ISLAMABAD: Women who have had an episode of depression have increased odds of having "metabolic syndrome" -- a cluster of conditions such as abdominal obesity, high blood pressure, elevated blood sugar and unhealthy cholesterol levels, that set the stage for type 2 diabetes, heart disease and stroke.
These findings, reported the journal Psychosomatic Medicine, may help explain why depression has long been linked to heart disease and other cardiovascular ills, the researchers write.
"Depressed individuals are more likely to engage in unhealthy behaviors, such as smoking, eating an unhealthy diet, leading a sedentary lifestyle, and being noncompliant with medical treatment," which may increase their risk of developing metabolic syndrome, says Dr. Leslie S. Kinder.
Kinder added that depression may also be linked to body changes that predispose people to metabolic syndrome and, consequently, cardiovascular disease.
"Women with depression should be aware that they may be especially vulnerable to medical problems, and therefore they should make special efforts to attend to their physical as well as their psychological health - through appropriate treatment and preventative therapies," noted the researcher, who is based at Stanford University School of Medicine in California.
To investigate whether depression’s link to heart troubles stems from its effect on metabolic syndrome risk, Kinder and colleagues reviewed health data collected from 6189 men and women between the ages of 17 and 39 between 1988 and 1994. All participants were free of heart disease and diabetes.
The investigators found that women who had experienced an episode of major depression were twice as likely to have metabolic syndrome as women with no history of depression.
Women who were depressed were particularly likely to have high blood pressure and a high level of blood fats.
The relationship between depression and metabolic syndrome persisted even after the investigators removed the influence of smoking, age, physical activity and other factors that could affect the results.
The investigators found no such relationship in men, however, a finding they cannot yet explain, Kinder said.
The researcher noted that these results suggest that clinicians should be especially attentive when treating women with a history of depression.
"Clinicians should be aware that depression is a important concern among women with the metabolic syndrome," Kinder noted.
source : paktribune.com
Showing posts with label Obstetric. Show all posts
Showing posts with label Obstetric. Show all posts
Monday, July 9, 2007
Low testosterone levels in post-menopausal women associated with heart disease
Post-menopausal women with lower levels of testosterone are more likely to suffer from heart disease. Research, published in the June edition of the European Journal of Endocrinology, shows that higher testosterone levels in post-menopausal women may have a protective effect against cardiovascular disease.
Researchers led by Dr Erik Debing at the Free University of Brussels in Belgium examined the levels of sex hormones in natural post-menopausal women (i.e. those not taking hormone replacement therapy) and their association with the presence of atherosclerosis. Atherosclerosis is a condition where the arteries become hardened and blocked by the deposition of substances such as cholesterol. It is commonly seen as a precursor to heart disease. The research team examined 56 post-menopausal women who had atherosclerosis of the carotid artery (the artery that supplies blood to the head and neck) and compared the levels of sex hormones in their blood with 56 age-matched controls.
While they found no significant difference between the levels of other sex hormones, women with atherosclerosis had significantly lower testosterone levels than women who were free from the disease (0.23?0.12 vs. 0.31?0.20 µg/l). Even after the researchers had controlled for other risk factors associated with heart disease (such as diet, high blood pressure, smoking and diabetes), the relationship between low testosterone levels and atherosclerosis remained strong.
Although the hormone testosterone is usually associated with men, women also produce some testosterone, mainly from their ovaries and adrenal glands. Testosterone performs many essential functions in the bodies of both men and women including maintaining muscle strength and bone density. While statistics show that the risk of heart disease increases in post-menopausal compared to pre-menopausal women, the reasons for this have remained unclear.
Traditionally seen as a male disease, heart disease is now one of the leading causes of death in post-menopausal women in Europe. This is the first time that a case-control study has been carried out, directly comparing the levels of sex hormones in post-menopausal women with and without atherosclerosis of the carotid artery. Further work is now required to enhance our understanding of the mechanisms behind this relationship and the implications for health provision.
Researcher Dr Erik Debing said:
"This is the first time that a case-control study has found that post-menopausal women with athlerosclerosis have lower testosterone levels. Athlerosclerosis is the main precursor to heart disease, one of the major causes of death in post-menopausal women. Our work suggests that higher levels of testosterone may have a protective role against atherosclerosis in women who have undergone the menopause.
This research represents an important step forward in our understanding of the causes of atherosclerosis and will allow us to develop more effective treatments and advice. We now need to carry out further research to examine why low testosterone levels in post-menopausal women may predispose them to develop cardiovascular disease."
source : www.news-medical.net
Researchers led by Dr Erik Debing at the Free University of Brussels in Belgium examined the levels of sex hormones in natural post-menopausal women (i.e. those not taking hormone replacement therapy) and their association with the presence of atherosclerosis. Atherosclerosis is a condition where the arteries become hardened and blocked by the deposition of substances such as cholesterol. It is commonly seen as a precursor to heart disease. The research team examined 56 post-menopausal women who had atherosclerosis of the carotid artery (the artery that supplies blood to the head and neck) and compared the levels of sex hormones in their blood with 56 age-matched controls.
While they found no significant difference between the levels of other sex hormones, women with atherosclerosis had significantly lower testosterone levels than women who were free from the disease (0.23?0.12 vs. 0.31?0.20 µg/l). Even after the researchers had controlled for other risk factors associated with heart disease (such as diet, high blood pressure, smoking and diabetes), the relationship between low testosterone levels and atherosclerosis remained strong.
Although the hormone testosterone is usually associated with men, women also produce some testosterone, mainly from their ovaries and adrenal glands. Testosterone performs many essential functions in the bodies of both men and women including maintaining muscle strength and bone density. While statistics show that the risk of heart disease increases in post-menopausal compared to pre-menopausal women, the reasons for this have remained unclear.
Traditionally seen as a male disease, heart disease is now one of the leading causes of death in post-menopausal women in Europe. This is the first time that a case-control study has been carried out, directly comparing the levels of sex hormones in post-menopausal women with and without atherosclerosis of the carotid artery. Further work is now required to enhance our understanding of the mechanisms behind this relationship and the implications for health provision.
Researcher Dr Erik Debing said:
"This is the first time that a case-control study has found that post-menopausal women with athlerosclerosis have lower testosterone levels. Athlerosclerosis is the main precursor to heart disease, one of the major causes of death in post-menopausal women. Our work suggests that higher levels of testosterone may have a protective role against atherosclerosis in women who have undergone the menopause.
This research represents an important step forward in our understanding of the causes of atherosclerosis and will allow us to develop more effective treatments and advice. We now need to carry out further research to examine why low testosterone levels in post-menopausal women may predispose them to develop cardiovascular disease."
source : www.news-medical.net
Breast Cancers Is More Aggressive In African-American Women, Study Shows
Breast Cancers Is More Aggressive In African-American Women, Study Shows
Science Daily — A study of more than 2,200 women at the Kimmel Cancer Center at Jefferson in Philadelphia shows that African American women have more advanced breast cancer at the time of diagnosis than Caucasian women. In addition, African American women tend to have breast cancer tumor types that are more aggressive and have poorer prognoses. The findings, the researchers say, are in line with other recent studies and provide more powerful evidence of the continuing need for early breast cancer screening for African American women and the development of individual treatment strategies.
The research was led by Edith P. Mitchell, M.D., clinical professor of medicine and medical oncology at Jefferson Medical College of Thomas Jefferson University and Gloria Morris, M.D., Ph.D., assistant professor of medical oncology at Jefferson Medical College. They compared clinical, molecular and demographic data from 2,230 African American and Caucasian women diagnosed with breast cancer at Thomas Jefferson University Hospital between 1995 and 2002 with similar data on slightly more than 197,000 women in the National Cancer Institute's Surveillance, Epidemiology and End Results database.
Reporting online July 9, 2007 in the journal Cancer, Drs. Mitchell and Morris and their co-workers found that in both databases, African Americans are more likely to have later stage and higher grade tumors at diagnosis, meaning more aggressive and invasive disease, than their Caucasian counterparts. In addition, the breast cancer tumors from African American women had characteristics that predicted worse prognoses and poorer outcomes.
When all stages of breast cancer in the Jefferson patients were analyzed, the results showed that African American women had tumors that were more often estrogen-receptor negative (48 percent versus 37 percent), had higher rates of expression of the growth-promoting gene Ki-67 and higher expression of a tumor inhibiting gene, p53. A more aggressive type of tumor, called the "triple negative," was found in 21 percent of African American women versus 10 percent of Caucasians.
"We know that there is high cell turnover and propensity for p53, a tumor suppressor gene, to be abnormal, in addition to these 'triple negative' features in the African American tumors, making them more aggressive and more likely to metastasize," Dr. Morris says. "These are preliminary data that enable us to plan how we want to pursue further gene studies."
The triple negative status of a tumor is particularly important, affecting the use of well known cancer drugs, notes Dr. Mitchell, who is also associate director of diversity programs at the Kimmel Cancer Center at Jefferson. Such tumors lack estrogen and progesterone receptors, resulting in a lack of effectiveness of the commonly used breast cancer drug tamoxifen. The tumors also lack the HER2-neu receptor protein, rendering the drug Herceptin ineffective as well.
While African American women have been found to have a lower incidence of breast cancer than Caucasian women, African American women die from the disease at a higher rate. The gap between death rates among African American and Caucasian women is increasing. Though access to healthcare is a strong factor contributing to disparities in cancer rates and outcomes between African Americans and Caucasians, says Dr. Mitchell, the Jefferson study and others have shown that biological differences play important roles.
"Our goal is to develop individualized treatment strategies for women with breast cancer and to also increase awareness, particularly in women in populations with poor access to health care and who are at risk for aggressive breast cancers," says Dr. Morris. "In the future, we'd like to be able to intervene in a more specific way with a more targeted therapy to reduce the risk of the cancer returning, and improve survival."
"We would like to explore future research that will enhance our knowledge and allow better understanding of these biological differences, and devise better treatment plans that could potentially be effective," says Dr. Mitchell.
Because the findings are similar to those in the federal database, says Dr. Morris, "This meant that they were representative nationally and that we could use this registry for future questions and it would reflect national trends."
They also provide some direction for therapy, Dr. Morris says, enabling physicians to better plan specific treatments for particular breast tumor types. "We want to be able to answer the question, is there something that is going to work better in this more aggressive tumor type?"
The overall goal, she notes, is to find new therapeutic targets. To that end, Drs. Morris, Mitchell and their colleagues want to use microarray technology to examine the more aggressive tumor types in African American women and compare them to tumors in Caucasian women to try to sort out differences at the molecular level.
Science Daily — A study of more than 2,200 women at the Kimmel Cancer Center at Jefferson in Philadelphia shows that African American women have more advanced breast cancer at the time of diagnosis than Caucasian women. In addition, African American women tend to have breast cancer tumor types that are more aggressive and have poorer prognoses. The findings, the researchers say, are in line with other recent studies and provide more powerful evidence of the continuing need for early breast cancer screening for African American women and the development of individual treatment strategies.
The research was led by Edith P. Mitchell, M.D., clinical professor of medicine and medical oncology at Jefferson Medical College of Thomas Jefferson University and Gloria Morris, M.D., Ph.D., assistant professor of medical oncology at Jefferson Medical College. They compared clinical, molecular and demographic data from 2,230 African American and Caucasian women diagnosed with breast cancer at Thomas Jefferson University Hospital between 1995 and 2002 with similar data on slightly more than 197,000 women in the National Cancer Institute's Surveillance, Epidemiology and End Results database.
Reporting online July 9, 2007 in the journal Cancer, Drs. Mitchell and Morris and their co-workers found that in both databases, African Americans are more likely to have later stage and higher grade tumors at diagnosis, meaning more aggressive and invasive disease, than their Caucasian counterparts. In addition, the breast cancer tumors from African American women had characteristics that predicted worse prognoses and poorer outcomes.
When all stages of breast cancer in the Jefferson patients were analyzed, the results showed that African American women had tumors that were more often estrogen-receptor negative (48 percent versus 37 percent), had higher rates of expression of the growth-promoting gene Ki-67 and higher expression of a tumor inhibiting gene, p53. A more aggressive type of tumor, called the "triple negative," was found in 21 percent of African American women versus 10 percent of Caucasians.
"We know that there is high cell turnover and propensity for p53, a tumor suppressor gene, to be abnormal, in addition to these 'triple negative' features in the African American tumors, making them more aggressive and more likely to metastasize," Dr. Morris says. "These are preliminary data that enable us to plan how we want to pursue further gene studies."
The triple negative status of a tumor is particularly important, affecting the use of well known cancer drugs, notes Dr. Mitchell, who is also associate director of diversity programs at the Kimmel Cancer Center at Jefferson. Such tumors lack estrogen and progesterone receptors, resulting in a lack of effectiveness of the commonly used breast cancer drug tamoxifen. The tumors also lack the HER2-neu receptor protein, rendering the drug Herceptin ineffective as well.
While African American women have been found to have a lower incidence of breast cancer than Caucasian women, African American women die from the disease at a higher rate. The gap between death rates among African American and Caucasian women is increasing. Though access to healthcare is a strong factor contributing to disparities in cancer rates and outcomes between African Americans and Caucasians, says Dr. Mitchell, the Jefferson study and others have shown that biological differences play important roles.
"Our goal is to develop individualized treatment strategies for women with breast cancer and to also increase awareness, particularly in women in populations with poor access to health care and who are at risk for aggressive breast cancers," says Dr. Morris. "In the future, we'd like to be able to intervene in a more specific way with a more targeted therapy to reduce the risk of the cancer returning, and improve survival."
"We would like to explore future research that will enhance our knowledge and allow better understanding of these biological differences, and devise better treatment plans that could potentially be effective," says Dr. Mitchell.
Because the findings are similar to those in the federal database, says Dr. Morris, "This meant that they were representative nationally and that we could use this registry for future questions and it would reflect national trends."
