filed in 2003.
The compromise decision is a partial victory for women's advocacy and medical groups, which say easier access could halve the nation's 3 million annual unplanned pregnancies.
"While we are glad to know the FDA finally ended its foot-dragging on this issue, Planned Parenthood is troubled by the scientifically baseless restriction imposed on teenagers. The U.S. has one of the highest rates of teen pregnancy in the Western world -- anything that makes it harder for teenagers to avoid unintended pregnancy is bad medicine and bad public policy," president Cecile Richards said.
Opponents contend that nonprescription availability could increase promiscuity and promote use of the pills by sexual predators.
"If the FDA thinks that enacting an age restriction will work, or that the drug company will enforce it ... then they are living in a dream world," said Wendy Wright, president of Concerned Women for America, who led the opposition.
Plan B contains a concentrated dose of the same drug found in many regular birth-control pills. Planned Parenthood estimates 41 other countries already allow women to buy emergency contraception without a prescription.
If a woman takes Plan B within 72 hours of unprotected sex, she can lower the risk of pregnancy by up to 89 percent. Plan B is different from the abortion pill: If a woman already is pregnant, Plan B has no effect.
The earlier the pills are taken, the more effective they are. Allowing nonprescription sales mean women won't have to hustle to get a prescription, something especially difficult on weekends and holidays, advocates said.
The FDA's long delay in deciding on Barr's application ensnared President Bush's nominee to head the regulatory agency. On Thursday, two senators said they would lift their block on Dr. Andrew von Eschenbach, making it likely he will win confirmation as FDA chief, perhaps next month.
In recent weeks, anti-abortion groups, angered that approval was imminent, had urged Bush to withdraw von Eschenbach's nomination. Bush said Monday he supported the doctor's decisions.
Barr hopes to begin nonprescription sales of Plan B by the end of the year. The pills will be sold only from behind the counter at pharmacies, but not at convenience stores or gas stations. Pharmacists will check photo identification.
There isn't enough scientific evidence that young teens can safely use Plan B without a doctor's supervision, von Eschenbach said in a memo. Over-the-counter use is safe for older teens and adults, the acting FDA commissioner added in explaining the age cutoff.
"This approach should help ensure safe and effective use of the product," wrote von Eschenbach.
Barr and others were disappointed that FDA imposed the age restriction. Bruce L. Downey, Barr's chairman, pledged to continue working with the agency to try to eliminate it.
The age restriction remains controversial even inside FDA, agency drugs chief Dr. Steven Galson told The Associated Press. Galson has acknowledged overruling his staff scientists, who concluded in 2004 that nonprescription sales would be safe for all ages.
"Let me be frank, there still are disagreements," Galson said in an interview. "There were disagreements from the first second this application came in the house."
The Center for Reproductive Rights said a lawsuit filed last year to do away with all age restrictions would continue.
As a condition of approval, Barr agreed to use anonymous shoppers and other methods to check whether pharmacists are enforcing the age restriction.
"I'm sure the FDA will follow through on that and make sure these important conditions are established and enforced," said White House spokeswoman Dana Perino.
Barr hasn't said if it will raise the price of the pills, which now cost $25 to $40 in prescription form.
Planned Parenthood, the largest dispenser of the pills, expects some insurers to continue covering prescription sales. Whether that would be cheaper will depend on a woman's insurance.
Nine states -- Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Washington and Vermont -- already allow certain pharmacies to sell Plan B without a doctor's prescription to women of any age.
Minors won't see any change in those states, because the pharmacist already technically writes the prescription, the American Pharmacists Association said.
The FDA approved prescription-only sales of Plan B in 1999. The quest to change its status began in 2003. That year, agency advisers endorsed nonprescription sales for all ages, and FDA's staff scientists agreed.
Take the Time to Stay Healthy Through Menopause August 02, 2006 8:22 PM
You may be 50 or older, but you don't have to feel like you're over the hill. Many women enjoy this special time of life and feel renewed. You have decades of life experience and may have achieved many of your goals. Your children are probably grown -- or getting there -- and now you have more time to devote to your own interests.
Giving more time and attention to your health needs is especially important at this stage in life. This is the decade of the hormone -- specifically, estrogen. Your estrogen level has been declining gradually as menopause gets closer. Menopause occurs around age 51 for most women. While menopause signals the end of the menstrual cycle and your reproductive years, less estrogen also means major changes for your body in other ways, too.
One of the first changes you're likely to notice if you've reached menopause is that you aren't having menstrual periods anymore. Or, if you're not quite there yet, periods may be few and far between. Hot flashes, one of the most common menopausal symptom, may be making you uncomfortable. And, you may notice that your skin is thinner and dryer now.
