How To Get Rid Of Man Boobs Permanently: April 2011

How I Overcame My 50-Year Struggle With Gynecomastia

Before we get started, here's a little story from one of my clients, Sammie Fields.

Hey there I’m Sammie.

I’m in my 70s now and I’m finally enjoying my life as a masculine-looking guy. I struggled with gynecomastia ever since puberty. Back in the day it was totally unheard of for a man to have breasts.

Man boobs were quite a rare thing. If you think having man boobs is bad now, try having them in the 60s. I spent my entire life in fear that someone would notice my breasts. I stayed away from women - I was horrified of the bedroom. I also stayed away from the beach and only got out wearing the thickest of clothing to try and conceal myself.

Back then there was no internet, and no information out there to help me. I tried everything I could to try and get rid of my man boobs. I lost weight and tried different diets but all to no avail.

One day however, just a few years ago I came across a newspaper article.

This article complained of how male fish in our waters were becoming feminized. Scientists had studied these male fish and found how they had developed feminine characteristics, even to the point of producing eggs! Apparently this was due to the prevalence of the female hormone estrogen in our water supply.

Apparently, due to most government water filtration systems (including the US), estrogen passes unfiltered right into our taps, and straight into your belly when you drink that glass of water.

The estrogen is being absorbed by us and is resulting in modern man having low sperm counts, fertility problems and gynecomastia. Heck it might even be responsible for the boom in the male cosmetics industry (joke).

So I went out there, did some research and found some other shocking sources of estrogen that exist especially in the modern environment, but were also there in the past albeit in much lower quantities and not as widespread back in the day.

Why am I telling you all this?

Well I lost my man boobs in my mid-sixties. The only way I managed to succeed was after I armed myself with the facts, and all the information I needed to know about the very root cause of my gynecomastia.

If I could get rid of my gynecomastia in my sixties, then I know for a fact that anyone else can do it too. So if you're about to give up or you have given up and are ready to face the world as a pseudo-man, then I'm here to tell you to wake up! Get out of that trance, shake yourself up and inform yourself of real working tactics that have been proven time and time again to help many thousands of guys lose their man boobs permanently using all-natural methods.

And I can't think of a better person to help you than my good friend Robert Hull. I leave you to his very capable hands and I'm sure that you will learn much on his new blog.

Saturday, April 30, 2011

New Hair Loss Prevention Robot Approved By FDA

Editor's Choice
Main Category: Medical Devices / Diagnostics
Also Included In: Men's health
Article Date: 27 Apr 2011 - 12:00 PDT

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In an attempt to fight balding, The Food and Drug Administration has approved a machine called the Artas System for commercial use that intends to bring one's follicles back to life.

The System combines several features including an interactive, image-guided robotic arm, special imaging technologies, small dermal punches and a computer interface.

After the System is positioned over the patient's scalp, Artas is capable of identifying and harvesting follicular units. The follicular units are stored until they are implanted into the patient's recipient area using manual techniques.

The production company says the system can improve extraction rates to 750 to 1,000 units per hour. This is much quicker and less invasive than traditional harvesting techniques.

However there is a catch; only males with brown or black hair are candidates.

There are many causes for hair loss in men. However, in the overwhelming majority of males with hair loss, the cause is hereditary androgenetic alopecia, more commonly known as "male pattern baldness." The tendency for male pattern hair loss is genetically inherited from either side of the family.

According to the manufacter's website:

"The presence of the hormone, dihydrotestosterone (DHT), in a genetically susceptible man, is necessary for this problem to occur and begins to develop after puberty. Hair on the scalp that is genetically susceptible (the hairline, crown and top of the scalp), starts to shrink in its shaft diameter and potential length, until it eventually disappears in a process known as hair miniaturization. The hair on the back and sides of the scalp is usually genetically 'permanent' hair, which is destined to remain for that man's lifetime."

What can be done for a man losing his hair that wants to keep it around? First, hair restoration surgery offers a permanent solution to lost scalp hair. Modern techniques of surgical hair transplantation can restore lost hair and replace the hairline with your own natural growing hair, which needs no more care than the ordinary washing, styling, and trimming you have always done.

Hair transplantation involves removing permanent hair-bearing skin from the back and/or sides of the scalp. There are two main techniques by which hair follicles can be harvested from the donor area: follicular unit extraction (FUE) and strip harvesting. FUE involves using a small dermal punch (e.g. 1mm in diameter or smaller) to individually dissect out follicular units directly from the scalp. Strip harvesting is carried out by excising a strip of scalp from the donor area and dissecting out the follicular units under a microscope.

These small follicular unit grafts are then meticulously implanted into the bald or thinning area of the scalp (recipient area) so as not to injure any follicles already existing in the area and at the same angle as the other hairs present. The creation of small follicular unit grafts has enabled hair restoration surgeons to create natural appearing hairlines and results.

Second, medical treatments are now offered in the form of a pill (finasteride) and a topical liquid (minoxidil). They require a life-long treatment however to maintain their effect.

Then there is the good old fashioned wig. Hairpieces are a non-surgical means to restore hair by covering bald areas of the scalp. There is a large variety of means for attaching these such as glues, "weaves," and clips.

Source: Restoration Robotics

Written by Sy Kraft

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Um androgenetic alopecia has nothing to do with aging.

posted by G. Floyd on 27 Apr 2011 at 1:52 pm

The opening sentence: "What ever happened to aging gracefully?" was offensive to me as a sufferer of male pattern baldness and completely irrelevant since MPB has nothing to do with aging. I began losing my hair in my early 20's and the disease has greatly reduced my quality of life. I have no wrinkles, gray hair, or any other symptoms of advanced age and the vast majority of other males my age do not exhibit any hair loss caused by male pattern baldness. Combating this disease through actual science and products like the one mentioned in this article offer quite a bit of hope to those currently struggling with MPB. I would like to see the author stick to the facts and refrain from editorializin her opinions on the "lack of grace" she perceives in treating androgenetic alopecia.

The mechanism of hair miniaturization is completely independent of the mechanism of cell aging. The author even quotes the (correct) current scientific thought on the causes of male pattern baldness. So I'm not sure why she saw fit to take a jab at those who are investigating the possibility of increasing their quality of life through new androgenetic alopecia treatments.

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Another option

posted by not hanging on on 27 Apr 2011 at 2:10 pm

Bic razors. You'll never see me with a comb-over or a horrid scar on the back of my scalp trying to hang on to what little hair I have left. I'll have my shiny and clean-shaven head for the rest of my life now. And the ladies dig it :)

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Skin Grafting

posted by g on 27 Apr 2011 at 10:59 pm

skin grafting is painful. i know a guy who had a partial op done to move hair. couldnt finish. now looks ridiculous

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Thanks for Modifying The Article

posted by G. Floyd on 29 Apr 2011 at 11:51 am

Thank you for editing the opening sentence of your article. I appreciate it.

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Source: http://www.medicalnewstoday.com/articles/223527.php

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Patients, beware of wrong-side surgeries

"I'm just beside myself. I have no idea what happened in that operating room," Tasha Gaul says of her son.

STORY HIGHLIGHTS

About 2,700 surgeries are performed each year on the wrong body part or patient
"It's serious, it's preventable, and it should never happen," expert says
Be aggressive, repeat your name and birthday, and trust your gut

(CNN) -- Early one morning in April, Tasha Gaul and Dale Matlock took their young son, Jesse, to a hospital in Portland, Oregon, for surgery to correct his lazy eye. It was supposed to be an easy procedure: Jesse, who was 3 at the time, wouldn't even have to spend the night at the hospital.

