Some women who carry the BRCA gene mutation, which predisposes to breast cancer, may choose to have a prophylactic mastectomy rather than undertake lifetime surveillance, a Dutch scientist will tell the 6th European Breast Cancer Conference (EBCC-6) today (Wednesday 16 April). The mastectomy option appears to give an excellent result in avoiding breast cancer, with a remaining risk of less than 1%, Dr. Reinie Kaas, from the Surgical Department of the Netherlands Cancer Institute, Amsterdam, The Netherlands, will say.
Dr. Kaas set out to study the effects of prophylactic mastectomy in 250 patients who were BRCA carriers. "It was thought that after such a mastectomy the risk of being diagnosed with breast cancer was about 5%," she says "and therefore there was debate about whether continued surveillance was necessary or not. We decided to try to answer this question in order that women at high risk should be able to make an informed choice."
Women with mutations in the BRCA1 or BRCA2 genes have an estimated lifetime risk of developing breast cancer of about 85%. Currently strategies to deal with this risk are surveillance with monthly breast self-examination, bi-annual clinical breast examination by a physician and annual mammography plus breast MRI, or prophylactic mastectomy, where the entire breast is removed. About half of the carriers choose the latter strategy. The surveillance strategy does not prevent breast cancer, and especially in BRCA1 carriers, who mostly have fast growing tumours, 25-30% of carriers are diagnosed when the tumour is already more than 2cm in diameter.
Dr. Kaas and her team found that only one out of the 250 carriers studied was diagnosed with a breast cancer, and this was likely to be because the axillary tail (a small part of the breast that extends towards the armpit) had not been completely removed. "Our epidemiologists are investigating how many breast cancers are avoided up to the age of 80 in these women," she says. "But on current evidence we can safely state that continued follow-up, which can be costly as well as stressful for the patient, is not warranted in patients who have had a prophylactic mastectomy. Surveillance in those BRCA carriers who do not opt for mastectomy has to start at an early age, and the frequent visits to the doctor and the many examinations which need to be undertaken regularly can be a source of great stress for many women.
"However, the decision to remove healthy breasts is solely the decision of the woman, and healthcare services should not press women to make this choice simply to reduce costs."
In another presentation to the conference tomorrow (Wednesday) Dr. Yvonne Kamm, a medical oncologist from the Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, will say that the costs of screening for BRCA carriers are very high, and even more so because the MRI that is used can have a high false positive rate, leading to further investigations.
"The MRI is expensive in itself, but useful because it can detect very small tumours which might not be picked up otherwise. But it also detects many other abnormalities that are not cancer, and this implies not just extra cost but also considerably anxiety for the women concerned," she says.
Between September 1999 and 2005, Dr. Kamm and her team screened 196 women at risk of hereditary breast cancer. When an abnormality was found, the women underwent further investigations. The women were screened for a median period of 2 years; this included 1149 breast examinations, 494 mammograms, and 436 MRI scans. Abnormalities led to further investigations; 32 breast examinations, 17 mammograms, 64 MRI scans, 114 ultrasound examinations, and 48 biopsies.
The cost of the first screening programme was ?‚¬254 per woman year, and the extra costs of further investigations ?‚¬61 per woman year. During the 6 year period 13 cancers were found.
"The total costs to find one breast cancer were high - ?‚¬13168," says Dr. Kamm. We know that such intensive screening works, and that it can find breast cancer at an early stage. Therefore, we have made the choice to screen intensively women at very high risk from breast cancer."
Catalogue nos: 109, Wednesday 14.30 hrs CEST (Hall 15.2)
18, Wednesday Poster Session (Hall 11)
European Breast Cancer Conference
суббота, 24 сентября 2011 г.
суббота, 17 сентября 2011 г.
Lost That Lovin' Feeling? Don't Blame The Pill
When your sex drive is sputtering, you may want to take a closer look at several factors in your life.
In fact, it's natural for people to ask: Is the loss of sexual desire due directly to taking the birth control pill? The answer to this question which has been asked for more than 40 years, since the oral contraceptive was introduced may now be less murky, according to researchers at the Ohio State University Medical Center.
Dr. Jonathan Schaffir, an obstetrician and gynecologist with the medical center, reviewed more than 25 years' worth of studies, examining the relationship between oral contraceptives and libido, and concluded that the pill has little, if any, effect on a woman's sex drive. His study was published in a recent issue of the Journal of Sex & Marital Therapy.
The issue has roots in the early forms of the pill, developed in the 1960s, which often contained high levels of estrogens and progestins many times as much as 80 to 150 micrograms in single doses. The makeup of birth control pills caused many women to become bloated, feel breast tenderness or experience nausea.
