ACOG Statement On Revised US Preventive Services Task Force RecommendationsOn Breast Cancer Screening

In response to today's US Preventive Services Task Force (USPSTF) statement that recommends against routine mammography screening for women in their 40s and recommends screening only once every two years for women ages 50 to 74, The American College of Obstetricians and Gynecologists (ACOG) maintains its current advice that women in their 40s continue mammography screening every one to two years and women age 50 or older continue annual screening. The USPSTF revised recommendations are published in the November 17, 2009, issue of Annals of Internal Medicine. (Read more.)


As the organization representing the nation's ob-gyns who provide health care exclusively for women, ACOG welcomes these new review data on breast cancer screening. However, the implications of the USPSTF's recommendations for both women and physicians are not insignificant and require that ACOG evaluate both the data and the USPSTF's interpretations in greater detail. All women, along with their physicians, should individually assess the benefits and as well as the risks of mammography screening.


The USPSTF also recommends against clinicians teaching women how to perform breast self-exams (BSE). At this time, ACOG's position is that ob-gyns should continue to counsel women that BSE has the potential to detect palpable breast cancer and can be performed.


ACOG strongly supports shared decision making between doctor and patient, and in the case of screening for breast cancer, it is essential.


Source

American College of Obstetricians and Gynecologists (ACOG)

Don't take HRT just to ward off cardiovascular disease

Doctors should not recommend that post-menopausal women start hormone replacement therapy (HRT) just to prevent
cardiovascular events. Also, women at particular risk of blood clots should be discouraged from using HRT to prevent
cardiovascular events.


Post-menopausal women are at higher risk of cardiovascular disease (CVD) than younger women. There are sound biological
arguments why giving post-menopausal women extra oestrogen might protect them from CVD, and various uncontrolled studies
appear to confirm this idea. However, the question of whether HRT has a long-term benefit for women at risk of CVD is
unresolved.


To answer this, Cochrane Review Authors drew on data from 10 large, well run studies. Pooling the results they were able to
compare the effects of giving HRT to 12,353 women, with giving placebos to 11,930 other women.


They concluded that giving HRT does not protect post-menopausal women from CVD. In addition, women who have specific risks
that may make them prone to suffer from blood clots should be discouraged from taking HRT at all.


Review title: Gabriel S?nchez et al: Hormone replacement therapy for preventing cardiovascular disease in post-menopausal
women. The Cochrane Database of Systematic Reviews 2005 Issue 2.


The Cochrane Library newsletter, 2005, issue 2

The best single source of reliable evidence about the effects of health care


John Wiley & Sons, Inc.

interscience.wiley

New Research Findings May Enable Earlier Diagnosis Of Uterine Cancer

Cancer is a genetic disease. It occurs when changes take place in the genes that regulate cell division, cell growth, cell death, cell signalling and blood vessel formation - either due to mutations caused by external factors such as smoking or radiation - or due to inherited changes. This interaction between defective genes and environmental factors means that cancer is an extremely complex disease. Cancer of the uterus, or endometrial carcinoma, is no exception.



Cancer of the uterus is the commonest gynaecological malignancy in the West and accounts for between five and six per cent of all cancers in Swedish women. However, the symptoms are often vague, and we know little about the genetic factors that lead to the appearance and development of this form of cancer. It is therefore vital that these genes are identified, as this could enable doctors to make the diagnosis much more quickly and easily, allowing the development of more effective cancer treatment.



In her study, Sandra Karlsson, a researcher at the Department of Cell and Molecular Biology, has used inbred rats to locate the defective genes that cause uterine cancer. Like monozygotic (identical) twins, these inbred rats are genetically almost identical, which makes it much easier to study the influence of the environment in which they live.



"More than 90 per cent of the female rats in the study spontaneously developed uterine cancer. By using advanced techniques to analyse gene expression in the tumours, we succeeded in identifying a gene signature that could be used as a future diagnostic test for human uterine cancer," says Sandra Karlsson.



The signature is made up of three genes. One of them protects the cell against oxygen free radicals. These free radicals are naturally and continuously produced in the cell, but excess amounts, which can damage the cell and the body's DNA, are associated with over 200 diseases, from arteriosclerosis and dementia to rheumatism, cerebral haemorrhage and cancer. The studies carried out by Sandra Karlsson on human malignant tumours have confirmed that changes in this gene are present in early as well as late stage cancer.



"This shows that the identified gene has an important role in the origin and development of uterine cancer," says Sandra Karlsson.







The thesis Gene Expression Patterns in a Rat Model of Human Endometrial Adenocarcinoma was publicly defended on the December 19th. Supervisor - Professor Karin Klinga Levan.



Source: Sandra Karlsson


University of Gothenburg

New York Times Editorials React To Reproductive Health-Related Issues In Health Reform Law

The New York Times recently published two editorials pertaining to the federal health reform law (PL 111-148).

~ Abortion: "In the fierce debate over health care reform, the United States Conference of Catholic Bishops charged that the legislation didn't do enough to restrict insurance coverage of abortions," while several "Catholic nuns and the Catholic Health Association of the United States, which represents hundreds of Catholic hospitals, looked at the same bill and concluded that it would have no effect on abortion financing," the Times writes. Bishop Lawrence Brandt of Greensburg, Pa., is now "punishing" nuns who signed a letter in support of the reform bill, the editorials states, adding that Brandt "has decreed that 'any religious community' that signed the letter would be forbidden to use the diocese's offices, parishes or newspaper to promote programs that encourage young people to consider the religious life." Brandt alleges that the nuns took "a public stance in opposition to the church's teaching on human life," according to the editorial. The nuns "saw the bill as a powerfully positive step, because it provided health insurance to millions of people without it, and hundreds of millions of dollars for the care of pregnant women," the editorial states. It concludes that the nuns who signed the letter "showed courage and compassion when they spoke out for reform. It makes no sense at all to try to punish them or thwart their efforts to find new sisters who would care for the sick and dying and lead exemplary Catholic lives" (New York Times, 5/1).

~ Rescissions: "Americans are already starting to see benefits of health care reform," a Times editorial states. Although the "new law requires health insurance companies -- starting in September -- to end their most indefensible practice: rescinding coverage after a policyholder gets sick," several insurers and their trade associations in recent days "have rushed to announce that they will end rescissions immediately," according to the editorial. Those announcements follow the release of an "investigative report by Reuters" that found that WellPoint, one of the nation's largest insurers, targeted women with breast cancer "for fraud investigations that could lead to rescissions," the editorial states. "WellPoint fiercely denied singling out breast cancer patients for scrutiny" but "acknowledged using computer algorithms to search for a range of conditions that applicants would likely have known about at the time they applied," according to the Times. This is "very good news for the thousands of people who each year pay their premiums but lose their coverage just when they are likely to run up big medical bills," the Times writes (New York Times, 5/3).


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