The surgery was indeed quick and simple. The problem was, it was on the wrong eye.

Gaul says she remembers what the surgeon, Dr. Shawn Goodman, said to her as she exited the operating room.

According to Gaul, Goodman told her, "Frankly, I lost my sense of direction, and by the time I realized it was the left eye, I was almost done."

Gaul claims that after Goodman realized her mistake, she performed the surgery on the correct eye.

In a statement to CNN, Goodman's office, Child Eye Care Associates, wrote that she cares very much about all of her patients and wants only the best for them. Because of patient confidentiality (HIPAA), she cannot talk about any patient to the public, the statement said.

I'm just beside myself. I have no idea what happened in that operating room," said Gaul, who'd been taking her son to Goodman for two years before the surgery.

Gaul and her fianc� have contacted Portland attorney Chuck Paulson and plan to sue.

"I feel like we had a right to know the second she realized she was in the wrong eye," Gaul said. "She went into the wrong eye first, and that's why we make a big deal about this."

Harmed in the hospital: Should you sue?

According to a 2006 study looking at the frequency of surgical errors in the United States, each year there could be as many as 2,700 mistakes where a surgery is performed on the wrong body part or the wrong patient. That's about seven per day.

Goodman works in her own private practice but has hospital privileges at Legacy Emanuel Medical Center, where Jesse Matlock underwent surgery. In a statement, Legacy says, "we are working with our operating room staff, and with the private practice physicians who were involved, to identify what happened so we can prevent it from happening again."

Protocols to prevent wrong-site surgeries are good but not infallible

"Not another one." That's the first thought that went through Dr. Kenneth Kizer's head when he learned of what happened to Jesse Matlock.

"It's serious, it's preventable, and it should never happen," he said.

Kizer is the former CEO of the safety advocacy group National Quality Forum and the man who helped coin the term "never events," a list of 28 adverse events -- such as operating on the wrong body part or giving a patient the wrong medication -- that happen in the health care system and put patients at serious risk.

He says efforts to prevent these types of surgical errors have gotten better over the past decade, but there is still room for improvement.

"People underestimate how complex the system is and the number of ways that errors can happen," he said. "There are dozens of doctors that will be involved in a case that goes to an operating room. Every time someone new sees a patient, there's the potential that they'll miss something or get a detail wrong."

Patient safety advocates suggest that hospitals use a checklist. The American Academy of Ophthalmology, for example, has a task force focused on patient safety and provides a checklist of recommendations that physicians should follow before, during and after an procedure on the eye to prevent wrong-site surgeries.

But, sometimes it doesn't happen.

"The checklist process is good, and people have adopted it better than expected, but there are limitations," said Dr. Samuel Seiden, an anesthesiologist and co-author of the 2006 study on surgical errors. "The systems we have in place prevent a lot of these kinds of mistakes, but not all of them."

For instance, Dr. Michael Repka, a spokesman for the American Academy of Ophthalmology, says it is possible for a mark to be covered up by surgical draping. He also says, "if the skin prep is particularly thorough, the indelible ink (used to mark surgical sights) can become less visible. You don't get rid of it completely, but some of it can come off."

Experts say even the best doctors can make mistakes. According to Repka, it is possible for eye surgeons to become disoriented because they're used to examining a patient from in seated position -- a different angle from the operating table. He says ophthalmologists are aware of this, which is why they take preoperative protocol very seriously.

Here are six things you can do to reduce your risk of a wrong-site surgery:

1. Ask, "What are you going to do to ensure that you don't operate on the wrong site?"

Kizer says that asking this question explicitly puts the concern on the doctor's radar. "Patients have to be aggressive sometimes," Kizer said. Also, if someone new is seeing you, this question may help to remind them to review your records and clarify one more time.

2. Request a "time-out" just before anesthesia.

The Joint Commission's Universal Protocol recommends that the operative team take what is called a time-out right before surgery. That's a time when all relevant members of the surgical team stop and communicate to ensure they are all in agreement on what's about to happen.

Diane Pinakiewicz, president of the National Patient Safety Foundation, says patients should consider themselves critical members of the health-care team.

"Patient involvement is one of the keys. It's imperative that they be proactive," she said.

Pinakiewicz suggests that before going under anesthesia, the patient or the patient's caregiver should not be shy about requesting a time-out or asking the head of the surgical team whether they have taken one.

3. Say: "My name is John Smith, and my birthday is January 21, 1976."

Patient advocates say to make sure your name is double- and triple-checked and that prior to surgery, whether you're speaking with the surgeon, the anesthetist or the nurse, make sure everyone involved in your care knows exactly who you are.

My colleague, CNN's senior medical correspondent, Elizabeth Cohen, advises that if your name really is John Smith, you should also include your middle name.

Don't underestimate the fact that patients in the same hospital may have similar names with slightly different spellings. Stating your full name and birthday can help ensure that you aren't confused with another patient.

4. Don't rush through the informed consent form.

Before having surgery, patients fill out a consent form, which details what specifically is being done and the possible risks and complications. Kizer says sometimes patients glaze over the details because they don't like to hear about the horrible things that can happen.

He says this is a missed opportunity to find potential errors that may have made their way that far.

5. Make sure your doctor initials your site.

The American Academy of Orthopaedic Surgeons urges its members to sign their initials directly on the site before surgery. Make sure your surgeon -- not someone else -- does the signing and that it's in the right place. The protocol may vary from hospital to hospital, but the bottom line is that patients should make sure the surgeon clearly marks the proper surgical site before you leave the pre-op area.

6. Trust your gut.

Jesse Matlock's parents said they initially had a bad feeling about how the surgery would go when, on the morning of the procedure, one of the surgical nurses mentioned paperwork that said the little boy would need surgery on one or both eyes.

"There'd been no mention of both eyes until then," Gaul said. "I immediately had this feeling of dread."

Gaul says her fears were allayed when Goodman, in the presence of other members of the surgical team, indicated the proper incision site by drawing several marks, including one about the size of a quarter on the skin above Jesse's right eye. According to Gaul, after the surgery, Goodman told her that one of the nurses preparing Jesse's eye may have covered up the mark.

The hospital is investigating what went wrong during Jesse's eye surgery.

The chief medical officer of Legacy Emanuel Medical Center issued a reminder to its staff immediately after Jesse's operation, informing them of the incident and reminding them of the importance of following appropriate procedures.

The family will not be charged for the surgery, and follow-up care with another provider will be provided at no additional cost.

"We have a commitment to quality and safety, and we take any failure very seriously," the hospital says.

Right now, Jesse's vision is fine, but his mother has noticed a slight lag in his good eye, his left eye, ever since the operation. She says it may be several weeks before they can know for sure.

"With any surgery on your child, you're going to be stressed and worried and want to make sure it happens the way it's supposed to because you're there to protect them," she said.

"I feel now I have to protect my child from these doctors no matter what. You really can't trust anybody."

CNN Senior Medical Correspondent Elizabeth Cohen contributed to this report.

