Medicine Lessons and articles

The Kansas Early Detection Works program, which provides uninsured low-income women in the state with breast and cervical cancer screenings at no cost, has depleted its operating funds and will delay almost all cancer screenings until July 1, the Wichita Eagle reports. Janet Neff, director of the Cancer Prevention and Control Program at the Kansas Department of Health and Environment, said the program has received about $2.3 million annually in recent years from CDC. The program also receives some funding from the state and the Mid-Kansas affiliate of the Susan G. Komen for the Cure Foundation.

The screening program depleted its funds in March. However, program officials reserved a limited amount of funding to provide diagnostic tests until the new fiscal year begins on July 1 to women who display symptoms of breast or cervical cancer. Women who inquire about the program will be placed on a waiting list and will be screened when funding becomes available. Kansas women ages 40 to 64 who are uninsured and meet income guidelines are eligible for the program. According to Neff, about 5,800 of the at least 27,000 women in Kansas who qualify to receive no-cost screenings have done so since July 1, 2007.

Neff said she requested slightly more than $2.3 million in federal funds for FY 2009 (Shideler, Wichita Eagle, 5/5).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2008 The Advisory Board Company. All rights reserved.

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2008 The Advisory Board Company. All rights reserved.

The intrauterine device (IUD) isn’t just an effective contraceptive, it also provides some protection against endometrial cancer, according to David A. Grimes, MD, of Chapel Hill, NC, who presented the 3rd Current Issues Update – “New Uses for IUDs: Contraception and Beyond” today at The American College of Obstetricians and Gynecologists’ (ACOG) 56th Annual Clinical Meeting.

Dr. Grimes said that the hormonal IUD is approved for the treatment of heavy menstrual bleeding in more than 80 countries (except the US). The hormonal IUD is also approved in a similar number of countries for protection of the endometrium in women taking estrogen in the menopause, he added.

“Only 2% of women who use contraception in the US choose an IUD, despite the proven safety and effectiveness of this long-term contraception,” said Dr. Grimes, vice president of biomedical affairs at Family Health International, Research Triangle Park, NC, and a clinical professor of ob-gyn at the University of North Carolina in Chapel Hill. “Worldwide, however, IUDs are the most widely used reversible contraceptive.”

IUDs are an attractive option for many women. The IUD offers similar contraceptive effectiveness as permanent tubal sterilization but it is immediately reversible when removed. Inserting the IUD is a simple office procedure, unlike surgical sterilization which is performed in a hospital.

The IUD is a small, T-shaped plastic device that is inserted into the uterus. There are two types of IUDs approved in the US: the hormonal and the copper IUD. The hormonal IUD releases small amounts of the hormone progestin that prevents pregnancy by preventing fertilization. It is approved for five years of use. The copper IUD releases small amounts of copper into the uterus and prevents pregnancy with similar high effectiveness. It is approved for up to 10 years of use.

IUDs can be appropriate for women who have never been pregnant and those with a history of ectopic pregnancy, according to Dr. Grimes. He added that studies have shown that the risk of pelvic inflammatory disease is negligible and limited to the first month after insertion.

“IUD use among women is associated with a 40% reduction in the risk of endometrial cancer, similar to the cancer protection provided by oral contraceptives, yet many clinicians are not aware of that,” said Dr. Grimes. For treating endometriosis, the hormonal IUD is an alternative to leuprolide acetate injections or a ‘watch and wait’ approach (to see if the pain improves by itself). Another emerging use for the hormonal IUD is treating endometrial hyperplasia, a condition in which there is abnormal overgrowth of the endometrium.

“The IUD is underutilized as a contraceptive in the US,” summarized Dr. Grimes. “Research is showing that it has health benefits far beyond preventing pregnancy.”

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

American College of Obstetricians and Gynecologists

Women who quit smoking significantly reduce risk of death from coronary heart disease within 5 years, but impact on risk of death from lung and other
cancers take longer.

These are the findings of Dr Stacey A Kenfield, of the Harvard School of Public Health, Boston, USA, and colleagues in a new study published in the May 7th
issue of the Journal of the American Medical Association, JAMA.

According to the World Health Organization, about 5 million deaths were smoking related in 2000, and estimates suggest that by 2030, this figure will rise to
10 million worldwide, 7 million of which will be in developing countries, wrote the authors, who also said that tobacco use is the leading cause of death in the
United States.

But while the link between smoking and increased risk of death from a range of diseases has been well established, the effect of quitting compared to
continuing to use tobacco has not.

Kenfield and colleagues examined data from the Nurses’ Health Study on over 100,000 women who were followed from 1980 to 2004. In this group there were
nearly 12,500 deaths, with nearly 4,500 among never smokers (36 per cent), 3,600 among current smokers (29 per cent) and just under 4,400 among past smokers
(35 per cent).