While sun exposure over the years is mostly responsible for changes in your skin's appearance -- more wrinkles and brown spots, for example -- declining estrogen levels can cause the lining of your vagina to be thinner and drier. That's why sexual activity for some women at this life stage can be uncomfortable or painful. Your skin care regimen should include moisturizing creams to prevent dry, flaky and sometimes itchy skin. Lubrication products can help with vaginal dryness, especially if sexual activity is painful.
It's important to remember that each woman experiences menopause in her own way -- while some don't seem bothered by symptoms, other women may feel miserable and overwhelmed by them. There are a wide variety of lifestyle changes and treatment options to help you manage menopausal symptoms, so don't give up! You may want to ask your health care professional about menopausal hormone therapy, which can relieve both vaginal dryness and hot flashes. Since each woman's menopausal experience is highly personal, your discussion with your health care professional should focus on what treatment option is best for you. If you have questions about your symptoms or feel you need relief, ask your health care professional for guidance.
During your 50s you can't help but notice the changes in your body shape and energy level. Your metabolism has been slowing down with each passing decade, and it get even more sluggish in your 50s. Your body's lean muscle mass is also changing: it gradually turns to fat as you age, unless you get aggressive about getting and staying active. You may find this change most noticeable at your waistline. Having a waist measurement of greater than 35 inches significantly increases your risk for developing diabetes and heart disease.
Because fat burns fewer calories than muscle, maintaining your weight becomes more of a challenge, and losing weight can be downright difficult as you get older. Consult your health care professional to calculate your daily calorie intake and help you develop a regular exercise program that maintains muscle, burns calories and raises your metabolic rate. Ask for a calculation of your body mass index (BMI). This measurement of your height and weight is one type of assessment used to determine if you are at a normal weight, overweight or obese. For more information on calculating your BMI, visit the National Heart, Lung and Blood Institute's Aim for a Healthy Weight Obesity Education Initiative.
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August 02, 2006 5:51 PM
Journal Issues Caution About Implant Study
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August 1, 2006
WASHINGTON (AP) -- A study that spurred concern about high concentrations of platinum in women with silicone breast implants seems to contain flaws and should be viewed "with caution," the scientific journal that published the work warned Monday.
Questions about platinum, a heavy metal that is a fairly common pollutant, come as the Food and Drug Administration nears a final decision on whether to allow the sale of silicone breast implants.
The FDA maintains on its Web site that while small amounts of platinum can leak from implants, it is in an inert state that doesn't pose any significant risk.
A study published this spring in the American Chemical Society's journal, Analytical Chemistry, came to the opposite view. Those researchers reported high concentrations of platinum in the hair, nails, urine and breast milk of about 18 implant recipients -- and called it a highly reactive form of platinum that has been associated with allergic responses.
On Monday, the editors of Analytical Chemistry stopped short of calling those results wrong, but concluded the evidence "falls short of this journal's standards."
"We firmly believe that journal editors act in the proper interests of science when they allow the publication of work that may prove to be controversial, provided that the science behind the results appears to be solid. In this case, at least some of the science may not meet that mark," wrote editor Royce Murray of the University of North Carolina, Chapel Hill, and associate editor Catherine Fenselau of the University of Maryland.
At issue are questions about how the platinum's reactivity was analyzed, including whether the researchers properly avoided contamination of the samples they tested -- questions raised in two letters from industry-affiliated scientists also published Monday.
The original researcher, Ernest Lykissa of the testing laboratory ExperTox Inc., didn't return a call seeking comment.
The FDA banned sale of silicone-gel implants in 1992 because of safety concerns. Since then, they have been available only in strictly controlled research studies. They have been largely exonerated of causing such serious illnesses as cancer or lupus, but remain contentious because, among other issues, they frequently break and require removal, and can form painful scar tissue.
July 25, 2006 7:12 PM
Estrogen-Testosterone Combo Could Up Risk
July 25, 2006
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CHICAGO (AP) -- Older women who take hormone pills that combine estrogen and testosterone more than double their risk of breast cancer, according to a study of more than 70,000 nurses.
"This type of hormone therapy may help with mood, libido and bone mineral density, but the possible risk of breast cancer may outweigh these benefits," said study co-author Rulla Tamimi of Harvard Medical School.
The findings, published in Monday's Archives of Internal Medicine, add to the evidence that certain types of hormone supplements, such as estrogen-progestin pills, increase women's risk of breast cancer, strokes and heart attacks. Earlier research also found a greater breast cancer risk in women with higher natural levels of testosterone.