Source: http://rss.cnn.com/~r/rss/cnn_health/~3/sz1lMLsHvr4/index.html

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VAP(R) Cholesterol Test Helps OB/GYNs In Dual Role As Primary Care Docs

Main Category: Women's Health / Gynecology
Also Included In: Pregnancy / Obstetrics;��Cardiovascular / Cardiology
Article Date: 28 Apr 2011 - 6:00 PDT

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Physicians in the OB/GYN discipline regularly see patients looking for a one-stop primary care visit. While these obstetricians and gynecologists specialize in pregnancy and reproductive health, their practices are growing broader to include managing their female patients' risk of future heart disease.

Cardiodiagnostic company Atherotech Diagnostics Lab is helping OB/GYNs to understand metabolic syndrome abnormalities and cardiovascular health disorders and disease. Atherotech will attend the 59th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG) held April 30-May 4 at the Walter E. Washington Convention Center in Washington, D.C.

Atherotech will showcase its VAP (Vertical Auto Profile) Test and offer blood draws to qualified attendees in booth #1744. Unlike the standard lipid profile, the VAP Test directly measures LDLc; therefore, fasting is not required.

Attending the meeting is Steven Foley, M.D., a Colorado Springs, Colo., OB/GYN and ACOG member, who routinely administers the VAP Cholesterol Test to patients at their annual exam. Foley specializes in the diagnosis and treatment of PCOS and will be available throughout the ACOG gatherings to discuss how he utilizes the VAP Test and other tests offered by Atherotech in his practice.

Atherotech Medical Advisory Board member and OB/GYN Robert A. Wild, M.D., Ph.D., M.P.H., is an experienced clinician and investigator with a focus on primary prevention strategies combining gynecology and preventive cardiology in women's health.

"Reproductive health and lipids pose challenges in primary prevention strategies for women," Wild said. "Issues such as reproductive endocrinology, PCOS, infertility, post- and peri-menopause and cardiovascular risk impact millions of American women and the OB/GYN is often their first source to turn to."

The VAP Test is widely covered by insurance, and results have shown a correlation between patients who have PCOS and low levels of HDL2, a highly protective subclass of high density lipoprotein (HDL). It also identifies markers of metabolic syndrome, often associated with early diabetes.

The VAP Test is the only expanded lipid test that routinely reports directly measured LDLc, which is included in the 22 reported cholesterol components - all at no additional cost. These components include Lp(a), apoB, apoA1, and the apoB/apoA1 ratio, making the VAP Test the only lipid profile that routinely reports all three lipid parameters - LDL, non-HDL and apoB - considered necessary by the American College of Cardiology and the American Diabetes Association.

Atherotech provides clinicians with a single source for the VAP Cholesterol Test and more than a dozen cardiovascular and metabolic tests, including C-Reactive Protein (hsCRP), LpPLA2, apoE genotype, NT-proBNP, cystatin C, T3 and T4 when TSH is abnormal, plus gamma-glutamyl transferase (GGT), a recognized cardiovascular risk biomarker.

Source:
Atherotech Diagnostics Lab

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VAP(R) Cholesterol Test Helps OB/GYNs In Dual Role As Primary Care Docs

Main Category: Women's Health / Gynecology
Also Included In: Pregnancy / Obstetrics;��Cardiovascular / Cardiology
Article Date: 28 Apr 2011 - 6:00 PDT

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Source: http://www.medicalnewstoday.com/articles/223629.php

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Thyroid Drugs May Raise Fracture Risk in Elderly

THURSDAY, April 28 (HealthDay News) -- Many seniors may be at increased risk for fractures because they take "excessive" doses of drugs used to treat thyroid problems, a new study says.

The findings suggest that treatment targets may have to be modified in elderly patients with thyroid problems and that regular dose monitoring of thyroid drugs is essential into older age, the researchers said.

Reporting in the online April 28 edition of the BMJ, they examined the link between fractures and levothyroxine, a synthetic form of thyroid hormone, which is widely used to treat an underactive thyroid gland (hypothyroidism).

Many patients with hypothyroidism are diagnosed in early or middle adulthood. Even though their treatment requirements change as they age, many patients remain on the same drug dose. This can lead to excess levels of thyroid hormone, which increases the risk of fractures, especially in older women, the study authors explained.

They analyzed data from over 213,500 patients, aged 70 or older, in the province of Ontario, Canada, who filled at least one prescription for levothyroxine between April 1, 2002 and March 31, 2007. During the study period, more than 22,000 (10.4%) of the patients suffered at least one fracture.

Current and recent past users (who had discontinued the drug 15 to 180 days before the start of the study) had a significantly higher fracture risk than "remote" users (who had discontinued use of the drug more than 180 days before the start of the study).

Among current users, those who took high or medium doses of the drug were much more likely to suffer a fracture than those who took a low dose.

"Our findings provide evidence that levothyroxine treatment may increase the risk of fragility fractures in older people even at conventional dosages, suggesting that closer monitoring and modification of treatment targets may be warranted in this vulnerable population," concluded Lorraine Lipscombe, a scientist at the Women's College Research Institute in Toronto, and colleagues.

One expert wasn't surprised by the findings.

"It has long been known that high or excessive doses of levothyroxine usage predispose [people] to increases in osteoporosis and the risk of fracture," said Dr. Irwin Klein, director of the thyroid unit and associate chairman of the department of medicine at the North Shore-LIJ Health System in Manhasset, N.Y. "This study further confirms this finding in an elderly population of women who are inherently at risk for this occurrence."

Klein also noted that the study underscores the need for preventive action.

"As the authors conclude, it is important to monitor thyroid blood tests -- especially TSH levels -- to prevent this potential adverse health burden," he said.

-- Robert Preidt

SOURCES: Irwin Klein, M.D., director, thyroid unit and associate chairman, department of medicine, North Shore-LIJ Health System, Manhasset, NY; BMJ, news release, April 28, 2011.

Source: http://www.medicinenet.com/guide.asp?s=rss&a=143745&k=Womens_Health_General

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What We're Reading This Week

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NEWS APRIL 29

Kristen Dold

The Perfect Pair
Sweet potato and red pepper, sitting in a tree. M-a-s-h-i-n-g. Ok, technically the pepper is pur�ed in a food processor with a garlic clove first. But then they get mashed into a lovely "spicy garlicy" sweet and savory dish! Goat cheese optional.
Via Spabettie

Is that a Skittle?
It's a hot spring day (let's imagine), and you're craving something sweet AND healthy. You reach into the freezer for a cool, refreshing...what? Is it a frozen banana slice with peanut butter, dipped in chocolate and sprinkled with granola and chopped skittles? Because it should be. Via Namely Marly

How to Go a Little Bit Vegetarian
Yes, it's difficult to give up bacon cold turkey (or, heck, even turkey cold turkey), but incorporating more fresh veggies into your diet really isn't that hard. Especially if you start with this five-ingredient white bean and eggplant soup. Easy, right?
Via Stone Soup

Unfocused Fun
You meet a cute guy at a bar, you have an amazing conversation for 30 minutes, and afterwards you can't remember a single thing either of you said. Sound familiar? Here's a scientific explanation for why being in a good mood can make you forgetful. Via Time

Faking It
Ever suspect that a friend taking Adderall doesn't really need the drug, and is using it as a performance enhancer instead? A new study finds that nearly 1 in 4 adults who seek meds for ADHD may be faking or exaggerating their symptoms.
Via MSNBC

Blush Away
Next time you slip up at work, don't try and hide your face! Let the crimson glow flow. Researches say if you blush, people are more likely to forgive the mistake.
Via US News

Last Updated: April 30, 2011 - 12:36pm

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Bone Drug Plus Statin Better at Fighting Plaque in Aorta: Study

By Steven Reinberg
HealthDay Reporter

THURSDAY, April 28 (HealthDay News) -- Taking both Lipitor and the bone-strengthening drug Didronel reduces plaque buildup in the aorta better than Lipitor alone, a small Canadian study suggests.

