Is It Safe To Use Oral Contraceptives To Eliminate Periods? Harvard Women's Health Watch Explores The Question

The new birth control pill
Lybrel is the first oral contraceptive designed to be taken 365 days a year
with no pill-free intervals. Women who use Lybrel don't have regular
periods, although they may have breakthrough bleeding. There are risks and
benefits to suppressing menstruation, reports the September 2007 issue of
Harvard Women's Health Watch.



The idea of preventing periods is not completely new. Conventional oral
contraceptives also stop periods if they are taken continuously, and a
clinician may suggest this approach to enable a woman to skip her period at
an inconvenient time, such as during her honeymoon. The notion of
suppressing periods over a longer term has become increasingly attractive,
partly because this strategy has helped with treating endometriosis and
managing the hormonal swings of perimenopause.




There's some justification for reducing the number of periods or
eliminating them altogether. For some women, eliminating periods can mean
avoiding cramps, mood swings, headaches, and heavy bleeding that can cause
anemia. On the other hand, many women are uncomfortable with the notion of
not having periods. One concern about Lybrel is that if it fails, a woman
may not know she is pregnant.



The Harvard Women's Health Watch notes that there are no long-term
safety data on Lybrel, but its risks are thought to be similar to
conventional oral contraceptives -- an increased incidence of blood clots,
heart attacks, and stroke, especially in smokers. On the plus side, birth
control pills appear to lower the risk of ovarian and endometrial cancers;
Lybrel might do the same. But the effects of taking Lybrel for more than a
year are unknown. The use of continuous birth control has to be considered
largely uncharted territory.


Harvard Women's Health Watch

health.harvard.edu/women

Psychological Interventions May Help Premenstrual Syndrome

A review article which is published in the current issue of Psychotherapy and Psychosomatics indicates that psychological interventions may help premenstrual syndrome.


A group of canadian investigators conducted a systematic review and meta-analysis to determine the efficacy of psychological interventions for premenstrual syndrome.They systematically searched and selected studies that enrolled women with premenstrual syndrome in which investigators randomly assigned them to a psychological intervention or to a control intervention. Trials were included irrespective of their outcomes and, when possible, they conducted meta-analyses.


Nine randomized trials, of which 5 tested cognitive behavioural therapy, contributed data to the meta-analyses. Low quality evidence (design and implementation weaknesses of the studies, possible reporting bias) suggests that cognitive behavioural therapy significantly reduces both anxiety (effect size [ES] = -0.58; 95% confidence interval [CI] = -1.15 to -0.01; number needed to treat [NNT] = 5), and depression (ES = -0.55; 95% CI = -1.05 to -0.05; NNT = 5), and also suggests a possible beneficial effect on behavioural changes (ES = -0.70; 95% CI = -1.29 to -0.10; NNT = 4) and interference of symptoms on daily living (ES = -0.78; 95% CI = -1.53 to -0.03; NNT = 4). Results provide much more limited support for monitoring as a form of therapy and suggest the ineffectiveness of education. Low quality evidence from randomized trials suggests that cognitive behavioural therapy may have important beneficial effects in managing symptoms associated with premenstrual syndrome.


PSYCHOTHERAPY AND PSYCHOSOMATICS

karger/pps

Sen. Coburn Should Lift Hold On Genetic Discrimination Bill, Editorial Says

Sen. Tom Coburn (R-Okla.) "should lift his hold" on a bill (HR 493), sponsored by Rep. Louise Slaughter (D-N.Y.), that would prohibit health insurers or employers from accessing the genetic information of patients or employees and considering it for hiring, firing and other business decisions, a Boston Globe editorial says (Boston Globe, 5/2). The Senate Health, Education, Labor and Pensions Committee on Jan. 31 approved a similar bill (S 358), sponsored by Sen. Olympia Snowe (R-Maine). Snowe has said she introduced the legislation, called the Genetic Information Nondiscrimination Act of 2007, because some women have said they were reluctant to be tested for genetic alterations that indicate increased risk of developing breast cancer because they feared difficulty in acquiring health insurance if they tested positive (Kaiser Daily Women's Health Policy Report, 4/27).

According to the Globe, Coburn objected to legislation that passed the Senate HELP Committee because he said it contained an exception allowing discrimination based on genetic information from embryos and fetuses. However, the House-approved measure "contains language closing that loophole" and gives Coburn "what he want[s]," the editorial says. The "importance" of the legislation "will only grow as technology evolves," the editorial says, adding that Coburn should "let the Senate get on with passing" it (Boston Globe, 5/2).

"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.

McCain Campaign Criticizes Romney's Abortion-Rights Position Shift

The campaign of Sen. John McCain (R-Ariz.), who is running for the 2008 Republican presidential nomination, on Wednesday released a 2005 video in which former Massachusetts Gov. Mitt Romney (R), who also is running for the nomination, affirms his support for maintaining Massachusetts' abortion-rights laws, the Washington Post reports (Goldfarb, Washington Post, 6/14).

Since Romney first ran for U.S. Senate in 1994, he has acknowledged that his position on abortion has changed from supporting abortion rights to saying that he would prefer to have Roe v. Wade -- the 1973 Supreme Court case that effectively barred state abortion bans -- overturned. Romney in 1994 said, "I believe that abortion should be safe and legal in this country," adding, "I believe that since Roe v. Wade has been the law for 20 years, we should sustain and support it." When he ran for Massachusetts governor in 2002, Romney promised to "preserve the status quo" on abortion rights in the state and oppose any changes to state laws that restricted or increased access to abortion.

Romney in 2004 while studying human embryonic stem cell research said he experienced an awakening that led him to believe "the sanctity of life had been cheapened" by the Roe decision (Kaiser Daily Women's Health Policy Report, 4/27). Romney in the video -- taken at a May 27, 2005, press conference -- said, "I am absolutely committed to my promise to maintain the status quo with regards to laws relating to abortion and choice." He added that his "personal, philosophical views" about the issue would not have done "anything other than distract" from what he thought was a "more critical agenda" (Washington Post, 6/14).

Matt David, a spokesperson for the McCain campaign, said that Romney's "biggest challenge" in the election will be "convincing Republicans he has principled positions on important issues, especially now that it's known that he remained committed to pro-choice policies" after he shifted his position on abortion rights in 2004 (Sidoti, AP/Houston Chronicle, 6/13). Romney spokesperson Kevin Madden said the McCain campaign used a selective quote from the video and ignored Romney's other comments "where he also made a passionate case for his veto of stem cell legislation that showed a level of disregard for the sanctity of human life" (Whitesides, Reuters, 6/13).

Group Calls for IRS Investigation of Bishop's Comments About Giuliani
In related news, Americans United for Separation of Church and State on Wednesday said that Roman Catholic Bishop Thomas Tobin -- head of the Roman Catholic Diocese of Providence, R.I. -- violated tax law when he criticized Republican presidential candidate and former New York City Mayor Rudy Giuliani's support for abortion rights, the Providence Journal reports. The group is asking the Internal Revenue Service to investigate the diocese reports (Providence Journal, 6/14).














Tobin in a column for the diocese's newspaper, the Rhode Island Catholic, said Giuliani's "public proclamations on abortion are pathetic and confusing," adding, "Even worse, they're hypocritical." Tobin also said that he never would support a candidate who supports abortion rights. According to Tobin, Catholics are "required to be pro-life, to cherish and protect human life as a precious gift of God from the moment of conception until the time of natural death" (Kaiser Daily Women's Health Policy Report, 6/6).

Barry Lynn, executive director of AUSCS, in a letter to the IRS said Tobin "appears to have violated federal tax law by attacking Giuliani." The group in a statement said that "federal tax law forbids non-profits to use organizational resources to support or oppose candidates for public office." Lynn said that if Tobin "wants to join the political fray, he should do so as an individual without dragging along his tax-exempt diocese" (Providence Journal, 6/14). He added, "The bishop is not a political boss, and he shouldn't be telling his flock with church resources which candidate to oppose."

IRS spokesperson Eric Smith said the agency does not confirm an investigation's existence until it makes a ruling. Tobin spokesperson Michael Guilfoyle said the complaint does not have merit. According to the Associated Press, the IRS rarely revokes a group's tax-exempt status for one violation (Henry, Associated Press, 6/13).


The AUSCS letter to the IRS is available online.

"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.

Head-To-Head Comparison Of Incontinence Treatments

As part of a national clinical trial, UT Southwestern Medical Center researchers found little difference in effectiveness between two popular treatments for one of the most common ailments among American women: stress urinary incontinence.



Stress incontinence affects up to 50 percent of women in the U.S. at some point in their lives. Women with stress incontinence experience leakage during increases in abdominal pressure typically brought on by sneezing, coughing, lifting heavy objects or other types of physical activities. UT Southwestern surgeons and colleagues at eight other sites compared the outcomes of two surgical procedures designed to alleviate symptoms of stress urinary incontinence. UT Southwestern was the only site in North Texas to participate in the trial.



The study, available online in the New England Journal of Medicine, shows that both surgical procedures - transvaginal sling (TVT) and transobturator midurethral sling (TOT) -appear to be similarly effective in women up to 12 months after the procedures were performed.



"Both procedures are done using minimally invasive techniques, but until now there haven't been any large prospective head-to-head randomized trials comparing the two popular techniques," said Dr. Gary Lemack, professor of urology and neurology and co-principal investigator at the UT Southwestern site.



The TVT sling, introduced in 1996, involves placing a thin strip of polypropylene mesh weave transvaginally and behind the urethra and pubic bone. The strip acts as a kind of scaffolding that supports the urethra, diminishing urine leakage.