The overall risk of breast cancer among the participants in the latest study was small, with 17 cases of the disease among the 500 or so women who took the estrogen-testosterone combination.
Women's natural levels of estrogen and testosterone decline with menopause.
Only about 2 percent of women taking hormones in the study in 2000 used a form that included testosterone. But usage climbed during the 24 years of the study as evidence appeared linking the hormone combination to better bone density, improved mood and greater sexual enjoyment.
Estrogen-testosterone pills are sold under the brand names Estratest and Estratest H.S. by Solvay Pharmaceuticals of Marietta, Ga. Those brand names appear on a Washington-based advocacy group's "Worst Pills" list because of breast cancer risk.
"We strongly urge women not to use this product or similar products from compounding pharmacists," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, which produces the Worst Pills list.
The Food and Drug Administration has asked Solvay for evidence the drug eases hot flashes in menopausal women, as the label claims. The company has requested a hearing on the matter.
The drug was approved 30 years ago, before such evidence was required.
The new study used data from the long-running Nurses' Health Study. The women who took estrogen and testosterone after menopause had a 2 1/2 times higher risk of developing breast cancer than women who never took hormones. Most of the women taking the combination used Estratest.
"The company has not yet had the opportunity to review the details of the study or the content of the article," said Solvay spokesman Gabrielle Braswell.
The researchers took into account other breast cancer risk factors, such as family history, weight and age at menopause and still found an increased risk associated with estrogen-testosterone pills.
July 19, 2006 6:54 PM
Report: Women Misled on Abortion Risks
July 18, 2006
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WASHINGTON (AP) -- Women who consult with pregnancy resource centers often get misleading information about the health risks associated with having an abortion, according to a report issued Monday by Democrats on the House Government Reform Committee.
Congressional aides, posing as pregnant 17-year-olds, called 25 pregnancy centers that have received some federal funding over the past five years.
The aides were routinely told of increased risk for cancer, infertility and stress disorders, said the report, which was prepared for Rep. Henry Waxman, D-Calif.
Only a small fraction of the more than 4,000 pregnancy clinics nationwide get any federal funding, mostly for promoting sexual abstinence.
With a few exceptions, the federal government doesn't give money specifically for the counseling operations, but Waxman's staff said 25 centers got "capacity building grants." Thus, Waxman said, they should be held accountable for the information they dispense.
Of the 25 centers called, two could not be reached. Eight told the caller that abortion leads to a greater risk of breast cancer, the report said.
Care Net, an umbrella group for evangelical pregnancy centers across the country, instructs its affiliates to tell callers there is a possibility that abortion can lead to greater risk of breast cancer, according to Molly Ford, an official with the organization. She said there have been several studies that say it does, and several that say it doesn't.
"I know the report is wanting to say that it's conclusive, but it isn't," Ford said.
None of the pregnancy centers the committee staff called was identified, and it could not be determined if any were linked to Care Net, which has helped about a quarter of the nation's pregnancy centers begin operations.
One pregnancy center told a congressional aide the risk of cancer after an abortion could be 80 percent higher, the report noted. Ford said she doubted a pregnancy center would go that far, but the Web site for a pregnancy center in Albuquerque says the risk for cancer after an abortion is 50 percent or greater.
In February 2003, a National Cancer Institute workshop concluded that having an abortion or miscarriage does not increase a woman's subsequent risk of developing breast cancer.
The report from the Democratic aides also said the pregnancy resource centers provided false information about the mental health effects of abortion, telling the aides that it could cause severe long-term emotional harm.
However, an American Psychological Association panel said, "Severe negative reactions are rare."
But Ford said that pregnancy center counselors don't need statistics to tell them that many women undergoing an abortion experience severe emotional trauma.
"This isn't about a medical statistic to us. We do post-abortion counseling every day," Ford said.
The Administration for Children and Families within the Department of Health and Human Services funds the abstinence programs overseen by some of the pregnancy centers. Aides referred questions about the report to Wade Horn, a Health and Human Services assistant secretary, who did not want to comment until he read the report.
Waxman said that Americans are divided on the issue of abortion, but no one should support misleading teenagers about basic medical facts.
" It's wrong to pour millions of federal dollars into organizations that are providing false health information to vulnerable teenagers," Waxman said.
Hystorectomy group July 13, 2006 8:44 AM
This is a great group for women who are to have or have had a hystorectomy.