"These side effects could easily have caused women to feel extremely uncomfortable, translating into decreased libido," noted Schaffir. "Also much less was known about the human sexual response at that time, which could have led to information based on opinion and not on fact."
Schaffir made a critical assessment of the published information, to see if there is a way to predict whether certain types of hormonal contraception or certain segments of the population are more prone to changes in libido.
Schaffir noted that some women, indeed, experience a change in libido while taking oral contraceptives, but he could find no predictable patterns for this in the literature.
When looking for a consistent biological effect of hormonal contraception on sexual desire, androgens would probably be the factor most suspected to play a role, said Schaffir. "It was shown that the birth control pill decreased the concentration of free androgens, including testosterone, but that doesn't necessarily translate to a loss of libido. Chemical changes occurred, but they did not apparently impact sexual behavior for the vast majority of women," he said.
Similarly, the effect of progestin on women's sexual desire was not dramatic. "A small minority of all the users of progestin were actually bothered by a low libido," said Schaffir.
Based on his review of studies dating from 1975 to 2004, Schaffir found that only a small minority of oral contraceptive users experienced a negative effect on sexuality. Furthermore, he found no reliable predictor of a negative effect in those who experienced such side effects.
"Studies showed that it was a problem for a small number of women using birth control pills to experience decreased libido, but it didn't happen predictably in any specific sub-population, or with any particular type of hormonal contraception," said Schaffir. "In fact, changes in sexual desire could as likely represent a combination of biological, psychological and social phenomena as any hormonal effect.
"The available literature illustrated that decreased libido is an idiosyncratic, unpredictable reaction in a small minority of women," stated Schaffir.
Schaffir reassured patients and clinicians that women should continue to use oral contraceptives without fear of an adverse effect on libido. "Don't let such fear factor into your decision of whether to take hormonal birth control pills," said Schaffir.
If you are experiencing a diminishing sex drive, you may want to ask yourself:
Have you recently started taking a medication?
There are some medications that are known to interfere with libido, and antidepressants are probably the most notorious group, said Schaffir. You may want to consult your physician, because stopping or changing the medication could be effective, he said. Schaffir and other researchers at Ohio State are part of ongoing FDA phase II and phase III trials, involving hormonal and non-hormonal medications that some day may directly improve sexual drive, noted Schaffir. But currently there is no one pill that you can take for a lack of libido.
Have you recently had increased tensions or stresses in your sexual relationship?
The only thing that to this point has been consistently effective in treating low libido is sex therapy, or couples therapy, in which you talk with a counselor about a relationship or discuss sexual goals, noted Schaffir. This emphasizes the fact that such a difficulty is probably many times psychological, and not just biological, he said.
Ohio State University Medical Center
450 W. 10th Ave.
Columbus, OH 43210
United States
osumedcenter.edu
In fact, it's natural for people to ask: Is the loss of sexual desire due directly to taking the birth control pill? The answer to this question which has been asked for more than 40 years, since the oral contraceptive was introduced may now be less murky, according to researchers at the Ohio State University Medical Center.
Dr. Jonathan Schaffir, an obstetrician and gynecologist with the medical center, reviewed more than 25 years' worth of studies, examining the relationship between oral contraceptives and libido, and concluded that the pill has little, if any, effect on a woman's sex drive. His study was published in a recent issue of the Journal of Sex & Marital Therapy.
The issue has roots in the early forms of the pill, developed in the 1960s, which often contained high levels of estrogens and progestins many times as much as 80 to 150 micrograms in single doses. The makeup of birth control pills caused many women to become bloated, feel breast tenderness or experience nausea.
"These side effects could easily have caused women to feel extremely uncomfortable, translating into decreased libido," noted Schaffir. "Also much less was known about the human sexual response at that time, which could have led to information based on opinion and not on fact."
Schaffir made a critical assessment of the published information, to see if there is a way to predict whether certain types of hormonal contraception or certain segments of the population are more prone to changes in libido.
Schaffir noted that some women, indeed, experience a change in libido while taking oral contraceptives, but he could find no predictable patterns for this in the literature.
When looking for a consistent biological effect of hormonal contraception on sexual desire, androgens would probably be the factor most suspected to play a role, said Schaffir. "It was shown that the birth control pill decreased the concentration of free androgens, including testosterone, but that doesn't necessarily translate to a loss of libido. Chemical changes occurred, but they did not apparently impact sexual behavior for the vast majority of women," he said.
Similarly, the effect of progestin on women's sexual desire was not dramatic. "A small minority of all the users of progestin were actually bothered by a low libido," said Schaffir.
Based on his review of studies dating from 1975 to 2004, Schaffir found that only a small minority of oral contraceptive users experienced a negative effect on sexuality. Furthermore, he found no reliable predictor of a negative effect in those who experienced such side effects.