The more recently developed TOT sling reduces the risk of bladder or bowel injury by passing the sling laterally into the groin through two small incisions in the upper thigh. This method works in the same way as the TVT, by supporting the urethra. Controversy exists as to which sling is more effective and which might be associated with a greater risk of complications.



"At one year, the two groups of patients were assessed both objectively and subjectively about the success of their procedures," said Dr. Lemack. "The outcomes appear very similar at one year regardless of the severity of the patient's stress incontinence symptoms."



Objective measures of success included testing whether or not there was any urine leakage with straining or coughing during an exam with a full bladder. Patients also were asked to wear a pad for 24 hours to determine if leakage occurred. Subjective self-reported criteria required patients to keep a three-day diary and record any symptoms of stress incontinence. They also reported the need for any further treatments.



"The rates of success using objective measures in patients with the transvaginal sling were around 81 percent, and 78 percent for patients who had the TOT procedure - equivalent by our preset criteria," Dr. Lemack said. "Rates of subjectively reported success were slightly higher in the transvaginal group and thus did not quite meet the criteria for equivalence."



Both procedures carry associated risks, albeit infrequently, and the key difference between procedures may be the rate of adverse events associated with each. For example, the TVT was associated with a greater likelihood of intraoperative bladder injury and postoperative voiding dysfunction, while the TOT was more likely to be associated with postoperative numbness and pain.



As a result, although the procedures are similar in effectiveness, Dr. Lemack says physicians could use the information gleaned from this study to more fully counsel patient about the risks and benefits of either operation.



Dr. Lemack said that future studies should help determine if any other parameters, such as bladder function studies, may help in predicting treatment success.



Other UT Southwestern faculty participating in the multi-center incontinence network included Dr. Philippe Zimmern, professor of urology; Dr. Joseph Schaffer, professor of obstetrics and gynecology; Dr. Marlene Corton, associate professor of obstetrics and gynecology; and Dr. Clifford Wai, associate professor of obstetrics and gynecology.



Funding for this study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases and by the National Institute of Child Health and Human Development.



Source:

Katherine Morales

UT Southwestern Medical Center

Women Previously Diagnosed With Abnormal Cervical Cell Growth At Higher Risk For Recurrence And Invasive Cancer

New research from the UC Davis Center for
Healthcare Policy and Research has found that women who have been treated
for cervical intraepithelial neoplasia (abnormal cervical cell growth),
are at higher risk for a recurrence of the disease or invasive cervical
cancer.



The large, population-based study, which appears in the May 12 online
issue of the Journal of the National Cancer Institute, sheds new light on
the long-term risks of subsequent abnormal cell growth or invasive cancer,
and should help in the development of follow-up treatment guidelines for
women with a history of treatment for abnormal cells.



"We now have a much more clear idea of the risks of recurrent abnormal
cells and invasive cervical cancer over time after treatment of these
cells," said Joy Melnikow, Professor of Family and Community Medicine and
Associate Director of the UC Davis Center for Healthcare Policy and
Research, who led the study. "Recurrence risk depends on the grade of
abnormal cells that was initially treated, what treatment was used, and
the woman's age."



In the study, which used data from the British Columbia Cancer Agency
cytology database and was funded by a grant from the National Cancer
Institute, Melnikow and colleagues identified 37,142 women who were
treated for abnormal cells from Jan. 1, 1986 through Dec. 31, 2000.



They compared them with a group of 71,213 women with no previous diagnosis
of abnormal cells. Both groups were under active surveillance through
2004.



They found that risk of subsequent abnormal cells or cervical cancer was
associated with the type of treatment they received, their age, and the
initial grade of diagnosis. There are three levels of abnormal cervical
cells; grade 3 is the most severe. There is no standard treatment for
abnormal cells; at early stages, abnormal cells are monitored to determine
if they resolve without treatment.



At later stages, the type of treatment depends on several variables,
including the grade and distribution of the abnormal cells and whether the
patient has been treated previously.



According to the study, the risk of invasive cervical cancer and
recurrence of grade 2 or grade 3 abnormal cells was highest for women who
were older than 40, previously treated for grade 3, or treated with
cryotherapy, a common treatment method in which the abnormal cells are
frozen to stop their growth. Rates of recurrence at grades 2 and 3 were
lowest among women treated with cone biopsy, a method in which the
abnormal cells are removed surgically.



Melnikow said the findings could help guide physicians in making
recommendations about the intensity of follow up needed after treatment
for abnormal cells. In addition, she said the findings may help physicians
and patients in deciding which type of treatment for abnormal cells to
choose. She explained, for example, that while cryotherapy was associated
in the study with a higher risk of recurrence, it carries less risk of
other harmful effects than cone biopsy or loop electrical excision,
procedures which have been associated with pre-term delivery in women who
later become pregnant.
















This suggests that a younger woman with grade 2 abnormal cells who plans
to start a family might opt for cryotherapy, while an older woman with
grade 3 abnormal cells who is at greater risk for recurrence might opt for
loop excision or cone biopsy.



"These data may help inform that treatment discussion, because we know
more about how age and different treatments appear to influence risks,"
Melnikow said.



The study also found that the highest rates of recurrence of abnormal
cells were observed in the first six years after treatment; the majority
of those were identified in the first two years. Recurrence rates for
grade 2 or grade 3 abnormal cells during the 6-year period ranged from 2.3
percent in the lowest risk group to 35 percent in the highest risk group.
Overall incidence of cervical cancer in the abnormal cell group was 37
cervical cancers per 100,000 woman-years, compared with six cervical
cancers per 100,000 woman-years among women not previously diagnosed.



Melnikow pointed out that the study also has different implications for
health policy depending on the health system and resources. In developing
countries where cervical cancer screening and treatment are more limited
and death rates higher for cervical cancer, cryotherapy, a simpler and
less expensive treatment method for abnormal cells, is likely to be
preferred.



Melnikow said the next step is to compare different treatment and
surveillance strategies in terms of cost-effectiveness.



Source
UC Davis Health System

Women Who Give Birth At California Hospitals Serving Mostly Minority, Low-Income Patients Less Likely Than Others To Breastfeed, Report Indicates

Women who give birth at California hospitals serving mostly non-white, low-income women and children are less likely to breastfeed than women who give birth at other hospitals around the state, according to a report released from the University of California-Davis Human Lactation Center and the California WIC Association, the Riverside Press-Enterprise reports (Dean, Riverside Press-Enterprise, 9/2). Research has shown that breastfeeding can reduce the likelihood of childhood obesity and ear infections and boosts children's immune systems (Reiter, Merced Sun-Star, 9/3). Hospitals with the highest rates of women who exclusively breastfed had trained staff, made lactation specialists available and supported exclusive breastfeeding, unless there was a medical reason not to, the Modesto Bee reports.

The report found, for example, that about 59% of white women in Stanislaus County who gave birth at hospitals reported breastfeeding their newborns exclusively, while 33% of Hispanic women and 32% of black women said they exclusively breastfed. The report's findings raise concerns that more targeted efforts are needed to address cultural gaps, according to the Bee (Carlson, Modesto Bee, 9/3).

Eighty-seven percent of women statewide began breastfeeding while at the hospital, the report found (Riverside Press-Enterprise, 9/2). However, an average of 42.7% of women continued to exclusively breastfeed their infants after leaving the hospital, according to the report (Halstead, Marin Independent Journal, 9/2). The California Department of Public Health has guidelines to help hospitals promote breastfeeding and emphasizes exclusive breastfeeding in the hospital, which can influence whether the infant will be breastfed at home (Modesto Bee, 9/3). Lisa Keckler, head of a breastfeeding quality improvement task force at Doctors Medical Center of Modesto, said that the hospital's lower breastfeeding rates could be explained by some premature infants having to spend time in intensive care. In addition, some women might have to return to work soon after giving birth and supplement breastfeeding with formula, she added.

The report also found that California hospitals with the World Health Organization's "baby-friendly" designation reported higher rates of women who breastfeed exclusively after leaving the hospital (Modesto Bee, 9/3). The program involves 10 steps to help improve breastfeeding rates and lower infant mortality rates and can include classes, lactation counseling and other services to assist women after giving birth (Riverside Press-Enterprise, 9/2). At the 19 baby-friendly hospitals in California, 71% of white women, 66% of Hispanic women and 62% of black women breastfed (Modesto Bee, 9/3).














Karen Farley, program manager of California WIC Association, said, "Our report shows that virtually all of the hospitals with the lowest exclusive breastfeeding rates reported here serve low-income and minority women -- the very population most affected by poor health outcomes such as diabetes and obesity" (Riverside Press-Enterprise, 9/2). She added, "Breastfeeding should not depend on where you are born. We know that when babies are exclusively breastfed in the hospital, they are more likely to be breastfed exclusively at home. We know these babies have healthier outcomes" (Modesto Bee, 9/3).


The report is available online.


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. All rights reserved.

Revision Of WHO Guidelines For Treating Some HIV-Infected Women Influenced By OCTANE Study

Findings from a study, winNew England Journal of Medicine, helped influence the World Health Organization (WHO) to change its guidelines this year for the treatment of HIV-infected women who receive a single dose of the antiretroviral drug nevirapine to prevent HIV transmission to their babies. The study demonstrated that the single dose of nevirapine used to prevent mother-to-child transmission of HIV can hamper the drug's effectiveness if it is also used later as part of a regimen to treat these same individuals.



The Phase III study, called Optimal Combination Therapy after Nevirapine Exposure (OCTANE), enrolled 745 women at 10 sites in seven African countries to address the critical question around nevirapine resistance. The drug nevirapine is inexpensive and accessible, and is widely used in resource-constrained settings for both treating HIV and preventing mother-to-child transmission (PMTCT).