They calculated the relative risks (as hazard ratios) among the three subgroups of death from any cause, and from specific diseases such as cardiovascular,
respiratory, lung and other cancers, and other causes.

The results showed that:

• There was a 13 per cent reduction in the risk of death from any cause within the first 5 years of quitting compared to continuing to smoke.
• This risk reduced to the same level as the never smokers after 20 years of quitting.
• Within this overall 20 year figure some causes took less time to go down to the never smokers’ risk level and others took longer.
• Vascular disease showed the most rapid reduction in risk to the never smokers’ level, with much of it showing in the first 5 years of quitting.
• These included coronary heart disease (62 per cent of excess risk gone in first 5 years of quitting) and cerebrovascular disease (42 per cent of excess
  risk gone in first 5 years of quitting).
• These figures were obtained from comparing the hazard ratios of recent quitters of less than 5 years with long term quitters of 20 years or
  more.
• Death from respiratory diseases showed an 18 per cent reduction in risk of death 5 to 10 years after quitting, going down to the never smokers’ level
  after 20 years.
• Risk of death from lung cancer showed a significant 21 per cent reduction in the first 5 years of quitting compared to continuing to smoke, but the
  excess risk did not go away for 30 years.
• Past smokers who had quit for 20 but less than 30 years, had an 87 per cent reduction in risk of death from lung cancer compared to current smokers.
• When risk of death from other smoking-related cancers was included, this figures approached the never smokers’ risk level more than 20 years after
  quitting.
• Risk of death from all causes, respiratory diseases, and smoking related cancers, was significantly higher among women who started smoking at a younger
  age.
• The figures also showed smoking was linked to increased risk of death from colorectal cancer but not ovarian cancer.
• About 64 per cent of deaths among current smokers and 28 per cent among past smokers were linked to cigarette smoking.

The authors concluded that:

“Most of the excess risk of vascular mortality due to smoking in women may be eliminated rapidly upon cessation and within 20 years for lung
diseases.”

They added that:

“Postponing the age of smoking initiation reduces the risk of respiratory disease, lung cancer, and other smoking-related cancer deaths but has little effect
on other cause-specific mortality. These data suggest that smoking is associated with an increased risk of colorectal cancer mortality but not ovarian cancer
mortality.”

The researchers emphasized the importance of maintaining school programs on preventing tobacco use and enforcing laws that deny young people access to
tobacco, given that early initiation is linked to higher risk of death. They also wrote that:

“Effectively communicating risks to smokers and helping them quit successfully should be an integral part of public health programs.”

“Smoking and Smoking Cessation in Relation to Mortality in Women.”
Stacey A. Kenfield; Meir J. Stampfer; Bernard A. Rosner; Graham A. Colditz
JAMA. 2008;299(17):2037-2047.
Vol. 299 No. 17, May 7, 2008

Cick here for Abstract.

Sources: JAMA press release and abstract.

Written by: Catharine Paddock, PhD

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

SRS Medical announced the launch of a new patient website, http://www.personalmed.com, devoted to female pelvic health. The launch announcement was timed to coincide with the ACOG conference (The American College of Obstetricians and Gynecologists) in New Orleans, where SRS Medical is conducting a physician survey to help in “fine tuning” the site.

SRS Medical is a leading manufacturer of equipment for urodynamics, the diagnostic procedures that are the standard of care for patients with lower urinary tract symptoms (LUTS). Kevin M. Connolly, CEO, states, “Working in the medical technology space, we are very aware that we are reaching only a small percentage of the women with pelvic problems, even though physicians now have very effective interventions. Personalmed is an outreach initiative to draw more women with pelvic problems into the healthcare system. It is intended to assist physicians by providing their patients with a single source for authoritative information and clinically proven products for first-line therapy, as well as a forum for sharing related experiences.”

Although reliable numbers for most pelvic problems are limited, urinary incontinence alone is known to affect over 13,000,000 adult women in the U.S., with similar prevalence in most developed countries. As common as this and other pelvic problems are, patients are still reluctant to discuss them. According to National Association for Continence (http://www.nafc.org), a leading patient advocacy group, many women with incontinence never seek help from a physician and those who do wait an average of seven years.

Personalmed’s goal is to increase patient comfort with their pelvic problems via basic education and peer discussion. Personalmed will provide information concerning incontinence, sexual problems, post-natal pelvic care, pelvic pain, chronic constipation, etc., as well as a blog refereed by nurse specialists. In addition, personalmed will sell selected OTC products, such as the StepFree™ vaginal weights. Since personalmed is “Dedicated to restoring dignity and quality of life to all women,” it will also donate a portion of its revenues to support worthy related causes. In 2008, personalmed will donate 3% of all net sales to: The West Africa Fistula Foundation.

