Gynecology Medical News

Last month, the BMJ reported a fall in the number of young women attending smear tests. Now, two senior doctors warn that a new policy not to screen women aged 20-24 may be a factor in falling coverage and could increase the risk of cancer developing in young women.

Prevalence of carcinoma in situ (a precursor to cancer known as CIN3) has increased in women aged 20-24, write consultants Amanda Herbert and John Smith. This new policy will add more than 3000 women with untreated CIN3 to the larger numbers failing to accept their invitations later on, they warn.

The authors accept that CIN may regress, that invasive cervical cancer (ICC) is rare in women under 25, and that screening does little to reduce its incidence in such young women. However, they argue that ICC can develop within a couple of years of missed cell analysis, failure to investigate cell abnormalities, or incomplete treatment, emphasising the importance of treating high-grade CIN when it is found.

Screening in the UK has been highly successful and, since 1988, incidence and mortality have fallen by more than 40% despite increased risk of disease. This has been achieved by treating high-grade CIN, particularly CIN3, in young women, say the authors. The peak prevalence of CIN3 is in women aged 25-29 amongst whom the fall in coverage has been greatest.

ICC is more difficult to prevent in young women because there are less screening opportunities to treat precancerous lesions before they become invasive, they add.

They believe that decisions about treatment of CIN should be based on a balance between risk of progression, likelihood of regression and risk of treatment. Women should be informed about the risk of high-grade CIN, its greater frequency in young women, the importance of surveillance, and the fact that an epidemic of cervical cancer has been prevented by screening women when they were young.

General practitioners and clinics should not be prevented from screening women whom they believe to be at risk if those women themselves want to be screened, they conclude.

Contact: Emma Dickinson

BMJ-British Medical Journal Continue reading →

Doctors in Sweden have shown for the first time that although endometriosis is associated with an increased risk of various cancers, this risk does not depend on the number of times women with the condition have given birth.

Dr Anna-Sofia Melin, told the 23rd annual meeting of the European Society of Human Reproduction and Embryology: “Several epidemiological studies have shown an increased cancer risk among women with endometriosis, especially ovarian cancer. Infertility and never having given birth (nulliparity) are also known risk factors for different types of cancer, such as breast and endometrial cancer. However, as far as we know, this is the first study to investigate cancer risk among women with endometriosis that also stratifies for parity.”

Dr Melin, a specialist doctor in the department of obstetrics and gynaecology at the Karolinska University Hospital in Stockholm, Sweden, and epidemiologists at the Karolinska Institute looked at data from 63,630 women who had been discharged from hospital with a diagnosis of endometriosis between 1969 and 2002. They were identified and followed up via the National Swedish Inpatient Register, the National Swedish Cancer Register and the Swedish Multi-Generation Register.

The researchers identified 3,822 cases of cancer amongst the women with endometriosis. While they found no overall increased risk of cancer, they did find that the women had an elevated risk of certain types of cancer, but that there was no significant difference in risk between women who had never given birth and those who had.

“We found that, contrary to what one might expect, endometriosis and nulliparity did not combine to give a higher risk of cancer,” said Dr Melin.

The researchers found that endometriosis increased the risk of developing ovarian cancer by more than a third (37%) above the risk for the normal population of women without endometriosis. There were similar increases in risk for endocrine tumours (38%), kidney cancer (36%) and thyroid cancer (33%). Slightly lower increases were found for brain tumours (27%) and malignant melanoma (23%), and there was a small increased risk of breast cancer (8%). Interestingly, women with endometriosis had a reduced risk of cervical cancer of just under a third (29%).

“There was no significant difference between nulliparous and parous women with endometriosis regarding cancer risk for any of the cancer types. We found a non-significant decrease in ovarian cancer risk the more children a woman had had,” said Dr Melin.

Little is known about the possible mechanisms involved in the increased risk of cancer from endometriosis (or decreased risk, in the case of cervical cancer).

Dr Melin said: “The fact that our study did not show an association between cancer risk and parity increases the possibility that it is the endometriosis disease in itself that causes the cancer and not the infertility issue.”

“Various theories have been suggested. For ovarian cancer it might be the exposure of the ovaries to the hostile endometrium cells that ‘invade’ the ovary during the course of the endometriosis disease. Or it could be defects in the immune system that allow the endometriosis to grow and also might allow cancer cells to grow in different parts of the body. Maybe the treatment of endometriosis, hormonal or surgical, can influence cancer development. We do not know yet.”