The Adult AIDS Clinical Trials Group conducted the study with funding from the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health. The U.S. Military HIV Research Program's (MHRP) network site in Kericho, Kenya, the Kenya Medical Research Institute/Walter Reed Project, and another partner site in Eldoret, Kenya, participated in the study and enrolled 74 participants.



"This is very exciting news indeed!" said Dr. Fred Sawe, MHRP partner and the local principal investigator for the OCTANE study in Kericho. "We now have a definite answer to a problem that has continued to haunt us for the last 10 years. Given the infrastructure we have so far built in PMTCT programs, we can now minimize use of single dose only nevirapine-based interventions, increase access to more efficacious regimens, and provide better care to women who have been exposed to single-dose nevirapine without slowing down the progress of eliminating pediatric AIDS: a win-win situation of great public health importance."



An interim review of the study in 2008 found that exposing HIV-infected women to a single dose of nevirapine for PMTCT may lead these women to develop nevirapine-resistant HIV. The development of drug resistance compromises the effectiveness of HIV treatment regimens that include nevirapine. Based on this information, the study leadership advised women who were previously exposed to nevirapine and were taking nevirapine as part of the study protocol to consult with their clinicians about how to proceed with HIV treatment.



One of the additional findings in the study was that the negative effect of previous exposure to nevirapine appears to decrease with time. Researchers also found that the negative effect appears to decrease when more time elapses between taking single-dose nevirapine and starting treatment. The study also found that for those women without prior exposure to nevirapine, the drug has similar efficacy to another regimen, which included ritonavir-boosted lopinavir.



The 2010 WHO guidelines now advise that HIV-infected women who take single-dose nevirapine for PMTCT should not be treated for their own infection with a drug regimen that includes nevirapine as well as other drugs in the same class (known as non-nucleoside reverse transcriptase inhibitors, or NNRTIs), if treatment begins fewer than 12 months later and if the women were not given other antiretroviral drugs to prevent the development of nevirapine-resistant HIV.



Articles:



S Lockman et al. Antiretroviral therapies in women after single-dose nevirapine exposure. New England Journal of Medicine DOI: 10.1056/NEJMoa09-06626 (2010).



WHO. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach - 2010 revision (2010).



Source:

Lisa Reilly

Henry M. Jackson Foundation for the Advancement of Military Medicine

Women And Health Coverage: The Affordability Gap

As 'Cover the Uninsured Week' approaches, a new Commonwealth Fund report by researchers at the National Women's Law Center finds that even women with health insurance coverage are more likely than insured men to go without needed health care because of costs. Also, a higher percentage of women than men struggle with medical bills.



The report, Women and Health Coverage: The Affordability Gap, by Elizabeth M. Patchias and Judith G. Waxman of the National Women's Law Center finds that women are at a disadvantage because they have greater health care needs and lower incomes than men. More specifically, the report finds that 38% of women are struggling with medical bills compared with 29% of men. And, the high cost of health care services and premiums is forcing many women, even women with health insurance, to go without needed care. In fact, 33% of insured women and 68% of uninsured women don't get the health care they need because they can't afford it. In contrast, 23% of insured and 49% of uninsured men are avoiding care because of cost. Further, 16% of women are underinsured, meaning they have high out-of-pocket costs compared to their income, while only 9% of men are underinsured.



"Women are more likely than men to go without needed health care services because of costs, yet they still have higher out-of-pocket expenses. This disparity exists for both insured and uninsured women," said Waxman, vice president for Health and Reproductive Rights at the National Women's Law Center. "As policymakers and advocates explore how to expand and improve health coverage, they should ensure that any proposal provides comprehensive benefits and low cost-sharing."



Other factors contribute to this gender gap in health care coverage and access: women are slightly more likely than men to purchase coverage in the individual insurance market which is often more expensive and less comprehensive than employer coverage. Women are also more likely than men to take prescription drugs.



"These findings show that comprehensive health care coverage that doesn't require high out-of-pocket costs is vital to ensuring that women get the care they need to be healthy," said Sara Collins, assistant vice president for the Program on the Future of Health Insurance at The Commonwealth Fund. "As policymakers consider health care reform initiatives, they should consider plan designs that will result in meaningful, affordable, and equitable access to health care for everyone."



Methodology:



Most data in the report are from three surveys: the Annual Social and Economic Supplement to the Current Population Survey (CPS), 2005 (a sample of about 99,000 households); the Medical Expenditure Panel Survey (MEPS), 2004, of about 13,000 families, representing approximately 33,000 people; and the Commonwealth Fund Biennial Health Insurance Survey, 2005, a nationally representative sample of 4,350 adults age 19 and older.



The National Women's Law Center also released a companion report, Understanding Women's Access to Health Coverage: A Framework for Moving Forward, which examines health coverage expansion policy proposals and analyzes their potential effects on women. The report can be found at nwlc/






The Commonwealth Fund is a private foundation working toward a high performance health system.



The National Women's Law Center is a non-profit organization that has been working since 1972 to advance and protect women's legal rights. The Center focuses on major policy areas of importance to women and their families including economic security, education, employment and health, with special attention given to the concerns of low-income women.



Contact: Mary Mahon


Commonwealth Fund

Mammography Saves Lives Campaign Helps Clear Confusion On When And How Often Women Should Receive Mammograms

Women confused about when to have a mammogram have a new interactive source of information - MammographySavesLives - launching this week along with a series of public service announcements on television and radio stations across the country.


To clear confusion, reduce unnecessary breast cancer deaths, and help women avoid extensive treatment for advanced cancers that went undetected because they did not get annual mammograms, the American College of Radiology (ACR), the Society of Breast Imaging (SBI), and the American Society of Breast Disease (ASBD) have launched the Mammography Saves Lives™ (MSL) campaign.


The MSL coalition has produced a series of TV and radio public service announcements, featuring breast cancer survivors, diagnosed in their 40s with the aid of mammography, who urge women to begin getting annual mammograms at age 40 and inform them that:


- Mammography has helped reduce the breast cancer death rate by nearly 1/3 since 1990

- Mammography can detect cancer early when it's most treatable and can be treated less invasively

- ?? of women diagnosed have no family history of breast cancer or other factors that put them at high risk for developing the disease (so screening only high risk women misses majority of cancers)


The PSAs direct women here where they can:


- Sign up to receive an annual reminder email to receive a mammogram

- Find scientific information regarding why they need to start mammography at age 40

- Hear from leading breast cancer experts why annual mammograms save lives

- Share their story of breast cancer survival and

- Find an ACR accredited mammography facility near them


"Mammography has been proven without a doubt to save lives. It is the best tool available to screen for breast cancer. At present, there is nothing to replace it. One in five breast cancers occur in women in their 40s. By not getting a yearly mammogram after age 40, women increase their odds of dying from breast cancer," said Carol H. Lee, MD, chair of the American College of Radiology Breast Imaging Commission.


"The ten year risk for breast cancer in a 40 year old woman is 1 in 69 and only increases with age. In European countries like Denmark and Sweden, where screening programs are more organized, the breast cancer death rate has been cut almost in half over the last 20 years. While we have saved and continue to save a significant number of women through mammography, a great many more breast cancer deaths can be avoided if more women would choose to begin annual mammograms at age 40," said Phil Evans, MD, president of the Society of Breast Imaging.


"Mammography helps catch cancer at an earlier stage. This enables physicians to offer women more choices in regards to their treatment, so early detection not only save lives, but it helps preserve quality of life as well. The take home message for women is clear: start getting annual mammograms at age 40," said Gail Lebovic, MD, breast surgeon and president of the American Society of Breast Disease.


Source:

American College of Radiology (ACR)

Kaiser Daily Women's Health Policy Report Summarizes Articles On New Supreme Court Term, Abortion-Related Cases

The docket for the U.S. Supreme Court term beginning Monday is scheduled to include a Department of Justice appeal to uphold a federal law banning so-called "partial-birth" abortion. President Bush signed the Partial-Birth Abortion Ban Act (S 3) into law in November 2003, but federal judges in California, Nebraska and New York each issued temporary restraining orders to prevent enforcement of the ban. The Planned Parenthood Federation of America, the American Civil Liberties Union on behalf of the National Abortion Federation and the Center for Reproductive Rights on behalf of four abortion providers filed lawsuits alleging that the law is unconstitutional because of the absence of a health exception, and federal judges in California, Nebraska and New York each issued temporary restraining orders to prevent enforcement of the ban. In place of a health exception, the law includes a long "findings" section with medical evidence presented during congressional hearings that, according to supporters of the law, indicates the procedures banned by the law are never medically necessary. The Supreme Court is scheduled to hear arguments in two of the cases on Nov. 8 (Kaiser Daily Women's Health Policy Report, 9/29). Several newspapers recently examined the new Supreme Court session, including the outlook for the two cases on the federal abortion ban. Summaries appear below.

Christian Science Monitor: Justice Anthony Kennedy is "emerging as a primary centrist power" on the Supreme Court, and his "new judicial clout" will be on display in the federal abortion ban cases and other appeals to be heard during the court's term, the Monitor reports. If Kennedy "sticks to the analysis in his dissent" in the court's 5-4 ruling in the 2000 Stenberg v. Carhart case to strike down a similar Nebraska law as unconstitutional, court experts say the federal law likely will be upheld, according to the Monitor. However, a federal abortion restriction "runs counter" to Kennedy's view of federalism and state's rights, and he could stick to his "strongly held belief" that the court's precedents should be upheld, which likely would mean the federal abortion ban would be struck down, the Monitor reports (Richey, Christian Science Monitor, 10/2).