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July 09, 2006 4:38 PM
Researchers Working on Ovarian Cancer Test
July 7, 2006
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SACRAMENTO, Calif. (The New York Times News Service) -- Researchers at UC Davis Medical Center hope to bring to market one day a test that will expose ovarian cancer -- long known as "the silent killer" -- while it's still in its early, treatable stages.
The road to profitability for a new diagnostic test is long and fraught with uncertainties.
Yet Carlito Lebrilla is willing to take the risk. The chemist and his research partners are stalking cancer cells, studying their tendency to produce and slough off strange carbohydrate molecules.
These compounds can then be detected -- at extremely low concentrations -- in a patient's blood. Even the stealthiest of killers leaves clues.
"People have known for a long time that the carbohydrates change" in a patient with cancer, said Lebrilla. "What has been difficult is developing methods to analyze them."
Lebrilla stressed that the new detection method is in its infancy. While it has shown enough promise to prompt the University of California to patent it, it must be validated by further research.
And, before the researchers can turn their discovery into a business, they must attract investors. That won't be easy in an environment where even the most innovative tests don't always net a juicy payoff.
"Investors in general are much more inclined to invest in therapeutics" -- such as new medications -- than in diagnostic tests, said Peter Matlock, a Davis consultant who advises life science companies.
Revenues for companies in the diagnostic test business are largely determined by Medicare reimbursement rates, Matlock explained. It's a struggle to get Medicare, and the many private insurers that use the federal program as a benchmark, to raise payout levels to a level that can make a costly new test profitable for the company that developed it.
The researchers have founded a West Sacramento-based company, Glycometrix Inc., and are in discussions with venture capitalists.
Glycometrix adds to the list of Sacramento-area companies trying to capitalize on one of the region's key biotechnology resources: a collection of chemists who are experts at analyzing tiny concentrations of naturally occurring molecules. It's one outgrowth of decades of UC Davis research on the delicate chemistry of plants, people and, for that matter, wine.
Glycometrix's test, if successful, would benefit thousands: More than 16,000 women died in the United States last year from ovarian cancer, a disease that so far has no reliable early detection test.
Doctors use a decades-old blood test to check for ovarian cancer, but it is useful only for monitoring patients who have been treated for the disease, said Gary Leiserowitz, a member of the research team and the chairman of the Division of Gynecologic Oncology at University of California, Davis, Medical Center. As an early detection tool, he added, it's terrible because it gives a positive result for many women who don't have ovarian cancer.
A make-or-break period for the new test is coming up, as researchers see if its early promise stands up to further testing.
The researchers are optimistic that their test will succeed where others have failed because it approaches the cancer detection problem from a new angle. While competitors have focused on detecting small changes in the very complex protein molecules that cancer cells produce, the Davis group is looking at changes in certain carbohydrates, which are much simpler.
Ordinary human blood is full of many different carbohydrates, but certain types appear only when cancer is growing somewhere in the body. However, the concentration of those telltale molecules generally is so low and the chemical aberrations so subtle that, until recently, it was not been practical to look for them as harbingers of disease.
The group is publishing in the Journal of Proteome Research today the results of a preliminary study that analyzed blood taken from 10 research subjects.
At this point, the researchers don't know if the test can distinguish between carbohydrates produced by ovarian cancer cells and those generated by other types of cancer cells. They plan experiments to answer that question.
About 22,000 women in the United States are diagnosed with ovarian cancer annually, according to the American Cancer Society.
For women, it is the fourth most deadly type of cancer -- behind lung, breast and colon cancer.
Once ovarian cancer spreads beyond the ovaries, only 28 percent of patients survive. But when doctors detect the disease before it spreads, the survival rate jumps to 95 percent.
About half of women who have early stage ovarian cancer do show some symptoms, like bloating or vague abdominal pain, Leiserowitz said. Unfortunately, since those symptoms could have many other causes, patients seldom end up getting a pelvic exam, which might reveal signs of cancer.
Even if a pelvic exam does spot an abnormality, the course of treatment isn't immediately clear, he said.
Because the process of taking a tissue sample from an ovary presents a high risk of spreading the cancer if it is present, the entire ovary must be removed and sent to a pathologist for analysis.
"You end up having to do a major surgical procedure to determine what's going on," he said. "All you need is a better test."
May 22, 2006 3:19 PM
Pills Rendering Menstrual Period Optional
May 22, 2006
TRENTON, N.J. (AP) -- For young women with a world of choices, even that monthly curse, the menstrual period, is optional.
Thanks to birth control pills and other hormonal contraceptives, a growing number of women are taking the path chosen by 22-year-old Stephanie Sardinha.
She hasn't had a period since she was 17.
