Survival Of Gynecological Cancer Improved In The Anglia Region Of England

Main Category: Ovarian Cancer
Also Included In: Women's Health / Gynecology;  Cancer / Oncology
Article Date: 16 Dec 2011 - 0:00 PST

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Gynaecological cancer survival rates have improved in Eastern England following the reorganisation of services and multidisciplinary team working finds a new study published in the gynaecological oncology themed issue of BJOG: An International Journal of Obstetrics and Gynaecology.

In 1999, the Department of Health (DH) produced good-practice guidance on commissioning cancer services for gynaecology, entitled Improving Outcomes in Gynaecological Cancer. The new guidance called for a reorganisation of services, working in multidisciplinary teams and a concentration of surgical expertise in centres.

In addition, in 2000 the DH published referral guidance for primary care for symptoms that were suggestive of cancer (the 2-week wait initiative). Hospital providers were expected to respond to the referral in a timely fashion, with a target of 2 weeks between the date of referral and the first appointment. It was hoped this would improve outcomes and address the variation in access to diagnosis and treatment.

In the Anglia Cancer Network (Bedfordshire, Cambridgeshire, Norfolk and Suffolk), the guidance was implemented by the year 2000, with the centralisation of care predominantly shifting to Addenbrookes Hospital, serving a population of 1.5 million and the Norfolk and Norwich Hospital serving a population of 850,000.

This paper looks at 3406 cases of invasive gynaecological cancer between 1996 and 2003 in this area. Sixty percent of the cases had known tumour stage and grade and the majority of cases relate to endometrial and ovarian cancer (77.4%).

The study found that the survival of cancers diagnosed between 1997 and 1999 was effectively identical to the survival of cancers diagnosed in the baseline year, 1996. Survival of cases diagnosed between 2000 and 2003 increased significantly: Overall 17% improvement; uterine cancer improved by nearly 10% (9.5) to 83% and ovarian cancer improved by 45% to nearly 40% when compared with cancers diagnosed in the four earlier years. These changes have been most significant within endometrial and ovarian cancers.

Dr Robin Crawford, Consultant Gynaecological Oncologist, Addenbrookes Hospital, Cambridge, and co-author of the paper said:

"The data shows that there has been a significant increase in survival of gynaecological cancers over the time period reviewed.

"In addition to the minor year-on-year improvements, there was a significant stepwise improvement in survival in 2000, following the major reorganisation in the region.

"Centralising services and working in multidisciplinary teams has been shown to improve patient care significantly and most importantly survival rates.

"Further work is being undertaken to ensure that these improvements are continued."

BJOG Deputy Editor-in-Chief, Pierre Martin-Hirsch, added:

"It is exciting to see such promising results. This cancer network implemented new policies very promptly and as a result there has been a significant improvement in the gynaecological cancer survival rates.

"This paper confirms the findings in a recent Macmillan report based on research from the Cancer Research UK Cancer Survival Group at the London School of Hygiene and Tropical Medicine demonstrating improved survival times for women with cancer. Cancer patients are surviving for longer and an example of new initiatives aiding this is the work being undertaken in the Anglia region."

The BJOG theme issue focuses on gynaecological oncology with papers looking at cervical cancer prevention, as well as new developments in cervical and ovarian cancer management.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our ovarian cancer section for the latest news on this subject. Crawford R, Greenberg D. Improvements in survival of gynaecological cancer in the Anglia region of England: are these an effect of centralisation of care and use of multidisciplinary management? BJOG 2011; DOI: 10.1111/j.1471-0528.2011.02961.x.
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New Study Shows Promise For Preventing Preterm Births

Main Category: Pregnancy / Obstetrics
Also Included In: Women's Health / Gynecology
Article Date: 16 Dec 2011 - 1:00 PST

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A new study co-authored by the University of Kentucky's Dr. John O'Brien found that applying vaginal progesterone to women who are at a high risk of preterm birth significantly decreased the odds of a premature delivery.

The new study, published in the American Journal of Obstetrics and Gynecology, described a two-prong strategy used by doctors: participating pregnant women underwent a measurement of the cervical length via transvaginal cervical ultrasound to define risk for preterm birth; and those found to have a short cervix were successfully treated with vaginal progesterone. A short cervix defined as a length of 25 millimeters or less is a major risk factor for preterm birth.