They also provide some direction for therapy, Dr. Morris says, enabling physicians to better plan specific treatments for particular breast tumor types. "We want to be able to answer the question, is there something that is going to work better in this more aggressive tumor type?"
The overall goal, she notes, is to find new therapeutic targets. To that end, Drs. Morris, Mitchell and their colleagues want to use microarray technology to examine the more aggressive tumor types in African American women and compare them to tumors in Caucasian women to try to sort out differences at the molecular level.
How NIH Misread Hormone Study in 2002
On July 9, 2002, federal government health officials announced that they had halted a major study of menopause hormones, saying the drugs increased a woman's risk of heart attack by 29%.
But in the five years since, it's become clear that some aspects of what was initially reported from the $725 million Women's Health Initiative study were either misleading or just wrong. Although the government initially said the findings applied to all women, regardless of age or health status, additional data published in recent months show that the age of a woman and the timing of hormone use dramatically changes the risk and benefits. WHI data published in April in the Journal of the American Medical Association showed that women in their 50s who took a combination of estrogen and progestin or estrogen alone had a 30% lower risk of dying than women who didn't take hormones.
Last month, the New England Journal of Medicine reported that 50-59-year-old women in the WHI who regularly used estrogen alone showed a 60% lower risk for severe coronary artery calcium, an important risk factor for heart attack.
How could the heart risks of menopause hormones for this crucial cohort change so dramatically in just five years? Officials from the National Institutes of Health, which directed the study of more than 27,000 women, say the interpretation of the WHI has simply evolved as researchers have used different methods to analyze the voluminous body of data.
The average age of women in the study was 63. While older women in the study did show a heart risk, researchers eventually focused on women in their 50s who were closer to menopause, finding that hormones were more likely to protect those women's hearts than harm them.
But critics including some of the WHI's own investigators, speaking out for the first time, say that NIH officials initially overgeneralized in large part because they excluded many of the study's own investigators and physicians from the first review. As a result, key questions that could have clarified the data far sooner weren't asked.
Just 11 days before the public announcement in July 2002, the WHI's 40 investigators met in Chicago, where they were told the study had been stopped early. Several people who attended the meeting say several WHI researchers were stunned and angry when they were given final page proofs of the study report for the Journal of the American Medical Association. Although some researchers expressed concern that the results were too broadly interpreted, it was too late to make meaningful changes to the JAMA article. Many investigators who had spent nearly a decade working on the WHI had no input in the final and most important paper.
"I think that had the initial report been written by a broader group, as almost all of our later papers have been, it would have been framed differently," says Robert D. Langer, the former principal investigator for the WHI's clinical center at University of California, San Diego, who was among those who protested at the time. He has since served as an expert witness for hormone maker Wyeth. Dr. Langer says he remains concerned that the interpretation of the WHI has unnecessarily scared a generation of women from the treatment.
Jacques Rossouw, a physician with the National Heart Lung and Blood Institute who has overseen the WHI since its inception, confirms that some investigators were upset that they weren't included in writing the first WHI report. "That was an NIH decision supported by the WHI executive committee to keep it to a small group because we realized it was a sensitive paper," he says.
Still, he defends the government's handling of the study results "based on what we knew at the time," and says that study officials wanted to make a dramatic statement. "Our main job at the time was to turn around the prevailing notion that hormones would be useful for long-term prevention of heart disease," he says. "That was our objective. That was a worthy objective which we achieved."
But many in the medical community disagree, saying key questions about long-term use still aren't answered. Although the WHI data clearly show that starting hormones at an older age is risky, what's not clear is whether the heart protection women get starting at a younger age will continue with long-term use.
That was the question that the WHI was supposed to answer when it was launched in 1991 after data from an ongoing trial of nurses showed that women who used menopause hormones have as much as a 50% lower risk of heart attack. But the WHI designers didn't take into account that the timing of hormone use might affect the results and recruited mostly older, symptom-free women. Some of the study participants were already 20 years past menopause when the WHI began.
[chart]
Since mostly older women were recruited, there weren't enough recently menopausal women under 60 to generate conclusive data in some of the findings. But the trends were provocative. Among recently menopausal women who used estrogen and progestin, heart attack risk fell 11%. By comparison, women who started taking hormones 10 or more years past menopause had a 22% to 71% higher risk of heart problems.
In a second part of the study, in which women who had undergone hysterectomy took estrogen without progestin, women who started hormones after the age of 70 had an 11% higher risk of heart problems. But women below 60 in the estrogen-only study had a 37% lower heart risk.
In a bid to draw a more definitive conclusion, the WHI in April 2007 published a report in JAMA combining the data from both hormone trials. That paper showed that the timing of hormone use matters: Younger women appear to receive heart protection, while older women are at risk.
"We now have a refined understanding of the benefits and risks of hormone therapy, and there has been so much reassuring evidence for younger women over the last few years," says Harvard professor and WHI investigator JoAnn Manson, who has no ties to drug firms.
Despite the recent data, questions about long-term use of hormones are far from resolved. While most people now agree that hormones are a reasonable option for women to treat menopause symptoms like hot flashes, the bigger question is whether hormones should be considered in the armamentarium of drugs used for heart protection, along with blood pressure medications and cholesterol-lowering drugs called statins.
The National Heart, Lung and Blood Institute, which oversaw the WHI, firmly believes that menopause hormones shouldn't be used to prevent heart disease because of potential risk of blood clot, stroke and breast cancer.
Indeed, the WHI showed that hormones have a range of risks and benefits. On the plus side, they may protect younger women's hearts, they definitely protect against hip fractures, they lower the risk for diabetes and may lower the risk for colon cancer.
On the other hand, menopause hormones do increase the risk for blood clots and stroke. Women in the WHI who used both estrogen and progestin were at 24% higher risk for breast cancer. But women who regularly use estrogen without progestin had a 33% lower risk of breast cancer.
"Hormone therapy long term has these other adverse events hanging around. It doesn't fit the paradigm of what you are looking for in a viable long-term prevention strategy," says Dr. Rossouw. "If you're going to use something to prevent atherosclerosis, your choice is statins, not hormones."
The data on women who use statins are mixed, but suggest that they lower a woman's heart risk by 15% to 20%. Statins carry their own risks, including liver effects, muscle pain, memory problems and in rare cases a life-threatening muscle disease call rhabdomyolysis. There are no studies showing the risks and benefits of long-term use of statins.
Many doctors now believe that for younger women without a uterus, estrogen should be an option for long-term prevention of heart disease. (The progestin is added to protect against uterine cancer.)
"If this is preventing heart disease and saving lives, I think it's really wrong not to consider it," says Yale associate professor Hugh Taylor, a principal investigator for the Kronos Early Estrogen and Prevention Study, a study of estrogen and heart disease funded by Arizona billionaire John Sperling, an education entrepreneur who was upset with the way the WHI study was initially interpreted. "Some of the other drugs we use for cardiovascular disease don't have the evidence that we have for hormone therapy."
Two important ongoing studies will further illuminate the role estrogen plays in heart disease. The KEEPS study is recruiting 720 women, ages 42 to 58, to study the effects of oral or transdermal estrogen as well as progesterone on the coronary arteries of healthy women. An NIH-funded Early Versus Late Intervention Trial will study 500 women and the effects of hormone therapy given within six years of menopause compared to treatment given 10 or more years after menopause. Both studies will also test whether using natural progesterone, instead of the synthetic progestin used in the WHI, lowers or eliminates the risk of breast cancer associated with combination therapy.
Even though the long-term heart issue is unresolved, some critics say the NIH's handling of the WHI data scared away younger women who might want to use hormones for menopause symptoms. "We've gone to considerable efforts to reassure women and gynecologists that it's okay [to use hormones] in the short term," to treat the symptoms of menopause, Dr. Rossouw says.
Still, since the WHI results were announced in 2002, hormone sales have plummeted 30% to $1.9 billion, according to IMS Health, a health-care information company.
"I don't think it's fair to extrapolate from the data that women should be put on this as a preventative treatment for heart disease," says Michael E. Mendelsohn, a Tufts University professor who recently wrote an NEJM editorial about estrogen and heart disease. "What the data do support is that women who use hormones to treat menopause symptoms can feel reassured that they are not increasing their cardiovascular risk and may be providing some long-term benefit."
source : online.wsj.com
But in the five years since, it's become clear that some aspects of what was initially reported from the $725 million Women's Health Initiative study were either misleading or just wrong. Although the government initially said the findings applied to all women, regardless of age or health status, additional data published in recent months show that the age of a woman and the timing of hormone use dramatically changes the risk and benefits. WHI data published in April in the Journal of the American Medical Association showed that women in their 50s who took a combination of estrogen and progestin or estrogen alone had a 30% lower risk of dying than women who didn't take hormones.
Last month, the New England Journal of Medicine reported that 50-59-year-old women in the WHI who regularly used estrogen alone showed a 60% lower risk for severe coronary artery calcium, an important risk factor for heart attack.
How could the heart risks of menopause hormones for this crucial cohort change so dramatically in just five years? Officials from the National Institutes of Health, which directed the study of more than 27,000 women, say the interpretation of the WHI has simply evolved as researchers have used different methods to analyze the voluminous body of data.
The average age of women in the study was 63. While older women in the study did show a heart risk, researchers eventually focused on women in their 50s who were closer to menopause, finding that hormones were more likely to protect those women's hearts than harm them.
But critics including some of the WHI's own investigators, speaking out for the first time, say that NIH officials initially overgeneralized in large part because they excluded many of the study's own investigators and physicians from the first review. As a result, key questions that could have clarified the data far sooner weren't asked.
Just 11 days before the public announcement in July 2002, the WHI's 40 investigators met in Chicago, where they were told the study had been stopped early. Several people who attended the meeting say several WHI researchers were stunned and angry when they were given final page proofs of the study report for the Journal of the American Medical Association. Although some researchers expressed concern that the results were too broadly interpreted, it was too late to make meaningful changes to the JAMA article. Many investigators who had spent nearly a decade working on the WHI had no input in the final and most important paper.
"I think that had the initial report been written by a broader group, as almost all of our later papers have been, it would have been framed differently," says Robert D. Langer, the former principal investigator for the WHI's clinical center at University of California, San Diego, who was among those who protested at the time. He has since served as an expert witness for hormone maker Wyeth. Dr. Langer says he remains concerned that the interpretation of the WHI has unnecessarily scared a generation of women from the treatment.
Jacques Rossouw, a physician with the National Heart Lung and Blood Institute who has overseen the WHI since its inception, confirms that some investigators were upset that they weren't included in writing the first WHI report. "That was an NIH decision supported by the WHI executive committee to keep it to a small group because we realized it was a sensitive paper," he says.
Still, he defends the government's handling of the study results "based on what we knew at the time," and says that study officials wanted to make a dramatic statement. "Our main job at the time was to turn around the prevailing notion that hormones would be useful for long-term prevention of heart disease," he says. "That was our objective. That was a worthy objective which we achieved."
But many in the medical community disagree, saying key questions about long-term use still aren't answered. Although the WHI data clearly show that starting hormones at an older age is risky, what's not clear is whether the heart protection women get starting at a younger age will continue with long-term use.
That was the question that the WHI was supposed to answer when it was launched in 1991 after data from an ongoing trial of nurses showed that women who used menopause hormones have as much as a 50% lower risk of heart attack. But the WHI designers didn't take into account that the timing of hormone use might affect the results and recruited mostly older, symptom-free women. Some of the study participants were already 20 years past menopause when the WHI began.
[chart]
Since mostly older women were recruited, there weren't enough recently menopausal women under 60 to generate conclusive data in some of the findings. But the trends were provocative. Among recently menopausal women who used estrogen and progestin, heart attack risk fell 11%. By comparison, women who started taking hormones 10 or more years past menopause had a 22% to 71% higher risk of heart problems.
In a second part of the study, in which women who had undergone hysterectomy took estrogen without progestin, women who started hormones after the age of 70 had an 11% higher risk of heart problems. But women below 60 in the estrogen-only study had a 37% lower heart risk.
In a bid to draw a more definitive conclusion, the WHI in April 2007 published a report in JAMA combining the data from both hormone trials. That paper showed that the timing of hormone use matters: Younger women appear to receive heart protection, while older women are at risk.
"We now have a refined understanding of the benefits and risks of hormone therapy, and there has been so much reassuring evidence for younger women over the last few years," says Harvard professor and WHI investigator JoAnn Manson, who has no ties to drug firms.
Despite the recent data, questions about long-term use of hormones are far from resolved. While most people now agree that hormones are a reasonable option for women to treat menopause symptoms like hot flashes, the bigger question is whether hormones should be considered in the armamentarium of drugs used for heart protection, along with blood pressure medications and cholesterol-lowering drugs called statins.
The National Heart, Lung and Blood Institute, which oversaw the WHI, firmly believes that menopause hormones shouldn't be used to prevent heart disease because of potential risk of blood clot, stroke and breast cancer.
Indeed, the WHI showed that hormones have a range of risks and benefits. On the plus side, they may protect younger women's hearts, they definitely protect against hip fractures, they lower the risk for diabetes and may lower the risk for colon cancer.
On the other hand, menopause hormones do increase the risk for blood clots and stroke. Women in the WHI who used both estrogen and progestin were at 24% higher risk for breast cancer. But women who regularly use estrogen without progestin had a 33% lower risk of breast cancer.
"Hormone therapy long term has these other adverse events hanging around. It doesn't fit the paradigm of what you are looking for in a viable long-term prevention strategy," says Dr. Rossouw. "If you're going to use something to prevent atherosclerosis, your choice is statins, not hormones."
The data on women who use statins are mixed, but suggest that they lower a woman's heart risk by 15% to 20%. Statins carry their own risks, including liver effects, muscle pain, memory problems and in rare cases a life-threatening muscle disease call rhabdomyolysis. There are no studies showing the risks and benefits of long-term use of statins.