"It's really one of the best things I've ever done," she says.
A college student and retail worker in Lisbon Falls, Maine, Sardinha uses Nuvaring, a vaginal contraceptive ring. After the hormones run out in three weeks, she replaces the ring right away instead of following instructions to leave the ring out for a week to allow bleeding. She says it has been great for her marriage, preventing monthly crankiness and improving her sex life.
"I would never go back," said Sardinha, who got the idea from her aunt, a nurse practitioner.
Using the pill or other contraceptives to block periods is becoming more popular, particularly among young women and those entering menopause, doctors say.
"I have a ton of young girls in college who are doing this," says Dr. Mindy Wiser-Estin, a gynecologist in Little Silver, N.J., who did it herself for years. "There's no reason you need a period."
Such medical jury-rigging soon will be unnecessary. Already, the Seasonale birth control pill limits periods to four a year. The first continuous-use birth control pill, Lybrel, likely will soon be on the U.S. market and drug companies are lining up other ways to limit or eliminate the period.
Most doctors say they don't think suppressing menstruation is riskier than regular long-term birth control use, and one survey found a majority have prescribed contraception to prevent periods. Women have been using the pill for nearly half a century without significant problems, but some doctors want more research on long-term use.
The new methods should be popular. A non-scientific Web survey for the Association of Reproductive Health Professionals found at least two-thirds of respondents are bothered by fatigue, heavy bleeding, "really bad cramps" and even anger. Nearly half said they would like to have no period at all or decide when to have one.
For some women, periods can cause debilitating pain and more serious problems.
Two recent national surveys found about 1 in 5 women have used oral contraceptives to stop or skip their period.
"If you're choosing contraception, then there's not a lot of point to having periods," says Dr. Leslie Miller, a University of Washington-Seattle researcher and associate professor of obstetrics and gynecology whose Web site, noperiod.com, explains the option. She points out women on hormonal contraception don't have real periods anyway, just withdrawal bleeding during the break from the hormone progestin.
According to Miller, modern women endure up to nine times more periods than their great-grandmothers, who began menstruating later, married young and naturally suppressed periods for years while they were pregnant or breast-feeding. Today's women may have about 450 periods.
Still, surveys also show most women consider monthly periods normal. Small wonder: Girls learn early on that menstruation is a sign of fertility and femininity, making its onset an eagerly awaited rite of passage.
The period is "way over-romanticized," says Linda Gordon, a New York University professor specializing in women's history and the history of sexuality.
"It doesn't take long for women to go from being excited about having a period to feeling it's a pain in the neck," said Gordon, author of "The Moral Property of Women: A History of Birth Control Politics in America."
She says caution is needed because there's not enough data on long-term consequences of using hormones continuously. Gordon notes menopausal women for years were told that hormone drugs would keep them young -- until research uncovered unexpected risks.
"People should proceed very cautiously," she says.
Today's birth control pills contain far less estrogen and progestin than those two generations ago, but still increase the risk of heart attack, stroke and blood clots. The pill should not be used by women who have had those conditions, unexplained vaginal bleeding or certain cancers, or if they are smokers over 35.
But there are benefits from taking oral contraceptives too, such as a lower risk of ovarian and endometrial cancer, osteoporosis and pelvic inflammatory disease. And forgoing periods means no premenstrual syndrome and a lower risk of anemia and migraines, says Dr. Sheldon Segal, co-author of "Is Menstruation Obsolete?" Segal has been involved in research for several contraceptives.
Almost since the first pill arrived in 1960, women have manipulated birth control to skip periods for events such as a wedding, vacation or sports competition. Female doctors and nurses were among the first to block menstruation long-term to suit their schedules, said Susan Wysocki, head of the National Association of Nurse Practitioners in Women's Health.
"They were then more comfortable recommending it to their patients," said Wysocki, who uses a vaginal ring to prevent menstruation.
The idea gained momentum after Barr Pharmaceuticals launched Seasonale in November 2003. It's a standard birth control pill taken for 12 weeks, with a break for withdrawal bleeding every three months. Amid wide acceptance by doctors, sales shot up 62 percent last year, to $110 million.
Publicity for Seasonale made women wonder, if just four periods a year are OK, why have any at all?
Users of Pfizer Inc.'s Depo-Provera, a progestin-only co
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May 09, 2006 6:36 AM
BOSTON, April 11 - The association between long-term hormone replacement therapy (HRT) and an elevated risk of breast cancer has been detected in a large prospective cohort study of black women.