Approximately 12.9 million births worldwide are preterm which is defined as less than 37 weeks of gestation. The United States has the highest rate of preterm births in the world. "Early" preterm births -- those less than 32 weeks -- are associated with a high rate of neonatal complications and long-term neurologic disability. "Late" preterm births (between 34 and 36-6/7 weeks) represent 70 percent of all preterm births; and although they have a lower rate of complications than early preterm births, they are still a major health care problem.

The study showed that the vaginal application of progesterone gel significantly reduces the rate of preterm birth in women at less than 33 weeks of gestation, but also is effective at less than 28, 32 and 35 weeks. This means that vaginal progesterone reduces both "early" and "late" preterm births.

Vaginal progesterone administered to women with a short cervix detected via ultrasound also reduced the rate of admissions to the newborn intensive care unit; respiratory distress syndrome; the need for mechanical ventilation; and a composite score of complications that included intracranial hemorrhage, bowel problems, respiratory difficulties, infection and death.

O'Brien, division chief of Maternal-Fetal Medicine at UK, says the progesterone treatment is safe because the natural pregnancy hormone is the made by the placenta and the ovaries during pregnancy.

"For too long, little progress has been made in the prevention of premature births," said O'Brien. "However, this new large study shows that it's possible to both help women determine if they are at risk for preterm birth, and provide a safe and effective treatment to help prevent preterm births."

Article adapted by Medical News Today from original press release. Source: University of Kentucky
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Warfarin Underutilized In Women

Main Category: Cardiovascular / Cardiology
Also Included In: Women's Health / Gynecology;  Seniors / Aging
Article Date: 16 Dec 2011 - 0:00 PST

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Dr. Rabab Mohsin, an internal medicine resident at the University of Kentucky, working with Dr. Alison Bailey of the University of Kentucky Gill Heart Institute, has discovered that the drug warfarin was underutilized in a large study group of women.

Working in conjunction with the Kentucky Women's Health Registry, Mohsin, Bailey and fellow investigators identified women who reported arrhythmia (irregular heartbeat) identification and treatment. Specifically, the investigators worked to determine whether prescription warfarin (an anti-coagulant known as a safe and effective treatment for atrial fibrillation) was being appropriately utilized among a population of Kentucky women with self-reported atrial fibrillation.

Survey data revealed that among the group of women who would be expected to be receiving warfarin, only 30 percent were receiving the drug. Notably, the research population was found to have a higher than average level of income and education as compared to other Kentucky women in their age group. Statistical analysis also revealed that older women were more likely to be taking warfarin (a mean age of 73.4 years was found for those with atrial fibrillation who were on warfarin, while the population with atrial fibrillation but without warfarin treatment had a mean age of 61.8).

Overall, Mohsin, Bailey and fellow investigators concluded that warfarin anticoagulation treatment for atrial fibrillation is underutilized in the group of Kentucky women studied, and that this underutilization is not attributable to economic or educational disparities.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Vaginal Progesterone Reduces Preterm Birth, Neonatal Morbidity And Mortality In Women At Risk

Main Category: Pregnancy / Obstetrics
Also Included In: Menopause;  Women's Health / Gynecology
Article Date: 15 Dec 2011 - 2:00 PST

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Women with a short cervix should be treated with vaginal progesterone to prevent preterm birth, according to a landmark study by leading obstetricians around the world. Vaginal progesterone decreased the rate of preterm birth by 42%, and significantly reduced the rate of respiratory distress syndrome and the need for mechanical ventilation, as well as a composite of several complications of premature newborns (e.g. infection, necrotizing enterocolitis, intracranial hemorrhage, etc.). An early online version of the study was published today in the American Journal of Obstetrics and Gynecology (AJOG), and is available on the AJOG website free of charge.