Many doctors now believe that for younger women without a uterus, estrogen should be an option for long-term prevention of heart disease. (The progestin is added to protect against uterine cancer.)
"If this is preventing heart disease and saving lives, I think it's really wrong not to consider it," says Yale associate professor Hugh Taylor, a principal investigator for the Kronos Early Estrogen and Prevention Study, a study of estrogen and heart disease funded by Arizona billionaire John Sperling, an education entrepreneur who was upset with the way the WHI study was initially interpreted. "Some of the other drugs we use for cardiovascular disease don't have the evidence that we have for hormone therapy."
Two important ongoing studies will further illuminate the role estrogen plays in heart disease. The KEEPS study is recruiting 720 women, ages 42 to 58, to study the effects of oral or transdermal estrogen as well as progesterone on the coronary arteries of healthy women. An NIH-funded Early Versus Late Intervention Trial will study 500 women and the effects of hormone therapy given within six years of menopause compared to treatment given 10 or more years after menopause. Both studies will also test whether using natural progesterone, instead of the synthetic progestin used in the WHI, lowers or eliminates the risk of breast cancer associated with combination therapy.
Even though the long-term heart issue is unresolved, some critics say the NIH's handling of the WHI data scared away younger women who might want to use hormones for menopause symptoms. "We've gone to considerable efforts to reassure women and gynecologists that it's okay [to use hormones] in the short term," to treat the symptoms of menopause, Dr. Rossouw says.
Still, since the WHI results were announced in 2002, hormone sales have plummeted 30% to $1.9 billion, according to IMS Health, a health-care information company.
"I don't think it's fair to extrapolate from the data that women should be put on this as a preventative treatment for heart disease," says Michael E. Mendelsohn, a Tufts University professor who recently wrote an NEJM editorial about estrogen and heart disease. "What the data do support is that women who use hormones to treat menopause symptoms can feel reassured that they are not increasing their cardiovascular risk and may be providing some long-term benefit."
source : online.wsj.com
Effective alternative to conventional smear test
Studies highlight an effective alternative to conventional smear test
But many New Zealand women unaware it is available
Two studies have highlighted the significant benefits of a relatively new cervical screening method, the ThinPrep Pap Test, compared to the conventional Pap smear, but it appears many New Zealand women are unaware it exists.
A landmark Australian study involving 55,000 women, which was published this week in the British Medical Journal, shows the computer assisted ThinPrep Imaging System[1] is 17 per cent more effective in detecting high-grade pre-cancer than the conventional Pap smear.
The leading researchers from the independent study, which was headed up by Dr Annabelle Farnsworth of Douglass Hanly Moir Pathology (Australian laboratory) and the University of Sydney, say the results are extremely important because by detecting lesions at this stage they can be treated before they become invasive cancer.
Dr Farnsworth says the results of the study show we can do even better in the fight against this highly preventable cancer.
“The conventional Pap smear has been the mainstay of screening for more than 50 years.
“Although the new vaccine is a major scientific breakthrough it only offers partial protection against the development of cervical disease. Women will continue to need cervical screening as it is still the only test which detects if a woman with a Human Papillomavirus (HPV) infection has developed clinically significant cell changes.
“The sample used for the ThinPrep System can also be used for HPV and other testing as well, which is another benefit of this method. This new technology provides the perfect test to fit in with the future needs of the cervical screening program,” Dr Farnsworth said.
While there is currently no laboratory in New Zealand with the ThinPrep Imaging System, New Zealand women can still access some of the benefits of the ThinPrep System, as seven out of the eight laboratories who screen Pap Smears are manually processing the ThinPrep Pap Test.
The improved clinical performance of the ThinPrep System was also reported in a study published in February of this year in the journal Diagnostic Cytopathology. The study, conducted by Dr Jennifer Roberts of Symbion Laverty Pathology, in Australia, involving over 11,000 women, compared the performance of the ThinPrep Imaging System with manually read ThinPrep Pap Test slides and manually read conventional Pap test slides.
The findings were that manually read ThinPrep Pap Test slides showed a significant reduction in false negative rates over the conventional Pap test. (A false negative is when abnormal cell changes are missed and the result is reported as normal.) The results were 25.7% false negatives for the conventional pap test and only 2.75% false negatives for the manually read ThinPrep Pap Test which equates to an 89% reduction in the rate of false negatives with the ThinPrep Pap Test.
This is backed up by the information on the NZ Ministry of Health website which states that currently in approximately 20% of cases abnormal cell changes can be missed with the conventional Pap smear test.
New Zealand Gynaecological Oncologist Dr Ai Ling Tan says the reduction of false negatives with the liquid-based cytology is significant for both New Zealand women and clinicians.
“The results are very important as clinicians can be reassured that they can trust the results they get back. ThinPrep is one of the tools in the armoury that clinicians can use to help combat this disease,” Dr Tan says.
Biocare medical liaison Jane McLean says anecdotal feedback and her own experience at health expositions indicates that there are a significant number of women who are totally unaware of the existence of an alternative to the conventional Pap smear.
Liquid-based cytology is already the standard of care in the UK and Ireland, and the ThinPrep Pap Test is extensively used throughout the western world. In the United States approximately 70 per cent of all Pap tests screened annually are ThinPrep Pap Tests, making it the de facto standard of care.
Women can ask their doctor or healthcare provider for the ThinPrep Pap Test for a small additional fee.
source ; www.scoop.co.nz
But many New Zealand women unaware it is available
Two studies have highlighted the significant benefits of a relatively new cervical screening method, the ThinPrep Pap Test, compared to the conventional Pap smear, but it appears many New Zealand women are unaware it exists.
A landmark Australian study involving 55,000 women, which was published this week in the British Medical Journal, shows the computer assisted ThinPrep Imaging System[1] is 17 per cent more effective in detecting high-grade pre-cancer than the conventional Pap smear.
The leading researchers from the independent study, which was headed up by Dr Annabelle Farnsworth of Douglass Hanly Moir Pathology (Australian laboratory) and the University of Sydney, say the results are extremely important because by detecting lesions at this stage they can be treated before they become invasive cancer.
Dr Farnsworth says the results of the study show we can do even better in the fight against this highly preventable cancer.
“The conventional Pap smear has been the mainstay of screening for more than 50 years.
“Although the new vaccine is a major scientific breakthrough it only offers partial protection against the development of cervical disease. Women will continue to need cervical screening as it is still the only test which detects if a woman with a Human Papillomavirus (HPV) infection has developed clinically significant cell changes.
“The sample used for the ThinPrep System can also be used for HPV and other testing as well, which is another benefit of this method. This new technology provides the perfect test to fit in with the future needs of the cervical screening program,” Dr Farnsworth said.
While there is currently no laboratory in New Zealand with the ThinPrep Imaging System, New Zealand women can still access some of the benefits of the ThinPrep System, as seven out of the eight laboratories who screen Pap Smears are manually processing the ThinPrep Pap Test.
The improved clinical performance of the ThinPrep System was also reported in a study published in February of this year in the journal Diagnostic Cytopathology. The study, conducted by Dr Jennifer Roberts of Symbion Laverty Pathology, in Australia, involving over 11,000 women, compared the performance of the ThinPrep Imaging System with manually read ThinPrep Pap Test slides and manually read conventional Pap test slides.
The findings were that manually read ThinPrep Pap Test slides showed a significant reduction in false negative rates over the conventional Pap test. (A false negative is when abnormal cell changes are missed and the result is reported as normal.) The results were 25.7% false negatives for the conventional pap test and only 2.75% false negatives for the manually read ThinPrep Pap Test which equates to an 89% reduction in the rate of false negatives with the ThinPrep Pap Test.
This is backed up by the information on the NZ Ministry of Health website which states that currently in approximately 20% of cases abnormal cell changes can be missed with the conventional Pap smear test.
New Zealand Gynaecological Oncologist Dr Ai Ling Tan says the reduction of false negatives with the liquid-based cytology is significant for both New Zealand women and clinicians.
“The results are very important as clinicians can be reassured that they can trust the results they get back. ThinPrep is one of the tools in the armoury that clinicians can use to help combat this disease,” Dr Tan says.
Biocare medical liaison Jane McLean says anecdotal feedback and her own experience at health expositions indicates that there are a significant number of women who are totally unaware of the existence of an alternative to the conventional Pap smear.
Liquid-based cytology is already the standard of care in the UK and Ireland, and the ThinPrep Pap Test is extensively used throughout the western world. In the United States approximately 70 per cent of all Pap tests screened annually are ThinPrep Pap Tests, making it the de facto standard of care.
Women can ask their doctor or healthcare provider for the ThinPrep Pap Test for a small additional fee.
source ; www.scoop.co.nz
Sunday, July 8, 2007
Endometriosis Increases The Risk Of Certain Cancers - But the risk is not affected by whether or not a woman has given birth
Doctors in Sweden have shown for the first time that although endometriosis is associated with an increased risk of various cancers, this risk does not depend on the number of times women with the condition have given birth.
Dr Anna-Sofia Melin, told the 23rd annual meeting of the European Society of Human Reproduction and Embryology: "Several epidemiological studies have shown an increased cancer risk among women with endometriosis, especially ovarian cancer. Infertility and never having given birth (nulliparity) are also known risk factors for different types of cancer, such as breast and endometrial cancer. However, as far as we know, this is the first study to investigate cancer risk among women with endometriosis that also stratifies for parity."
Dr Melin, a specialist doctor in the department of obstetrics and gynaecology at the Karolinska University Hospital in Stockholm, Sweden, and epidemiologists at the Karolinska Institute looked at data from 63,630 women who had been discharged from hospital with a diagnosis of endometriosis between 1969 and 2002. They were identified and followed up via the National Swedish Inpatient Register, the National Swedish Cancer Register and the Swedish Multi-Generation Register.
The researchers identified 3,822 cases of cancer amongst the women with endometriosis. While they found no overall increased risk of cancer, they did find that the women had an elevated risk of certain types of cancer, but that there was no significant difference in risk between women who had never given birth and those who had.
"We found that, contrary to what one might expect, endometriosis and nulliparity did not combine to give a higher risk of cancer," said Dr Melin.
The researchers found that endometriosis increased the risk of developing ovarian cancer by more than a third (37%) above the risk for the normal population of women without endometriosis. There were similar increases in risk for endocrine tumours (38%), kidney cancer (36%) and thyroid cancer (33%). Slightly lower increases were found for brain tumours (27%) and malignant melanoma (23%), and there was a small increased risk of breast cancer (8%). Interestingly, women with endometriosis had a reduced risk of cervical cancer of just under a third (29%).
"There was no significant difference between nulliparous and parous women with endometriosis regarding cancer risk for any of the cancer types. We found a non-significant decrease in ovarian cancer risk the more children a woman had had," said Dr Melin.
Little is known about the possible mechanisms involved in the increased risk of cancer from endometriosis (or decreased risk, in the case of cervical cancer).
Dr Melin said: "The fact that our study did not show an association between cancer risk and parity increases the possibility that it is the endometriosis disease in itself that causes the cancer and not the infertility issue."
"Various theories have been suggested. For ovarian cancer it might be the exposure of the ovaries to the hostile endometrium cells that 'invade' the ovary during the course of the endometriosis disease. Or it could be defects in the immune system that allow the endometriosis to grow and also might allow cancer cells to grow in different parts of the body. Maybe the treatment of endometriosis, hormonal or surgical, can influence cancer development. We do not know yet."
Dr Melin plans to investigate whether hormonal or surgical treatment of endometriosis might be involved in the increased cancer risk, and she also wants to identify which women are more at risk of developing cancer than others.
But she said that it was too early to use the results of her study to give advice to doctors about improved treatments for women with endometriosis.
"Our hope is that doctors in general start to view the endometriosis disease as a serious disease that causes a lot of suffering to the patient and also may lead to cancer. We hope that in the future we will be able to identify those women with endometriosis that may have a more aggressive form of disease with more atypical cells, for instance, and that this may lead to better care for the patient and, hopefully, to a early diagnosis if cancer should occur," she concluded.
source : www.medicalnewstoday.com
Dr Anna-Sofia Melin, told the 23rd annual meeting of the European Society of Human Reproduction and Embryology: "Several epidemiological studies have shown an increased cancer risk among women with endometriosis, especially ovarian cancer. Infertility and never having given birth (nulliparity) are also known risk factors for different types of cancer, such as breast and endometrial cancer. However, as far as we know, this is the first study to investigate cancer risk among women with endometriosis that also stratifies for parity."
Dr Melin, a specialist doctor in the department of obstetrics and gynaecology at the Karolinska University Hospital in Stockholm, Sweden, and epidemiologists at the Karolinska Institute looked at data from 63,630 women who had been discharged from hospital with a diagnosis of endometriosis between 1969 and 2002. They were identified and followed up via the National Swedish Inpatient Register, the National Swedish Cancer Register and the Swedish Multi-Generation Register.
The researchers identified 3,822 cases of cancer amongst the women with endometriosis. While they found no overall increased risk of cancer, they did find that the women had an elevated risk of certain types of cancer, but that there was no significant difference in risk between women who had never given birth and those who had.
"We found that, contrary to what one might expect, endometriosis and nulliparity did not combine to give a higher risk of cancer," said Dr Melin.
The researchers found that endometriosis increased the risk of developing ovarian cancer by more than a third (37%) above the risk for the normal population of women without endometriosis. There were similar increases in risk for endocrine tumours (38%), kidney cancer (36%) and thyroid cancer (33%). Slightly lower increases were found for brain tumours (27%) and malignant melanoma (23%), and there was a small increased risk of breast cancer (8%). Interestingly, women with endometriosis had a reduced risk of cervical cancer of just under a third (29%).
"There was no significant difference between nulliparous and parous women with endometriosis regarding cancer risk for any of the cancer types. We found a non-significant decrease in ovarian cancer risk the more children a woman had had," said Dr Melin.