Los Angeles Times: President Bush's two nominees serving on the court -- Chief Justice John Roberts and Justice Samuel Alito -- will have the chance to "shift" abortion-rights law with their decisions in the upcoming cases, the Times reports. According to the Times, former Supreme Court Justice Sandra Day O'Connor often provided the fifth vote to strike abortion-rights restrictions, and now that she has been replaced by Alito, "the balance may tip the other way" (Savage, Los Angeles Times, 10/2).

New York Times: "[T]here is no escaping the fact" that the court will have to declare whether the federal law is constitutional, which will require justices to "grapple with the meaning" of the Stenberg v. Carhart ruling, the Times reports. According to the Times, the Bush administration will argue that the ruling should be overturned if the federal law "cannot coexist with that precedent" (Greenhouse, New York Times, 10/2). A Times editorial says that Roberts and Alito "should not want to reverse" the Sternberg decision "if they are true to the statements they made at their confirmation hearings about respecting precedent" (New York Times, 10/2).















San Francisco Chronicle: Although few people expect the cases to damage the abortion rights established by the court's ruling in the 1973 Roe v. Wade case -- which effectively barred state abortion bans -- the court's ruling could give "tremendous encouragement to those who would like to see Roe ... overturned," former Supreme Court clerk Edward Lazarus said, the Chronicle reports. According to the Chronicle, the court's term also is likely to test Roberts' "embrace of judicial modesty and humility at his confirmation hearings" in 2005 (Egelko, San Francisco Chronicle, 10/2).

Washington Post: The court's "term will be closely watched not only for the results the court reaches, but for how it reaches them," the Post reports. According to the Post, the court could uphold the federal law as constitutional without overturning the Sternberg ruling because the findings in the federal law "distinguish" it from the Nebraska measure. However, the Center for Reproductive Rights in its brief said the court should not respect the findings of Congress on medical practices (Lane, Washington Post, 10/1).


NPR's "Morning Edition" on Monday reported on issues the Supreme Court will consider in its new term, including a challenge to the federal abortion ban. The segment includes comments from James Foreman, professor at Georgetown University Law School and former clerk for former Justice Sandra Day O'Connor; Tom Goldstein, a lawyer who teaches Supreme Court litigation at Harvard University and Stanford University; Michael Paulsen, professor of University of Minnesota Law School; and Kenneth Starr, dean of Pepperdine University Law School (Totenberg, "Morning Edition," NPR, 10/2). The complete segment is available online in RealPlayer. In addition, NPR's "Weekend Edition Sunday" included an interview with Mimi Wesson, professor at the University of Colorado School of Law, about the Supreme Court's new session (Seabrook, "Weekend Edition Sunday," NPR, 10/1). The complete segment is available online in RealPlayer.

"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.

NARAL Pro-Choice America Calls On Kroger To Stock EC In All Pharmacies

Representatives of NARAL Pro-Choice America on Wednesday in a letter to Cincinnati-based grocery store chain Kroger called on executives to stock the emergency contraception Plan B, which can prevent pregnancy if taken within 72 hours of sexual intercourse, at all of its pharmacies nationwide, AP/International Herald Tribune reports (Gross, AP/International Herald Tribune, 3/21). Advocates called on Kroger stores to make Barr Laboratories' Plan B available to women at its pharmacies after Rome, Ga., resident Carrie Baker said a pharmacist at a Kroger store in December 2006 refused to sell her the drug. FDA in August 2006 approved nonprescription sales of Plan B to women ages 18 and older. Major pharmacy chains -- such as CVS, Rite-Aid and Walgreen -- are carrying Plan B in all their stores and have pledged to ensure that customers can buy it at each store even if a certain employee declines to sell the pill because of moral objections. Glynn Jenkins, a spokesperson for Kroger, said that the company has a similar policy for prescription medications but not for over-the-counter drugs, such as Plan B. Kroger earlier in the month announced that it is reiterating to its pharmacists that the company's drug policy requires its pharmacies to "make accommodations" to have a prescription filled if a pharmacist refuses to fill it (Kaiser Daily Women's Health Policy Report, 3/13). Ted Miller, communications director for NARAL Pro-Choice America, said members of the group called 231 Kroger-run pharmacies across the country and found that 21% of the stores did not make the drug immediately available to women. A Kroger spokesperson said the chain does carry the drug at all of its locations, adding that some employees might not have understood the company's policies. She said that the company sent messages to all of its pharmacies clarifying company policy and that many of the calls NARAL members made to stores came before the policy was clarified. "We think some of this is due to some confusion over the policy," Kroger spokesperson Lynn Marmer said. She said that pharmacists who refuse to sell the pill could ask another employee to sell Plan B and that a customer should never be sent to another store to purchase it (AP/International Herald Tribune, 3/21).


The letter is available online.

"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.

Efficacy Of HPV Vaccine Gardasil Among Women Previously Infected With HPV Lower Than Expected, Study Says

The efficacy of Merck's human papillomavirus vaccine Gardasil among women previously infected with the virus is lower than expected, according to a study published in the May 10 issue of the New England Journal of Medicine, the Los Angeles Times reports (Chong/Maugh, Los Angeles Times, 5/10).

Gardasil in previous clinical trials has been shown to be 100% effective in preventing infection with strains 16 and 18, which together cause about 70% of cervical cancer cases, and about 99% effective in preventing HPV strains 6 and 11, which together with strains 16 and 18 cause about 90% of genital wart cases, among women not already infected with these strains. FDA in June 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices later that month voted unanimously to recommend that girls ages 11 and 12 receive the vaccine, which is given in a three-shot series (Kaiser Daily Women's Health Policy Report, 5/1).

For the study, Laura Koutsky, an epidemiologist at the University of Washington, and colleagues studied 12,157 women between ages 15 and 26 (Los Angeles Times, 5/10). The participants were from 13 countries, Reuters reports (Emery, Reuters, 5/10). About 93% of the women enrolled in the study were not virgins when the study began, the USA Today reports (Rubin, USA Today, 5/10). Half of the women and girls were given Gardasil in the recommended three doses over six months and half were given a placebo, the Times reports. All the participants were followed for three years, during which time the researchers recorded any precancerous lesions that developed that had a high risk of progressing into cancer (Los Angeles Times, 5/10).

Before the women received Gardasil or the placebo, they were screened to see whether they had ever been infected by any of the four strains of HPV targeted by the vaccine. The researchers found that less than 1% of the women had been infected with all four strains but 27% had been infected with at least one of the strains (USA Today, 5/10).














The study -- funded by Merck -- found that Gardasil was 98% effective at preventing precancerous lesions of the cervix related to strains 16 and 18 among women previously uninfected with these two strains of the virus. The efficacy of the vaccine was 44% among women previously infected with HPV strains 16 and 18 and was 17% when all precancerous lesions caused by vaccine and nonvaccine types were taken into account, the study found (Carreyrou/Weinstein, Wall Street Journal, 5/10). According to the Times, the data indicate that the vaccine is not "living up" to its original prospects and that 129 women would have to be vaccinated to prevent one precancerous lesion (Los Angeles Times, 5/10).

In a related study, Suzanne Garland of the Royal Women's Hospital in Melbourne, Australia, and colleagues enrolled 5,455 women and girls ages 16 to 24 (Reuters, 5/10). The study found that Gardasil was 100% in preventing cancer, lesions and warts among women who had never been infected with the HPV strains targeted by the vaccine, and efficacy was 20% among women already infected with at least one of the strains (HealthDay News/Forbes, 5/9).

Comments
"It's important that women understand if they're sexually active, there's a chance they won't receive full benefit from the vaccine," Koutsky said (USA Today, 5/10). She added, "The overall message, in my mind, is that among susceptible young women, the vaccine was highly effective in preventing HPV [strains] 16 or 18 precancerous cervical lesions." W. Martin Kast -- an immunologist of the University of Southern California's Keck School of Medicine, who was not involved in the research -- said, "In a three-year follow-up, it is very hard to reach statistical significance in a disease process that takes about a decade to fully develop." He added, "Thus, it is not fair to state that the vaccine is not effective. It will be, but it needs more time to materialize."

Diane Harper of Dartmouth University, who helped design one of the studies, said she is still in favor of giving Gardasil to girls because it is safe and it "protects against the main HPV bad actors," but she said that "neither physicians nor women should be lulled into a false sense of security" by the vaccine. "I don't think this is the gun that is going to take cervical cancer off the map," Harper said (Los Angeles Times, 5/10).

NEJM Editorial, Comments
In an accompanying NEJM editorial, George Sawaya and Karen Smith-McCune, both of the University of California-San Francisco's Department of Obstetrics, Gynecology and Reproductive Sciences, write that the overall efficacy of Gardasil is "modest," adding that a "cautious approach ... may be warranted in light of important unanswered questions about overall vaccine effectiveness, duration of protection and adverse effects that may emerge over time." The authors write that one reason for the limited efficacy might be that other cancer-causing strains of HPV might fill "the biological niche left behind after the elimination of HPV types 16 and 18" (Wall Street Journal, 5/10). Douglas Lowy of the National Cancer Institute, who originally developed Gardasil, said that even if other types of HPV proliferate, there might not be a significant increase in cancers because the other strains are less carcinogenic (Los Angeles Times, 5/10).


The study led by Koutsky and the study led by Garland are available online.

Related NEJM Perspectives, Opinion Pieces
NEJM in the May 10 edition included several perspectives and opinion pieces. Headlines appear below.

"Politics, Parents, and Prophylaxis: Mandating HPV Vaccination in the United States" (Charo, NEJM, 5/10).

"Introducing HPV Vaccine in Developing Countries: Key Challenges and Issues" (Agosti/Goldie, NEJM, 5/10).

"Human Papillomavirus Vaccine: Opportunity and Challenge" (Baden et al., NEJM, 5/10).