"Our analysis provides compelling evidence that vaginal progesterone prevents preterm birth and reduces neonatal morbidity/mortality in women with a short cervix," said lead investigator Dr. Roberto Romero, Chief of the Perinatology Research Branch and Head of the Program in Perinatal Research and Obstetrics of the Division of Intramural Research for the NICHD/NIH/DHHS, Bethesda, MD and Detroit, MI. "Importantly, progesterone reduced early preterm birth (those occurring before 33 or 28 weeks of gestation). These immature babies are at the greatest risk for complications, death, and long-term disability (e.g. cerebral palsy). Progesterone also decreased a fraction of 'late preterm births,' which are the most common preterm deliveries. The profile of adverse events was no different from placebo.

Follow-up studies of babies exposed to progesterone in utero to the age of 18 or 24 months showed no evidence of any behavioral or physical problems. The authors of this study recommend that transvaginal sonographic measurement of the cervix be performed in all pregnant women between 19 to 24 weeks of gestation to assess the risk of preterm delivery. This strategy also allows the identification of women at risk for preterm delivery during their first pregnancy. Other strategies, which are based on treating women with a previous preterm birth, do not address the challenge of prevention in women with their first pregnancy."

Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. Moreover, preterm birth is also the main cause of infant mortality (death to the age of one year). Approximately 12.9 million births worldwide are preterm, of which 92.3% occur in Africa, Asia, Latin America, and the Caribbean. In the United States and Europe, there are 1,000,000 preterm births per year.

Progesterone is a natural hormone produced by the ovary during the menstrual cycle and in early pregnancy, and subsequently, in the placenta. A decline in progesterone action is considered to be important for the onset of labor. If such a decline occurs in the mid-trimester, cervical shortening may lead to the onset of preterm labor. The administration of progesterone is postulated to work by maintaining a high concentration of the hormone in the uterine cervix.

Several studies had evaluated the administration of vaginal progesterone versus placebo to prevent preterm birth when a short cervix was found by ultrasound in the mid-trimester of pregnancy. What is unique about the study published today is that investigators worldwide pooled the data from the different studies and performed a meta-analysis of individual patient data (IPD). This is the "gold standard" for summarizing evidence across clinical trials. It has the advantage of increasing the power to detect differences in efficacy and adverse events, and also allows subgroup analyses that may not have been possible in each individual study.

The IPD meta-analysis included five high-quality trials of vaginal progesterone versus placebo, was conducted at multiple centers in both developed and developing countries, and included a total of 775 women and 927 infants. The primary endpoints were: 1) preterm birth at <33 weeks; and 2) a composite index of perinatal morbidity and mortality. The authors also studied other secondary endpoints and explored the effect of cervical length, a history of previous preterm birth, maternal age, race/ethnicity, and body mass index on progesterone action.

The results were remarkably consistent and significant across trials performed in different parts of the world. Administering vaginal progesterone to asymptomatic women with a short cervix revealed by sonogram in the mid-trimester was associated with a 42% reduction in the rate of preterm birth before 33 weeks of gestation. There was also a significant reduction in the risk of preterm birth before 35, 34, and 28 weeks.

The study also found a 43% decrease in neonatal morbidity and mortality. Vaginal progesterone significantly reduced the risk of respiratory distress syndrome by 52%, and there was significantly lower admission to NICUs (placebo, 20.7% vs. progesterone, 29.1%).

Results of previous trials about the effects of vaginal progesterone or injectable progestins (synthetic compounds with progesterone action) in women with a twin gestation had been negative. However, a subset of patients in the study published today focused on women with a twin gestation and a short cervix. In this particular group, vaginal progesterone reduced the rate of preterm birth at <33 weeks by 30% and significantly reduced the composite neonatal morbidity/mortality of twins. Dr. Romero indicated that a study of vaginal progesterone in twin pregnancies with a short cervix is urgently needed to confirm these findings because the reduction in preterm birth did not reach significance (most likely due to the small number of twins available to study).

A major finding of this study is that progesterone benefits not only women who have a short cervix, but also those who have a prior preterm birth and a short cervix. This has practical implications, because vaginal progesterone is a less expensive and less invasive alternative than the placement of a cervical suture (cerclage) in patients who had a previous preterm birth and have a short cervix.