Little is known about the possible mechanisms involved in the increased risk of cancer from endometriosis (or decreased risk, in the case of cervical cancer).
Dr Melin said: "The fact that our study did not show an association between cancer risk and parity increases the possibility that it is the endometriosis disease in itself that causes the cancer and not the infertility issue."
"Various theories have been suggested. For ovarian cancer it might be the exposure of the ovaries to the hostile endometrium cells that 'invade' the ovary during the course of the endometriosis disease. Or it could be defects in the immune system that allow the endometriosis to grow and also might allow cancer cells to grow in different parts of the body. Maybe the treatment of endometriosis, hormonal or surgical, can influence cancer development. We do not know yet."
Dr Melin plans to investigate whether hormonal or surgical treatment of endometriosis might be involved in the increased cancer risk, and she also wants to identify which women are more at risk of developing cancer than others.
But she said that it was too early to use the results of her study to give advice to doctors about improved treatments for women with endometriosis.
"Our hope is that doctors in general start to view the endometriosis disease as a serious disease that causes a lot of suffering to the patient and also may lead to cancer. We hope that in the future we will be able to identify those women with endometriosis that may have a more aggressive form of disease with more atypical cells, for instance, and that this may lead to better care for the patient and, hopefully, to a early diagnosis if cancer should occur," she concluded.
source : www.medicalnewstoday.com
Sunday, June 24, 2007
Oestrogen helps heart
Oestrogen helps heart
Younger women who start taking oestrogen as soon as they enter menopause may be protected from heart disease, researchers say.
They found women aged 50 to 59 who took oestrogen were 30 per cent to 40 per cent less likely than women taking placebos to have large amounts of calcified plaque in their arteries – a widely accepted predictor of heart attack risk.
When women took their oestrogen religiously, the risk was 60 per cent lower, they reported in the New England Journal of Medicine.
Dr JoAnn Manson of Harvard Medical School's Brigham and Women's Hospital, who led the study, says the results should be reassuring to women in their 50s who have been taking oestrogen for their menopausal symptoms.
But, she stresses, hormone replacement therapy, or HRT, is not completely safe and women should not take it unless they have a good reason to.
"Hormone therapy should not be used for the express purpose of preventing cardiovascular disease due to other known risks, and it should be limited to treatment of menopausal symptoms at the lowest dose for the shortest duration necessary," Dr Manson says.
"So I do not believe it should be started in all women for the purpose of protecting their hearts."
Dr Manson led the original Women's Health Initiative study, which found in 2002 that hormone replacement therapy raised the risk of blood clots, breast cancer and heart attacks.
Many women stopped taking HRT, though researchers at the time noted that many women in their study were well past menopause, with an average age of 63.
"There are still many women out there with moderate to severe symptoms who are not seeking treatment because they are concerned that oestrogen could increase the risk of heart disease and other health problems," she says.
The new finding, based on 1064 women, "does provide some additional reassurance for women who have been denying themselves relief," Dr Manson says.
Robert Rebar, executive director of the American Society for Reproductive Medicine, says, "We are clearly learning that the benefits of oestrogen in young, healthy, symptomatic, postmenopausal women outweigh the risks."
source : www.stuff.co.nz
Younger women who start taking oestrogen as soon as they enter menopause may be protected from heart disease, researchers say.
They found women aged 50 to 59 who took oestrogen were 30 per cent to 40 per cent less likely than women taking placebos to have large amounts of calcified plaque in their arteries – a widely accepted predictor of heart attack risk.
When women took their oestrogen religiously, the risk was 60 per cent lower, they reported in the New England Journal of Medicine.
Dr JoAnn Manson of Harvard Medical School's Brigham and Women's Hospital, who led the study, says the results should be reassuring to women in their 50s who have been taking oestrogen for their menopausal symptoms.
But, she stresses, hormone replacement therapy, or HRT, is not completely safe and women should not take it unless they have a good reason to.
"Hormone therapy should not be used for the express purpose of preventing cardiovascular disease due to other known risks, and it should be limited to treatment of menopausal symptoms at the lowest dose for the shortest duration necessary," Dr Manson says.
"So I do not believe it should be started in all women for the purpose of protecting their hearts."
Dr Manson led the original Women's Health Initiative study, which found in 2002 that hormone replacement therapy raised the risk of blood clots, breast cancer and heart attacks.
Many women stopped taking HRT, though researchers at the time noted that many women in their study were well past menopause, with an average age of 63.
"There are still many women out there with moderate to severe symptoms who are not seeking treatment because they are concerned that oestrogen could increase the risk of heart disease and other health problems," she says.
The new finding, based on 1064 women, "does provide some additional reassurance for women who have been denying themselves relief," Dr Manson says.
Robert Rebar, executive director of the American Society for Reproductive Medicine, says, "We are clearly learning that the benefits of oestrogen in young, healthy, symptomatic, postmenopausal women outweigh the risks."
source : www.stuff.co.nz
Baby Boomer Women Hardest Hit By Pelvic Health Conditions
Baby Boomer Women Hardest Hit By Pelvic Health Conditions
Pelvic Health Conditions
At least one-third of all women (about 35 million) will be treated for a pelvic health condition by the age of 60, with the onset of these conditions highest among Baby Boomers.
Researchers estimate that even more women are affected but silently suffer. Their reluctance to consult a physician is attributed to lack of education and stigma associated with the conditions.
"Women learn about periods, pregnancy and menopause but are unprepared for what happens in between. The fact is, pelvic health conditions can happen at any age, particularly after a woman's had a baby," explained Elizabeth Battaglino Cahill, RN, executive director of the not-for-profit NWHRC.
The D.C.-based health and human services consulting firm, The Lewin Group, looked at four pelvic health conditions: menorrhagia (heavy menstrual bleeding), uterine fibroids, stress urinary incontinence (SUI) and pelvic organ prolapse (POP) for the report. At least one-third of all Baby Boomers (13.5 million) are affected by heavy periods and SUI. Forty percent of women over 40 are affected by POP. By age 50, 80 percent of African American and 70 percent of Caucasian women have developed fibroids.
"We think the sheer magnitude of how many Baby Boomer women are affected matters because such a large group will have the power to set new expectations for pelvic health, driving more women to seek treatment," said Cahill. "Think back to when the default treatment for breast cancer was a total mastectomy. Those rates have dramatically declined primarily because women advocated for more minimally invasive treatment options. The same needs to be true for pelvic health."
Pelvic health conditions can be uncomfortable, painful and embarrassing, and have a significant impact on everyday quality of life. Symptoms range from sexual dysfunction to abdominal pain and pressure, complications with fertility and pregnancy, anemia, low self-esteem and depression.
The report indicates these conditions can be traced to a variety of factors - most commonly, pregnancy and childbirth or genetic factors - but maintaining a healthy weight and lifestyle can help, and understanding the risks, symptoms and treatment options is a woman's first step in getting back to a healthy lifestyle if she does experience a pelvic condition.
"What I find most unsettling is that women are often under- or misdiagnosed for these conditions because they are hesitant to talk to their doctors," said Dr. Pamela Peeke, medical advisor for the NWHRC. "The findings of this report really stress the need for raising awareness about pelvic health."
In fact, the report revealed that 50-75 percent of women who likely have SUI don't tell their physician about their symptoms, and only 10-20 percent of women with POP seek medical care, because they don't know their symptoms are abnormal or they are too embarrassed to ask. As a result, they are never diagnosed and treated.
Treatment varies by patient and should depend on the severity of the condition and how it affects a woman's life. The choice of treatment also depends on whether a woman wants to have children. Treatments can include pelvic floor exercises, medications, minimally invasive procedures like endometrial ablation for heavy periods and sling procedures for SUI.
A key finding in the report showed the rate of hysterectomy (about 600,000 per year) has essentially remained constant for 25 years, and fibroids and menorrhagia are the leading indications for hysterectomy (representing 44 percent of all procedures in 2005), despite the availability of less invasive treatments that are associated with less pain and a quicker return to normal activities.
According to the NWHRC, women will feel more empowered to ask about alternative treatments to hysterectomy when they have access to reliable information.
source : www.emaxhealth.com
Pelvic Health Conditions
At least one-third of all women (about 35 million) will be treated for a pelvic health condition by the age of 60, with the onset of these conditions highest among Baby Boomers.
Researchers estimate that even more women are affected but silently suffer. Their reluctance to consult a physician is attributed to lack of education and stigma associated with the conditions.
"Women learn about periods, pregnancy and menopause but are unprepared for what happens in between. The fact is, pelvic health conditions can happen at any age, particularly after a woman's had a baby," explained Elizabeth Battaglino Cahill, RN, executive director of the not-for-profit NWHRC.
The D.C.-based health and human services consulting firm, The Lewin Group, looked at four pelvic health conditions: menorrhagia (heavy menstrual bleeding), uterine fibroids, stress urinary incontinence (SUI) and pelvic organ prolapse (POP) for the report. At least one-third of all Baby Boomers (13.5 million) are affected by heavy periods and SUI. Forty percent of women over 40 are affected by POP. By age 50, 80 percent of African American and 70 percent of Caucasian women have developed fibroids.
"We think the sheer magnitude of how many Baby Boomer women are affected matters because such a large group will have the power to set new expectations for pelvic health, driving more women to seek treatment," said Cahill. "Think back to when the default treatment for breast cancer was a total mastectomy. Those rates have dramatically declined primarily because women advocated for more minimally invasive treatment options. The same needs to be true for pelvic health."
Pelvic health conditions can be uncomfortable, painful and embarrassing, and have a significant impact on everyday quality of life. Symptoms range from sexual dysfunction to abdominal pain and pressure, complications with fertility and pregnancy, anemia, low self-esteem and depression.
The report indicates these conditions can be traced to a variety of factors - most commonly, pregnancy and childbirth or genetic factors - but maintaining a healthy weight and lifestyle can help, and understanding the risks, symptoms and treatment options is a woman's first step in getting back to a healthy lifestyle if she does experience a pelvic condition.
"What I find most unsettling is that women are often under- or misdiagnosed for these conditions because they are hesitant to talk to their doctors," said Dr. Pamela Peeke, medical advisor for the NWHRC. "The findings of this report really stress the need for raising awareness about pelvic health."
In fact, the report revealed that 50-75 percent of women who likely have SUI don't tell their physician about their symptoms, and only 10-20 percent of women with POP seek medical care, because they don't know their symptoms are abnormal or they are too embarrassed to ask. As a result, they are never diagnosed and treated.
Treatment varies by patient and should depend on the severity of the condition and how it affects a woman's life. The choice of treatment also depends on whether a woman wants to have children. Treatments can include pelvic floor exercises, medications, minimally invasive procedures like endometrial ablation for heavy periods and sling procedures for SUI.
A key finding in the report showed the rate of hysterectomy (about 600,000 per year) has essentially remained constant for 25 years, and fibroids and menorrhagia are the leading indications for hysterectomy (representing 44 percent of all procedures in 2005), despite the availability of less invasive treatments that are associated with less pain and a quicker return to normal activities.
According to the NWHRC, women will feel more empowered to ask about alternative treatments to hysterectomy when they have access to reliable information.
source : www.emaxhealth.com
Requiring HPV Vaccination For School-Age Girls Too Soon
Requiring HPV Vaccination For School-Age Girls Too Soon
HPV Vaccination For School-Age Girls
It is premature to require middle-school age girls to receive Merck's human papillomavirus vaccine Gardasil for the upcoming school year, Doug Lowy -- head of the National Cancer Institute's Laboratory of Cellular Oncology and one of the scientists responsible for the development of the vaccine -- said on Wednesday, CQ HealthBeat reports (Bartolf, CQ HealthBeat, 6/20).
Gardasil in clinical trials has been shown to be 100% effective in preventing infection with HPV 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 HPV 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, 5/18).
Lowy, referring to opposition from parents and pro-abstinence groups who believe the vaccine could promote sexual promiscuity, said, "We should minimize the degree to which [Gardasil is] politically polarized by giving parents the option of opting out of the vaccine."
He added that mandating the vaccine before a long safety record has been established is a risky move because the current research does not indicate how long the vaccine will remain effective or if women will need to receive booster shots. "We know it will work for five years, but having a longer record of high effectiveness would make it more reasonable to mandate the vaccine," Lowy said (CQ HealthBeat, 6/20).
FDA To Review Merck's Application for Additional Gardasil Uses
Merck on Wednesday announced that FDA has accepted its application to FDA for extended approval of Gardasil to help prevent vaginal and vulvar cancers under a standard review period, Reuters reports (Reuters, 6/20).
A study published last month in the journal Lancet found that after three years of follow-up, Gardasil was 71% effective in preventing vaginal and vulvar cancers related to HPV strains 16 and 18 among women who previously had been exposed to HPV strains 6, 11, 16 and 18. It was 100% effective among women who previously had not been exposed to those strains. The vaccine was not effective in fighting vaginal or vulvar lesions that already had formed, according to the study. According to Merck, vaginal and vulvar cancers account for about 3% and 4% of gynecological cancers, respectively. HPV is present in about 80% of the 6,000 vaginal and vulvar cancers diagnosed annually in the U.S. (Kaiser Daily Women's Health Policy Report, 5/18).
According to the AP/Forbes, the application also includes data on immune memory, or the ability of the immune system to continue fighting off HPV after the vaccination. If approved, Gardasil's label would include the additional information (AP/Forbes, 6/20). A standard review period usually takes about 10 months, Merck said, adding that it expects FDA to decide on the application in the first quarter of 2008 (Reuters, 6/20).