SRS Medical Systems, Inc. is a privately held Delaware corporation with facilities in Redmond, WA and Billerica, MA.

SRS Medical Systems

More women than men in Uganda sought services of the AIDS Support Organization, or TASO, according to a recently released TASO report, Uganda’s Weekly Observer reports. TASO provides HIV testing and counseling, as well as antiretroviral drugs and other HIV/AIDS-related services.

According to the report, of the nearly 60,000 people who received counseling at TASO clinics, about 42,000 were women and about 18,000 were men. The group registered 23,800 new clients last year at its 11 clinics — 15,323 women and 8,477 men — the report found. Robert Nakibumba, a TASO spokesperson, said that TASO’s finding that more women than men sought HIV/AIDS services reflects an international trend and could be in part because “women are free and own up to responsibilities more than men.” The report found that men were more responsive to television, radio and theater dramas aimed at educating people about the disease.

Other Findings
Among the new clients registered last year, 8,000 were ages 20 to 51, and less than 1,000 were older than age 60, the report said. About 55% of TASO’s new clients are from rural areas. About 91% of people who received counseling shared their HIV status with friends, relatives or neighbors. About 97% of roughly 26,000 TASO clients who were sexually active discussed their HIV status with someone else, and 31% told their sexual partners.

The report found that about 8,000 of the 27,000 clients screened for antiretroviral eligibility in 2007 were eligible for treatment; however, many people did not adhere to their treatment regimens. Only 323 children enrolled in the TASO’s antiretroviral program, the report said, noting that there are inadequate testing services for children and an “unwillingness of some parents and guardians to take their children for [antiretroviral] screening” (Mubangizi, Weekly Observer, 5/1).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The American College of Obstetricians and Gynecologists (ACOG) awarded first prize to ACOG Junior Fellow, Bliss Kaneshiro, MD, for her research paper Relationship Between Body Mass Index and Sexual Behavior. Dr. Kaneshiro, an assistant professor at the University of Hawaii in Honolulu, presented her winning paper at ACOG’s 56th Annual Clinical Meeting.

Some studies have suggested that obese and overweight women have a higher risk of unintended pregnancy than do normal weight women, according to Dr. Kaneshiro. Although multiple factors, including contraceptive use and its efficacy, may increase the risk of unintended pregnancy among these women, sexual behavior and the frequency of intercourse could also be a factor.

Dr. Kaneshiro’s objective was to study the impact of body mass index (BMI) on sexual behavior. It is important to understand this relationship because preexisting physician biases can affect how heavy women are counseled about pregnancy and STD prevention. Dr. Kaneshiro studied the relationship between BMI and sexual behavior, including sexual orientation, age at first intercourse, number of partners, and frequency of intercourse.

“Our analysis of the National Survey of Family Growth Cycle 6 demonstrated that obese and overweight women do not differ significantly in some of the objective measures of sexual behavior compared to women of normal weight,” said Dr. Kaneshiro. “This study indicates that all women deserve diligence in counseling on unintended pregnancy and STD prevention, regardless of BMI.

“The obesity epidemic in the US has resulted in serious health consequences for many individuals and for the health care system as a whole,” according to Dr. Kaneshiro. “Physicians of all specialties must factor body weight into their clinical decision-making process on a daily basis.”

Alison B. Edelman, MD, MPH; Jeffrey T. Jensen, MD, MPH; and Mark D. Nichols, MD, from the Oregon Health & Science University (OHSU) in Portland, were co-researchers with Dr. Kaneshiro (formerly of OHSU).

** This year’s meeting will include many sessions related to obesity issues in obstetrics-gynecology, including postgraduate courses, clinical seminars, interactive sessions, paper sessions, and luncheon conferences. **

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

American College of Obstetricians and Gynecologists

Spiraling health care costs and the imperative to improve patient safety and quality performance represent the most important issues on the US health care agenda, according to Gail Wilensky, PhD, a leading health care economist, who delivered the Samuel A. Cosgrove Memorial Lecture, “The Future of Health Care,” during the opening session of The American College of Obstetricians and Gynecologists’ (ACOG) 56th Annual Clinical Meeting.

“Over the last 40 years, annual health care spending has been growing faster than inflation,” said Dr. Wilensky, an economist and senior fellow at Project HOPE, a health education foundation that works to make health care available around the world. “This is simply not sustainable, and to me, is the No. 1 priority of health care reform.

“If we don’t find a way to slow spending down-not reduce spending, but slow it down-this spending growth will put tremendous pressure on the federal budget and also on the rest of the economy,” added Dr. Wilensky. “To make matters worse, health care spending exacerbates the already huge problem of access to health care for millions of Americans.”