Dr Melin plans to investigate whether hormonal or surgical treatment of endometriosis might be involved in the increased cancer risk, and she also wants to identify which women are more at risk of developing cancer than others.

But she said that it was too early to use the results of her study to give advice to doctors about improved treatments for women with endometriosis.

“Our hope is that doctors in general start to view the endometriosis disease as a serious disease that causes a lot of suffering to the patient and also may lead to cancer. We hope that in the future we will be able to identify those women with endometriosis that may have a more aggressive form of disease with more atypical cells, for instance, and that this may lead to better care for the patient and, hopefully, to a early diagnosis if cancer should occur,” she concluded.

Source: Emma Mason

European Society for Human Reproduction and Embryology Continue reading →

As part of a process to determine what essential health benefits should be included in health plans offered through state-based insurance exchanges by 2014, an Institute of Medicine panel is weighing whether infertility treatments are an essential benefit to help people manage a medical disorder or a “life-enhancing” but not essential benefit, Michelle Andrews writes in a Kaiser Health News column. The IOM panel will deliver its recommendations on essential health benefits to HHS, Andrews adds.

According to CDC, one in eight couples of childbearing age is infertile. Women under age 35 who complete one assisted reproductive therapies cycle have a 40% chance of giving birth, but by the time a woman reaches age 43 or 44, the figure drops to 5%, according to a CDC report on assisted reproductive technology.

Andrews writes that 15 states require that insurance plans cover infertility treatments, according to the Georgetown University’s Health Policy Institute. However, many employers are exempt from covering infertility treatments despite mandates, according to the American Society for Reproductive Medicine spokesman Sean Tipton. Only about 20% of employers’ health plans cover ART, according to a 2006 survey of 931 employers. A majority of employers that did not offer such coverage cited costs as a factor in the decision; 91% of employers that covered infertility treatments said doing so had not significantly increased their costs, according to the report conducted by Resolve: The National Infertility Association.

Some health plans cover fertility drugs to stimulate ovulation or intrauterine insemination, but not assisted reproductive technology procedures, such as in vitro fertilization, Andrews explains. Even if a plan covers IVF, it might cover only a certain number of cycles or place a cap on how much it will pay.

“It’s too soon to know how the coverage issue will be resolved in the health insurance exchanges,” Andrews writes. She adds that “it’s worth noting that when employers in the Resolve survey were asked why they covered infertility benefits, 65% said it was because employees asked them to” (Andrews, Kaiser Health News, 1/24).

Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families.

© 2010 National Partnership for Women & Families. All rights reserved.

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The AP/Long Island Newsday on Friday examined a petition Wyeth has submitted to FDA for increased regulation of compounding pharmacies that prepare customized hormone replacement therapy because some are “duping women with products that pose a serious health risk.” Compounding pharmacies can revise the dosages of HRT, prepare the medications in creams or liquids or eliminate preservatives and other non-active ingredients that might cause allergies, but FDA has not approved the practice. The petition, which Wyeth filed last October, asks FDA to address the issue with warning letters, injunctions and seizures. According to the AP/Newsday, many women began to use HRT prepared by compounding pharmacies after a 2002 study, part of the Women’s Health Initiative, found that such medications manufactured by Wyeth and other pharmaceutical companies increased risk for heart attack, breast cancer and stroke. However, Wyeth and other critics maintain that HRT prepared by compounding pharmacies is not more effective or safer than medications manufactured by pharmaceutical companies. Larry Sasich, a pharmacist with the Health Research Group of Public Citizen, said, “They haven’t been studied for safety or effectiveness and are not produced in facilities that meet good manufacturing practices,” adding, “We suspect a majority of patients aren’t aware of this.” Wyeth spokesperson Candace Steele said, “We filed our petition so that we can ensure that women who received these bio-identical hormones also receive truthful information about the risks of therapy.” However, L.D. King, executive director of the International Academy of Compounding Pharmacists, said, “It seems to be an attempt to use the FDA inappropriately to eliminate competition.” FDA officials recently told Wyeth that they will need more than six months to review the petition and more than 27,000 related public comments they have received (Bridges, AP/Long Island Newsday, 4/21).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Results of two Phase 1 clinical trials of S-equol (AUS-131) were published in the February issue of Menopause: The Journal of the North American Menopause Society. This first-in-class, nonsteroidal, nonhormonal estrogen receptor beta (ERbeta) agonist offers a potentially safer alternative to estrogen for the treatment of menopausal symptoms. As part of a drug development program, these studies were the first to investigate AUS-131 in humans. Results demonstrated a favorable safety and pharmacokinetic profile for AUS-131, and have allowed the company to proceed to Phase 2 clinical trials, which will be completed in Q3 2011.