"Studies showed that it was a problem for a small number of women using birth control pills to experience decreased libido, but it didn't happen predictably in any specific sub-population, or with any particular type of hormonal contraception," said Schaffir. "In fact, changes in sexual desire could as likely represent a combination of biological, psychological and social phenomena as any hormonal effect.
"The available literature illustrated that decreased libido is an idiosyncratic, unpredictable reaction in a small minority of women," stated Schaffir.
Schaffir reassured patients and clinicians that women should continue to use oral contraceptives without fear of an adverse effect on libido. "Don't let such fear factor into your decision of whether to take hormonal birth control pills," said Schaffir.
If you are experiencing a diminishing sex drive, you may want to ask yourself:
Have you recently started taking a medication?
There are some medications that are known to interfere with libido, and antidepressants are probably the most notorious group, said Schaffir. You may want to consult your physician, because stopping or changing the medication could be effective, he said. Schaffir and other researchers at Ohio State are part of ongoing FDA phase II and phase III trials, involving hormonal and non-hormonal medications that some day may directly improve sexual drive, noted Schaffir. But currently there is no one pill that you can take for a lack of libido.
Have you recently had increased tensions or stresses in your sexual relationship?
The only thing that to this point has been consistently effective in treating low libido is sex therapy, or couples therapy, in which you talk with a counselor about a relationship or discuss sexual goals, noted Schaffir. This emphasizes the fact that such a difficulty is probably many times psychological, and not just biological, he said.
Ohio State University Medical Center
450 W. 10th Ave.
Columbus, OH 43210
United States
osumedcenter.edu
суббота, 10 сентября 2011 г.
Maternal Health Must Become A Priority In Developing Countries
"Mothers are the backbones of communities. When they die, children become orphaned, families are fragmented," said Jean Chamberlain Froese, MD, during the President's Program at The American College of Obstetricians and Gynecologists (ACOG) 57th Annual Clinical Meeting. Although making pregnancy and childbirth safer in countries where maternal mortality is extraordinarily high can seem like a daunting task, employing practical solutions is possible to improve maternal health and pregnancy outcomes, according to Dr. Froese.
In her presentation, "Where Have All the Mothers Gone?," Dr. Chamberlain Froese spoke about her personal experience working in Uganda to make childbirth safer there. The logical first step in improving a community's overall health care is to improve maternal health, she said, because the equipment and systems necessary for a strong maternal health program also benefit the overall community. "The needs in developing countries are so immense and seem overwhelming, but once you've got the basics for a good maternal health program, you've got a good structure that will help the general population as well," Dr. Chamberlain Froese said.
Communities need to be educated about pregnancy risks and common pregnancy complications so that pregnant women become a priority, according to Dr. Chamberlain Froese. Two key components in reaching this goal include grassroots public education and agenda setting.
Governments need to allocate money toward improving the infrastructure, such as roads, because muddy and pothole-laden roads can make an emergency trip slow and dangerous. In some instances, pregnant women may stand on the side of the road, hemorrhaging while trying to flag down a car or public bus, but no one stops.
Agenda setting among political leaders is key to improving maternal health. Four members of the Ugandan Parliament have participated in a master's of public health (MPH) leadership program overseen by Dr. Chamberlain Froese. This program trains Ugandan professionals from many disciplines to make motherhood safer for African women. One member of the Ugandan Parliament has introduced new legislation to improve safe motherhood.
Awareness is increasing little by little. A Uganda journalist from the national daily newspaper has completed the MPH program and has helped bring attention to the issue. "There was nothing on safe motherhood for three months in the national newspapers. And now there are regular features every one to two weeks that cover issues concerning safe motherhood and reproductive health," Dr. Chamberlain Froese said.
Dr. Chamberlain Froese is the executive director of the nonprofit organization Save the Mothers and assistant professor of ob-gyn at McMaster University in Hamilton, Ontario. For the last four years, she has spent eight months of the year in Uganda overseeing the MPH leadership program. Before that, she spent five years in Yemen improving conditions for pregnant women.
The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization, ACOG: strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's health care.
Source
American College of Obstetricians and Gynecologists
In her presentation, "Where Have All the Mothers Gone?," Dr. Chamberlain Froese spoke about her personal experience working in Uganda to make childbirth safer there. The logical first step in improving a community's overall health care is to improve maternal health, she said, because the equipment and systems necessary for a strong maternal health program also benefit the overall community. "The needs in developing countries are so immense and seem overwhelming, but once you've got the basics for a good maternal health program, you've got a good structure that will help the general population as well," Dr. Chamberlain Froese said.
Communities need to be educated about pregnancy risks and common pregnancy complications so that pregnant women become a priority, according to Dr. Chamberlain Froese. Two key components in reaching this goal include grassroots public education and agenda setting.