U.K. Recommends Gardasil for Girls Ages 12 to 13
The United Kingdom's Joint Committee on Vaccination and Immunisation on Wednesday recommended that girls ages 12 and 13 in the country receive Gardasil, London's Guardian reports (Sample, Guardian, 6/21). The country's Department of Health said it has agreed "in principle" to accept the committee's advice, subject to an independent review of its cost to the National Health Service, the Press Association reports. According to the health department, the vaccine will be administered in three doses over six months and will cost 300 pounds, or about $600, for the full course of treatment. Public Health Minister Caroline Flint said the government hopes to begin vaccinating girls as early as 2008 (Kirby, Press Association, 6/20).
Gardasil has been approved in the European Union and 76 countries worldwide -- including Australia, Canada, and the U.S. Merck and Sanofi-Aventis on Monday announced that Switzerland has recommended that girls ages 11 to 14 in the country receive Gardasil. The Swiss decision follows similar recommendations in Austria, Belgium, France, Germany, Italy, Luxembourg and Norway. Sanofi Pasteur, a joint company of Merck and Sanofi-Aventis, is funding a campaign advocating for European governments to vaccinate young girls with Gardasil (Kaiser Daily Women's Health Policy Report, 6/20).
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
source : www.emaxhealth.com
HPV Vaccination For School-Age Girls
It is premature to require middle-school age girls to receive Merck's human papillomavirus vaccine Gardasil for the upcoming school year, Doug Lowy -- head of the National Cancer Institute's Laboratory of Cellular Oncology and one of the scientists responsible for the development of the vaccine -- said on Wednesday, CQ HealthBeat reports (Bartolf, CQ HealthBeat, 6/20).
Gardasil in clinical trials has been shown to be 100% effective in preventing infection with HPV 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 HPV 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, 5/18).
Lowy, referring to opposition from parents and pro-abstinence groups who believe the vaccine could promote sexual promiscuity, said, "We should minimize the degree to which [Gardasil is] politically polarized by giving parents the option of opting out of the vaccine."
He added that mandating the vaccine before a long safety record has been established is a risky move because the current research does not indicate how long the vaccine will remain effective or if women will need to receive booster shots. "We know it will work for five years, but having a longer record of high effectiveness would make it more reasonable to mandate the vaccine," Lowy said (CQ HealthBeat, 6/20).
FDA To Review Merck's Application for Additional Gardasil Uses
Merck on Wednesday announced that FDA has accepted its application to FDA for extended approval of Gardasil to help prevent vaginal and vulvar cancers under a standard review period, Reuters reports (Reuters, 6/20).
A study published last month in the journal Lancet found that after three years of follow-up, Gardasil was 71% effective in preventing vaginal and vulvar cancers related to HPV strains 16 and 18 among women who previously had been exposed to HPV strains 6, 11, 16 and 18. It was 100% effective among women who previously had not been exposed to those strains. The vaccine was not effective in fighting vaginal or vulvar lesions that already had formed, according to the study. According to Merck, vaginal and vulvar cancers account for about 3% and 4% of gynecological cancers, respectively. HPV is present in about 80% of the 6,000 vaginal and vulvar cancers diagnosed annually in the U.S. (Kaiser Daily Women's Health Policy Report, 5/18).
According to the AP/Forbes, the application also includes data on immune memory, or the ability of the immune system to continue fighting off HPV after the vaccination. If approved, Gardasil's label would include the additional information (AP/Forbes, 6/20). A standard review period usually takes about 10 months, Merck said, adding that it expects FDA to decide on the application in the first quarter of 2008 (Reuters, 6/20).
U.K. Recommends Gardasil for Girls Ages 12 to 13
The United Kingdom's Joint Committee on Vaccination and Immunisation on Wednesday recommended that girls ages 12 and 13 in the country receive Gardasil, London's Guardian reports (Sample, Guardian, 6/21). The country's Department of Health said it has agreed "in principle" to accept the committee's advice, subject to an independent review of its cost to the National Health Service, the Press Association reports. According to the health department, the vaccine will be administered in three doses over six months and will cost 300 pounds, or about $600, for the full course of treatment. Public Health Minister Caroline Flint said the government hopes to begin vaccinating girls as early as 2008 (Kirby, Press Association, 6/20).
Gardasil has been approved in the European Union and 76 countries worldwide -- including Australia, Canada, and the U.S. Merck and Sanofi-Aventis on Monday announced that Switzerland has recommended that girls ages 11 to 14 in the country receive Gardasil. The Swiss decision follows similar recommendations in Austria, Belgium, France, Germany, Italy, Luxembourg and Norway. Sanofi Pasteur, a joint company of Merck and Sanofi-Aventis, is funding a campaign advocating for European governments to vaccinate young girls with Gardasil (Kaiser Daily Women's Health Policy Report, 6/20).
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Women's Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Women's Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
source : www.emaxhealth.com
Saturday, June 23, 2007
Women can avoid breast reduction surgery by being fitted for their bras
Women can avoid breast reduction surgery by being fitted for their bras
Doctors in Britain are calling for women to be offered free bra-fittings on the National Health Service (NHS) in an effort to reduce unnecessary breast reductions.
According to the British Medical Association (BMA) if women wore the right size underwear the NHS could save the tens of thousands of pounds each year it currently spends on such operations.
Breast reduction surgery is one of the most common forms of cosmetic surgery carried out in Britain and a large NHS hospital may well carry out over 100 breast reductions a year, at a cost of around £4,500 for each operation.
The BMA says bra-fitting should be a precursor to a referral for breast reduction surgery as studies show that nine in every ten women do not wear the correct size of bra, and 22 per cent have never been measured at all.
An ill-fitting bra, apart from being uncomfortable, can cause wires to dig into breast tissue and chafing and pain in the neck and shoulders, all of which might encourage a woman to feel that a breast reduction operation is the answer.
At their annual conference later this month the BMA intends to announce that the services of bra-fitters should be made available on the NHS as the first step in the referral for breast reduction surgery.
Experts say cosmetic surgeons are often consulted by women who mistakenly thought they needed breast reduction surgery when a correctly fitted bra would have ended their discomfort.
One study found 100 per cent of women requesting breast reduction surgery were all wearing the wrong bra and had underestimated the back size and overestimated the cup size.
The British Association of Aesthetic Plastic Surgeons (BAAPS), say 3,219 people paid to have private breast reduction surgery last year, an increase of 19 per cent on the year before.
There does appear to be agreement with the BMA on the issue from consultant plastic surgeons and from bra expert working for underwear companies.
The major food and clothing chain Marks and Spencer, which sells more bras than any other high street retailer, does offer women a free bra fitting service carried out by trained personnel for any woman to take advantage of.
source : www.news-medical.net
Doctors in Britain are calling for women to be offered free bra-fittings on the National Health Service (NHS) in an effort to reduce unnecessary breast reductions.
According to the British Medical Association (BMA) if women wore the right size underwear the NHS could save the tens of thousands of pounds each year it currently spends on such operations.
Breast reduction surgery is one of the most common forms of cosmetic surgery carried out in Britain and a large NHS hospital may well carry out over 100 breast reductions a year, at a cost of around £4,500 for each operation.
The BMA says bra-fitting should be a precursor to a referral for breast reduction surgery as studies show that nine in every ten women do not wear the correct size of bra, and 22 per cent have never been measured at all.
An ill-fitting bra, apart from being uncomfortable, can cause wires to dig into breast tissue and chafing and pain in the neck and shoulders, all of which might encourage a woman to feel that a breast reduction operation is the answer.
At their annual conference later this month the BMA intends to announce that the services of bra-fitters should be made available on the NHS as the first step in the referral for breast reduction surgery.
Experts say cosmetic surgeons are often consulted by women who mistakenly thought they needed breast reduction surgery when a correctly fitted bra would have ended their discomfort.
One study found 100 per cent of women requesting breast reduction surgery were all wearing the wrong bra and had underestimated the back size and overestimated the cup size.
The British Association of Aesthetic Plastic Surgeons (BAAPS), say 3,219 people paid to have private breast reduction surgery last year, an increase of 19 per cent on the year before.
There does appear to be agreement with the BMA on the issue from consultant plastic surgeons and from bra expert working for underwear companies.
The major food and clothing chain Marks and Spencer, which sells more bras than any other high street retailer, does offer women a free bra fitting service carried out by trained personnel for any woman to take advantage of.
source : www.news-medical.net
Breast feeding for thirteen months or more reduces mother's risk of developing rheumatoid arthritis
Breast feeding for a period of thirteen months or more has been shown to reduce the mother's the risk of developing rheumatoid arthritis (RA), according to new data presented at EULAR 2007, the Annual European Congress of Rheumatology in Barcelona, Spain. In the study, the longer the breast feeding period, the lower the mother's risk of developing RA in later life.
Comparable use of oral contraceptives (OCs) or hormone replacement therapy (HRT) did not show a significant effect on the risk of developing RA.
Lead researcher Dr Mitra Keshavarz, of Malm, Hospital University, Sweden, said of the study, "Whilst other studies suggest that hormonal factors play a part in the development of RA, and we know that pregnancy can result in an improvement in RA symptoms, we wanted to investigate the long term effect of breast-feeding. This study specifically highlights the potential of naturally-induced hormones in protecting individuals from developing RA in the future. Furthermore, it adds to the growing body of evidence in favour of breast feeding and its positive health implications , this time demonstrating its protective benefits for the mother."
The study found that breast feeding for 13 or more months was associated with a reduced risk of developing RA (odds ratio 0.46; confidence interval 95% 0.24-0.91). For women with between 1 and 12 months history of breast feeding, the odds ratio was 0.74, with a 95% confidence interval (0.45-1.20) compared directly to those who had never breast fed.
The data was taken from a community-based health study incorporating information from the Swedish National Hospital Discharge and the National Cause of Death Register between 1991 and 1996, comparing health information from 136 women who later developed RA with that of 544 controls. Information on the use of OCs, HRT and other lifestyle factors was derived from a self-administered questionnaire and analysed by a team from Malm, University Hospital, Sweden.
All females with RA utilised in the case control group of the study were diagnosed according to the 1987 American College of Rheumatology (ACR) criteria for RA. Individuals were matched with four female controls for every case. Controls were identified as those alive and free from diagnosed RA when the index individual was diagnosed with RA.
The median age of the onset of RA in the sample population was 63.3 years, with an average length of 5.5 years between enrolment in the study and onset of RA.
source : www.news-medical.net
Comparable use of oral contraceptives (OCs) or hormone replacement therapy (HRT) did not show a significant effect on the risk of developing RA.
Lead researcher Dr Mitra Keshavarz, of Malm, Hospital University, Sweden, said of the study, "Whilst other studies suggest that hormonal factors play a part in the development of RA, and we know that pregnancy can result in an improvement in RA symptoms, we wanted to investigate the long term effect of breast-feeding. This study specifically highlights the potential of naturally-induced hormones in protecting individuals from developing RA in the future. Furthermore, it adds to the growing body of evidence in favour of breast feeding and its positive health implications , this time demonstrating its protective benefits for the mother."
The study found that breast feeding for 13 or more months was associated with a reduced risk of developing RA (odds ratio 0.46; confidence interval 95% 0.24-0.91). For women with between 1 and 12 months history of breast feeding, the odds ratio was 0.74, with a 95% confidence interval (0.45-1.20) compared directly to those who had never breast fed.
The data was taken from a community-based health study incorporating information from the Swedish National Hospital Discharge and the National Cause of Death Register between 1991 and 1996, comparing health information from 136 women who later developed RA with that of 544 controls. Information on the use of OCs, HRT and other lifestyle factors was derived from a self-administered questionnaire and analysed by a team from Malm, University Hospital, Sweden.
All females with RA utilised in the case control group of the study were diagnosed according to the 1987 American College of Rheumatology (ACR) criteria for RA. Individuals were matched with four female controls for every case. Controls were identified as those alive and free from diagnosed RA when the index individual was diagnosed with RA.
The median age of the onset of RA in the sample population was 63.3 years, with an average length of 5.5 years between enrolment in the study and onset of RA.
source : www.news-medical.net
Periodontal diseases are a threat to women of all ages
Periodontal diseases are a threat to women of all ages
Two new studies in the June issue of the Journal of Periodontology (JOP) suggest that periodontal diseases are a threat to women of all ages due to hormonal fluctuations that occur at various stages of their lives.
One study looked at 50 women who were between the ages of 20 to 35 with varying forms of periodontitis. The study found that women who currently were taking oral contraceptive pills had more gingival bleeding upon probing and deeper periodontal pockets (signs of periodontitis) than those who were not taking oral contraceptive pills.
"Younger women often think that periodontal disease is a condition associated with old age," explained study author Brian Mullally, PhD. "Our study shows that it is very possible for younger women to experience periodontal disease. It is important for women to alert their dental practitioners of any medications they are taking, such as oral contraceptive pills, because it is possible that their oral health may be affected. It might also be prudent where possible for young women to ensure that their periodontal health has been checked before commencing oral contraceptive therapy."
Another study in this month's issue of the JOP examined 1,256 postmenopausal women and looked for a potential association between periodontal bacteria and bone loss in the oral cavity. The study results showed that women with periodontal bacteria in their mouths were also more likely to have bone loss in the oral cavity, which can lead to tooth loss if not treated.
"Our study's findings are important for postmenopausal women because they suggest that good periodontal health is extremely important in the postmenopausal years," said study author Renee Brennan, PhD. "We found that oral bone loss was associated with presence of oral bacteria. In fact, 62% of the women in our study had at least one species of subgingival bacteria present, and the women with these bacteria had more evidence of oral bone loss. Interestingly, women who had a Body Mass Index in the overweight range were much more likely to have oral bone loss associated with presence of oral bacteria. Oral bone loss has been associated with osteoporosis in this group as well. This association has been difficult to study because many risk factors for periodontal disease and osteoporosis, including smoking, age, medications, and overall general health are similar. It should be noted that our study was limited in that it included a relatively healthy group of mostly Caucasian women and that future studies are needed to determine the effects of periodontal bacteria on bone loss in other groups of postmenopausal women."