At Project HOPE, Dr. Wilensky analyzes and develops policies related to health care reform and ongoing changes in the health care environment. In the early 1990s, she directed the Medicare and Medicaid programs and served as deputy assistant to President George H.W. Bush for policy development, advising him on health and welfare issues. From 1997 to 2001, Dr. Wilensky chaired the Medicare Payment Advisory Commission, which advises Congress on Medicare issues.

The other reform initiatives Dr. Wilensky believes are necessary to improve the US health care system include addressing the serious quality problems in both patient safety and appropriateness of care. She acknowledged that the patient safety movement gathered momentum after the Institute of Medicine’s report To Err is Human (published in 2000) indicated that, at best guess, about 100,000 people are dying every year from medical errors, but she asserted, “Not nearly enough has been done to address the issue of patient safety in the last five years.”

One of the areas Dr. Wilensky has been working on is comparative clinical effectiveness-the rationale being that providers can be paid more per service if they reduce the volume and intensity of services that don’t seem to be productive. She noted that in terms of quality performance, studies have indicated that patients receive on average about 55% of procedures and treatment that are clinically appropriate.

“ACOG has a long-standing commitment to improving quality and safety in women’s health care,” said ACOG President Kenneth L. Noller, MD, MS. “We strongly believe that quality assurance and patient safety programs are pivotal to advancing women’s health. We will advocate for these important issues in any and all health care reform.”

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

American College of Obstetricians and Gynecologists

New advances in reproductive technology have pushed medical diagnostics to both theoretical and practical limits, according to Mark Hughes, MD, PhD, director of Genesis Genetics Institute in Detroit and director of the Applied Genomics Technology Center of Michigan, who spoke at the opening session of The American College of Obstetricians and Gynecologists’ (ACOG) 56th Annual Clinical Meeting.

“The rapid growth and clinical adaptation of genetically based information and technology are fundamentally changing the practice of medicine, especially for ob-gyns,” said Dr. Hughes. Because of these advances, there are technologies now available to couples wanting to avoid inherited disease in their offspring even before a pregnancy begins.

“Knowing the roadmap of the human genome gives us powerful tools to help our patients in ways we might barely have imagined just a few years ago,” added Dr. Hughes. “In ob-gyn this information presents especially complex practice dilemmas.”

The field of reproductive medicine, perhaps more than any other field, is continually confronted with ethical considerations. “Just because we technically can do something doesn’t mean we should,” noted Dr. Hughes. “Through the ages, technology has been the fuel that drives the engine of science, and science is the vehicle that propels the progress of medicine, and medicine routinely drives us into bioethical corners.

“Preimplantation genetic diagnosis was invented 18 years ago, and it’s come a mighty long way,” said Dr. Hughes. “It is now possible to detect quite complex problems in the smallest unit of life (one cell), in the smallest unit of inheritance (one gene), for the smallest part of a gene (one DNA nucleotide), out of 3.3 billion letters that comprise the human genome. “Even in 100 years of medical advances, diagnostics will not be smaller than examining-overnight-one molecule. The technology itself will surely evolve with time, but we are now at the limits of the biology that can produce severe pathology in our patients,” added Dr. Hughes.

Preimplantation genetic diagnosis (PGD) is a reproductive technology used with an in vitro fertilization cycle. It involves testing the genetic material of embryos to look for specific genetic mutations or chromosomal rearrangements. It is generally used by patients who know they are at risk of transmitting a genetic disease or chromosomal abnormality to their offspring.

For example, a couple could face a 25% or 50% risk of a producing a child with a particular disease. This risk is not trivial, Dr. Hughes said, and many couples choose not to have children. Other couples may accept this high risk and wait anxiously during the first months of pregnancy, wondering if their fetus has cystic fibrosis, muscular dystrophy, hemophilia, or any one of hundreds of genetic disorders.

“Their anxiety is significant. Do they want diagnostic testing such as chorionic villus sampling (CVS) or amniocentesis, and what will they do with the information after they have it?” commented Dr. Hughes. “By testing a fertilized egg prior to implantation, modern science can now eliminate this risk and this stressful time for couples.”

PGD has largely been used to help couples who suffer with infertility and for couples at risk of having children with a heritable genetic disease. The concern now, however, is that the technique might be used to select characteristics that range from less serious disease to purely matters of preference, such as gender.

“Who decides what’s ethical and what isn’t?” asked Dr. Hughes. “It varies from one country to the other.” Dr. Hughes points out that while most people approve of a couple finding out before implantation whether an embryo has a lethal disease, the discussion becomes murkier when it concerns a non-fatal disease or condition or even gender.

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

American College of Obstetricians and Gynecologists