Governments need to allocate money toward improving the infrastructure, such as roads, because muddy and pothole-laden roads can make an emergency trip slow and dangerous. In some instances, pregnant women may stand on the side of the road, hemorrhaging while trying to flag down a car or public bus, but no one stops.
Agenda setting among political leaders is key to improving maternal health. Four members of the Ugandan Parliament have participated in a master's of public health (MPH) leadership program overseen by Dr. Chamberlain Froese. This program trains Ugandan professionals from many disciplines to make motherhood safer for African women. One member of the Ugandan Parliament has introduced new legislation to improve safe motherhood.
Awareness is increasing little by little. A Uganda journalist from the national daily newspaper has completed the MPH program and has helped bring attention to the issue. "There was nothing on safe motherhood for three months in the national newspapers. And now there are regular features every one to two weeks that cover issues concerning safe motherhood and reproductive health," Dr. Chamberlain Froese said.
Dr. Chamberlain Froese is the executive director of the nonprofit organization Save the Mothers and assistant professor of ob-gyn at McMaster University in Hamilton, Ontario. For the last four years, she has spent eight months of the year in Uganda overseeing the MPH leadership program. Before that, she spent five years in Yemen improving conditions for pregnant women.
The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization, ACOG: strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's health care.
Source
American College of Obstetricians and Gynecologists
суббота, 3 сентября 2011 г.
Children Of Women Who Smoked During Pregnancy At Increased Risk Of Becoming Smokers
New research has revealed that prenatal exposure to nicotine increases the vulnerability to nicotine self-administration in adolescent mice. The results support the hypothesis that adolescents with prenatal nicotine exposure are more likely to start smoking earlier than their peers and that they are also more susceptible to the addictive effects of nicotine, especially as a result of stress and peer pressure. The study performed with mice is part of a project researching the behavioural and molecular mechanisms of nicotine addiction. The research project was carried out under the Academy of Finland's Research Programme on Substance Abuse and Addictions.
The key observation made by the Finnish and Russian researchers in the project was that adding nicotine to the drinking water of pregnant mice led to differences between the control and nicotine-exposed offspring in terms of nicotine self-administration. Treating the dams with nicotine during the prenatal period increased the frequency of self-administration in the offspring compared to the control group, even at lower doses.
The study also examined the receptor-level combined effects of opioids (morphine and morphine-related compounds) and nicotine. A receptor is a human protein to which endogenous and exogenous compounds bind. Once the receptors are activated, they trigger a number of intracellular signals. The compounds that bind to a receptor may also alter or turn off the receptor signalling. The present study was conducted using cell lines that express different subtypes of nicotinic receptors. Nicotine attaches to these receptors and activates them.
The results of the research project show that morphine and its related compounds, which normally attach to their own receptors, also bind to nicotinic receptors, causing altered nicotine responses. This provides a possible explanation for the common concurrent use of nicotine and other substances. The results may also pave the way for the development of new medication used to treat both smoking and drug addiction.
The study was conducted as a joint Finnish-Russian project between the Division of Pharmacology and Toxicology at the University of Helsinki, the Saint Petersburg Pavlov Medical University and Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry in Moscow. The project was a concrete example of how people, research and knowledge can transcend national and cultural boundaries. The Finnish part of the project received funding from the Academy of Finland.
Sources: Suomen Akatemia, AlphaGalileo Foundation.
The key observation made by the Finnish and Russian researchers in the project was that adding nicotine to the drinking water of pregnant mice led to differences between the control and nicotine-exposed offspring in terms of nicotine self-administration. Treating the dams with nicotine during the prenatal period increased the frequency of self-administration in the offspring compared to the control group, even at lower doses.
The study also examined the receptor-level combined effects of opioids (morphine and morphine-related compounds) and nicotine. A receptor is a human protein to which endogenous and exogenous compounds bind. Once the receptors are activated, they trigger a number of intracellular signals. The compounds that bind to a receptor may also alter or turn off the receptor signalling. The present study was conducted using cell lines that express different subtypes of nicotinic receptors. Nicotine attaches to these receptors and activates them.
The results of the research project show that morphine and its related compounds, which normally attach to their own receptors, also bind to nicotinic receptors, causing altered nicotine responses. This provides a possible explanation for the common concurrent use of nicotine and other substances. The results may also pave the way for the development of new medication used to treat both smoking and drug addiction.
The study was conducted as a joint Finnish-Russian project between the Division of Pharmacology and Toxicology at the University of Helsinki, the Saint Petersburg Pavlov Medical University and Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry in Moscow. The project was a concrete example of how people, research and knowledge can transcend national and cultural boundaries. The Finnish part of the project received funding from the Academy of Finland.
Sources: Suomen Akatemia, AlphaGalileo Foundation.
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