"Taking care of your teeth and gums is a lifelong commitment," explained Preston D. Miller, Jr., DDS, President of the American Academy of Periodontology. "Women should pay special attention to their oral health as they enter different stages of their lives because additional periodontal care may be needed during different points such as the reproductive years or menopause. Knowing your ,pocket size, depth can be a good way for women to keep track of their periodontal health; periodontal pockets of one to two millimeters with no bleeding are not a concern but pockets of three and four millimeters may need a more in depth cleaning called scaling and root planing."
source : www.news-medical.net
Two new studies in the June issue of the Journal of Periodontology (JOP) suggest that periodontal diseases are a threat to women of all ages due to hormonal fluctuations that occur at various stages of their lives.
One study looked at 50 women who were between the ages of 20 to 35 with varying forms of periodontitis. The study found that women who currently were taking oral contraceptive pills had more gingival bleeding upon probing and deeper periodontal pockets (signs of periodontitis) than those who were not taking oral contraceptive pills.
"Younger women often think that periodontal disease is a condition associated with old age," explained study author Brian Mullally, PhD. "Our study shows that it is very possible for younger women to experience periodontal disease. It is important for women to alert their dental practitioners of any medications they are taking, such as oral contraceptive pills, because it is possible that their oral health may be affected. It might also be prudent where possible for young women to ensure that their periodontal health has been checked before commencing oral contraceptive therapy."
Another study in this month's issue of the JOP examined 1,256 postmenopausal women and looked for a potential association between periodontal bacteria and bone loss in the oral cavity. The study results showed that women with periodontal bacteria in their mouths were also more likely to have bone loss in the oral cavity, which can lead to tooth loss if not treated.
"Our study's findings are important for postmenopausal women because they suggest that good periodontal health is extremely important in the postmenopausal years," said study author Renee Brennan, PhD. "We found that oral bone loss was associated with presence of oral bacteria. In fact, 62% of the women in our study had at least one species of subgingival bacteria present, and the women with these bacteria had more evidence of oral bone loss. Interestingly, women who had a Body Mass Index in the overweight range were much more likely to have oral bone loss associated with presence of oral bacteria. Oral bone loss has been associated with osteoporosis in this group as well. This association has been difficult to study because many risk factors for periodontal disease and osteoporosis, including smoking, age, medications, and overall general health are similar. It should be noted that our study was limited in that it included a relatively healthy group of mostly Caucasian women and that future studies are needed to determine the effects of periodontal bacteria on bone loss in other groups of postmenopausal women."
"Taking care of your teeth and gums is a lifelong commitment," explained Preston D. Miller, Jr., DDS, President of the American Academy of Periodontology. "Women should pay special attention to their oral health as they enter different stages of their lives because additional periodontal care may be needed during different points such as the reproductive years or menopause. Knowing your ,pocket size, depth can be a good way for women to keep track of their periodontal health; periodontal pockets of one to two millimeters with no bleeding are not a concern but pockets of three and four millimeters may need a more in depth cleaning called scaling and root planing."
source : www.news-medical.net
Estrogen use lowered one risk factor for heart disease among some younger postmenopausal women
Estrogen use lowered one risk factor for heart disease among some younger postmenopausal women
A follow-up study to the federally funded Women's Health Initiative should help allay one concern in a subset of women in their 50s who are considering taking estrogen to relieve hot flashes.
The study shows that among women who have had hysterectomies, estrogen use was associated with a significantly reduced risk for one predictor of future heart attacks.
However, a Stanford University School of Medicine researcher who is the senior author of the follow-up study reminded women that hormone therapy still carries other health risks, such as the increased likelihood of blood clots and stroke, and stressed that the latest findings shouldn't be interpreted to mean that estrogen should be used to prevent heart disease.
"Heart disease is complex, and the effect of estrogen on one risk factor does not adequately predict the risk of having a heart attack," said Marcia Stefanick, PhD, professor of medicine at the Stanford Prevention Research Center and chair of the national steering committee for the overall WHI study. "But this study offers some reassurance for women of menopausal age that it's not unsafe, in terms of the risk of heart attack, to take estrogen, at least for a few years."
The latest study, which will be published in the June 21 issue of the New England Journal of Medicine, shows that women who took estrogen during the WHI study had lower levels of calcified plaque in their coronary arteries than did women who took placebo pills. The result adds yet another nuance to the complicated picture of hormone therapy that has emerged over the last five years.
Hormones relieve hot flashes and other symptoms of menopause. Until WHI was undertaken, observational studies over the years had been interpreted to suggest that hormones also protected women against heart disease, weak bones and dementia.
But WHI - the largest-ever study of postmenopausal women's health - published findings in 2002 that essentially blew up the conventional wisdom about hormone therapy and raised concerns among a few medical organizations that remain critical of the findings.
The hormone therapy portion of the WHI study had two placebo-controlled trials: one (for women who still had their uteruses) in which half of the women were assigned to take a combination of estrogen and progestin, and a similar trial for women who had undergone hysterectomies in which half the participants took estrogen alone. The estrogen-progestin arm was called to an early halt in 2002 when evidence showed that women taking the combined therapy faced a greater risk of breast cancer, stroke, blood clots and, in the first year of treatment, heart attack.
The estrogen-alone arm of the study involved women who had previously undergone a hysterectomy. Half of the women were given a form of estrogen known as conjugated equine estrogens, while the other half were given a placebo. It was stopped in 2004, one year before its scheduled conclusion, because of concerns that estrogen increased the risk of stroke and blood clots, with no benefit in terms of heart disease.
Since the end of both trials, Stefanick and the other WHI investigators have continued to analyze the data for a more detailed understanding of hormone therapy's effects.
Although the initial analysis of the WHI data found that estrogen had no effect on the risk of heart attack among all the women, who ranged in age from 50 to 79, secondary analyses suggested that there might be some benefit for women in their 50s and those within 10 years of menopause. However, the evidence showed no heart health benefit for older women or for those who began taking estrogen more than 10 years after menopause.
To delve into the possible benefit of estrogen in the younger age group, Stefanick and her WHI colleagues at 28 of the 40 original WHI clinical centers across the United States, including Stanford, invited participants who were in the 50-59 age group at the time they were accepted into the estrogen-only trial to have cardiac computed tomography scans to assess one indicator of heart disease, their levels of coronary artery calcium. If a buildup of calcified plaque ruptures, it could block the flow of blood through the arteries, possibly causing a heart attack or stroke.
These scans were completed an average of 1.3 years after the estrogen-only arm was halted in 2004, by which time an average of 8.7 years had elapsed since the women were randomly assigned to either placebo or active estrogen. At the time of the scans, calcified artery plaque was 20 to 40 percent lower in women who had taken estrogen compared with the women assigned to placebo pills. When the researchers narrowed the focus to those women who took 80 percent of their study pills during the trial, the coronary artery calcium score was 50 to 60 percent lower for those on estrogen compared with those on placebo.
But Stefanick noted that there was no way to know whether the reduced plaque levels will continue to be a reliable indicator of the progression of coronary artery disease in these women as they age. She also noted that other researchers have begun exploring whether heart disease in women, particularly those in their 50s, is linked to a more diffuse type of disease involving the small vessels of the heart. It is unclear how the scans for coronary artery calcification account for this disease, she added.
"Regardless, we have to keep in mind that heart disease is only one potential health risk of hormone therapy," Stefanick said. "When women are thinking about taking estrogen, they should consider the overall risk/benefit balance, which includes an increased risk of stroke and blood clots, regardless of age."
A related editorial that will appear in the same issue of the New England Journal of Medicine says the latest findings support the "timing hypothesis," meaning that estrogen use may have beneficial effects on heart health if initiated as "replacement therapy" before ovarian estrogen levels have been low for an extended period. The same hypothesis holds that if the therapy is initiated after a period of estrogen deprivation, it may be harmful.
However, Stefanick said the study data don't address the "timing hypothesis" because "only younger women were studied, so we don't know whether coronary artery calcium was higher or lower in the older women assigned to estrogen vs. placebo. Furthermore, without a baseline CT scan, we have no data about changes over time."
Stefanick said the medical advice for women experiencing hot flashes and other menopausal discomforts remains unchanged: If they choose to start estrogen, they should take the lowest dose that relieves their symptoms and limit the duration of the therapy.
source : www.news-medical.net
A follow-up study to the federally funded Women's Health Initiative should help allay one concern in a subset of women in their 50s who are considering taking estrogen to relieve hot flashes.
The study shows that among women who have had hysterectomies, estrogen use was associated with a significantly reduced risk for one predictor of future heart attacks.
However, a Stanford University School of Medicine researcher who is the senior author of the follow-up study reminded women that hormone therapy still carries other health risks, such as the increased likelihood of blood clots and stroke, and stressed that the latest findings shouldn't be interpreted to mean that estrogen should be used to prevent heart disease.
"Heart disease is complex, and the effect of estrogen on one risk factor does not adequately predict the risk of having a heart attack," said Marcia Stefanick, PhD, professor of medicine at the Stanford Prevention Research Center and chair of the national steering committee for the overall WHI study. "But this study offers some reassurance for women of menopausal age that it's not unsafe, in terms of the risk of heart attack, to take estrogen, at least for a few years."
The latest study, which will be published in the June 21 issue of the New England Journal of Medicine, shows that women who took estrogen during the WHI study had lower levels of calcified plaque in their coronary arteries than did women who took placebo pills. The result adds yet another nuance to the complicated picture of hormone therapy that has emerged over the last five years.
Hormones relieve hot flashes and other symptoms of menopause. Until WHI was undertaken, observational studies over the years had been interpreted to suggest that hormones also protected women against heart disease, weak bones and dementia.
But WHI - the largest-ever study of postmenopausal women's health - published findings in 2002 that essentially blew up the conventional wisdom about hormone therapy and raised concerns among a few medical organizations that remain critical of the findings.
The hormone therapy portion of the WHI study had two placebo-controlled trials: one (for women who still had their uteruses) in which half of the women were assigned to take a combination of estrogen and progestin, and a similar trial for women who had undergone hysterectomies in which half the participants took estrogen alone. The estrogen-progestin arm was called to an early halt in 2002 when evidence showed that women taking the combined therapy faced a greater risk of breast cancer, stroke, blood clots and, in the first year of treatment, heart attack.
The estrogen-alone arm of the study involved women who had previously undergone a hysterectomy. Half of the women were given a form of estrogen known as conjugated equine estrogens, while the other half were given a placebo. It was stopped in 2004, one year before its scheduled conclusion, because of concerns that estrogen increased the risk of stroke and blood clots, with no benefit in terms of heart disease.
Since the end of both trials, Stefanick and the other WHI investigators have continued to analyze the data for a more detailed understanding of hormone therapy's effects.
Although the initial analysis of the WHI data found that estrogen had no effect on the risk of heart attack among all the women, who ranged in age from 50 to 79, secondary analyses suggested that there might be some benefit for women in their 50s and those within 10 years of menopause. However, the evidence showed no heart health benefit for older women or for those who began taking estrogen more than 10 years after menopause.
To delve into the possible benefit of estrogen in the younger age group, Stefanick and her WHI colleagues at 28 of the 40 original WHI clinical centers across the United States, including Stanford, invited participants who were in the 50-59 age group at the time they were accepted into the estrogen-only trial to have cardiac computed tomography scans to assess one indicator of heart disease, their levels of coronary artery calcium. If a buildup of calcified plaque ruptures, it could block the flow of blood through the arteries, possibly causing a heart attack or stroke.
These scans were completed an average of 1.3 years after the estrogen-only arm was halted in 2004, by which time an average of 8.7 years had elapsed since the women were randomly assigned to either placebo or active estrogen. At the time of the scans, calcified artery plaque was 20 to 40 percent lower in women who had taken estrogen compared with the women assigned to placebo pills. When the researchers narrowed the focus to those women who took 80 percent of their study pills during the trial, the coronary artery calcium score was 50 to 60 percent lower for those on estrogen compared with those on placebo.
But Stefanick noted that there was no way to know whether the reduced plaque levels will continue to be a reliable indicator of the progression of coronary artery disease in these women as they age. She also noted that other researchers have begun exploring whether heart disease in women, particularly those in their 50s, is linked to a more diffuse type of disease involving the small vessels of the heart. It is unclear how the scans for coronary artery calcification account for this disease, she added.
"Regardless, we have to keep in mind that heart disease is only one potential health risk of hormone therapy," Stefanick said. "When women are thinking about taking estrogen, they should consider the overall risk/benefit balance, which includes an increased risk of stroke and blood clots, regardless of age."
A related editorial that will appear in the same issue of the New England Journal of Medicine says the latest findings support the "timing hypothesis," meaning that estrogen use may have beneficial effects on heart health if initiated as "replacement therapy" before ovarian estrogen levels have been low for an extended period. The same hypothesis holds that if the therapy is initiated after a period of estrogen deprivation, it may be harmful.
However, Stefanick said the study data don't address the "timing hypothesis" because "only younger women were studied, so we don't know whether coronary artery calcium was higher or lower in the older women assigned to estrogen vs. placebo. Furthermore, without a baseline CT scan, we have no data about changes over time."
Stefanick said the medical advice for women experiencing hot flashes and other menopausal discomforts remains unchanged: If they choose to start estrogen, they should take the lowest dose that relieves their symptoms and limit the duration of the therapy.
source : www.news-medical.net
Baby Boom Women Confronting Pelvic Health Conditions
Baby Boom Women Confronting Pelvic Health Conditions
(HealthDay News) - Baby boomer women still have hysterectomies at nearly the same rate that women did 25 years ago, despite the development of less drastic medical and surgical alternatives, a new report finds.
In 2005, more than 181,000 hysterectomies done in the United States were on Baby Boomers with two common uterine problems - fibroid tumors and heavy bleeding. But both conditions can often be treated with newer, less-invasive approaches, according to the report commissioned by the National Women's Health Resource Center.