Long-term use of hormone therapy (10 years or more) was associated with a more than 50% increase in breast cancer risk among black women, reported Lynn Rosenberg, Sc.D., of the Slone Epidemiology Center at Boston University here.
Most previous studies included white women predominantly, and few examined hormone use and breast cancer risk in black women specifically, Dr. Rosenberg and colleagues said in the April 10 issue of Archives of Internal Medicine.
The study included more than 23,000 black women ages 40 or older enrolled in the Black Women's Health Study, which started in 1995. Data on hormone use, breast cancer risk factors, and the occurrence of breast cancer were collected via questionnaires administered every two years through 2003.
Compared with women who had never used hormones, those on hormone therapy for 10 years or more had an incidence rate ratio for breast cancer of 1.58 (95% confidence interval=1.12-2.23). Women on hormone therapy for five to nine years also had increased risk, but this finding was not statistically significant.
Risk was slightly greater for estrogen combined with progestin (OR=1.45) than for estrogen alone (OR=1.41). Although the study did not examine the effect of particular drugs or drug combinations, the authors noted that most women in the study took hormone pills and about 10% used transdermal patches.
The HRT-breast cancer link remained significant after adjusting for breast cancer risk factors such as alcohol consumption, oral contraceptive use, family history of breast cancer, age at menarche, age at menopause, and age at the birth of first child, the investigators said.
The study also confirmed previous findings of increased risk in leaner women (those with a body-mass index of less than 25). The incidence rate ratio for lean women using hormones for 10 or more years was 3.08 (95% CI=1.70-5.56).
There was a slightly elevated but non-significant risk for women with BMIs between 25 and 29. Women with BMIs of 30 or greater, the traditional cutoff for obesity, had no increased risk associated with hormone therapy, the study found.
Because endogenous estrogens, which are associated with increased breast cancer risk, are produced by fat tissue, "exogenous estrogens may have less of an effect on estrogen levels in heavier women, perhaps explaining the stronger association with female hormone supplement use in leaner women," the authors said.
"These results based on data from U.S. black women strengthen the evidence that use of estrogen alone and estrogen with progestin increases the risk of breast cancer and that the association is stronger among leaner women," the authors concluded.
Results of the Women's Health Initiative, reported in the Journal of the American Medical Association in 2004, indicated an 81% increase in breast cancer risk for women on long-term estrogen combined with progestin. The study found no increased risk associated with estrogen alone, the current study authors noted.
Other studies, most notably the Million Women Study, which presented results in The Lancet in 2003, have found an elevated breast cancer risk associated with estrogen alone as well, they added
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May 08, 2006 5:51 PM
Long-Term Estrogen Therapy Linked to Breast Cancer
May 8, 2006
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(The New York Times News Service) -- Postmenopausal women who've had a hysterectomy and have used estrogen therapy for 15 years or more appear to be at higher risk of breast cancer, a new study found.
The new findings help clarify researchers' understanding of the potential link between estrogen therapy and breast cancer. Past studies that looked at estrogen taken with the hormone progestin have linked this combination to an increased risk of breast cancer among postmenopausal women. But results released in April from the Women's Health Initiative, a large clinical trial of hormone therapy, found no significant connection between estrogen therapy alone and breast cancer in women who took the hormone for seven years.
"Estrogen only causes cancer after prolonged exposure," says Dr. Wendy Y. Chen, lead researcher of the new study, who's with Brigham and Women's Hospital and the Dana Farber Cancer Institute in Boston.
Chen's team believes the effect of estrogen is cumulative. "We found that there was a 42 percent increased risk for all types of breast cancer for women who had used estrogen alone for 20 or more years," she says. However, for the type of breast cancer that is hormone sensitive, there was a 48 percent increased risk after 15 years of estrogen use, she says.
The study findings appear in the May 8 issue of the Archives of Internal Medicine.
For the study, Chen and her colleagues collected data on 28,835 women who were part of the Nurses' Health Study. During the study period, 934 women developed invasive breast cancer. These included 226 women who had never used hormones -- typically taken to ease menopausal symptoms such as hot flashes, vaginal dryness and loss of energy -- and 708 women who were using estrogen at the time.
Given these findings, women need to consider whether they want to use estrogen over an extended period, Chen says. "For women who use estrogen alone, and have been on it for more than 10 years, they would want to consider how much longer they want to remain on estrogen," she says.
"If you are taking it for less than 15 years, we haven't seen a significant increase in risk," Chen adds. "But after 15 years, women should speak to their physician about the benefits of being on estrogen and how would that be weighted against the risks."
Women who decide to stay on estrogen need to have regular mammograms, she says.
Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City, thinks these findings show that the current guidelines for estrogen use make sense.
"This study highlights the importance of appropriate use of hormone therapy," she says. "Patients must understand that the benefits of estrogen come with certain risks. Current guidelines for estrogen therapy hold true. The current recommendation for estrogen therapy is to use the lowest effective dose for the shortest duration of time."
May 03, 2006 7:44 PM
Breast-Cancer Risk Reduced by Exposure to Vitamin D
May 3, 2006
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WEST PALM BEACH, Fla. (The New York Times News Service) -- Though scientists have suspected that Vitamin D helps to prevent and possibly even treat breast cancer, population-based studies on the possible link have been few and of limited scope.
Now, new studies by researchers at the Samuel Lunenfeld Research Institute at Mount Sinai Hospital in Toronto suggest the "sunshine" vitamin may play a significant role in reducing breast cancer risk. The results, based on population data, found the reduction was most apparent among subjects exposed to the highest levels of vitamin D when they were young.
By interviewing about 576 patients who had been diagnosed with breast cancer and 1,135 people who had no cancer, the scientists discovered that significant reductions in breast cancer were found in those who had either worked in an outdoor job, had taken part in outdoor activities when young, or consumed cod liver oil or milk.
Working an outdoor job between ages 10 to 19 resulted in an estimated 40 percent reduced risk of breast cancer, while frequent outdoor activities between ages 10 to 29 lowered breast cancer risk by an estimated 35 percent. "These outdoor activities included those that didn't involve physical activity," said Julie Knight, who headed the Mount Sinai research team. "And so we believe that this is evidence of a reduction of breast cancer risk, associated with earlier exposure to the sun."
For dietary influences on cancer development, taking cod liver oil between ages 10 to 19 reduced breast cancer risk by about 25 percent, and consuming at least nine glasses of milk every week between the ages of 10 to 29 reduced the risk by 35 percent.
May 01, 2006 8:54 PM
Coping with Menopause Naturally -
Alternatives to HRT
By Monique N. Gilbert, B.Sc.
Many women are searching for an effective natural approach to relieving their menopausal symptoms because of the recent negative findings concerning hormone replacement therapy (HRT). On May 31, 2002, the National Institutes of Health in the US stopped a major long-term clinical trial of the risks and benefits of combined estrogen and progestin before the trial was completed. Due to the increased risk of breast cancer, coronary heart disease, stroke, and blood clots, it was determined that HRT's risks outweigh its benefits.
The first thing to remember is that menopause is not a disease. It is a natural part of a woman's reproductive life cycle which can be managed with exercise and diet. Hot flashes, night sweats, mood swings and bone loss are the chief complaints among women going through menopause. Learning to deal with these unpleasant symptoms will help you cope with life's changes.
Menopause not only causes a decline in hormone levels, but can also leave you feeling moody, irritated, tired and unfocused. This is partly due to the lack of a good night's sleep caused by night sweats. Regular exercise (at least 3 to 4 times a week) is probable the most important thing you can do to improve your nighttime rest and overall health. (Taking a cool shower before bedtime can also help promote a good night's sleep.)
Exercising strengthens your muscles and bones, helps circulate your blood (which nourishes the skin and internal organs); improves your mental outlook (about yourself and life in general), and promotes a tranquil night's sleep. It also increases your levels of serotonin, endorphins and dopamine. Serotonin, a chemical your brain manufactures, produces a calming effect and creates a sense of satisfaction and well-being. Endorphins decrease pain, reduce stress, cause mood stability and a sense of happiness and joy. Dopamine increases your vitality, concentration and alertness.
Weight bearing exercises and strength training is also one of the most effective methods of fighting bone loss and osteoporosis. Resistance placed upon the skeleton during physical activity makes bones stronger and denser while improving posture, balance and muscle tone. The positive effects of exercising keeps you fit, trim, feeling younger and energetic. Taking a daily dose of calcium (1,200 mg to 1,500 mg), magnesium (500 mg to 750 mg) and vitamin D (400 IU) also helps preserve bone density and strength.
The next step to help you through the symptoms of menopause is to increase your intake of phytoestrogen rich foods. Many women experience positive results by eating soy. Soy foods contain isoflavones (natural plant estrogen) that have similar properties to human estrogen, but are much weaker. Isoflavones can bind to the body's estrogen receptors and help offset the drop in estrogen that occurs at menopause.
Scientists have shown isoflavones function similarly to HRT without producing the risks associated with this controversial treatment. Soy foods offer women a more natural way to treat their menopausal symptoms. Research on soy's protein and isoflavones indicate that soy can help to relieve hot flashes, night sweats, fatigue, and vaginal dryness.
