By Dennis Thompson

HealthDay Reporter

TUESDAY, Jan. 9, 2018 (HealthDay News) -- Breakthroughs in breast cancer screening and treatment have slashed the percentage of women dying from the disease, a new analysis reveals.

"Advances in screening and treatment are saving lives," said lead researcher Sylvia Plevritis, a professor of radiology and biomedical data science at the Stanford University School of Medicine. "Here's an example that all this investment in research and discovery has had a real benefit. This has translated into making a difference."

Screening and treatment reduced breast cancer deaths by 49 percent in 2012, compared with a 37 percent reduction in 2000, according to the study.

Treatments that target specific types of breast cancer have generated the most scientific advancement and, as such, have taken a larger role in saving lives, the researchers found.

Better cancer treatments accounted for 63 percent of the reduction in breast cancer deaths in 2012, compared with 37 percent due to early detection of cancer through screening, the study findings showed.

Back in 2000, treatment and screening were of equal importance, splitting 50-50 the lives saved from breast cancer, the researchers said.

Hormone therapy now is available to counter breast cancers spurred by estrogen, while the targeted drug Herceptin (trastuzumab) has been a wonder in treating breast cancers caused by genetic abnormalities, explained Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society.

These new treatments, combined with improvements in traditional chemotherapy, are helping more women beat breast cancer, Lichtenfeld said.

The greatest advance in breast cancer screening during the same period was the move to digital mammography, which produces cleaner and better images, he added.

"For the period between 2000 and 2012, there were some advances made in the technology for screening for breast cancer, but there was greater impact made by treatment," Lichtenfeld said.

For the study, Plevritis and her colleagues fed breast cancer monitoring data into a series of six different computer simulations.

Each simulation estimated what the death rate would have been in a given year between 2000 and 2012 without the availability of state-of-the-art screening and treatment, and how much each contributed to the reduction in deaths, Plevritis said.

The computer analysis also looked at how much reduction had taken place within different subtypes of breast cancer.

For example, treatment accounts for about 69 percent of the lives saved in women with cancers driven by both estrogen and genetic abnormalities, while screening is associated with only 31 percent of the mortality decline, the investigators said.

On the other hand, screening still plays a large role in saving the lives of women with so-called "triple-negative" breast cancer, which is not driven by either hormones or genetics. Triple-negative cancers account for about 12 percent of all breast cancer cases, but are nearly twice as common in black women than white women, according to the American Cancer Society.

About 48 percent of the decline in deaths due to triple-negative breast cancer can be chalked up to screening and 52 percent to treatment, similar to the split found in 2000, the researchers said.

"Mammography is an important contributor to the reduction in breast cancer mortality," Plevritis said. "But the overall benefit is greater largely because of the advances in treatment."

Screening remains important because breast cancers detected early are easier to treat, said Dr. Daniel Hayes, clinical director of the University of Michigan breast oncology program.

"Early detection makes the systemic treatment better as well," said Hayes, who's also immediate past president of the American Society of Clinical Oncology. "Most of us who take care of patients still believe rational screening programs are good public health policy. No matter what kind of cancer you have, detecting it early with screening and then treating it substantially reduces your risk of dying from it," he added.

According to Lichtenfeld, "These computer models clearly show that mammography reduces mortality from breast cancer and has made a significant contribution over time. We should not take the message that everything's about treatment. That's not the right message."

The study findings were published Jan. 9 in the Journal of the American Medical Association.

More information

For more on breast cancer, visit the American Cancer Society.

SOURCES: Sylvia Plevritis, Ph.D., professor, radiology and biomedical data science, Stanford University School of Medicine, Stanford, Calif.; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society; Daniel Hayes, M.D., clinical director, breast oncology program, University of Michigan, and immediate past president, American Society of Clinical Oncology; Jan. 9, 2018, Journal of the American Medical Association

Last Updated: Jan 9, 2018

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January is National Cervical Cancer Awareness Month. Complete this six-module curriculum to learn more about cervical and other gynecologic cancers. Learn the risk factors, symptoms, and prevention strategies as well as screening guidelines and HPV vaccination recommendations. Earn free CE.

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APAOG WEBINAR: TODAY’S LONG-ACTING REVERSIBLE CONTRACEPTION PRACTICAL CONSIDERATIONS

Tuesday, January 23, 2018
5PM PT/7PM CT/8PM ET 

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APAOG Members, be sure you are logged in to see the member rate.

Title: Today’s Long-Acting Reversible Contraception Practical Considerations

Speaker: Nisha McKenzie PA-C, IF, CSC

Objectives:

• Equip PAs with guideline and evidence-based knowledge on several forms of birth control methods
  
• Review relevant safety and efficacy data on several forms of birth control methods
  
• Explore common concerns and priorities related to Long Acting Reversible Contraception (LARC) that apply to women in various life stages
  

December 20, 2017, University of Leeds

Read full article here. 

Scientists are using the latest imaging techniques usually used to map the brain to try and understand why some pregnant women miscarry or go into early labour.

They have developed 3D images of the cervix, the load bearing organ which lies at the base of the womb and stops a developing baby from descending into the birth canal before the due date.

Around a quarter of miscarriages during the fourth to sixth month of pregnancy (mid-trimester) occur because of weaknesses in the cervix.

The researchers at the University of Leeds hope by developing a detailed image of its structure, they can develop ways of monitoring women for signs of potential problems before they become pregnant.

Mr Nigel Simpson, Associate Professor in Obstetrics and Gynaecology, said: "Ultrasound monitoring is used to identify women at risk - where their cervix is unable to support the pregnancy. But little is known about why that problem develops.

"This research is attempting to answer that question."

MRI techniques were used to create 3D images of the cervix. This is the first time extremely high resolution imaging has been used to understand the detailed micro-structure of this organ.

The research is published in the international obstetrics and gynaecology journal, BJOG.

James Nott, from the Faculty of Medicine and Health and lead author, said: "A lot of our understanding of the biology of the cervix is rooted in research carried out 50 years ago.

"By applying the imaging techniques that have been used on the brain, we can get a much clearer understanding of the tissue architecture that gives the cervix its unique biomechanical properties."

The images reveal a fibrous structure running along the upper part of the cervix. The fibres are much more pronounced near to where it joins the womb. The fibres are made of collagen and smooth muscle and form a ring around the upper aspect of the cervical canal.

During pregnancy, these fibres provide a strong supporting barrier - keeping the foetus and amniotic sac in place and preventing micro-organisms from entering the uterus.

The images reveal that these support tissues are less prominent further down the cervix as it joins the birth canal.

During labour, the body releases chemicals which result in the cervix opening and allowing the baby to enter the birth canal.

But there are medical conditions where earlier in the pregnancy, the cervix fails to support the baby, leading to a miscarriage or premature birth.

Mr Simpson said: "This study's findings have encouraged us to explore new imaging techniques to check the integrity of these fibres before or during pregnancy in order to identify at-risk mums, intervene earlier, and so prevent late pregnancy loss and pre-term birth."

The study was funded by Cerebra, the charity for children with brain conditions.

The scientists used diffusion tensor MRI, which is a technology that can remotely sense different types of tissue based on their water content.

 Explore further: Cervical device may help lower preemie birth risk

More information: JP Nott et al, Diffusion tensor imaging determines three-dimensional architecture of human cervix: a cross-sectional study, BJOG: An International Journal of Obstetrics & Gynaecology (2017). DOI: 10.1111/1471-0528.15002

Provided by: University of Leeds  

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12/12/2017

December 12, 2017 – The U.S. Preventive Services Task Force released today a final recommendation statement on hormone therapy for the primary prevention of chronic conditions in postmenopausal women. The Task Force recommends against hormone therapy for preventing chronic conditions in women who have gone through menopause, as the benefits do not outweigh the harms. To view the recommendation and the evidence on which it is based, please go to https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/menopausal-hormone-therapy-preventive-medication1. The final recommendation statement can also be found in the December 12, 2017 online issue of JAMA.

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Bacterial vaginosis is a common vaginal infection that causes discharge, odor, and irritation. It can predispose women to sexually transmitted infections (STIs) including HIV. Recurrent bacterial vaginosis may require prolonged treatment to return the vaginal flora to a normal predominately lactobacilli-dominated environment. 

LINK

• by Kristen Monaco, Staff Writer, MedPage TodayDecember 06, 2017

Menopause-related vasomotor symptoms (VMS) may heighten diabetes risk, researchers reported.

VMS, such as hot flashes and night sweats, were tied to an 18% increased risk for type 2 diabetes (95% CI 1.14-1.22), according to Kristen E. Gray, PhD, of the VA Puget Sound Health Care System in Seattle and colleagues. Independent of obesity status, VMS persisting for a longer duration were tied to a continually increasing risk for diabetes (4% per 5 years, 95% CI 1.03-1.05), they wrote in Menopause: The Journal of The North American Menopause Society.

Diabetes risk also increased with the severity of symptoms:

• Mild symptoms: hazard ratio 1.13 (95% CI 1.08-1.17)
• Moderate: HR 1.29 (95% CI 1.22-1.36)
• Severe: HR 1.48 (95% CI 1.34-1.62)

The prospective study, previously at the 2016 American Diabetes Association annual meeting, included 150,007 postmenopausal women who participated in the Women's Health Imitative, conducted at 40 centers across the U.S. All women had data regarding VMS and no history of diabetes at baseline. Menopause-related VMS were self-reported via a questionnaire, while diabetes was defined as the initial report of insulin or oral treatment.

During an average 13.1-year follow-up, there were 18,316 cases of type 2 diabetes reported among the cohort. Women who did not report experiencing VMS at baseline had a lower incidence of diabetes than women who did (8.4 per 1,000 person-years versus 11.3 per 1,000).

With regard to specific VMS, night sweats had a slightly stronger association with diabetes risk than hot flashes alone:

• Night sweats only: HR 1.20 (95% CI 1.13-1.26)
• Hot flashes only: HR 1.08 (95% CI 1.02-1.15)
• Both: HR 1.22 (95% CI 1.17-1.27)

Women who only reported experiencing VMS early on did not have an increased associated risk for type 2 diabetes (HR 0.99, 95% CI 0.95-1.04). However, those who only reported late-onset symptoms, or who experienced early and late symptoms, did have significantly associated risks (HR 1.12, 95% CI 1.07-1.18; HR 1.16, 1.11-1.22, respectively).

"There are several potential explanations for our pattern of findings," the authors noted. "The most plausible and consistent explanation may be through associations with sleep disturbance. VMS overall are associated with objective and subjective sleep disturbance, 28 and individuals with disruptions in both the quantity and quality of sleep have a higher risk of diabetes."

Gray's group found sleep disturbances were commonly reported among the cohort, with 36% of women having experienced short sleep durations. Similarly, 24% of women were considered to be at high risk of sleep-disordered breathing, while 31% were at high risk of insomnia. Those who experienced more severe VMS, as well as experiencing both hot flashes and night sweats, were more likely to report sleep disturbances.

Study limitations included the fact that much of the cohort were clinical trial participants, which "were likely healthier than the general population," they stated.

While the results do not support different clinical care for women who experience VMS, "they suggest that leveraging the immediate repercussions of VMS may be a particularly effective strategy for eliciting behavior change among affected women as compared with counseling about the more distant and abstract future risk of diabetes and CVD," the authors said.

"Menopause is a perfect time to encourage behavior changes that reduce menopause symptoms, as well as the risk of diabetes and heart disease," noted JoAnn Pinkerton, MD, executive director of the North American Menopause Society, in a press release. "Suggestions include getting regular exercise and adequate sleep, avoiding excess alcohol, stopping smoking, and eating a heart-healthy diet. For symptomatic women, hormone therapy started near menopause improves menopause symptoms and reduces the risk of diabetes."

Click here for the American Association of Clinical Endocrinologists' comprehensive type 2 diabetes management algorithm and guidelines for the treatment of menopause.

The study was supported by the US Department of Veterans Affairs Health Services Research & Development Program.

Gray and co-authors disclosed no relevant relationships with industry.

• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

• Primary Source

  Menopause: The Journal of The North American Menopause Society

  Source Reference: Gray K, et al "Vasomotor symptom characteristics: are they risk factors for incident diabetes?" Menopause 2017; DOI: 10.1097/GME.0000000000001033.

During menopause a woman’s ovaries stop working—leading to hot flashes, sleep problems, weight gain, and worse, bone deterioration.

Now scientists are exploring whether transplanting lab-made ovaries might stop those symptoms. In one of the first efforts to explore the potential of such a technique, researchers say they used tissue engineering to construct artificial rat ovaries able to supply female hormones like estrogen and progesterone.

The work, carried out at Wake Forest Baptist Medical Center, suggests a potential alternative to the synthetic hormones millions of women take after reaching middle age. A paper describing the findings was published Tuesday in Nature Communications.

When tested in rats, the pieces of tissue, known as organoids, were better than traditional hormone replacement drugs at improving bone health and preventing weight gain. The treatment was also as good as hormone drugs at maintaining healthy tissue in the uterus.

Clinical trials of artificial ovaries are not likely to happen soon. For one thing, it is uncertain where the cells needed to build the organoids would come from. Emmanuel Opara, a professor at Wake Forest who led the research, says younger women might need to donate the tissue.

Women going through menopause, as well as those who have undergone cancer treatment or had their ovaries removed for medical purposes, lose the ability to produce important hormones, including estrogen and progesterone. Lower levels of these hormones can affect a number of different body functions.

To counteract unpleasant symptoms, many women turn to combinations of hormone replacement medications—synthetic estrogen and progestin. But hormone replacement carries an increased risk of heart disease and breast cancer, so it’s not recommended for long-term use. Opara thinks artificial ovaries could be safer and more effective.

To engineer the organoids, Opara and his colleagues combined two cell types—granulosa and theca cells. They collected samples of these cells from female rats that had their ovaries removed and grew them in the lab so they eventually formed three-dimensional tissue.  

Within a week of implantation, the artificial ovaries started secreting estrogen, progesterone, and two other natural hormones not found in current hormone replacement drugs.  

Cynthia Stuenkel, a clinical professor of medicine at the University of California, San Diego, and a spokeswoman for the Endocrine Society, says the report  is “fascinating” but sees a downside if such treatments really reverse menopause. She wonders if the hormones would be enough to bring back a woman’s period and the symptoms that often come along with it.

IMAGE CREDIT: 

• WAKE FOREST INSTITUTE FOR REGENERATIVE MEDICINE