"HPV Vaccination: More Answers, More Questions" (Sawaya/Smith-McCune, NEJM, 5/10).

"Human Papillomaviruses in Head and Neck Carcinomas" (Syrj?¤nen, NEJM, 5/10).

"Mandating HPV Vaccination: Private Rights, Public Good" (Stewart, NEJM, 5/10).

Broadcast Coverage

NBC's "Nightly News" on Wednesday included a discussion with Nancy Snyderman, NBC News chief medical editor, about the studies and other topics (Williams, "Nightly News," NBC, 5/9). Video of the segment is available online.


NPR's "All Things Considered" on Wednesday reported on the studies. The segment includes comments from Sawaya; Koutsky; and Connie Trimble, an ob-gyn and cervical cancer specialist at Johns Hopkins University (Neighmond, "All Things Considered," NPR, 5/9). Audio and a partial transcript of the segment are available online.

"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.



View drug information on Gardasil.

Senate Democrats Block Health Bill They Say Could Have Reduced Insurance Coverage Requirements, Including For Contraceptives

The U.S. Senate on Thursday voted 55-43 for cloture, which would have limited debate, on a proposed health insurance bill (S 1955) that some Democrats say could allow insurance companies to offer reduced coverage, including minimizing women's access to contraception, the AP/Forbes reports (Freking, AP/Forbes, 5/11). Wednesday's cloture vote fell five votes short of the 60 needed to move the measure forward, the Los Angeles Times reports (Alonso-Zaldivar, Los Angeles Times, 5/12). Under the bill, insurers would be permitted to sell plans that do not meet current state benefits requirements to businesses and individuals. However, they then also would have to offer a plan with benefits provided under a state employees' plan in one of the five most heavily populated states -- California, Florida, Illinois, New York and Texas. In addition, the bill would preempt state laws that limit how much insurers can vary premiums from one small business to another. Senate Minority Leader Harry Reid (D-Nev.) and Sen. Hillary Rodham Clinton (D-N.Y.) on Wednesday said the bill, sponsored by Senate Health, Education, Labor and Pensions Committee Chair Michael Enzi (R-Wyo.), could reduce women's access to contraceptives, subsequently leading to an increase in the number of abortions in many states (Kaiser Daily Women's Health Policy Report, 5/11). Two hundred advocacy groups, including the American Cancer Society, also said the health plan bill could exempt small businesses from covering other state-mandated benefits, including cancer screenings (Phillips, New York Times, 5/12). Enzi, after the vote, said he would work with Democrats to draft a compromise bill that could be introduced later this year. However, it is unlikely the measure would reappear after this week, supporters and opponents of the bill said (Los Angeles Times, 5/12).


"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.

Oral Contraceptive Yaz About as Effective as Antidepressants in Treating Premenstrual Dysphoric Disorder, Study Says

Yaz - an oral contraceptive made by the German pharmaceutical company... Schering -- is about as effective as antidepressants in treating symptoms of premenstrual dysphoric disorder, a severe form of premenstrual syndrome, according to a study scheduled to be published in the September issue of Obstetrics & Gynecology, AFX/Forbes reports. Kimberly Yonkers, an associate professor at the Yale University School of Medicine, and colleagues conducted a double-blind clinical trial involving 450 women with symptoms of PMDD at 64 U.S. medical centers. The researchers found that 48.8% of women taking Yaz showed improvement in symptoms, compared with 36.1% of women taking a placebo. Researchers said Yaz was about as effective at reducing PMDD symptoms as serotonin reuptake inhibitors, which are commonly used as antidepressants (AFX/Forbes, 8/31). However, Yaz might be more efficient than serotonin reuptake inhibitors for women seeking contraception in addition to control of PMDD because they would only have to take one treatment, Yonkers said (Yale release, 8/30). Yaz, which is a low-dose version of Schering's FDA-approved contraceptive pill Yasmin, contains ethinyl estradiol and drospirenone and is taken once a day for 24 days followed by four days of placebo to induce a menstrual period. Most oral contraceptives are taken for 21 consecutive days followed by seven days of placebos (Kaiser Daily Reproductive Health Report, 11/19/04). GlaxoSmithKline's Paxil, Pfizer's Zoloft, and Eli Lilly's Prozac and Sarafem -- all antidepressants -- are the only drugs approved by the FDA to treat PMDD (Fay Cortez, Bloomberg, 8/31). FDA in November 2004 sent an "approvable letter" to Schering subsidiary Berlex for Yaz. To receive FDA approval, Berlex must supply the agency with additional data to support the clinical benefit of the pill's dosing regimen (Kaiser Daily Reproductive Health Report, 11/19/04). NIH estimates that between 3% and 8% of women suffer from PMDD during their reproductive years (Bloomberg, 8/31).


"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.


View drug information on Estradiol Transdermal System; Paxil CR; Prozac Weekly.

Construction Of 'Artificial Ovary' To Develop Oocytes Into Mature Human Eggs

Researchers at Brown University and Women & Infants Hospital have invented the first artificial human ovary, an advance that provides a potentially powerful new means for conducting fertility research and could also yield infertility treatments for cancer patients. The team has already used the lab-grown organ to mature human eggs.



"An ovary is composed of three main cell types, and this is the first time that anyone has created a 3-D tissue structure with triple cell line," said Sandra Carson, professor of obstetrics and gynecology at the Warren Alpert Medical School of Brown University and director of the Division of Reproductive Endocrinology and Infertility at Women & Infants Hospital. Carson is a senior author of a recent article in the Journal of Assisted Reproduction and Genetics that describes the innovation.



Carson said that the ovary not only provides a living laboratory for investigating fundamental questions about how healthy ovaries work, but also can act as a testbed for seeing how problems, such as exposure to toxins or other chemicals, can disrupt egg maturation and health.



Clinically, the artificial ovary could play a role in preserving the fertility of women facing cancer treatment in the future, said Stephan Krotz, a Houston fertility doctor who is the paper's lead author and a former fellow in Carson's lab. Immature eggs could be salvaged and frozen before the onset of chemotherapy or radiation, he said, and then matured outside the patient in the artificial ovary.



Building an ovary



What makes the artificial ovary a functional tissue, rather than just a cell culture, is that it brings all three ovarian cell types into a 3-D arrangement similar to a real ovary in the body. The means for making such compositions of cells was invented in the lab of Jeffrey Morgan, associate professor of medical science and engineering, who is a co-author of the paper published online Aug. 25. His so-called 3D Petri dishes are made of a moldable agarose gel that provides a nurturing template to encourage cells to assemble into specific shapes.



To create the ovary, the researchers formed honeycombs of theca cells, one of two key types in the ovary, donated by reproductive-age (25-46) patients at the hospital. After the theca cells grew into the honeycomb shape, spherical clumps of donated granulosa cells were inserted into the holes of the honeycomb together with human egg cells, known as oocytes. In a couple days the theca cells enveloped the granulosa and eggs, mimicking a real ovary.



The big test, however, was whether the structure could function like an ovary - namely to mature eggs. In experiments the structure was able to nurture eggs from the "early antral follicle" stage to full maturity.



"[This] represents the first success in using 3-D tissue engineering principles for in vitro oocyte maturation," the researchers wrote in the journal article.



Carson said her goal was never to invent an artificial organ, per se, but merely to create a research environment in which she could study how theca and granulosa cells and oocytes interact. When she learned of Morgan's 3-D Petri dishes, they began to collaborate on creating an organ. Morgan said this is the first fully functional tissue to be made using the method.



To help fund the work, Morgan and Carson applied for and won a Collaborative Research Award from the Rhode Island Science and Technology Advisory Council (STAC). STAC grants encourage research with commercial potential. Morgan has recently founded a local Rhode Island startup, MicroTissues Inc. The company will begin selling these micro-mold tools in about a month to researchers looking to engineer 3-D tissues. Other funding came from Women & Infants Hospital.



With what appears to be a fully functional artificial organ, Carson and Morgan continue to collaborate and are now embarking on the studies she dreamed it would make possible. She's reluctant to predict what they'll turn up, however.



"This is really very, very new," she said.



The paper's other authors are Jared Robins, Toni-Marie Ferruccio, Richard Moore and Margaret Steinhoff, all of Brown University.



Source:

David Orenstein

Brown University

Low-income Hispanic Women Buy, Eat More Healthy Foods Than Low-Income Blacks, Whites, Study Finds

Low-income Hispanic women are more likely than their black and white counterparts to follow diets that are rich in fruits and vegetables, according to a study published in the Journal of the American Dietetic Association, Reuters Health reports. The study, led by researcher Sharon Hoerr, a professor of food science and nutrition at Michigan State University, looked at 603 low-income mothers who participate in Head Start programs in Alabama and Texas.

Researchers found that while diets among all women in the study tended to be low in important nutrients, Hispanic women in general consumed more fruits and vegetables than blacks and whites. Hispanic women consumed 4.6 cups of fruits and vegetables daily -- which health experts considered an adequate amount -- while black and white women consumed an average of two to three cups daily. Hispanic women also consumed a lower percentage of daily calories from fat.

According to Reuters, the Hispanic women likely followed a traditional Hispanic diet, which includes more beans, grains and produce than the typical U.S. diet.
Hoerr said that Hispanic women likely "prioritized" fruits and vegetables when they shopped and budgeted. She said the study "refutes the idea that it's impossible" to eat healthy foods on a small budget, adding that low-income families should be taught methods for securing low-cost nutritious food items, such as shopping at farmers' markets or choosing canned or frozen vegetables rather than fresh (Norton, Reuters Health, 5/1).


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. All rights reserved.