"The results of this analysis of five large randomized trials have the potential to result in a sea change in obstetrical practice in the U.S. and Europe and eventually in the rest of the world," commented AJOG Co-Editor-in-Chief, Thomas J. Garite, MD. "Prematurity is the leading cause of death and damage for newly born babies and despite enormous efforts, no impact has been made in the rate of preterm birth, which is actually rising in recent years."

As advocated in an accompanying editorial by C. Andrew Combs, MD, PhD, Obstetrix Medical Group, San Jose, CA, in the print version of the Journal, the potential for reducing prematurity lies in implementing routine vaginal ultrasound for all pregnant women in the middle months of pregnancy to measure the length of the cervix and if a short cervix is found, treat these patients with progesterone. The majority of premature births occur in women with no risk factors, so this approach has real potential to make an impact in the overall premature birth rate. Two recently published cost analysis studies, suggest that this approach can not only save lives and prevent the devastating damages often caused by prematurity, but can also result in a annual savings of nearly 1/2 billion dollars in health care costs in the U.S. alone.

Article adapted by Medical News Today from original press release. Source: Elsevier
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Regaining Weight After Losing It Might Harm Menopausal Women

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Academic Journal
Main Category: Menopause
Also Included In: Women's Health / Gynecology;  Obesity / Weight Loss / Fitness
Article Date: 15 Dec 2011 - 8:00 PST

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According to a study recently published in the American Journal of Clinical Nutrition, older women who lose weight but do not maintain the loss might suffer some negative consequences in their overall health. The National Institute on Aging sponsored the investigation.

Investigators at Wake Forest Baptist Medical Center, demonstrated that within a year, some older women gain a considerable amount of weight back after losing it.

Barbara Nicklas, Ph.D., a gerontologist at the J. Paul Sticht Center on Aging and Rehabilitation at Wake Forest Baptist and lead researcher for the investigation, explained:

"The body composition of some of the women was worse than before their weight loss. When older women lose weight, they also lose lean mass. Most women will gain a lot of the weight back, but the majority of the weight regained is fat."

78 postmenopausal women were analyzed in the study, one year after losing 12% of their body weight by dieting in a completely separate studey. Participants averaged 58 years of age. The team recorded their body composition, including change in body weight, fat and muscle, immediately before and after initial weight loss, and then again 6 and 12 months later. During the first year after initial weight loss no weight loss intervention occurred.

Their was to find out if the composition of body weight regained following intentional weight loss is comparable to the composition of body weight lost.

At the six-month follow-up after the study ended, 53 of 78 (68%) of women regained some weight, while 52 of 68 (76%) of women regained some weight at the 12-month follow-up. 16 women (24%) continues to lose weight after the program, while 11 women (16%) weighed more than they did at baseline at the 12-month follow-up.

75% of women who regained weight gained over 4.4 pounds at the 6-month follow-up. At 12-month follow-up this number increased to 84%. The researchers examined whether lost lean mass from intentional weight loss was recovered in women who regained more weight.

The team discovered that the fat mass in these women was rising to a higher level than was lean mass during the post-intervention period.

During the diet program, 67% of weight loss was fat while 33% was muscle. 81% of the entire weight regained during 12 months of follow up was fat, while 19% was muscle. On average, 26% of fat lost was regained by 12-months after the diet program, while only 6% of muscle lost was gained back.

Nicklas explains:

"Most people will regain their weight after they lose it. Young people tend to regain weight in the proportion that they lost it. But the older women in our study did not appear to be regaining the muscle they lost during initial weight loss in the same way."

Although researchers are unsure what the long term effects of losing muscle mass in middle age and older women are, combined with loss of bone density which is known to occur as individuals age, the loss of muscle may increase their risk of falling, as well as other things.

Nicklas said:

"There are certainly a lot of health benefits to weight loss, if you can keep the weight off. For older women who lose weight, however, it is particularly important that they keep the weight off and continue to eat protein and stay physically active so that, if the weight does come back, it will be regained as muscle instead of fat."

Nicklas warns that study results were restricted to sedentary, abdominally obese, postmenopausal women, and the among younger populations or men the discoveries may differ. "Future studies of weight cycling are needed to determine its effects on muscle strength, quality, and function and body composition in older adults after all weight lost is regained", she said.