Besides helping regulate estrogen when it is declining, soy can also help with other conditions such as osteoporosis, heart attack, stroke and breast cancer. Women have an increased risk for these disorders during and after menopause. Many studies show that soy can prevent these diseases by helping the body absorb and retain calcium, inhibit bone loss, lower LDL (the bad) cholesterol and decrease blood clotting.
The best forms of soy are those with the highest amount of isoflavones and protein; like whole soybeans (edamame), tempeh, textured soy protein (TVP), soynuts, and some soy protein powders. Next would be tofu, soymilk and miso. However, the actual isoflavone content has to be high enough to produce positive effects. Some foods made from soy protein concentrate, like soy hotdogs, have very little isoflavones due to their processing method. Other products, such as soybean oil and soy sauce, contain no isoflavones in them at all.
Researchers recommend consuming at least 25 grams of soy protein and 30-50 milligrams of isoflavones daily (equal to 1-2 servings). This is only a starting point. You can safely consume 2-3 times this amount. The North American Menopause Society suggests 60 to 90 milligrams of isoflavones a day.
Many health experts encourage people to incorporate soy foods into a balanced diet and discourage solely taking soy supplements. Soy foods have various nutrients and compounds that contribute to its health benefits, while soy supplements usually only contain isoflavones. They advise taking soy supplements along with soy foods. This way the benefits of both forms can complement and enhance each other.
Some women have found that taking Black Cohosh and Vitamin E (400 IU to 800 IU daily) can also provide relief from hot flashes, night sweats and other menopausal symptoms. Black Cohosh is a phytoestrogen herb that women have used for centuries to help manage their hormones. Other beneficial herbs include Dong Quai, Evening Primrose Oil and Red Clover.
Since each woman is unique and reacts differently to natural treatments, try them out for yourself. Women who exercise regularly and consume soy daily generally have fewer menopausal symptoms than those who do not. Test these approa
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May 01, 2006 5:48 PM
Osteoporosis Drug Prevents Breast Cancer
A drug prescribed to prevent osteoporosis may do double duty as a breast cancer fighter. Initial study results released this week find that the osteoporosis drug raloxifene may be as effective as tamoxifen, the current standard treatment, for preventing breast cancer in postmenopausal women -- and cause fewer side effects. The National Cancer Institute study looked at nearly 20,000 postmenopausal women at high risk for breast cancer. Such women usually are prescribed the drug tamoxifen; rare but serious side effects of this drug include uterine cancer and blood clots, The Associated Press reports. The NCI study compared tamoxifen and raloxifene, which is chemically similar. When taken daily for up to five years, both drugs cut a woman's risk for invasive breast cancer in half, the study found. While raloxifene has the potential to cause the same side effects as tamoxifen, the study found 36% fewer uterine cancers and 29% fewer blood clots in the women taking raloxifene compared to those taking tamoxifen. Researchers say the findings could mean more options for postmenopausal women at risk for breast cancer because of age, family history or other factors. However, the findings do not apply to premenopausal women at risk for breast cancer -- raloxifene hasn't been tested in that group, the researchers say. They add that tamoxifen users who have not experienced side effects from the drug do not necessarily change their medication, the AP says.
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WOMENS HEALTH May 01, 2006 1:55 PM
Adenomyosis, (ad-en-oh-MY-oh-sis) is a condition where endometrial glands and supporting tissues are found in the muscular wall of the uterus where it would not occur normally.
Adenomyosis is also called: endometriosis interna, uterine endometriosis, endometriosis of the uterus, and internal endometriosis.
Adenomyosis is a disease that is closely related to endometriosis. Endometriosis is a disease where the cells that normally line the inside of the uterus and are shed during menstruation, become implanted and grow outside of the uterus. Adenomyosis may also be found in women who have already been diagnosed with endometriosis. It usually occurs in the posterior wall of the uterus.
The most common symptoms of adenomyosis are: abnormal uterine bleeding, large uterus (uterus is often 2-3 times the normal size), and pelvic pain during menstruation.
Note: In many cases, the woman may not have any symptoms.
How does Adenomyosis occur?
Adenomyosis occurs when the old tissue and blood cannot escape the uterine muscle and flow out of the cervix as part of normal menses.
What causes Adenomyosis?
The exact cause is unknown.
Some of the treatment options are: Hysterectomy and pain medication.
Good news about Adenomyosis?
Symptoms usually go away after menopause occurs. A hysterectomy will make symptoms go away.
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