Widespread media coverage contributed to rapid fall in HRT prescribing, new study

The number of women prescribed Hormone Replacement Therapy (HRT) fell rapidly in the Netherlands after widespread media coverage of the UK's Million Women Study, according to research published in the December issue of the British Journal of Clinical Pharmacology.


However a study with similar findings, which received hardly any media attention in the country when it was published the previous year, had little impact on prescribing rates.


Researchers led by a team from the University of Groningen looked at dispensing data from women aged 45-69 who had received at least one prescription for HRT.


The research covered a total study population of 233,000 women over the four-year period between 2000 and 2003 - just over 58,000 a year.


They discovered that prescribing levels fell suddenly after August 2003 when the Million Women Study was published. By the end of that year HRT was being used by 8.7 per cent of women aged 45-69 compared with 10 per cent a year earlier.


Over the same period, new users fell by 29 per cent and the number of women who continued to use HRT fell by 42 per cent. However, the 2002 Women's Health Initiative Study failed to have the same impact in the Netherlands as the 2003 study. The researchers believe that this was partly due to the fact that the first study received little media coverage in the Netherlands - compared with other countries such as the UK and USA - while the second study was widely publicised in the Dutch medical and lay press.


Both studies reported that the risks of HRT outweighed the benefits. Cited problems included increased rates of breast cancer, coronary heart disease, stroke, dementia and venous thromboembolism. Advantages included decreased rates of hip fractures and colorterm HRT.


"There was a modest decline in HRT prescribing following the Women's Health Initiative study, which did not receive much media coverage in the Netherlands" says Professor Lolkje de Jong-van den Berg. "However, the publication of the Million Women's Study, which received considerable media coverage here, was followed by a sharp decline in HRT prescribing."


The authors also note that countries that did give widespread media coverage to the earlier Women's Health Initiative study, notably the USA and New Zealand, did report substantial reductions in HRT prescribing.


"We don't suggest that media coverage was the only factor affecting the reduction of HRT use in the Netherlands" says the Professor. "For example the Dutch associations of gynaecologists and general practitioners were prompt to issue guidelines that HRT should only be used for short durations in women with severe complaints.


"However the media coverage, which included the front pages of six national newspapers together with women's magazines and medical journals, definitely played a role in reducing the number of women using, and being prescribed, HRT.


"This pattern does seem to be borne out by studies carried out in other countries after widespread negative media coverage of HRT research."


- - Dramatic changes in prescribing of hormone replacement therapy in the Netherlands after publication of the Million Women Study: a follow-up study. Faber et al. Groningen University and Utrecht University. British Journal of Clinical Pharmacology. Volume 60.6, pages 641 - 647 (December 2005).


- - The British Journal of Clinical Pharmacology is published monthly on behalf of the British Pharmacological Society by Blackwell Publishing. It contains papers and reports on all aspects of drug action in humans: invited review articles, original papers, short communications and correspondence. The Journal, which was first published in 1974, enjoys a wide readership, bridging the gap between the medical profession, clinical research and the pharmaceutical industry.


British Journal of Clinical Pharmacology


SOURCE:
www.clara

Women In Government Commends FDA For Approving HPV Vaccine In Fight Against Cervical Cancer

Women In Government, a non-profit,
bi-partisan organization representing women state legislators, today
commended the U.S. Food and Drug Administration (FDA) for its approval of a
vaccine for the human papillomavirus (HPV), the virus that causes cervical
cancer. The FDA approved the vaccine, made by Merck and known as Gardasil,
for girls and women between the ages of 9 and 26, in order to help prevent
cervical cancer.


"The FDA's decision marks an historic milestone in the fight against
cervical cancer and should be celebrated by women and health advocates
around the world," said Susan Crosby, president of Women In Government.
"The availability of an HPV vaccine brings us one major step closer to our
goal of ensuring that no more women die of this preventable disease. For
the HPV vaccine to truly achieve its potential, however, it must be
available to all recommended age groups, regardless of their socioeconomic
status. We urge the federal Advisory Committee on Immunization Practices
(ACIP) to assist in this effort."


The ACIP is expected to issue recommendations on who should receive the
HPV vaccine and to determine if the vaccine will be included in the federal
government's Vaccines for Children Program, which provides free
immunization for under-insured and uninsured children. Their guidelines are
also frequently used as the basis for insurance coverage decisions, medical
guidelines and inclusion in other public health programs.


Gardasil has been shown in clinical trials to be 100 percent effective
in preventing infection with the two types of HPV (16 and 18) that are
responsible for approximately 70 percent of all cervical cancers. Clinical
data also showed the HPV vaccine to be effective in targeting HPV types 6
and 11, which can cause 90 percent of genital warts.


Ms. Crosby emphasized that, even with the availability of an HPV
vaccine, screening will still be important to target cervical cancer caused
by those HPV types not covered by the vaccine and to reach women who have
already been exposed to high-risk HPV. "The HPV vaccine should become a
part of comprehensive cervical cancer prevention programs that also use
advanced and medically appropriate screening methods, such as HPV testing,"
said Ms. Crosby.


Research shows that the Pap test's ability to detect cervical cancer or
its early signs ranges from 51 to 85 percent. The FDA recently approved a
new screening test for HPV, which, when used in conjunction with a Pap in
women age 30 and older, increases the accuracy of the Pap to almost 100
percent.


In 2004, Women In Government launched its "Challenge to Eliminate
Cervical Cancer Campaign," which mobilizes legislators to educate women
about cervical cancer and HPV and ensure that all age-appropriate females
have access to advanced and appropriate prevention technologies. To date,
45 states have introduced legislation or resolutions targeting cervical
cancer prevention and 39 states have enacted such measures.















About Cervical Cancer


Worldwide, cervical cancer is the second leading cancer-killer of
women, with almost a quarter-million deaths each year. In the United
States, the American Cancer Society estimates 9,710 women will be diagnosed
with and more than 3,700 women will die of cervical cancer. According to
the U.S. Centers for Disease Control and Prevention, approximately 20
million people are currently infected with HPV, with 6.2 million new
infections occurring annually and approximately 80 percent of sexually
active women will be infected with HPV by age 50. For 90 percent of
infected women, the virus is naturally cleared by the body and becomes
undetectable within two years. However, persistent infection with
"high-risk" types of HPV is the cause of cervical cancer.


About Women In Government


Women In Government is a national, 501(c)(3), non-profit, bi-partisan
organization of women state legislators providing leadership opportunities,
networking, expert forums and educational resources to address and resolve
complex public policy issues. For more information, visit
womeningovernment.



Women In Government

womeningovernment/


View drug information on Gardasil.

Women With Osteoporosis Suffer More If They Have Previously Broken A Bone, Say Scientists

Osteoporosis is more common in women who have fractured bones when they were younger - and they experience a similar loss in health-related quality of life as those with arthritis, lung disease, diabetes and other chronic diseases.


In an international study, led in the UK by scientists from the universities of Southampton and Cambridge, 60,000 women over the age of 55 were interviewed, 4079 of them British. The team found that 90 per cent of women with fractures suffered more mobility problems, pain, anxiety or depression.


Cyrus Cooper, professor of rheumatology at the Medical Research Council Lifecourse Epidemiology Unit, University of Southampton's Faculty of Medicine, comments: "Our study shows that the effects of fractures result in significant reductions in quality of life that are as lasting and as disabling as other chronic conditions. As important, the greater the number of fractures, the greater the disability. More needs to be done to more to identify and treat individuals at the highest risk of fractures."


Approximately 40 per cent of women over 50 will suffer a fracture; the most common sites are the hip, spine and wrist. These fractures often carry with them chronic pain, loss of independence, and especially in the case of hip fracture, an increased risk of death. Because the likelihood of fractures increases substantially with older age, fracture numbers are projected to rise as the population ages.


Using a standardized index measuring five dimensions of health (mobility, self-care, usual activities, pain or discomfort, and anxiety or depression), the study authors administered health surveys to compare the overall health status, physical function and vitality of participants and assess health-related quality of life. The study found that spine, hip and upper leg fractures resulted in the greatest decrease in quality of life.


Study Details


The study is from the Global Longitudinal Study of Osteoporosis in Women (GLOW), which is led by the University of Massachusetts Medical School. It was published online, 15 July 2010, in the Mayo Clinic Proceedings.


The lead author of the paper is Jonathan D. Adachi, the Alliance for Better Bone Health Chair in Rheumatology at St. Joseph's Healthcare and McMaster University in Ontario.


GLOW is a prospective, international cohort study of women 55 years of age and older who visited their primary care physician during the 2 years prior to enrolment in the study. More than 60,000 women were recruited by more than 700 primary care physicians in 17 cities in 10 countries (Australia, Belgium, Canada, France, Germany, Italy, Netherlands, Spain, United Kingdom and United States). In GLOW, information is being gathered on fracture risk factors, treatments, life style characteristics, and fracture outcomes over a 5 year period.


GLOW in Southampton


25,300 European women are participating in GLOW. Professor Cyrus Cooper, professor of rheumatology, MRC Lifecourse Epidemiology Unit, based at Southampton General Hospital and Professor Juliet Compston, professor of bone medicine and honorary consultant physician at the University of Cambridge, School of Clinical Medicine, both co authors of this article, collaborated to enrol 4079 women from the Southampton area. Of these participants, 21 per cent had a previous fracture.


Source: Southampton University

Global Problem Of Adherence To Osteoporosis Treatment Puts Lives At Risk And Costs Billions

A new report from the International Osteoporosis Foundation (IOF) details for the first time the global implications and significant personal, social and economic costs associated with women not staying on their osteoporosis treatment.



Approximately half of patients stop taking their weekly treatment within a year,1,2 leaving them open to a greater risk of broken bones and increasing the strain on financially-strapped healthcare systems. The report signals the launch of the IOF Staying Power: Closing the Adherence Gap in Osteoporosis campaign, which seeks to highlight the true burden of non-adherence.