These studies evaluated the pharmacokinetics and tolerability of single and multiple oral doses of AUS-131 in healthy volunteers. These studies also established the doses for proof-of-concept Phase 2 studies investigating AUS-131 as a treatment for postmenopausal women with vasomotor symptoms (VMS), commonly referred to as hot flashes. Results also support Ausio’s development of AUS-131 as a treatment option to inhibit prostate cell growth in men with benign prostatic hyperplasia (BPH).

The full paper is available here.

“One of the compelling reasons for developing S-equol as a pharmaceutical product is that women are reluctant to take estrogens for their menopausal symptoms” said Richard Jackson, PhD, Ausio Pharmaceuticals, LLC, President and CEO, and the study’s lead author. “Based on the Phase 1 studies, AUS-131 offers an oral medication that safely delivers therapeutic levels of S-equol, which may benefit patients with a variety of diseases and conditions.”

History of Treatment of Menopausal Symptoms and Significance of S-Equol

Whereas hormone therapy (HT) has been the therapy of choice for the management of menopausal symptoms in women, the Women’s Health Initiative has shown that HT has been associated with increased risk of invasive breast cancer, coronary heart disease, stroke, and deep vein thrombosis. This increased risk is associated with the abundance and prominent role of the estrogen receptor ?

UroToday -Presented Monday, 03 September 2007 at the 29th Congress of the Societe International d’Urologie – SIU 2007 – Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas – The Second Annual Symposium on Advanced GU Malignancy – Palais des Congres de Paris, France

Introduction: The aim of the study was to evaluate female sexuality in a selective population of newly diagnosed Multiple Sclerosis (MS) women’s and to compare these findings with those from a control group of healthy female volunteers.

Methods: In this clinic-based study, 63 newly diagnosed consecutive women affected by definite MS were admitted. Disability and psychological functioning were evaluated with the Expanded Disability Status Scale (EDSS) and Beck’s Depression Inventory (BDI) respectively. Sexual function was evaluated with the Female Sexual Function Index (FSFI). MS patients were matched and compared with a group of 61 female healthy volunteers with the same baseline characteristics.

Results: All the evaluated patients were ambulant with no major neurological impairment (mean EDSS score 2.5, range 0-3.5). None of the patients were considered clinically depressed, but some of them were sad or worried. According to the sexual history and FSFI scores, sexual dysfunction (SD) was diagnosed in 41 (65.1%) out of the 63 patients and in 9 (14.7 %) out of the 61 health females. Orgasm and Lubrication problems were higher in the MS patients but with no significantly difference (p Continue reading →

Chicken sold in supermarkets, restaurants and other outlets may place young women at risk of urinary tract infections (UTI), McGill researcher Amee Manges has discovered. Samples taken in the Montreal area between 2005 and 2007, in collaboration with the Public Health Agency of Canada and the University of Guelph, provide strong new evidence that E. coli (Escherichia coli) bacteria originating from these food sources can cause common urinary tract infections.

Eating contaminated meat or food does not directly lead to a UTI. While some E. coli such as O157:H7 can cause serious intestinal disease, these E. coli bacteria can live in the intestine without causing problems. In women however, the bacteria can travel from the anus to the vagina and urethra during sex, which can lead to the infection.

The research team is also investigating whether livestock may be passing antimicrobial-resistant bacteria on to humans. This is due to the use of antibiotics to treat or prevent disease in the animals and to enhance their growth, which may lead them to develop resistance to the medication. When animals are slaughtered and their meat is processed for sale, the meat can be contaminated with these bacteria.

“These studies might open the door to discussions with policymakers,” Manges said, “about how antibiotics are used in agriculture in Canada. It’s certainly something we need to continue studying”.