While Lipitor is a statin that lowers cholesterol, Didronel (etidronate) belongs to a class of drugs called bisphosphonates, which are typically taken by people with osteoporosis.

"Calcified plaques in the abdominal aorta have been reported to be a risk factor for cardiovascular disease," said lead researcher Dr. Tetsuya Kawahara, from the University of Calgary in Alberta.

"Bisphosphonate plus statin combination therapy can be considered as the more effective therapeutic agents for atherosclerosis and cardiovascular disease than statin monotherapy in the near future," Kawahara said.

The results of the study were scheduled to be presented Thursday at the American Heart Association's Arteriosclerosis, Thrombosis and Vascular Biology 2011 Scientific Sessions in Chicago.

For the study, Kawahara's team randomly assigned 251 patients with high cholesterol to daily doses of Lipitor alone or in combination with Didronel.

After two years, the researchers had patients undergo an MRI to gauge the buildup of plaque in their aortas. The aorta is the large blood vessel that carries blood from the heart to other parts of the body.

The researchers found that patients in both groups had similar reductions in the wall thickness of the aorta in the chest.

However, in the part of the aorta that passes through the abdomen, those on combination therapy had a 12% reduction in aorta thickness, compared with a 1% reduction in those taking only Lipitor, Kawahara's group reported.

In addition, only 1% of those on combination therapy had a heart attack, cardiac bypass or died from heart problems, compared with 5% of those taking Lipitor alone. This difference was statistically significant, the researchers added.

While this combination of drugs might sound promising in further reducing the risks from heart disease, long-term use of bisphosphonates has been linked to a risk of atypical fractures of the thigh bone and also to an increased risk for stroke and irregular heartbeat in cancer patients.

Kawahara noted that the trial wasn't long enough to see if bisphosphonates had any of these effects. Moreover, not all bisphosphonates have the same effect on plaque buildup. Other commonly prescribed bisphosphonates include Fosamax (alendronate), Boniva (ibandronate) and Actonel (risedronate).

"Only etidronate and clodronate (Bonefos), which are first-generation bisphosphonates, might have this effect," Kawahara added. "So at this time, we cannot recommend that people take bisphosphonates solely for reduction of the atherosclerosis."

Dr. Gregg Fonarow, associate chief of cardiology at UCLA's David Geffen School of Medicine, said that "there is a biological link between bone and vascular calcification."

Bisphosphonates reduce bone resorption and fracture risk, but emerging new evidence suggested these drugs may have the potential to reduce the atherosclerotic process. Bisphosphonates have been shown to inhibit cholesterol production, inflammation and oxidative stress, he added.

"These preliminary findings, while intriguing, require replication in large-scale, prospective, randomized clinical trials," Fonarow said.

SOURCES: Tetsuya Kawahara, M.D., University of Calgary, Alberta, Canada; Gregg Fonarow, M.D., associate chief, cardiology, David Geffen School of Medicine, University of California, Los Angeles; April 28, 2011, presentation, American Heart Association's Arteriosclerosis, Thrombosis and Vascular Biology 2011 Scientific Sessions, Chicago

Source: http://www.medicinenet.com/guide.asp?s=rss&a=143740&k=Womens_Health_General

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Your Body on Smoking

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WOMEN SMOKING

If you think lighting up on girls' nights out is a harmless vice, think again

Laura Beil

The average cigarette is gone in 10 puffs and five minutes, but that's five minutes of havoc as 4,000 chemicals infiltrate your organs.

0 to 10 Seconds
As you take the first drag, smoke passes through your mouth, leaving a faint brown film on your pearly whites. Toxic gases such as formaldehyde and ammonia immediately put your immune system on alert, causing allover inflammation.

Once in the windpipe, the cigarette smoke temporarily slows your cilia, the tiny sweepers that work to clear your respiratory system of mucus and invading particles. Meanwhile, airborne nicotine passes instantly into your bloodstream through the millions of capillaries in your lungs.

Your body gets a jolt of energy as that nicotine hits your adrenal glands, triggering an outpouring of adrenaline that raises your blood pressure and heart rate. Your heart is unable to relax fully between beats?and you are now at a higher risk of having a stroke.

At the same time, carbon monoxide (a toxic component also found in car exhaust) from the smoke is starting to build up in your blood, limiting your body's ability to transport oxygen to your vital organs.

Via the blood-stream, nicotine hits your brain, where certain nerve cells respond by letting loose a torrent of the feel-good neurotransmitter dopamine.

After 5 Minutes
As dopamine levels quickly plummet back to normal, your body yearns for another high?even if you're not aware of it. If you frequently give in to the craving, your brain will get hooked and you'll crash into withdrawal when you try to stop smoking (some experts posit that nicotine could be just as addictive as heroin).

The cigarette smoke is gone, but your body will be mopping up toxic substances for the next six to eight hours.

Forever
The cigarette's parting gift: gooey brown tar in your lungs.

TB screening assessed

?TB screening misses 70% of latent cases,? reported The Guardian. The newspaper says that experts have called for a change to tuberculosis (TB) screening policy. They suggest that a relatively new blood test should now be used to screen arrivals to the UK from the Indian subcontinent for hidden TB as well as arrivals from other high-risk areas of the world. This, they say, would mean treatment could be given to prevent most cases of the latent or hidden form of the disease from developing into full infectious TB.

This is a well designed study, and goes towards answering a clear and important question for policy decision makers. It is accompanied by an analysis of the overall cost of a change to policy and, importantly, the cost of averting an additional case of TB in people from different countries, allowing the researchers to suggest the best approach to screening those who come to the UK from these areas of the world.

Several papers have focused on the fact that the previous technique for screening for active TB, using X-ray alone, missed 70% of latent TB. This new strategy identified 92% of latent cases, therefore ?missing? only 8%. UK guidance currently specifies the groups of people who are offered screening for active TB and includes those arriving in the UK from countries known to have high rates of TB. By specifying countries for screening for latent TB as well as active cases, and using this new test, it is likely that more people can be treated and cured of this increasingly common illness.

Recent NICE guidance, updated earlier this year, has a section on new entrant screening and advises a co-ordinated programme linked to local services that is designed to detect latent TB and start treatment where needed. A positive IGRA test is one of the suggested tests, along with a positive tuberculin skin test in people under 35 years. This study was unpublished at the time and NICE asked for this sort of cost-effectiveness study to target the treatment of latent TB better. There is a small difference between the guidance and the conclusions of this study, relating to the countries that are recommended for this sort of screening for latent TB. Details of this are given below.

�

Where did the story come from?

The study was carried out by researchers from Imperial College London and other TB services around the UK. The research was funded by the Medical Research Council. The study was published in the peer-reviewed medical journal The Lancet Infectious Diseases.