Implications of not staying on treatment


Osteoporosis is a widespread disease affecting one woman in three and one man in five.3,4,5 It is treatable, yet lack of adherence to treatment is a huge problem in osteoporosis, with many patients finding it difficult to continue with medication for the recommended long-term period. This lack of adherence is important for people with osteoporosis, since fewer than one third of women who experience a fracture will regain their previous level of mobility and over a third will require constant care.6



It also has a significant financial impact since, in Europe alone, osteoporosis now costs more than ?4.8 billion a year in hospital healthcare7 - and unless the fracture rate is reduced these costs are likely to increase still further. In women over 45, osteoporosis accounts for more days spent in hospital than many other diseases, including diabetes, heart attack and breast cancer.8



European trends extend worldwide with huge economic cost


The Staying Power dossier builds on a 2005 IOF report, The Adherence Gap: Why Osteoporosis Patients Don't Continue with Treatment, which identified lack of adherence in five large European countries. The new report shows that the European pattern of non-adherence extends throughout the world.



-- By 2050 the worldwide cost burden is forecasted to increase to a minimum of ?106 billion (US$131.5 billion)9


-- Over half of Brazilian physicians questioned in a new survey, included in the dossier, estimated the annual cost of treating osteoporosis-related fractures to be in excess of ?81 million (US$100 million)10


-- In the UK the annual cost of osteoporotic fractures is between ?2.2 - ?2.6 billion (?1.5 - ?1.8 billion)11


-- In Spain 25,000 fractures occur each year, resulting in direct costs of more than ?126 million and indirect costs of ?420 million12


-- During 2001-2003, an estimated 2.39 million osteoporosis fractures occurred in the USA, resulting in government health insurance costs of ?10 billion (US$13 billion)13















-- In Australia, musculoskeletal disorders amount to an estimated total expenditure of ?1.8 billion (AUS $3 billion)14



Staying Power campaign launched


International film star Britt Ekland, who has osteoporosis, joined IOF representatives today in Vienna to launch the Staying Power campaign. This multi-dimensional campaign calls for women, doctors and patient groups around the world to work together in their efforts to help women stay on their treatment long-term and lessen the risk of unnecessary, debilitating broken bones.



Ms Ekland, known for her role in films such as Get Carter and the James Bond film The Man With the Golden Gun commented: "I have had osteoporosis for ten years and I urge all women with osteoporosis to seek advice from their doctor and local patient groups in order to understand what treatments are available and how best to stay on therapy."



Staying on treatment is recognised as a major problem in the management of many chronic diseases, including osteoporosis. Ms Ekland continued: "I am aware of the profound impact osteoporosis can have on everyday activities and, whilst I have been fortunate enough to continue leading an active life, many women are not so lucky. Staying on treatment could mean avoiding a life of decreased mobility, chronic pain, deformity and low self-esteem."



The issue of adherence is important because once a bone breaks, patients are significantly more likely to break another.15,16 With an ageing global population, the number of people suffering from osteoporosis is likely to increase in coming years, making it even more important to help patients get the bone strengthening benefits their treatment can only provide over time.



Professor Jean-Yves Reginster, Professor of Epidemiology, Public Health and Health Economics at the University of Liege, Belgium and IOF General Secretary said: "The social and economic costs of women not staying on their treatment simply cannot be sustained. Doctors, women and patient groups must all work together now to combat this situation. Ensuring osteoporosis treatments are more 'patient-friendly' is crucial and there are new options available, including less frequent dosing, which can help."



Paul Spencer Sochaczewski, Head of Communications for IOF echoed these thoughts: "The adherence issue needs to be addressed as a matter of urgency. Through the Staying Power campaign, IOF calls for action from people with osteoporosis, physicians, patient groups and government healthcare systems to address the worrying findings published in the report issued today. As a starting point, IOF will bring together its member patient groups later this year to discuss adherence, identify workable solutions and implement them as quickly as possible. We urge anyone involved in the field of osteoporosis to give this issue similar focus."



Osteoporosis, in which the bones become porous and break easily, is one of the world's most common and debilitating diseases. The result: pain, loss of movement, inability to perform daily chores, and in many cases, death. One out of three women over 50 will experience osteoporotic fractures, as will one out of five men. 3,4,5



Unfortunately, screening for people at risk is far from being a standard practice. Osteoporosis can, to a certain extent, be prevented, it can be easily diagnosed and effective treatments are available.



The International Osteoporosis Foundation (IOF) is the only worldwide organization dedicated to the fight against osteoporosis. It brings together scientists, physicians, patient societies and corporate partners. Working with its 170 member societies in 84 locations, and other healthcare-related organizations around the world, IOF encourages awareness and prevention, early detection and improved treatment of osteoporosis.



osteofound




REFERENCES



1. Cramer J, Amonkar MM, Hebborn A and Suppapanya N. Does dosing regimen impact persistence with bisphosphonate therapy among postmenopausal osteoporotic women? Journal Bone Mineral Research 2004; 19 Suppl 1: S448


2. Ettinger MP, Gallagher R, Amonkar M, Smith JC, and MacCosbe PE. Medication persistence is improved with less frequent dosing of bisphosphonates, but remains inadequate. Arthritis Rheum. 2004; 50 Suppl 1: S513


3. Melton LJ, Chrischilles EA, Cooper C, Lane AW and Riggs BL. Perspective. How many women have osteoporosis? Journal Bone and Mineral Research 1992; 7 (9): 1005-10


4. Melton LJ, Atkinson EJ, O'Connor MK, O'Fallon WM and Riggs BL. Bone density and fracture risk in men. Journal of Bone Mineral Research 1998; 13 (12): 1915-23


5. Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis International 2000; 11 (8): 669-74


6. Milne HW; International Osteoporosis Foundation (IOF) Committee of Scientific Advisors. Invest in your bones: make it or break it. How exercise helps to build and maintain strong bones, prevent falls and fractures, and speed rehabilitation. Osteoporosis Australia and International Osteoporosis Foundation. Sydney (Australia): 2005


7. Lips P; International Osteoporosis Foundation (IOF) Committee of Scientific Advisors. Invest in your bones: quality of life. Why prevent the first fracture? International Osteoporosis Foundation (IOF). Nyon (Switzerland): 2003


8. Kanis JA, Delmas P, Burckhardt P, Cooper C and Torgerson D; The European Foundation for Osteoporosis and Bone Disease. Guidelines for diagnosis and management of osteoporosis. Osteoporosis International 1997; 7: 390-406


9. Johnell O. The socioeconomic burden of fractures: today and in the 21st century. American Journal of Medicine 1997; 103(2A): 20S-25S


10. TCA Pesquisa e Assessoria de Marketing Ltda. Osteoporosis Project. April 2005. Sponsored by Roche


11. National Institute for Health and Clinical Excellence (NICE). Bisphosphonates (alendronate, etidronate, risedronate), selective oestrogen receptor modulators (raloxifene) and parathyroid hormone (teriparatide) for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. Technology Appraisal 87. London (UK): 2005


12. Gimeno A, Gua?abens N, Monegal A and Peris P. Consulta de... osteoporosis. Prous Science. Barcelona (Spain): 2005


13. King AB, Saag KG, Burge RT, Pisu M and Goel N. Fracture reduction affects Medicare economics (FRAME): impact of increased osteoporosis diagnosis and treatment. Osteoporosis International 2005; 16: 1545-1557


14. Access Economics Pty Ltd. The Burden of brittle bones: costing osteoporosis in Australia. Canberra (Australia): 2001


15. Nevitt MC, Ross PD, Palermo L, Musliner T, Genant K and Thompson DE; Fracture intervention trial research group. Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: Effect of number and spinal location of fractures. Bone 1999; 25 (5): 613-619


16. Johnell O, Oden A, Caulin F and Kanis JA. Acute and long-term increase in fracture risk after hospitalisation for vertebral fracture. Osteoporosis International 2001; 12: 207-214




The Staying Power report and related activities are supported by an unrestricted educational grant from Roche and GlaxoSmithKline (GSK).



There are many medically-proven treatments for osteoporosis. The International Osteoporosis Foundation (IOF) does not endorse or recommend any specific treatment. Such decisions must be made by the physician and patient.

Risk For Weight Gain In Children May Be Increased By Certain Behavioral Traits And Feeding Practices

Many clinicians and public health officials view parental involvement as an essential part of solving the current childhood obesity epidemic. However, it's important for parents to use the right approach when trying to combat childhood obesity. Restrictive feeding practices, or forbidding certain foods, may not always be the best solution. A child's inhibitory control, a behavior similar to self-control, may be more important than parental restrictions. An article and related editorial soon to be published in The Journal of Pediatrics, explore the relationship between a child's low inhibitory control, parental restrictive feeding practices, and childhood weight gain.



Stephanie Anzman, MS, and Leann Birch, PhD, of the Center for Childhood Obesity Research at Pennsylvania State University studied 197 non-Hispanic white girls. They collected information from the girls and their parents over a 10-year period, beginning when the girls were 5 years old. In addition to recording their body mass index (BMI), the researchers asked the girls whether their parents restricted or forbade certain foods. The researchers also recorded the parents' BMI, income, and education level. Additionally, mothers were asked to describe their child's level of self-control.



Anzman and Birch found that girls with lower self-control had higher BMIs and gained more weight than those girls who demonstrated better self-regulation. Girls with lower self-control were almost twice as likely to be overweight by the age of 15. The authors also noticed a relationship between a child's perception of parental restrictive feeding practices and weight gain. In other words, the combination of high parental restriction and low self-control put girls at the highest risk for weight gain among the group studied.