The investigators explain:

"Many health complications associated with overweight and obesity are improved with weight loss. However, negative consequences (such as loss of muscle mass and bone density) are also associated with weight loss and are detrimental for older adults, which results in a reluctance to recommend international weight loss in this population. Because lean mass loss in older adults may be associated with the development of adverse health events and disability, it is important to examine whether the benefits of weight loss outweigh the risks in this population."

Written by Grace Rattue
Copyright: Medical News Today
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HPV DNA Testing Advised For Females Over 30

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Academic Journal
Main Category: Cervical Cancer / HPV Vaccine
Also Included In: Women's Health / Gynecology
Article Date: 15 Dec 2011 - 11:00 PST

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HPV DNA testing is better than cytology alone in preventing cervical cancer or detecting it early on for women over thirty, researchers reported in The Lancet Oncology. The authors explained, after reporting on the POBASCAM trial, that they now have compelling evidence in favour of routine HPV testing in national screening programs.

In an Accompanying Comment, Hormuzd Katki and Nicolas Wentzensen wrote:

"POBASCAM reinforces findings from cohort studies, clinical trials, and routine clinical practice by providing overwhelming evidence of the benefits of inclusion of HPV testing in screening programmes"

Experts already knew that HPV testing is better than cytology at identifying precancerous high-grade cervical lesions. However, before this study, nobody could be sure which method of testing was best over a 5-year screening interval.

Chris Meijer and team from the VU University Medical Centre, Amsterdam, carried out the POBASCAM trial, involving 45,000 females aged between 29 and 56 years. All of them attended routine cervical screening in the Netherlands.

The researchers wanted to find out whether HPV testing was associated with fewer high-grade lesions and cervical cancer during the second round of screening, because the first round had detected and treated the lesions. They also wanted to determine what the best age might be to start HIV testing.

Initially, the participants were selected at random to receive: HPV DNA testing plus cytology, orCytology aloneFive years later, all of them had a second screening which involved both HPV and cytology testing.

The researchers found that: During the first screening - Considerably more cancer precursors were identified through HPV testing compared to cytology aloneDuring the second screening (five years later) - those in the HPV testing group had considerably fewer women had CIN grade 3 or worse lesions and cervical cancer than the ones who had been in the cytology alone groupThe authors explained:

"Implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant CIN grade 2 or worse, which when adequately treated, improves protection against CIN grade 3 or worse and cervical cancer."

Better CIN3+ in the HPV groups was mainly due to better early detection of high-grade lesions caused by HPV16. The authors say their findings indicate that HPV testing will most likely eventually reduce death rates as well as the number of cancer-related illness.

HPV testing does not appear to be linked to over-diagnosing of regressive CIN2+ lesions in younger females either, the authors added. When they combined the data from both screening rounds, the accumulated detection of CIN2+ and CIN3+ were the same among females aged 29-33 and those aged over 33.

The authors wrote:

"Our results . . . lend support to the implementation of HPV DNA testing in programmed cervical screening starting at age 30 years."

The authors of the Accompanying Comment wrote:

"The POBASCAM trial shows that 5 year screening intervals are safe, and that conservative management of HPV-positive women can control excess CIN grade 2 or 3 while preventing cervical cancer. However, how the POBASCAM protocol would perform in other populations that have different baseline cancer rates, compliance, and management infrastructure, is unclear."

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our cervical cancer / hpv vaccine section for the latest news on this subject. "Human papillomavirus testing for the detection of high-grade cervical intraepithelial neoplasia and cancer: final results of the POBASCAM randomised controlled trial"
Dorien C Rijkaart MD a, Johannes Berkhof PhD b, Lawrence Rozendaal MD a, Folkert J van Kemenade MD a, Nicole WJ Bulkmans MD a, Daniëlle AM Heideman PhD a, Prof Gemma G Kenter MD c, Prof Jack Cuzick PhD d, Prof Peter JF Snijders PhD a, Prof Chris JLM Meijer MD
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Indoor Tanning Strong Risk Factor For Skin Cancer In Young People

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Academic Journal
Main Category: Melanoma / Skin Cancer
Also Included In: Dermatology;  Women's Health / Gynecology
Article Date: 14 Dec 2011 - 6:00 PST

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Compared to those who have never used it, young people who use indoor tanning have a 69% higher risk of developing a type of skin cancer called basal cell carcinoma (BCC), according to a new study led by researchers from the Yale School of Public Health in the US that was published online on 12 December in the Journal of the American Academy of Dermatology.