The center describes the report as a first-of-its kind study on the prevalence of pelvic health disorders among American women.
Baby Boomer women, born between 1946 and 1964, are now in the age group where other pelvic disorders, such as stress urinary incontinence and pelvic prolapse, are common. Both stress urinary incontinence and pelvic prolapse, when the pelvic organs shift downward, may be significantly under-diagnosed in American women. That lack of diagnosis may be due to several factors, including lack of awareness or the perceived stigma associated with the conditions, according to the report released Tuesday. The National Women's Health Resource Center (NWHRC) commissioned the report because there "are so many new treatment options for pelvic disorders available," said Elizabeth Battaglino Cahill, the organization's executive vice president. "What we're finding out is that so many women don't know about" those options, she added.
Cahill said the report found that many women don't report the symptoms of fibroids, heavy bleeding, stress urinary incontinence or pelvic prolapse out of embarrassment or the belief that they are part of the normal course of aging.
She added that the NWHRC wants to make pelvic health the subject of the kind of discussion that's now commonplace for menopause. That way women will become more aware and ask their doctors about newer treatments, she said.
Continue Article
With that in mind, the group is launching a campaign called "What's Going on Down There?" It seeks to educate women how to maintain pelvic health throughout their lives and to provide information about common pelvic conditions and available treatments.
The number of women 40 to 49 years old who are having hysterectomies is a "secret in plain view," added Henrick Harwood, a vice president of the Lewin Group, which prepared the report for the NWHRC. "It's estimated that at least 25 percent of boomers will have a hysterectomy by the age of 60," he said.
What makes Baby Boom women turn to hysterectomies, the same treatment their mothers and grandmothers underwent, when better, newer options are available?
"That's the real question," said Dr. William H. Parker, an obstetrician and gynecologist and clinical professor at the University of California, Los Angeles School of Medicine.
"The numbers still haven't changed," Parker said, despite such surgical advances as myomectomy, which removes the fibroid rather than the entire uterus, and endometrial ablation, which destroys a thin layer of the uterine lining. "It's shocking," he added.
Parker said some women may not turn to the newer treatments, which have a quicker recovery time and preserve the uterus and ovaries, because the doctor who delivered their children and whom they've seen for 20 years recommended a hysterectomy.
Many doctors, Parker added, aren't trained to do the newer surgeries, insurance companies may not reimburse for them, or women may simply not be aware of them.
"A major part of my practice is giving second and third opinions because women are not getting the information they want," Parker said.
There are other factors that may compel women to continue to have unnecessary hysterectomies.
Dr. David Archer, a reproductive endocrinologist at Eastern Virginia Medical School in Norfolk, said endometrial ablation may not always be the cure for heavy bleeding, called menorrhagia. "The improvement in blood loss may not mean no blood loss at all," he explained. He added that, with a hysterectomy, the bleeding stops, so some women may choose that option to get it over with.
The report said an estimated 33 percent of Baby Boom women have stress urinary incontinence, but only about 47 percent of all women have ever asked their doctor about it. Many women don't realize that treatment may be as simple as floor exercises or biofeedback, or that surgical interventions are also available, the report said.
Some statistics show that as many as 40 percent of women between the ages of 50 and 79 have some form of pelvic prolapse, the report added. But only about 10 percent to 20 percent of women seek medical care, which includes surgical and non-surgical treatments, the report added.
source : www.cbc.ca
(HealthDay News) - Baby boomer women still have hysterectomies at nearly the same rate that women did 25 years ago, despite the development of less drastic medical and surgical alternatives, a new report finds.
In 2005, more than 181,000 hysterectomies done in the United States were on Baby Boomers with two common uterine problems - fibroid tumors and heavy bleeding. But both conditions can often be treated with newer, less-invasive approaches, according to the report commissioned by the National Women's Health Resource Center.
The center describes the report as a first-of-its kind study on the prevalence of pelvic health disorders among American women.
Baby Boomer women, born between 1946 and 1964, are now in the age group where other pelvic disorders, such as stress urinary incontinence and pelvic prolapse, are common. Both stress urinary incontinence and pelvic prolapse, when the pelvic organs shift downward, may be significantly under-diagnosed in American women. That lack of diagnosis may be due to several factors, including lack of awareness or the perceived stigma associated with the conditions, according to the report released Tuesday. The National Women's Health Resource Center (NWHRC) commissioned the report because there "are so many new treatment options for pelvic disorders available," said Elizabeth Battaglino Cahill, the organization's executive vice president. "What we're finding out is that so many women don't know about" those options, she added.
Cahill said the report found that many women don't report the symptoms of fibroids, heavy bleeding, stress urinary incontinence or pelvic prolapse out of embarrassment or the belief that they are part of the normal course of aging.
She added that the NWHRC wants to make pelvic health the subject of the kind of discussion that's now commonplace for menopause. That way women will become more aware and ask their doctors about newer treatments, she said.
Continue Article
With that in mind, the group is launching a campaign called "What's Going on Down There?" It seeks to educate women how to maintain pelvic health throughout their lives and to provide information about common pelvic conditions and available treatments.
The number of women 40 to 49 years old who are having hysterectomies is a "secret in plain view," added Henrick Harwood, a vice president of the Lewin Group, which prepared the report for the NWHRC. "It's estimated that at least 25 percent of boomers will have a hysterectomy by the age of 60," he said.
What makes Baby Boom women turn to hysterectomies, the same treatment their mothers and grandmothers underwent, when better, newer options are available?
"That's the real question," said Dr. William H. Parker, an obstetrician and gynecologist and clinical professor at the University of California, Los Angeles School of Medicine.
"The numbers still haven't changed," Parker said, despite such surgical advances as myomectomy, which removes the fibroid rather than the entire uterus, and endometrial ablation, which destroys a thin layer of the uterine lining. "It's shocking," he added.
Parker said some women may not turn to the newer treatments, which have a quicker recovery time and preserve the uterus and ovaries, because the doctor who delivered their children and whom they've seen for 20 years recommended a hysterectomy.
Many doctors, Parker added, aren't trained to do the newer surgeries, insurance companies may not reimburse for them, or women may simply not be aware of them.
"A major part of my practice is giving second and third opinions because women are not getting the information they want," Parker said.
There are other factors that may compel women to continue to have unnecessary hysterectomies.
Dr. David Archer, a reproductive endocrinologist at Eastern Virginia Medical School in Norfolk, said endometrial ablation may not always be the cure for heavy bleeding, called menorrhagia. "The improvement in blood loss may not mean no blood loss at all," he explained. He added that, with a hysterectomy, the bleeding stops, so some women may choose that option to get it over with.
The report said an estimated 33 percent of Baby Boom women have stress urinary incontinence, but only about 47 percent of all women have ever asked their doctor about it. Many women don't realize that treatment may be as simple as floor exercises or biofeedback, or that surgical interventions are also available, the report said.
Some statistics show that as many as 40 percent of women between the ages of 50 and 79 have some form of pelvic prolapse, the report added. But only about 10 percent to 20 percent of women seek medical care, which includes surgical and non-surgical treatments, the report added.
source : www.cbc.ca
Monday, June 18, 2007
McCain Campaign Criticizes Romney's Abortion-Rights Position Shift
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).
source : www.medicalnewstoday.com
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).
source : www.medicalnewstoday.com
Uruguayan Ministers, Public Figures Join Internet Campaign To Legalize Abortion
Uruguayan Ministers, Public Figures Join Internet Campaign To Legalize Abortion
Two government ministers and other Uruguayan public figures recently joined an Internet-based campaign to legalize abortion in the country, Reuters reports (Avila, Reuters, 6/11). Women who undergo abortion in Uruguay can face a three- to nine-month prison sentence, and anyone who is convicted of performing an abortion can face six to 24 months in prison. Abortion has been illegal in Uruguay since 1938 (Kaiser Daily Women's Health Policy Report, 5/10/04). About 30,000 illegal abortions are performed annually in the country, which has a population of about 3.3 million, according to nongovernmental organizations.
According to Reuters, about 3,500 people have signed a petition at despenalizar.blogspot.com since June 1, including the interior and social development ministers, writers and artists. The Web site says, "Those of us signing this have violated the law ... either by having an abortion or financing one, by accompanying a woman to have one, (or) knowing the identity of many women who have had one and keeping quiet. Either we are criminals or the law is unjust."
According to a recent poll, 61% of the country's population support legalizing abortion. A bill that would ease restrictions on the procedure was recently introduced in Congress, but Uruguayan President Tabare Vazquez has said he will veto any such legislation. The Senate defeated a similar bill in 2004 after the lower chamber passed it (Reuters, 6/11).
source : www.medicalnewstoday.com
Two government ministers and other Uruguayan public figures recently joined an Internet-based campaign to legalize abortion in the country, Reuters reports (Avila, Reuters, 6/11). Women who undergo abortion in Uruguay can face a three- to nine-month prison sentence, and anyone who is convicted of performing an abortion can face six to 24 months in prison. Abortion has been illegal in Uruguay since 1938 (Kaiser Daily Women's Health Policy Report, 5/10/04). About 30,000 illegal abortions are performed annually in the country, which has a population of about 3.3 million, according to nongovernmental organizations.
According to Reuters, about 3,500 people have signed a petition at despenalizar.blogspot.com since June 1, including the interior and social development ministers, writers and artists. The Web site says, "Those of us signing this have violated the law ... either by having an abortion or financing one, by accompanying a woman to have one, (or) knowing the identity of many women who have had one and keeping quiet. Either we are criminals or the law is unjust."
According to a recent poll, 61% of the country's population support legalizing abortion. A bill that would ease restrictions on the procedure was recently introduced in Congress, but Uruguayan President Tabare Vazquez has said he will veto any such legislation. The Senate defeated a similar bill in 2004 after the lower chamber passed it (Reuters, 6/11).
source : www.medicalnewstoday.com
Actions Taken On Women's Health-Related Legislation, Programs In Louisiana, Maryland, Massachusetts
Actions Taken On Women's Health-Related Legislation, Programs In Louisiana, Maryland, Massachusetts
The following highlights recent news of state and local actions on women's health-related issues.
Abortion
* Louisiana: The Senate on Monday voted 38-0 to approve a bill (SB 161) that would ban so-called "partial birth" abortions in the state and create criminal penalties for physicians who perform the procedure, the AP/New Orleans Times Picayune Times Picayune reports. Under the bill, sponsored by Sen. Ben Nevers (D), physicians violating the ban would be subject to a fine of $1,000 to $10,000 and a prison term of one to 10 years. The legislation would allow exceptions to the ban when the life of the pregnant woman is in danger. The measure, which is similar to a federal law, has been sent to the House (Simpson, AP/New Orleans Times Picayune, 6/11). The House last month unanimously voted to approve a similar measure (HB 614), sponsored by Rep. Gary Beard (R) (Kaiser Daily Women's Health Policy Report, 5/31).
Human Papillomavirus Vaccines
* Massachusetts: Health officials have no plans to require adolescent girls in the state to receive HPV vaccines for school enrollment, Susan Lett, medical director of the state's child immunization program, said Thursday at a hearing convened by the Legislature's Joint Committee on Public Health, the Boston Globe reports. Lett said that the state will have an optional HPV vaccination program. According to the Globe, the hearing was intended to help lawmakers decide whether the state should cover the HPV vaccine, as well as vaccines for meningitis and a severe form of diarrhea. The administration of Gov. Deval Patrick (D) had requested money in its budget proposal to expand the state's child immunization program, but the House eliminated the increase, and the Senate included funding only for the meningitis and diarrhea vaccines. State officials estimate it would cost nearly $23 million to provide the three vaccines to every eligible child in the state (Smith, Boston Globe, 6/8).
Sex Education
* Maryland: Montgomery County, Md., Public Schools Superintendent Jerry Weast last week recommended to the county's Board of Education that all middle and high schools in the district this fall implement a new sex education curriculum that teaches eighth- and 10th-grade students about sexual and gender identity issues and that includes a condom demonstration video, the Washington Post reports (de Vise, Washington Post, 6/8). The Board of Education in January voted 8-0 to approve a pilot program to test the curriculum, which includes two 45-minute classes for eighth-graders and three 45-minute classes for 10th-graders. Only students whose parents have provided written consent can participate in the lessons (Kaiser Daily Women's Health Policy Report, 3/8). The curriculum was tested at six schools in the spring. According to the Post, a citizens advisory committee on Friday asked Weast in a memo to add five statements concerning homosexuality and same-sex attraction. Weast and his staff rejected most of the additions, but he said teachers would be allowed to tell students that homosexuality is not a mental illness or a disease if they ask about it (de Vise, Washington Post, 6/12). The board is scheduled to consider the recommendations on Tuesday (Washington Post, 6/8). The groups Citizens for a Responsible Curriculum, Family Leader Network and Parents and Friends of Ex-Gays and Gays on Feb. 7 filed a petition against implementation of the curriculum with the Maryland State Board of Education (Kaiser Daily Women's Health Policy Report, 3/8). According to the Post, a decision on the petition is expected this summer (Washington Post, 6/8).
source : www.medicalnewstoday.com
The following highlights recent news of state and local actions on women's health-related issues.
Abortion
* Louisiana: The Senate on Monday voted 38-0 to approve a bill (SB 161) that would ban so-called "partial birth" abortions in the state and create criminal penalties for physicians who perform the procedure, the AP/New Orleans Times Picayune Times Picayune reports. Under the bill, sponsored by Sen. Ben Nevers (D), physicians violating the ban would be subject to a fine of $1,000 to $10,000 and a prison term of one to 10 years. The legislation would allow exceptions to the ban when the life of the pregnant woman is in danger. The measure, which is similar to a federal law, has been sent to the House (Simpson, AP/New Orleans Times Picayune, 6/11). The House last month unanimously voted to approve a similar measure (HB 614), sponsored by Rep. Gary Beard (R) (Kaiser Daily Women's Health Policy Report, 5/31).