According to Ms. Anzman, "Parental attempts to help children with lower self-control by restricting their access to favorite snack foods can make the forbidden foods more attractive, thereby exacerbating the problem." She suggests that parents can help their children learn to control their eating habits by allowing them to choose between healthy options. She adds that it is often better to not keep restricted foods in the house. "That way," she explains, "it is not necessary to constantly tell children they cannot have the foods they want."



In a related editorial, Nancy F. Krebs, MD, MS, and Susan L. Johnson, PhD, of the University of Colorado point out that it is unclear how these findings might apply to boys because the researchers only studied girls. Drs. Krebs and Johnson view this as an opportunity for future studies to explore the relationship between low self-control, parental restrictions, and weight gain among a more diverse group of children and families. According to Dr. Krebs, "The implications of this study can be considered in both the clinical and public health arenas."



The study, reported in "Low Inhibitory Control and Restrictive Feeding Practices Predict Weight Outcomes" by Stephanie L. Anzman, MS, and Leann L. Birch, PhD, DOI: 10.1016/j.jpeds.2009.04.052 and related editorial, "Internal vs External Influences on Energy Intake: Are Disinhibited Eaters Born or Created?" by Susan L. Johnson, PhD, and Nancy F. Krebs, MD, MS, DOI: 10.1016/j.jpeds.2009.06.041 appear in The Journal of Pediatrics, published by Elsevier.



Source:
Brigid Huey


Elsevier Health Sciences

As HRT Drops Breast Cancer Drops

One year after millions of post-menopausal women in the United States stopped using Hormone Replacement Therapy (HRT) in 2002, the number of new breast cancer cases dropped by 7% nationwide. Researchers from The University of Texas M. D. Anderson Cancer Center believe the two are linked - that the incidence of breast cancer went down largely because so many older women stopped using HRT.


The investigators are reporting their findings at the 29th annual San Antonio Breast Cancer Symposium.


The researchers found that:


-- There was an overall 7% fall in breast cancer incidence in 2003, compared to 2002

-- There was a 12% fall in breast cancer incidence among women aged 50-69 in 2003, compared to 2002, specifically those diagnosed with estrogen receptor positive (ER-positive) breast cancer

-- 14,000 fewer women were diagnosed with breast cancer in 2003, compared to 2002


Researcher Peter Ravdin, M.D., Ph.D., said "It is the largest single drop in breast cancer incidence within a single year I am aware of. Something went right in 2003, and it seems that it was the decrease in the use of hormone therapy, but from the data we used we can only indirectly infer that is the case. But if it is true, the tumor growth effect of stopping use of HRT is very dramatic over a short period of time, making the difference between whether a tumor is detected on a mammogram in 2003 or not."


Lead researcher, Donald Perry, Ph.D., said he and his team were surprised at how big the drop was and how soon it happened. He said "Incidence of breast cancer had been increasing in the 20 or so years prior to July 2002, and this increase was over and above the known role of screening mammography. HRT had been proposed as a possible factor, although the magnitude of any HRT effect was not known. Now the possibility that the effect is much greater than originally thought all along is plausible, and that is a remarkable finding."


A large study of 16,608 women, the Women's Health Initiative study, was abruptly stopped in July 2002 when it was found that older women using HRT (estrogen and progestin combination) had a significantly higher risk of developing invasive breast cancer. About one third of women over 50 in the USA had been taking HRT before the study.


Ravdin said "Research has shown that ER-positive tumors will stop growing if they are deprived of the hormones, so it is possible that a significant decrease in breast cancer can be seen if so many women stopped using HRT."


Perry said "It takes breast cancer a long time to develop, but here we are primarily talking about existing cancers that are fueled by hormones and that slow or stop their growing when a source of fuel is cut. These existing cancers are then more likely to make it under mammography's radar."


The researchers have cautioned that as their study is based purely on population statistics, they cannot be completely sure why the numbers have dropped.


The National Cancer Institute and M.D. Anderson funded the study.


mdanderson

Young Women Often Subject To Controlling Behavior Linked To Violence, Study Finds

More than two-thirds of young women surveyed at a New York City reproductive health center reported they had been subjected to controlling behavior by romantic partners, and such behavior appears associated with increased risk of sexual or physical relationship violence.


The findings, from a survey of 603 women aged 15 to 24 years, are reported by a team of researchers from Columbia and Indiana universities in the April 2011 issue of the Archives of Pediatrics & Adolescent Medicine.


"To my knowledge, this is the first study that's documented that not only do these women report being monitored or controlled by their partners, there's also a direct relationship between being controlled or monitored by a partner and physical as well as sexual victimization," said Vaughn I. Rickert, Psy.D., director of the Section of Adolescent Medicine at IU School of Medicine and senior author of this study.


Controlling behaviors included such acts as always wanting to know where the young woman was, suspicions of infidelity and attempting to keep her from seeing friends or family.


Of the women who had been subjected to such behavior, nearly 45 percent also reported being subjected to physical aggression, sexual aggression or both.


The study, authored by Marina Catallozzi, M.D., assistant professor of clinical population and family health at the Mailman School of Public Health at Columbia University, also found that young women who had been subjected to controlling behavior were more reluctant to report violence in their relationships, and were more likely to be unsure whether they would be able to answer such questions honestly if they were asked about it by a health care provider.


While many experts recommend that efforts to screen for relationship violence should include teenage girls, these findings suggest that the screenings must be done with care to elicit candid responses. Moreover, multiple screenings may be necessary because girls appear more likely to answer honestly as they get older, said Dr. Rickert, Donald Orr M.D. Professor of Adolescent Medicine and professor of pediatrics at IU.


Funding for the research was provided by Centers for Disease Control and Prevention.


Source:

IU School of Medicine

Ultrasonography Capable Of Detecting Endometrial Cancer Before Symptoms Are Evident In Postmenopausal Women

Transvaginal ultrasound screening (TVS) has good (80-90%) sensitivity and specificity at detecting endometrial cancer before symptoms appear in postmenopausal women, according to the first large-scale study to assess the performance of TVS screening for endometrial cancer. However, the findings published Online First in The Lancet Oncology, report that further studies to examine acceptability, health economics, and risk are needed before routine population screening or targeted screening for endometrial cancer can be advocated.


Endometrial cancer is the most common gynaecological cancer. But because of the good prognosis of patients with endometrial cancer compared with other cancers, few studies have been done to assess the benefits of screening in asymptomatic women (without bleeding). However, increasing obesity, falling fertility, and an aging population suggest that incidence will continue to rise.


To date, no screening test to detect early stage endometrial cancer in asymptomatic women has been shown to be effective. Measuring endometrial thickness with TVS (a technique commonly used to assess symptomatic women with abnormal vaginal bleeding) has been suggested as a possible screening method.


To investigate the performance of TVS screening on a large scale, a team led by Ian Jacobs from University College, London, UK, analysed data from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). As part of the trial, TVS was performed on 37 038 postmenopausal women.


The researchers calculated the performance characteristics of endometrial thickness (ET) and endometrial abnormalities at detecting endometrial cancer within 1 year of TVS screening, and examined the sensitivity and specificity of TVS for different risk groups. Modelling using epidemiological variables was done to assess a screening strategy for women at higher risk.


In the 133 women diagnosed with endometrial cancer or atypical endometrial hyperplasia (AEH) within 1 year of screening, 107 (81%) had an ET of 5mm or greater. Most of the 36 731 women who did not have cancer had an ET of less than 5mm.


At the optimum ET cutoff of 5.15mm, TVS would detect 80.5% of cancer cases (sensitivity) and would have a 14.3% false-positive rate (85.7% specificity). Using this threshold, if the entire population were screened, one case of endometrial cancer would be detected for every 47.7 women.


The authors point out that although the number of false positives could be reduced substantially by increasing the cutoff for ET, this would result in a corresponding fall in sensitivity. An increased cutoff of 10mm would detect 54.1% of cancer cases with 97.2% specificity, and 17 women would undergo further procedures to detect each case of endometrial cancer.


When the analysis was restricted to the 96 women with cancer who reported no symptoms of postmenopausal bleeding at the scan, an ET cutoff of 5mm was able to detect 77.1% of women who developed cancer with a 14.2% false-positive rate.















Additionally, the modelling analysis identified 25% of the population as at high risk, and this high risk group included 40% of endometrial cancer or AEH cases. In this group, the optimum ET cutoff of 6.75mm would detect 84.3% of cancer cases and achieve a specificity of 89.9%. According to the researchers, "this would reduce the burden of screening to 25% of the population with detection of about 40% of the cases."


The authors say: "A targeted screening approach might help reduce the overall number of false-positive findings while maintaining a high sensitivity."


They conclude: "Although the role of population screening for endometrial cancer remains uncertain, the findings are of immediate value in the management of increased endometrial thickness in postmenopausal women undergoing pelvic scans for reasons other than vaginal bleeding...Our findings provide the basis for further studies to assess the acceptability, health economics, and risk stratification."


In a Comment, Ignace Vergote and colleagues from University Hospitals Leuven, Leuven, Belgium caution that the findings do not prove "a benefit for screening for endometrial cancer because of an absence of survival data."


They add: "The study...provides important ultrasonographic endometrial findings in asymptomatic postmenopausal women, but screening for endometrial cancer with ultrasonography has not been sufficiently proven to be beneficial because of the high cost, the prevalence of cancers that are not clinically relevant or hyperplasia, the number of unnecessary surgical interventions and associated morbidity, the presence of clinically detected symptoms such as bleeding that happen at an early stage in many women with endometrial cancer, and the absence of prospective randomised trial data that show a survival benefit in screened patients."


Click here to view Article and Comment

Source:

The Lancet Oncology