The researchers found the risk was strongest among women and went up with every year of using indoor tanning.

A number of studies published recently shows an increase in people, particularly young women, with BCC. The researchers in this study concluded that a quarter of cases of early-onset BCC could be prevented, and as many as 43% among women, if people never used indoor tanning at all.

Senior author Susan T Mayne, professor at the School of Public Health, told the press:

"Indoor tanning was strikingly common in our study of young skin cancer patients, especially in the women, which may partially explain why 70 percent of early-onset BCCs occur in females."

Mayne said they were also "surprised to find that one-third of our study participants with BCC had already had at least one additional BCC before age 40, which is very alarming as skin cancers increase in frequency with age".

BCC is the most common type of skin cancer, it rarely spreads or kills, but it can invade surrounding tissue and cause unsightly disfigurement. Most occur on parts of the body that are repeatedly exposed to the sun, such as the head and neck, but there appears to be an increase in cases of them appearing on the torso.

For the study, Mayne and colleagues interviewed 376 patients diagnosed with BCC and 390 controls without BCC who had been diagnosed with minor, benign, skin conditions. All subjects were under 40 years of age. They answered questions about whether they had ever used indoor tanning, and if so, at what age they started, how often they used it, how long did sessions last, the number of burns received as a result of tanning, and the type of tanning machine.

Using statistical tools, they then calculated the odds of developing BCC, using those who had never used indoor tanning machines as the referent group.

The analysis showed that: Ever using an indoor tanning machine was linked to a 69% higher risk of early-onset BCC.
This link was stronger among young women, for those who developed more than one BCC, and for those whose BCCs appeared on the torso or extremities.
The risk went up in a "dose-dependent" fashion for each of three variables: each year of using indoor tanning, number of overall burns, and burns to biopsy site.
27% of early-onset BCCs, and as many as 43% in women, could be prevented if individuals never used indoor tanning machines.The researchers conclude:

"Indoor tanning was a strong risk factor for early-onset BCC, particularly among females. Indoor tanning should continue to be targeted by both policy-based and behavioral interventions, as the impact on BCC-associated morbidity may be substantial."

They say due to some of the study limitations, such as "potential recall bias of indoor tanning by patients and generalizability of the control population", the results need to be confirmed by further research.

Should these findings be confirmed, they add to recent evidence that indoor tanning is linked to melanoma, a less common but much deadlier form of skin cancer that is also increasing among young women.

First author Leah M. Ferrucci, a postdoctoral fellow at the School of Public Health, said:

"Importantly, indoor tanning is a behavior that individuals can change. In conjunction with the findings on melanoma, our results for BCC indicate that reducing indoor tanning could translate to a meaningful reduction in the incidence of these two types of skin cancer."

Estimates suggest around 30 million Americans use indoor tanning beds every year, with young women being the most common users.

Written by Catharine Paddock PhD
Copyright: Medical News Today
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Visit our melanoma / skin cancer section for the latest news on this subject. "Indoor tanning and risk of early-onset basal cell carcinoma"; Leah M. Ferrucci, Brenda Cartmel, Annette M. Molinaro, David J. Leffell, Allen E. Bale, Susan T. Mayne; Journal of the American Academy of Dermatology 12 December 2011; Article in Press DOI: 10.1016/j.jaad.2011.11.940; Link to Abstract
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posted by Karl G on 14 Dec 2011 at 8:20 am

It is possible to "prove" anything with statistics.

In the case of tanning bed use, it is important not to burn the skin.

Still, and according to real experts on tanning and vitamin D, it is 10 to 30 times more dangerous for health not to tan regularly than the, easily negotiable, risk of tanning too much.

Why was not the statistic of BCC among people who used tanning beds but never burned themselves, reported?

Probably it was not enough scaring, if measured at all.

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