The news coverage is generally accurate. The newspapers do all emphasise the poor accuracy of chest X-rays when used as a screening test for TB, though the study did not look at this. They all then go on to describe the new study and its main findings, along with the researchers? call for a change to screening policy. Quotes from a range of commentators are also included, including a comment from the Department of Health that the research backs up the latest guidance from the National Institute for Health and Clinical Excellence (NICE) on TB, issued in March 2011.

�

What kind of research was this?

This was a cohort study accompanied by a cost effectiveness analysis. Between 2008 and 2010 the researchers analysed data collected from 1,229 immigrants to the UK, from immigration centres in Westminster, Leeds and Blackburn. All three centres were using a relatively new blood test called the interferon-gamma release-assay (IGRA) specifically to test for TB. Only people aged 35 or younger who had been screened for latent or hidden TB infection using this test were included in the analysis. In a decision analysis model, the results for people from different countries of origin were modelled separately so that the researchers could test the strategy for different levels of underlying TB.

The research was carefully conducted and has provided a clear answer to the question of how accurate the test is when used in a population similar to those in these centres. It has also provided an estimate of cost effectiveness and the cost per case of avoided TB, the results of which look favourable and will help to inform immigrant screening policy. There are some practical limitations to how the study was conducted in terms of selection of patients and the assumptions the researchers had to make in the decision model. There are also different IGRA tests available, so this one may not necessarily be the best one. Despite these points, the testing strategy looks promising.

�

What did the research involve?

The researchers explain that cases of diagnosed TB have risen in the UK from 6,167 to 9,040 in the 10 years to 2009, and this is mainly due to rising numbers of cases in foreign-born immigrants. They say that national guidance for immigrant screening is hampered by a lack of data. They wanted to address this shortfall by finding out the number of cases of latent infection in immigrants to the UK and by examining the prevalence (rate of latent cases found per 100,000 population) so that they could define the groups that should be screened. They also wanted to model the cost-effectiveness of different strategies so that they could estimate the number of additional cases of full TB that could potentially be avoided with each strategy and at what cost to the tax payer.

TB is a bacterial infection caught by breathing in the bacteria that cause it. These bacteria are spread through sneezing or coughing by someone who has TB. There are two main types of TB, active and latent. In active TB, some people become ill a few weeks or months after breathing in the bacteria and can spread the disease. However, in most people, the body?s immune system kills the bacteria and the person does not get ill. In other people, the bacteria are not killed but stay in the body at a low level, and the person does not get ill and is not infectious. This is called latent TB. The bacteria can start to multiply again months or years later (for example, if the person?s immune system is weakened by another disease such as HIV) and active TB can develop.

In this study, the participants were all foreign-born new entrants who had come to the UK within the past five years and were aged 35 years or younger. They were screened between January 2008 and July 2010 in Westminster, Leeds and Blackburn following referral by ?port-of-entry? screening systems, health protection units or after registration with primary-care services. These centres serve a total of 1.6 million people, of which 6.5% are born abroad.

All participants were screened first with a symptom questionnaire followed by four blood tests, including the one-step IGRA test of interest. Immigrants who were symptomatic or who had a positive IGRA result were referred for chest radiography and further clinical assessment to see if they had active tuberculosis. Those with latent infection were offered treatment with either three months of two drugs or six months of one drug, in accordance with their wishes and standard UK guidance.
The researchers also asked about age and sex, BCG vaccination status (ascertained through documentary evidence, reliable history of vaccination or a characteristic scar) and country of origin.

The researchers used standard techniques for their cost effectiveness analysis. They costed the benefit of using this test from a UK National Health Service perspective, modelling the use of IGRA testing for 20 years. Two main questions were asked:

What are the costs of screening at different incidence thresholds?
Is screening at specific thresholds a cost effective use of resources and, if so, at what threshold?

�

What were the basic results?

Of 1,229 immigrants, 245 (20%) tested positive in the IGRA tests, 982 (80%) tested negative and two people (0.2%) had indeterminate results.

They say that positive results were independently linked to the TB incidence in immigrants? countries of origin. This means that test results were more likely to be positive in countries with higher rates of TB after taking into account other factors that were also linked to an increase in rates (male sex and age).

They say that the current national policy for detecting active TB used a chest X-ray in people from countries where more than 40 per 100,000 population per year develop TB. If this was used to screen for latent TB, it would fail to detect 71% of individuals with latent infection.

From the modelling analysis, they found that the most cost-effective strategy would be to screen people for latent TB from countries with a TB incidence of more than 250 cases per 100,000 per year. Using the IGRA test would result in an additional cost of �17,956 for each case of tuberculosis prevented compared�with the next most effective strategy.

The next most cost effective strategy would be also to screen immigrants from the Indian subcontinent, where there are more than 150 TB cases per 100,000 people per year. It was estimated that this would identify 92% of infected immigrants and prevent an additional 29 cases of TB over 20 years compared�with no screening.

�

How did the researchers interpret the results?

The researchers say that implementation of screening for latent infection would be cost effective. They recommend the level of incidence (150 cases per 100,000 per year) that identifies most immigrants with latent tuberculosis, and which is likely to prevent substantial numbers of future cases of active TB.

�

Conclusion

Until recently, it has been unclear who best to screen for latent TB. This research supports recent decisions made by NICE regarding how to screen and adds to the evidence on who, from a cost-effectiveness perspective, it might be best to target. This was clearly an area that needed research, as the screening for active TB using a chest X-ray was not effective at identifying latent TB. There are several points the researchers make about their research:

UK national policy from NICE since 2006 specifies that immigrants who intend to stay in the UK for more than six months need to be identified at their port of entry, and those from certain countries with normal chest X-rays need screening for latent TB. This includes children aged less than 16 years from countries with a tuberculosis incidence or more than 40 per 100 000 per year, and 16?35-year-olds from either sub-Saharan countries or from those with a disease incidence of more than 500 per 100,000 per year. Individuals older than 35 years are not screened because the risks of treatment outweigh the potential benefits.
The suggestion here is to widen the groups referred for testing to include screening for latent TB for people aged 16 to 35 years from countries that have rates above 150 cases per 100,000 per year and those from the Indian sub-continent. This is, in effect, a different screening approach and will result in more people being screened from the countries with lower rates of TB.
In this cohort, the prevalence of latent infection was moderately high at 20%, and it is not clear what the accuracy and cost effectiveness of the test would be in populations with a lower prevalence of latent TB. The researchers say that their study may be biased towards showing an increased prevalence of latent infection, as people who were concerned that they may have the illness may be more likely to attend for screening.
The researchers were unable to test the accuracy of the test against tuberculin skin testing, which is an alternative way of testing for latent infection, as this skin test is not routinely performed on new entrants.
The economic models rely on some assumptions, including that all patients identified with latent infection are treated and cured. Different estimates could result from assuming some drug-resistance, for example.

Overall, this is a useful study which is likely to be discussed by those deciding on immigration screening policies. The one-step IGRA blood test may prove to be the preferred option, however it is too soon to say this is the best approach. It is not the only test and further work is needed to compare different screening protocols (such as tuberculin skin test with IGRA compared with skin test alone or IGRA alone). There are also different types of IGRA test, some of which may have different costs.

Links To The Headlines

Tests on immigrants 'miss most TB'.�The Independent, April 21 2011

TB screening misses 70% of latent cases.�The Guardian, April 21 2011

TB screening 'missing most cases'.�BBC News, April 21 2011

Links To Science

Pareek M,� Watson JP,� Ormerod LP, et al.�Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis. The Lancet Infectious Diseases, Early Online Publication, April 21 2011

Source: http://www.nhs.uk/news/2011/04April/Pages/tb-screening-assessed.aspx

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Kidney damage 'reversed' in diabetic mice

BBC News has reported that ?diet can ?reverse kidney failure? in mice?. It said that a diet high in fat and low in carbohydrate can repair kidney damage in diabetic mice.

The research looked at the effect on kidney function of a ?ketogenic diet?, consisting of 87% fat, 5% carbohydrate and 8% protein, compared to a standard carbohydrate-rich diet in mouse models of type 1 and type 2 diabetes.

The diabetic mice, which had abnormal amounts of protein in their urine, indicating poor kidney function, showed improvement in kidney function over eight weeks of being on the ketogenic diet.

This was a small animal study and further research is needed to see what aspect of the diet underlies the effects seen. The implications for humans are limited and, as the researchers point out, it is unfeasible for humans to adopt such a high-fat diet in the long term owing to the health risks of consuming so much fat. Follow-up studies are more likely to look at the proteins involved in fat metabolism and their effect on kidney cells, to try to produce drugs that mimic the effect of the diet. As the BBC points out, the diet ?mimics the effect of starvation and should not be used without medical advice?.

�

Where did the story come from?

The study was carried out by researchers from Mount Sinai School of Medicine, New York. Funding was provided by The Juvenile Diabetes Research Foundation. The study was published in the peer-reviewed medical journal PLoS One.

The research was covered very well by the BBC, which highlighted the preliminary nature of the animal study and that the diet was unlikely to be recommended for people with diabetes.

�

What kind of research was this?

This animal study investigated the effect of a ?ketogenic? diet on mouse models of type 1 or type 2 diabetes, in which the mice had damage to their kidneys. Kidney damage is a common complication of diabetes and is known as diabetic nephropathy. The high levels of blood sugar associated with diabetes gradually cause damage to the tiny blood vessels and microstructures of the kidney, affecting their ability to filter correctly. Leakage of blood proteins (albumin) into the urine is the key sign of diabetic nephropathy.

A ketogenic diet is high in fat, low in carbohydrate and contains an average amount of protein. It mimics starvation and encourages the body to burn fats rather than carbohydrates. Burning fats replaces glucose as the energy source.

In both type 1 and type 2 diabetes, the body is less able to regulate blood glucose levels. Insulin is the hormone that regulates blood sugar levels. Type 1 diabetes results from the body?s failure to produce insulin. Type 2 results from insulin resistance, or a lack of sensitivity of the body?s cells to the actions of insulin.

�

What did the research involve?

The researchers used two mouse models of diabetes: a type of mouse called the Akita mouse, which produces less insulin (mimicking type 1 diabetes), and db/db mice, which are less responsive to insulin (mimicking type 2 diabetes). The researchers set up two experiments, one comparing 28 Akita and 28 normal mice, and the other comparing 20 db/db and 20 normal mice.

The mice were all 10 weeks old at the start of the study. The researchers collected urine samples when the mice were 20 weeks of age. At that time in the Akita versus control study, half of the mice from each group were placed on a ketogenic diet (5% carbohydrate, 8% protein, 87% fat). The other half of the animals were kept on a standard high-carbohydrate control diet (64% carbohydrate, 23% protein, 11% fat).

In the db/db versus control study, the ketogenic diet was started in half the mice from each group when the mice were 12 weeks old. The mice were kept on the ketogenic diets for eight weeks and urine samples were collected. The researchers measured levels of albumin in the mouse urine samples to assess how well their kidneys were functioning.

The Akita mice had a shorter life expectancy than the normal mice. The researchers expected that the Akita mice would not survive on the standard diet for eight weeks. They found that after 2 weeks on the standard diet (when the mice were 22 weeks old) two of the Akita mice had died. The researchers therefore decided to cull all of the Akita mice and also the normal mice that had received the standard diet so that they could compare the gene activity of Akita versus the control mice on the standard diet when they were the same age. The Akita and normal mice that were given the ketogenic diet all survived for the full eight weeks of the study, therefore the researchers compared the gene activity of the akita mice verses the control mice on the ketogenic diet when they were 28 weeks old. In the db/db versus normal mice study all of the mice that had received either the standard or the ketogenic mice were followed for the full eight weeks.

�

What were the basic results?

The Akita mice developed high blood sugar at four weeks of age and by the time they were 20 weeks their urine samples showed that they had developed kidney damage. Within one week of switching to the ketogenic diet when they were 20 weeks old, their blood sugar levels were in the normal range. Although the researchers sacrificed all of the non-diabetic mice and Akita mice who had received the control diet 2 weeks after they started the diet, they continued to monitor the non-diabetic mice versus the Akita mice on the ketogenic diet. They found, based on urine measurements, that the kidney damage seen in the Akita mice was reversed within two months on the ketogenic diet.

In the db/db type 2 diabetes mouse model, the mice developed high blood sugar by 12 weeks of age. At this time, half of the db/db mice and the non-diabetic mice were placed on the ketogenic diet. The ketogenic diet reduced blood sugar levels by around 50%, but they were still outside normal levels. Within eight weeks of being on the diet, the abnormalities in the urine samples indicating kidney damage were almost completely corrected. The db/db mice, compared with the non-diabetic mice, gained weight while on the ketogenic diet.

When the researchers examined the activity of genes in the kidney, they found there were nine genes that were more active in the Akita mice and db/db mice compared with the non-diabetic mice. However, the increased activity of these genes completely reversed in the Akita mice and largely or completely reversed in the db/db mice given the ketogenic diet.

In the laboratory, the researchers then examined the structure of the kidneys themselves in the db/db mice. They found that the abnormal structure indicating kidney damage was less common in the db/db mice on the ketogenic diet compared with mice on the standard diet, but their kidneys still showed damage compared with non-diabetic mice.

�

How did the researchers interpret the results?

The researchers say that previous studies of models of type 1 diabetes have found that good glucose control could prevent, but not reverse, kidney damage. This present study showed that the ketogenic diet could actually reverse the damage.

The researchers say that their research proves that manipulating a diet can prevent some of the damage caused by diabetes. However, they say that the ?ketogenic diet is probably too extreme for chronic use in adult patients? and may produce side effects. They say that if they can refine what aspects of the diet caused the effects then this may lead to the development of drugs that act in a more targeted way.

�

Conclusion

This preliminary animal research shows that a high-fat, low-carbohydrate diet was associated with some benefit in mouse models of type 1 and type 2 diabetes, in terms of reducing the kidney damage usually seen in these animals.

Though this animal model is meant to be representative of the kidney damage that can occur in people with diabetes, it is not clear whether a similar effect would be seen in humans. This research is unlikely to lead to a similar diet-based therapy for people with diabetes, as the side effects of eating such a high-fat diet are likely to outweigh any benefits. It is more likely that this study may form the basis for further studies looking at the proteins involved in fat metabolism and how they can affect kidney function and damage.

The researchers demonstrated that kidney function was restored over time by measuring albumin in the urine before and after the diet. However, as they only looked at the structure of the kidney at the end of the study it is not clear whether damage to the structure of the kidney was reversed by the diet, or whether the diet had prevented subsequent damage. To see if damage to the kidney structure was reversed the researchers would need to compare the structure of the kidney in age-matched mice before and after the diet. This small study would need further follow-up in animals to see the precise effect of this diet on the kidneys.

This study has no current implications for the prevention or treatment of diabetic nephropathy in humans.

Links To The Headlines

Diet 'can reverse kidney failure' in mice with diabetes.�BBC News, April 26 2011

Links To Science

Poplawski MM, Mastaitis JW, Isoda F, Grosjean F, Zheng F, et al. (2011)�Reversal of Diabetic Nephropathy by a Ketogenic Diet. PLoS ONE 6 (4)

Source: http://www.nhs.uk/news/2010/04April/Pages/kidney-damage-reversed-in-diabetic-mice.aspx

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Oral Sex Linked To Head And Neck Cancers

Oral cancer used to be something that happened mostly to men over 50 who were smokers. Today, cancers of the head and neck have been linked to HPV, which is known to causes virtually all cases of cervical cancer in women. The rise in oral sex may be to blame for the significant rise in oral cancers, particularly cancers of the base of the tongue and tonsils.

Peter Giannini, D.D.S. of the University of Nebraska Medical Center has a passion for exploring the possible links between oral cancer and HPV.? Dr. Giannini is alarmed by the increased numbers of young people being diagnosed with oral cancers. While smoking is still the number one cause of oral cancers, with alcohol use a strong second, the significant number of young people being diagnosed with oral sex related oral cancers is cause for worry.

The good news is that a vaccine for certain types of HPV is available, and while it won't do anything for those already infected with HPV, the vaccine does offer hope for less cancers in today's young people.

What Do You Think? Does the possibility of oral cancers affect your plans to start, or to continue, having oral sex?

Source: http://womenshealth.about.com/b/2011/04/16/oral-sex-linked-to-head-and-neck-cancers.htm

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Royal wedding: will you be a blubbering wreck?

Swooning at the altar

Faint heart, fair lady. Should Kate feel light-headed on the steps of the Abbey, a bridesmaid could reach for a bottle of Aromatherapy Associates Support Breathe Essence. The delightful scent of this combination of essential eucalyptus, peppermint and tea-tree oils will clear the head, revive the senses and even decongest the sinuses at a sniff.

Aromatherapy Associates Support Breathe Essence, 10ml for �15.50; aromatherapyassociates.com

Tears of joy

Everyone cries at weddings, but no one wants red eyes in the official portrait. Bausch & Lomb, the contact lens specialists, have developed a new eye drop, Artelac Splash, which might help. It includes compounds found naturally in healthy eyes and tears, such as hyaluronic acid, which binds with water and clings to the surface of the eye, keeping it hydrated and sparkling fresh.

Artelac Splash (30 doses for �10.49); artelac.co.uk and pharmacies

Bridal break-out

Kate will have make-up artists galore to ensure she looks blooming all day. But the rest of us are not so fortunate. Should a distinctly unpatriotic pimple pop up, Pure & Clear Blemish Gel contains extra-strength tea tree oil which has antibacterial properties and will help clear the spot while you cover up with foundation.

Pure & Clear Blemish Gel; �8.17 for 10g; nelsonsnaturalworld.com

Tummy churns

For the thousands who suffer spasms in the stomach brought on by nerves, Buscopan Cramps is a new product that aims to relax the digestive tract rather than act as a pain-killer. Contains an active ingredient called hyoscine butylbromide, and can be used up to four times a day. Available only from pharmacists.

Buscopan Cramps, �4.39; www.stomachcramps.co.uk

Unwanted gifts

Silver toasters and jewelled kettles aside, there are things you really don?t want to pick up at weddings ? germs. But you can?t offend the guests by slapping on the alcohol rub between handshakes. Vicks First Defence Protective Hand Foam has a more pleasant cucumber-mint scent, and kills 99.9 per cent of germs on contact, including swine flu. As it is claimed to last for up to three hours, one sneaky application could last an entire reception line.

Vicks First Defence Protective Hand Foam; 50ml for �3.99; lloydspharmacy.com

Best man?s speech impediment

A tickly cough is the nemesis of the nervous groom, his best man and father of the bride, who pray their speeches won?t start with a squeak. Berry-flavoured Covonia Double Action Cough Lozenges have a dual action: one side warms the mouth and soothes the throat, the other simultaneously targets airways, clears congestion and helps you breathe, making public speaking that little bit easier.

Covonia Double Action Cough Lozenges, �1.62 for 51g pack; covonia.co.uk

Clumsy groom syndrome

With an abundance of champagne and footloose guests on the dancefloor, it wouldn?t be a wedding reception without a few trodden-on toes. You could apply a handful of ice from the wine bucket and elevate your foot for 10 minutes ? or keep handy some arnica cream, the traditional remedy for bruises.

Nelsons Arnicare cream; �6.20 for 50g; boots.com

Source: http://telegraph.feedsportal.com/c/32726/f/568409/s/146796c5/l/0L0Stelegraph0O0Cnews0Cuknews0Croyal0Ewedding0C84687220CRoyal0Ewedding0Ewill0Eyou0Ebe0Ea0Eblubbering0Ewreck0Bhtml/story01.htm

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Friday, April 29, 2011

New guidance for ovarian cancer tests

The diagnosis and early treatment of ovarian cancer is in the news today, with the publication of new NICE guidance for doctors on recognising ovarian cancer. NICE calls for more initial investigations (such as a blood test) to take place in GP surgeries. This is so that more women are referred to hospital specialists and begin treatment sooner, greatly increasing their chances of survival.

The guidance focuses on areas where there is current uncertainty or wide variation in clinical practice with regard to the detection of ovarian cancer.�Most women will first visit their GP to discuss their symptoms and the guidance gives clear advice to GPs on the best course of action when cancer is suspected.

Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said:

?NICE is advising GPs and other primary care professionals to offer women (particularly those over 50) a blood test to measure the level of a protein called CA125 if they present with the following symptoms on a regular basis - bloating, feeling full quickly, lower abdominal pain and needing to urinate urgently or frequently.

?Based on the results of this test, women should then be offered an ultrasound scan of their abdomen and pelvis. If this suggests ovarian cancer, they should then be referred to see hospital specialists within two weeks; this is the existing national target set by the Department of Health.?

�

Where does the news come from?

The news stories are based on new guidance from the National Institute for Health and Clinical Excellence (NICE). NICE is the independent body that advises health professionals on the prevention and treatment of ill health.

NICE points out that ovarian cancer is the leading cause of death from gynaecological cancer in the UK and its incidence is rising. The outcome for women with this cancer is generally poor, with an overall five-year survival rate of less than 35%. This is because most women are only diagnosed when the disease is advanced, even though many women have symptoms months before, and also because of delays between when they first go to the doctor with symptoms and when referral is made for specialist investigations and treatment.

To increase the survival rates for ovarian cancer, NICE says there is a need for greater awareness of the disease among GPs and for earlier referral and optimum treatment.

?Delayed presentation coupled with lack of awareness around the possible symptoms, unfortunately mean that far too many women are being referred to hospitals for suspected ovarian cancer once their disease is at an advanced stage,? said Mr Charles Redman, a consultant gynaecological oncologist and contributor to the development of the guidelines. He continues, ?This is frustrating as the stage of diagnosis is crucial in determining which treatments can then be offered?.

The guidance focuses on areas where NICE says there is either uncertainty or wide variation in clinical practice, regarding the detection, diagnosis and initial management of the disease. The guidance is applicable to women with suspected or confirmed epithelial ovarian cancer (the most common type), as well as women with fallopian tube cancer, borderline ovarian cancer or primary peritoneal carcinoma (a rare cancer of the thin lining covering the organs of the abdomen and pelvis). It does not cover other types of gynaecological cancer or cancer of other abdominal organs.

�

What does the NICE guidance advise?

Specifically, the guidelines advise GPs and other healthcare professionals to offer women (particularly those over 50) a blood test to measure the level of a protein called CA125 if they present with certain symptoms on a regular basis. These symptoms are bloating, feeling full quickly, lower abdominal pain and needing to urinate urgently or frequently. CA125 is often called a ?tumour maker?; however, testing for CA125 is not a way of detecting any one disease. Levels are known to be raised in women with ovarian cancer, but they can also be raised by other cancers (including other cancers of the gynaecological system, bowel and lung) and other non-cancerous conditions such as endometriosis. However, raised levels in the presence of other symptoms should always raise the suspicion of cancer, until it is ruled out.

Based on the results of these tests NICE advises that women should then be offered an ultrasound scan of their abdomen and pelvis. If this suggests ovarian cancer, they should then be referred to hospital within two weeks, in line with existing targets from the Department of Health.

�

What are the key points from NICE?

Below are the ?key priorities? which NICE says need to be implemented:

Awareness of symptoms and signs
GPs, says NICE, should offer tests to any woman (especially if they are aged 50 or over) who reports any of the following symptoms, either persistently or frequently (particularly more than 12 times in a month):

persistent bloated feeling in the abdomen (abdominal distension)
loss of appetite or feeling full quickly (early satiety)
pain in the abdomen or pelvic area
needing to pass urine urgently or more often than usual

GPs should carry out appropriate tests in any woman aged 50 or over who has had symptoms in the last 12 months that may be suggestive of irritable bowel syndrome (IBS), because the onset of IBS is rare in women of this age. Symptoms include changes of bowel habit (for example, constipation or diarrhoea and abdominal pain).

Asking the right questions ? first tests

If symptoms suggest ovarian cancer, GPs should offer women a blood test to measure the levels of a protein called CA125. Levels of this protein can be raised in women who have ovarian cancer.
If blood levels of CA125 are 35IU/ml or greater, the GP should arrange for an ultrasound scan of the abdomen and pelvis.
If the ultrasound suggests that further tests are needed, GPs should urgently refer the patient (within two weeks) to a gynaecologist who specialises in cancer.
If blood levels of CA125 are normal (below 35IU/ml), or if the ultrasound is normal, doctors should check to see whether any other condition might be causing the symptoms and investigate if appropriate. If no other cause is found, the GP should advise the patient to return if symptoms become more frequent or persistent.

In hospital

Where the results of the blood tests and ultrasound indicate suspected ovarian cancer (calculated using a risk of malignancy index), the woman should be referred to a specialist multidisciplinary team of healthcare professionals who are experienced in treating women with this type of cancer.

The NICE guidance also covers the diagnosis and treatment of ovarian cancer and the support needs of women who have been diagnosed. These further aspects of management of ovarian cancer are not the focus of this Q&A report.

�

What are the symptoms of ovarian cancer?

As Dr Craig Dobson, a GP and one of the developers of the guidelines said: "Ovarian cancer is difficult to diagnose from the symptoms alone?. The symptoms of ovarian cancer can often be non-specific and are frequently confused with those of other conditions, including irritable bowel syndrome. However, experiencing changes in bowel habits (for example, bouts of constipation or diarrhoea) can also be associated with ovarian cancer. Dr Dobson continued, ?It is important for GPs to remember that irritable bowel syndrome rarely presents for the first time in women over fifty. Conversely, most ovarian cancers present in women over the age of fifty. Recurrent or prolonged symptoms require a diagnosis at any age."

NICE experts say that the important factor here is the persistence of these symptoms. Age is also a factor to consider, but although most cancers occur in women above the age of 50, the possibility of cancer should not be ruled out in younger women with unexplained symptoms.

Alongside the abdominal and pelvic symptoms listed above (bloating, pain, feeling full quickly or change in bowel or urinary habit), ovarian cancer can also sometimes cause a change in periods (if the woman is pre-menopausal),�post-menopausal bleeding or pain during sexual intercourse. Ovarian cancer can also often present with other non-specific symptoms common to many cancers, such as feeling very tired, or losing weight for no obvious reason.

�

What does the test involve?

The test is a simple blood test, which reportedly costs about �20. It measures blood levels of a key protein called CA125. This can be raised in women with ovarian cancer because CA125 is sometimes produced by ovarian cancer cells. Testing for CA125 has been carried out for many years within the NHS system and is a well-established test used in cases of suspected cancer. The primary purpose of the NICE guidance is to encourage the increased use of the test in primary care and to establish consistency among GPs about when they should be using the test and how they should be responding to the results.

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How accurate is the blood test?

The CA125 test alone cannot diagnose ovarian cancer and having a high level of CA125 does not necessarily mean a woman has ovarian cancer. Some healthy women have naturally high levels and levels can also be raised in women who have other conditions such as endometriosis or fibroids. However, if levels of CA125 are high it can indicate the need for further investigations. Diagnosis of ovarian cancer will most likely be made through the use of ultrasound initially, followed by MRI or CT scans.

As CA125 is non-specific for ovarian cancer, the test can also sometimes miss cases of cancer and return lower, less-suspect levels when a woman actually has cancer. This is particularly the case if a woman has early stage disease. Women with advanced cancer almost always have high CA125 levels, but not all women with early stage cancer will have raised levels. For this reason, it is vital to take account of the individual?s medical history and presenting symptoms, without complete reliance on the blood test, and if symptoms are persistent or unexplained, or there is any doubt at all as to the cause, referral for hospital assessment and urgent ultrasound should always be arranged.

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Why is NICE advising greater use of the blood test?

Women who have ovarian cancer have a greater chance of surviving the disease if it is caught earlier. Standard use of blood tests when women first complain of symptoms, by GPs and in other primary care settings, will, NICE says, lead to earlier referrals to cancer specialists and more timely treatment.

The NICE recommendations for use of the blood test by GPs are based on evidence of how the test performs, as well as an evaluation of its cost effectiveness. The CA125 test is, they say, currently the most widely used and reliable tumour marker for ovarian cancer.

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How do the new guidelines affect you?

The guidelines are important for patients because they set out a recommended standard procedure for investigating possible symptoms of ovarian cancer, which GPs are expected to meet. NICE has also produced�information on the new guidelines for patients and carers, in language that is easy to understand.

Links To The Headlines

GPs 'should offer �20 ovarian cancer blood test'.�The Daily Telegraph, April 27 2011

Call for action to detect ovarian cancer earlier.�BBC News, April 27 2011

Simple blood test could save hundreds from ovarian cancer.�The Independent, April 27 2011

A �20 lifesaver: GPs urged to test blood for ovarian cancer to improve survival rates.�Daily Mail, April 27 2011

Simple cancer blood test may save hundreds.�Daily Express, April 27 2011

Links To Science

The recognition and initial management of ovarian cancer.�NICE 2011

Source: http://www.nhs.uk/news/2010/04April/Pages/new-advice-for-testing-for-ovarian-cancer.aspx

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