Human Papillomavirus Vaccines
* Massachusetts: Health officials have no plans to require adolescent girls in the state to receive HPV vaccines for school enrollment, Susan Lett, medical director of the state's child immunization program, said Thursday at a hearing convened by the Legislature's Joint Committee on Public Health, the Boston Globe reports. Lett said that the state will have an optional HPV vaccination program. According to the Globe, the hearing was intended to help lawmakers decide whether the state should cover the HPV vaccine, as well as vaccines for meningitis and a severe form of diarrhea. The administration of Gov. Deval Patrick (D) had requested money in its budget proposal to expand the state's child immunization program, but the House eliminated the increase, and the Senate included funding only for the meningitis and diarrhea vaccines. State officials estimate it would cost nearly $23 million to provide the three vaccines to every eligible child in the state (Smith, Boston Globe, 6/8).
Sex Education
* Maryland: Montgomery County, Md., Public Schools Superintendent Jerry Weast last week recommended to the county's Board of Education that all middle and high schools in the district this fall implement a new sex education curriculum that teaches eighth- and 10th-grade students about sexual and gender identity issues and that includes a condom demonstration video, the Washington Post reports (de Vise, Washington Post, 6/8). The Board of Education in January voted 8-0 to approve a pilot program to test the curriculum, which includes two 45-minute classes for eighth-graders and three 45-minute classes for 10th-graders. Only students whose parents have provided written consent can participate in the lessons (Kaiser Daily Women's Health Policy Report, 3/8). The curriculum was tested at six schools in the spring. According to the Post, a citizens advisory committee on Friday asked Weast in a memo to add five statements concerning homosexuality and same-sex attraction. Weast and his staff rejected most of the additions, but he said teachers would be allowed to tell students that homosexuality is not a mental illness or a disease if they ask about it (de Vise, Washington Post, 6/12). The board is scheduled to consider the recommendations on Tuesday (Washington Post, 6/8). The groups Citizens for a Responsible Curriculum, Family Leader Network and Parents and Friends of Ex-Gays and Gays on Feb. 7 filed a petition against implementation of the curriculum with the Maryland State Board of Education (Kaiser Daily Women's Health Policy Report, 3/8). According to the Post, a decision on the petition is expected this summer (Washington Post, 6/8).
source : www.medicalnewstoday.com
AP/Houston Chronicle Examines Debate On Initiative That Aims To Reduce Number Of Unintended Pregnancies, Abortions
AP/Houston Chronicle Examines Debate On Initiative That Aims To Reduce Number Of Unintended Pregnancies, Abortions
The AP/Houston Chronicle on Thursday examined the debate concerning the so-called "prevention first" initiative, a package of legislation that aims to reduce the need for abortions by reducing the number of unintended pregnancies.
According to proponents of the initiative, providing better information about contraceptives and expanding access to them are methods that could reduce unintended pregnancies and subsequent abortions. Opponents of the initiative believe it is an "alarming effort to eliminate abstinence-only sex education, strengthen abortion-rights groups and encourage sex outside of marriage," the AP/Chronicle reports.
The "centerpiece" of the initiative is a bill (S 21), sponsored by Senate Majority Leader Harry Reid (D-Nev.), that would expand Medicaid and private health insurance coverage to include contraceptives and require hospitals to make emergency contraception available to rape survivors. The measure, called the Prevention First Act, also would allocate funds for comprehensive sex education programs that teach youth about contraception, as well as abstinence.
Another measure (HR 2596, S 1555) in the package would require pharmacies to provide women access to contraceptives (Crary, AP/Houston Chronicle, 6/7). The measure, introduced last week by Rep. Carolyn Maloney (D-N.Y.) and Sen. Frank Lautenburg (D-N.J.), also would make it illegal for a pharmacy to refuse to fill a birth control prescription and for a pharmacist to "intimidate, threaten or harass customers" or "intentionally breach, or threaten to breach, medical confidentiality," according to a Maloney release (Maloney release, 6/6).
According to the AP/Chronicle, groups that support abortion rights -- including Planned Parenthood Federation of America and NARAL Pro-Choice America -- are advocating for similar legislation at the state level. Colorado and Washington earlier this year passed laws barring abstinence-only sex education in public schools, and five states -- Arkansas, Connecticut, Colorado, Minnesota and Oregon -- passed laws requiring hospitals to provide EC or information about the drug to rape survivors.
source : www.medicalnewstoday.com
The AP/Houston Chronicle on Thursday examined the debate concerning the so-called "prevention first" initiative, a package of legislation that aims to reduce the need for abortions by reducing the number of unintended pregnancies.
According to proponents of the initiative, providing better information about contraceptives and expanding access to them are methods that could reduce unintended pregnancies and subsequent abortions. Opponents of the initiative believe it is an "alarming effort to eliminate abstinence-only sex education, strengthen abortion-rights groups and encourage sex outside of marriage," the AP/Chronicle reports.
The "centerpiece" of the initiative is a bill (S 21), sponsored by Senate Majority Leader Harry Reid (D-Nev.), that would expand Medicaid and private health insurance coverage to include contraceptives and require hospitals to make emergency contraception available to rape survivors. The measure, called the Prevention First Act, also would allocate funds for comprehensive sex education programs that teach youth about contraception, as well as abstinence.
Another measure (HR 2596, S 1555) in the package would require pharmacies to provide women access to contraceptives (Crary, AP/Houston Chronicle, 6/7). The measure, introduced last week by Rep. Carolyn Maloney (D-N.Y.) and Sen. Frank Lautenburg (D-N.J.), also would make it illegal for a pharmacy to refuse to fill a birth control prescription and for a pharmacist to "intimidate, threaten or harass customers" or "intentionally breach, or threaten to breach, medical confidentiality," according to a Maloney release (Maloney release, 6/6).
According to the AP/Chronicle, groups that support abortion rights -- including Planned Parenthood Federation of America and NARAL Pro-Choice America -- are advocating for similar legislation at the state level. Colorado and Washington earlier this year passed laws barring abstinence-only sex education in public schools, and five states -- Arkansas, Connecticut, Colorado, Minnesota and Oregon -- passed laws requiring hospitals to provide EC or information about the drug to rape survivors.
source : www.medicalnewstoday.com
New Hampshire Senate Approves Bill That Would Repeal Parental Notification Law; Gov. Lynch Says He Will Sign It Into Law
New Hampshire Senate Approves Bill That Would Repeal Parental Notification Law; Gov. Lynch Says He Will Sign It Into Law
The New Hampshire Senate on Thursday voted 15-9 to pass a House-approved bill (HB 184) that would repeal a state law (HB 763) requiring physicians to notify by certified letter a parent or guardian of a minor who is seeking an abortion at least 48 hours before performing the procedure, the New York Times reports. The bill now goes to Gov. John Lynch (D), who has said he will sign it into law. According to the Times, New Hampshire will be first state to repeal a parental notification measure if Lynch signs the bill (Belluck, New York Times, 6/8).
The law that would be repealed also bars parents from forbidding the procedure, and the notification requirement could be bypassed by a judge if a doctor determines that the minor's life is in danger. Planned Parenthood of Northern New England; the American Civil Liberties Union; the Concord Feminist Health Center; the Feminist Health Center of Portsmouth, N.H.; and Manchester, N.H.-based ob-gyn Wayne Goldner in November 2003 filed a lawsuit challenging the constitutionality of the law. U.S. District Judge Joseph DiClerico and the 1st U.S. Circuit Court of Appeals subsequently struck down the entire law.
New Hampshire Attorney General Kelly Ayotte (R) appealed the rulings to the U.S. Supreme Court, saying that the judicial bypass clause in the measure combined with other state laws that allow doctors to act in an emergency protect a woman's health. The Supreme Court in January 2006 unanimously ruled that the lower courts should not have invalidated the entire measure and ordered lower courts to review the legislative intent regarding exceptions to the law for medical emergencies. DiClerico on Feb. 1 said he will continue to block enforcement of the law while the Legislature considers the measure that would repeal it (Kaiser Daily Women's Health Policy Report, 5/14).
State Senate Majority Leader Joseph Foster (D) said the issue before lawmakers is not about abortion or parental rights, adding, "This is about a bill that, when adopted, was known by the Legislature to be unconstitutional"
source : www.medicalnewstoday.com
The New Hampshire Senate on Thursday voted 15-9 to pass a House-approved bill (HB 184) that would repeal a state law (HB 763) requiring physicians to notify by certified letter a parent or guardian of a minor who is seeking an abortion at least 48 hours before performing the procedure, the New York Times reports. The bill now goes to Gov. John Lynch (D), who has said he will sign it into law. According to the Times, New Hampshire will be first state to repeal a parental notification measure if Lynch signs the bill (Belluck, New York Times, 6/8).
The law that would be repealed also bars parents from forbidding the procedure, and the notification requirement could be bypassed by a judge if a doctor determines that the minor's life is in danger. Planned Parenthood of Northern New England; the American Civil Liberties Union; the Concord Feminist Health Center; the Feminist Health Center of Portsmouth, N.H.; and Manchester, N.H.-based ob-gyn Wayne Goldner in November 2003 filed a lawsuit challenging the constitutionality of the law. U.S. District Judge Joseph DiClerico and the 1st U.S. Circuit Court of Appeals subsequently struck down the entire law.
New Hampshire Attorney General Kelly Ayotte (R) appealed the rulings to the U.S. Supreme Court, saying that the judicial bypass clause in the measure combined with other state laws that allow doctors to act in an emergency protect a woman's health. The Supreme Court in January 2006 unanimously ruled that the lower courts should not have invalidated the entire measure and ordered lower courts to review the legislative intent regarding exceptions to the law for medical emergencies. DiClerico on Feb. 1 said he will continue to block enforcement of the law while the Legislature considers the measure that would repeal it (Kaiser Daily Women's Health Policy Report, 5/14).
State Senate Majority Leader Joseph Foster (D) said the issue before lawmakers is not about abortion or parental rights, adding, "This is about a bill that, when adopted, was known by the Legislature to be unconstitutional"
source : www.medicalnewstoday.com
U.S. Circuit Court Of Appeals Rules That Women Who Underwent Forced Abortions Can Seek Asylum In U.S.
U.S. Circuit Court Of Appeals Rules That Women Who Underwent Forced Abortions Can Seek Asylum In U.S.
A three-judge panel of the 9th U.S. Circuit Court of Appeals in San Francisco on Wednesday unanimously ruled that women from other countries, such as China, who are forced to undergo abortion can be awarded asylum in the U.S., the AP/Houston Chronicle reports (Elias, AP/Houston Chronicle, 6/6). A three-judge panel of the court in March 2005 ruled that women who were forcibly sterilized under China's "coercive population control policies" and their husbands are entitled to political asylum in the U.S. (Kaiser Daily Women's Health Policy Report, 3/10/05).
The panel on Wednesday said that women who underwent forced abortion should receive the same protection given to women who underwent forced sterilizations, according to the AP/Chronicle. The panel in its ruling wrote that both forced abortion and sterilization have "serious, ongoing effects," adding, "We see no way to distinguish between the victims of forced sterilization and the victims of forced abortion for withholding of removal eligibility purposes."
The court made the determination based on the case of Zi Zhi Tang, whose wife in 1980 was forced to undergo an abortion in China because the couple was not yet married, the AP/Chronicle reports. Zi Zhi's employer, a Chinese construction company, in 1991 sent him and his wife to Guam to work on a project. Immigration officials in 2002 notified Zi Zhi that his worker's visa had expired, and he was instructed to leave the country. Zi Zhi appealed the order, saying that his wife had suffered persecution in China because of the forced abortion.
An immigration judge ruled that the abortion was not forced because Zi Zhi's wife did not hide after receiving a notice about the planned abortion from Chinese officials and ordered that the couple be deported. The appeals court overturned the decision of the lower court, finding that an official order to undergo abortion constitutes force. Zi Zhi's attorney and an attorney for the Department of Justice, which argued for the deportation, declined to comment.
source : www.medicalnewstoday.com
A three-judge panel of the 9th U.S. Circuit Court of Appeals in San Francisco on Wednesday unanimously ruled that women from other countries, such as China, who are forced to undergo abortion can be awarded asylum in the U.S., the AP/Houston Chronicle reports (Elias, AP/Houston Chronicle, 6/6). A three-judge panel of the court in March 2005 ruled that women who were forcibly sterilized under China's "coercive population control policies" and their husbands are entitled to political asylum in the U.S. (Kaiser Daily Women's Health Policy Report, 3/10/05).
The panel on Wednesday said that women who underwent forced abortion should receive the same protection given to women who underwent forced sterilizations, according to the AP/Chronicle. The panel in its ruling wrote that both forced abortion and sterilization have "serious, ongoing effects," adding, "We see no way to distinguish between the victims of forced sterilization and the victims of forced abortion for withholding of removal eligibility purposes."
The court made the determination based on the case of Zi Zhi Tang, whose wife in 1980 was forced to undergo an abortion in China because the couple was not yet married, the AP/Chronicle reports. Zi Zhi's employer, a Chinese construction company, in 1991 sent him and his wife to Guam to work on a project. Immigration officials in 2002 notified Zi Zhi that his worker's visa had expired, and he was instructed to leave the country. Zi Zhi appealed the order, saying that his wife had suffered persecution in China because of the forced abortion.
An immigration judge ruled that the abortion was not forced because Zi Zhi's wife did not hide after receiving a notice about the planned abortion from Chinese officials and ordered that the couple be deported. The appeals court overturned the decision of the lower court, finding that an official order to undergo abortion constitutes force. Zi Zhi's attorney and an attorney for the Department of Justice, which argued for the deportation, declined to comment.
source : www.medicalnewstoday.com
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