The public should not be alarmed. Manges advises that consumers should cook meat thoroughly and prevent contamination of other foods in the kitchen. Although some infections caused by these E. coli are resistant to some antibiotics, the infections can still be treated. Manges hopes that understanding how these bacteria are transmitted will help reduce infections. She also hopes more attention will be focused on how meat is produced in Canada. Her research is part of a broader study concerning food safety and is financed through funding by the Government of Canada, Public Health Agency of Canada, in collaboration with the Laboratory for Foodborne Zoonoses, specifically the Canadian Integrated Program for Antimicrobial Resistance Surveillance, and also the Division de l’inspection des aliments, Ville de Montr?

Citing waning efforts to fight HIV/AIDS in Uganda, President Yoweri Museveni on Thursday called for increased prevention strategies, particularly concerning mother-to-child transmission, Uganda’s New Vision reports. Museveni was speaking at the opening of the $2.5 million Baylor Children’s Centre of Excellence at Mulago Hospital — which will provide care for children living with HIV/AIDS and was funded by Baylor College of Medicine, CDC and John Damonti, president of the Bristol-Myers Squibb Foundation. Museveni said that all pregnant women should undergo HIV testing, and, if they test positive for the virus, receive treatment to prevent transmission to their infants (Baguma, New Vision, 10/3). He added that with improved MTCT prevention, Uganda can reduce the number of children born with HIV, which currently is recorded at 25,000 each year.

According to the Monitor, although the country decreased the prevalence of HIV/AIDS from the early 1990s to 2000, the rate is said to be on the rise again (Kirunda, Monitor, 10/3). Furthermore, the New Vision reports that care for the 150,000 children living with HIV/AIDS in Uganda continues to lag behind care for adults, and Adeodata Kekitiinwa, director of Baylor College of Medicine Children’s Foundation, said that of the 133 health centers that offer HIV/AIDS treatment to adults, only 32 do so for children. Museveni said that about 10,000 of the 150,000 children in need of antiretroviral drugs receive them, 40% of whom receive treatment through Baylor, mainly in urban areas. “We must ensure equity to life-saving interventions to cater for children,” he added (New Vision, 10/3).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation.?

A survey carried out among 250 pregnant women showed that 24 percent of them do not feel adequately informed by their gynaecologist, and almost half do not take part in any prenatal course. The study, prepared by the Head of the Obstetrics Department at the Hospital Cl?

The percentage of caesarean section deliveries at New York City hospitals increased from 26.6% of all births in 2003 to 28.6% in 2004, according to a report released on Monday by the Public Advocate for the City of New York, the New York Post reports (Campanile, New York Post, 12/5). The nationwide c-section rate increased from 27.5% in 2003 to 29.1% in 2004. The report, Public Advocate Betsy Gotbaum, says the c-section rate at several of the 44 city hospitals offering labor and delivery services was more than twice the 15% maximum rate recommended by the World Health Organization and three times the preferred rate cited by researchers. Although the city’s public hospitals had lower c-section rates than privately operated facilities, all 44 hospitals failed to comply with the New York state Maternity Information Act, according to the report (Public Advocate release, 12/4). Under the law, hospitals are required to provide data on the number of c-section deliveries they perform to any patients who request it (Kaiser Daily Women’s Health Policy Report, 7/14/05).

Recommendations, Reaction
The report recommended:The New York State Department of Health oversee and assess New York City hospitals’ adherence to the Maternity Information Act;

The New York City Health and Hospitals Corporation collaborate with the city health department to ensure the city’s 12 public hospitals offering labor and delivery services comply with the law;

The city health department make efforts to gather, calculate and redistribute figures on deadline; and

The city health department works with the New York City Department of Health and Mental Hygiene to make all information required by Maternity Information Act accessible on their respective Web sites.”Our hospitals are doing a great disservice to expectant mothers by failing to comply with state law and provide detailed information on c-section deliveries,” Gotbaum said, adding, “We’re seeing an increase in c-section deliveries, and women need to understand the potential risks involved with this procedure” (Public Advocate release, 12/4). Hugh Randall, vice chair of New York University’s ob-gyn department, said physician concern about malpractice lawsuits is a “significant factor” for the increase in the c-section rate (New York Post, 12/5).

The report is available online with Adobe Acrobat.

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →