You Are Not Too Old To Have Mammogram

Many of my older patients don't come to the office so they can be screened for breast cancer through mammography. A recent study of women aged 80 to 84 showed that those who had regular mammograms had their breast cancer diagnosed earlier as opposed to those who had infrequent mammograms. It means that you're not too old to have your mammogram.


Reference:Journal Watch

Mediterranean Diet May Reduce The Risk of Diabetes

A study that appeared in the British Medical Journal showed that adults who ate the Mediterranean diet may be less likely to develop diabetes.

Diabetes is a common condition that affects many women. It appears that modifying your life style and eating well may go a long way to help you prevent diabetes.


Reference: The British Medical Journal

Google Unveils Free Electronic Medical Records On Line

How will you feel when you can have access to your medical records on line? Well, if you're one of those people who will like to try something new, this is for you. Google has created a medical records storage site on the web which is password protected. This way your medical records would be portable. This will make it easy for you when you see a different doctor who does not have your records. You can also modify your records yourself so you can bring it up to date. This a great idea. Please, read on...

Women Using Hormone Replacement Therapy Risk Having a Stroke

Dr Francine Grodstein and her colleagues at the Brigham and Women's Hospital and Harvard Medical School collected data on 121,700 women who participated in the Nurses' Health Study from 1976 to 2004. The study looked at the relationship of hormone replacement therapy to the occurrence of stroke. Over the course of the study, 360 women who had never used hormones had stroke compared with 414 women on hormones.

This increased risk was observed in women initiating hormone therapy at young ages or near menopause and at older ages or more than 10 years after menopause." Younger women taking estrogen for less than 5 years had decreased chance of getting stroke. Age is thus a factor in the occurrence of stroke. The take home message is that if you need to take estrogen for menopausal symptoms, take the low dose for less than 5 years. Beyond that, you may be taking the risk of having a stroke.

Reference: NIH NEWS

Caffeine Intake In Pregnancy Leads To The Risk Of Miscarriage.

Is caffeine safe for pregnant women? There has been speculation that excessive caffeine intake can lead to pregnancy loss. The Kaiser Permanente Division of Research conducted a study on 1,063 pregnant Kaiser Permanente members in San Francisco from October 1996 through October 1998 to answer this question. The researchers examined the caffeine effect on women who never changed their pattern of caffeine consumption during their pregnancy.

Women who consumed 200 mg or more of caffeine per day (two or more cups of regular coffee or five 12-ounce cans of caffeinated soda) had twice the miscarriage risk as women who consumed no caffeine. Women who consumed less than 200 mg of caffeine daily had more than 40 percent increased risk of miscarriage. The increase in the risk appears to come from the caffeine itself. The main message from this study is that pregnant women who consume caffeinated beverages should go off caffeine.

Reference: http://www.sciencedaily.com/releases/2008/01/080121080402.htm

Polycystic Ovarian Disease Predisposes Young Women To Heart Disease.

"These findings underscore the need to screen and aggressively counsel and treat these women to prevent symptomatic cardiovascular disease."

Dr. Rupal Shroff and colleagues.

Journal of Clinical Endocrinology and Metabolism. (December 2007 issue).

University of Iowa, Iowa City.

Polycystic ovarian disease is common among young women, especially when they are obese. This disease can lead to high blood pressure, increased cholesterol and predisposition to diabetes mellitus. Dr. Rupal and his colleagues studied women, 21 to 50 years with polycystic ovarian disease. They found that a third of the women had early onset of heart disease (coronary heart disease). Most of these women did not have any risk factors for heart disease. Though the number of patients involved in this study is small, it appears that polycystic ovarian disease is by itself a risk factor for coronary heart disease and hence healthcare providers should diagnose this disease early and treat it to prevent its complications.

Depot Provera Injection Induced Bone Density Loss Recovers After Discontinuation.

Depot Provera is a commonly used contraceptive method by women in the childbearing age. In 2004, the FDA raised concerns about the loss on bone in women who use the medication for a prolonged period. Many South African women use this type of contraception. A recent study was done on South African women who used Depot Provera and Norethindrone (given by injection and is similar to Depot Provera). Bone loss measurement by ultrasound showed loss of bone that was worse in women who used the medications for ten years or more. The good news is that when the women discontinued the injections, the loss of bone recovered within 2 years.

This is good news for women who are using this medication to prevent pregnancy. There is hope that when they discontinue the injections their bone loss recover. This should give assurance to caregivers and women to continue using this effective and convenient hormonal contraceptive method.

Reference: Bone status after cessation of use of injectable progestin contraceptives. Rosenberg et al.

Women Positive About Aging

A recent poll on women on their attitudes towards aging showed that many said the best was yet to come. Please, read more:

CHP Lorain Spirit of Women Wins National Recognition

Mario Sertich, MD, introduced the spirit of women to the Lorain Community Hospital. This organization aims at bringing women's attention to different programs in the community hospital. Please, read on:

Gardasil Vaccine Protects Older Women.

Gardasil, the new Human Papilloma Virus vaccine approved for use in women aged 9 -26 years, in recent studies has been found to effective in women older than 27 years. It is effective up to age 45 years. I have had many of my older patients inquiring about the use of the Gardasil vaccine in older women. This is good news for those older women who are not already infected by the Human Papilloma Virus.

Raloxifene (Evista) Approved for Lowering Breast Cancer Risk in Postmenopausal Women

The FDA has approved Raloxifene to be used in two groups of women, namely those with osteoporosis and those at high risk of having breast cancer. This drug is like Tamoxifen that is currently used as prophylaxis in women with breast cancer. However, unlike Tamoxifen, Raloxifene does not cause cancer of the uterus. Both of them can cause hot flashes and clots in the veins. Unlike drugs like Fosamax or Actonel, Raloxifene does not prevent hip fractures. This is a boon to women with a history of osteoporosis in their spine and with a family history of breast cancer.

Loop Electrosurgical Procedure (LEEP) and the Risk of Premature Labor.

Abnormal Pap smear can be classified as low grade disease or high grade disease or cancer of the cervix. The treatment of the low grade disease may involve observation with Pap smears or freezing of the cervix. The high grade diseases are usually treated with removal of the affected area of the cervix by LEEP (Loop Electrosurgical Procedure). The treatment of cancer of the cervix is radical hysterectomy depending on the stage of the disease.

The benefit of the LEEP procedure in the treatment of precancerous disease of the cervix is that it removes the diseased cervix which is examined by a pathologist to determine the severity and the extent of the disease.

I had a patient who had severe dyspalsia on the cervix for which she had LEEP procedure. She got pregnant. At 13 weeks, I discussed cervical cerclage with her becasue of her short cervix. She had to see another physician because of insurance issues. The new physician refused to place the stich in the cervix. At 24 weeks she went into premature labour and had to stay off work throughout the pregnancy.

It is therefore interesting that a recent study in Danish pregnant women looking at the relationship between previous LEEP procedure and subsequent risk of preterm labor showed that women who had LEEP procedure had 2x chance of having premature labor.

If you have had LEEP procedure, you should let your obstetrician or midwife know about it. Your caregiver may measure the length of your cervix in early pregnancy with ultrasound to determine whether your cervix needs to be stitched or not. If your cervix is long enough to hold the baby, you may still have your baby early and hence you need to be followed up closely.

Reference:
Acta Obstet Gynecol Scand. 2007; 86(5):596-603

Antidepressants In Pregnancy. Are they Safe?

Depression is a common condition that afflicts women. Depressed pregnant women are at risk of preterm labor and worsening of their depression. Hence, treatment of these patients is important. That is why two recent articles that appeared in the New England Journal of Medicine about drug treatment of depression in pregnancy are important.

Previous studies implicated the selective serotonin reuptake inhibitors (SSRI's) like Paxil, Prozac and Zoloft in causing birth defects. These two new studies agree that the SSRI's have low risk of causing fetal abnormalities. Pregnant women who have depression should take comfort that they can take the SSRI's without having to worry about having abnormal babies. The abnormalities found in previous studies are rare.

Reference: New England Journal of Medicine.

Depressed Women May Have Premature Babies

A study done in England on depressed pregnant women showed the severely depressed women who were not taking medications had premature labor.

That depression produces stress hormones is exemplified by this study. Dr. O'Keane, a perinatal psychiatrist at the King's College in London measured corticotrophin releasing hormone (CRF) in 25 depressed pregnant women who were not on any antidepressant medications and 35 pregnant women who had no depression.

Levels of CRF and cortisol, hormones related to stress and also produced  by the placenta in pregnancy were found to be higher in women with depression.

While none of the mothers that were not depressed had premature deliveries, on the average, the depressed mothers had their babies 2 days earlier and 3 of them had premature deliveries.

During the follow up visit, the babies whose mothers had depression had high levels of cortisol in their saliva, a sign that their mothers' stress had effect on them..

The study involved a few patients. More studies are needed to elucidate the findings of this interesting small study. The take home message is that depressed pregnant patients' stress may have effect on their unborn babies. The effect may even continue after delivery. Hence pregnant women who are depressed should be treated with antidepressants despite the fear that some of the antidepressants may have effect on the newborn babies.

 

Reference: From issue 2599 of New Scientist magazine, 14 April 2007, page 18

Estrogen Therapy is good for the Young Postmenopausal Woman’s Heart.

The estrogen therapy controversy has not been put to rest yet. The WHI study that was highly publicized showed that postmenopausal women who took estrogen did not benefit from the estrogen replacement therapy and may even be at an increased risk of having heart disease.

In 1994, the Women Health Initiative trial using estrogen alone showed no adverse effect from the estrogen therapy. That study was stopped prematurely.

A study published by Manson and her colleagues in the most recent New England Journal of Medicine showed that estrogen therapy in younger women (50 -59 years), who have recently undergone hysterectomy with removal of their ovaries and hence have had surgical menopause, have protection against heart disease by keeping the lumen of the blood vessels open. Without the estrogen, calcium is deposited in the walls of the blood vessels thus causing narrowing.

The take home message is that in women who have had hysterectomy with removal of their ovaries in their 40’s to early 50’s, estrogen replacement therapy may be beneficial to the heart as it slows down the narrowing of the blood vessels.

Oral Sex Is Not Free. It Can Cause Throat Cancer.

A study which is appearing in this week's New England Journal of Medicine showed that both men and women who claimed they had six or more oral sex partners during their lifetime had about 9x increased risk of having cancer of the base of the tongue or the tonsils. The Human Papilloma Virus (HPV) was the culprit. In the study, the participants who had HPV infection were 32 times more likely to develop this type of oral cancer than those without the HPV infection.

The Gardasil vaccine contains 4 types of HPV viruses, namely 16 and 18 that cause about 70% of all cervical cancers and 6 and 11 that cause genital warts. In this study, of the 100 cancer patients enrolled, 72 had HPV 16. Two major risks that promote throat cancer are smoking (3 times greater) or drinking (2.5 times greater). These cancers are more common in men than in women. Does it mean that to prevent oral cancer in men who practise oral sex, these men should be offered the Gardasil vaccine? Only more studies can tell.

Between 12,000 and 15,000 new cases of oral and pharynx cancer are diagnosed each hear. 3000 people die form it. Dr. Robert Haddad, clinical director of the Head and Neck Oncology Program at the Dana-Farber Cancer Institute has seen younger men in their 30's and 40's getting this cancer. The bottom line is that since men don't know which women will have cancer causing viruses in their vagina, they should avoid oral sex as the price has become too much to ignore.

Reference:

New England Journal of Medicine (NEJM)

Cervical Cancer Vaccine May Prevent Precancerous Changes on the Cervix

An article published in the May 10th New England Journal of Medicine showed that young women not infected with Human Papilloma Virus HPV 16 and 18 who were vaccinated with the Gardasil vaccine had a lower occurrence of the high grade precancerous diseases on the cervix than those who were vaccinated with placebo.

The study was done on 12,167 women aged 15-26 years who had not been previously infected with the HPV. Thus the vaccine, if given to young women who have not already been exposed to the Human Papilloma Virus, is effective in preventing cervical dysplasia in women that will be apparent within years rather than decades.

"Human papillomavirus types 16 (HPV-16) and 18 (HPV-18) cause approximately 70% of cervical cancers worldwide,"

Laura A. Koutsky, PhD, from the University of Washington in Seattle, and colleagues from the FUTURE II study group.

Reference:N Engl J Med. 2007;356:1915-1917.

Gonorrhea -The Super Bug

Gonorrhea, the second most notifiable disease in the US, is rapidly becoming resistant to Fluoroquinolones, such as Cipro according to the CDC. Physicians are advised to use the last line of defense, the Cephalosporins. In the April 13^th issue of the Morbidity and Mortality weekly, the Center for Disease Control reported there was 13% overall resistance. In some areas 39% of the bug is resistant to the Fluoloquinolones. On the basis of this evidence the CDC

"No longer recommends the use of Fluoroquinolones for the treatment of gonococcal infections and associated conditions such as pelvic inflammatory disease."

Mend Your Bones with One Shot per Year

"Preventing hip fractures remains the holy grail of treating osteoporosis, as we know that six months after a hip fracture, nearly a fifth of patients will be dead."

David Reid

University of Aberdeen

A study on brittle bone disease (Osteoporosis) published in the recent edition of the New England journal of Medicine showed that once a year injection of a drug called Zoledronic Acid effectively treated osteoporosis compared to pills. This will be convenient than taking daily or weekly or even monthly pills for the treatment of osteoporosis (brittle bone disease) that afflicts many postmenopausal women.

Australian Women Seeking Vaginal Plastic Surgery

Many unmarried Australian women are seeking plastic surgery to improve the look of their vulva according to Dr. Colin Moore, a plastic surgeon who has been performing this kind of surgery for about 30 years.