Updates

UPDATES

Genetic link between melanoma and breast Ca

Families with the CDKN2A 113insArg mutation are not only at increased risk for multiple melanomas and pancreatic carcinoma but also breast cancer, according to a report from Sweden [J Natl Cancer Inst. 2000;92:1260-1266]. The study looked at 52 families with at least two cases of melanoma in first- or second-degree relatives. Women in families prone to breast cancer were at high risk for multiple melanomas. The authors suggest that CDKN2A be added to the list of breast cancer susceptibility genes and that breast cancer families with multiple cases of melanoma should be offered CDKN2A mutation screening.

Hysterectomy may cause delayed incontinence

A review of more than 10 years of medical research revealed an association between hysterectomy and urinary incontinence that shows up years after the procedure [Lancet. 2000;356:535-539]. An analysis of 12 studies that met the researchers' selection criteria found that women 60 years and older who had a hysterectomy are 60% more likely to be incontinent than women who did not have the surgery. The odds were not increased, however, for women younger than 60.

Several previous studies have reported that incontinence does not increase within 6 to 12 months of hysterectomy. Others have found, however, that incontinence increases several years after childbirth and the authors of the present study suggest a similar mechanism may operate with hysterectomy. "We recommend that women be counseled about sequelae of hysterectomy, and that incontinence should be discussed as a possible long-term adverse effect," they conclude.

New treatment for menstrual migraines

Oral rizatriptan in 10- and 5-mg doses is an effective treatment for migraine attacks associated with menstruation, two large trials show [Obstet Gynecol. 2000;96:237-242]. Two hours after taking the medication, 68% of the women who took 10 mg of rizatriptan and 70% of the those who took 5 mg experienced pain relief, compared with 44% taking placebo. Similar results were found in women who had migraine headaches not associated with menstruation.

Literature News

Patients still don't understand the mammography debate

Many women have misunderstood the recent controversy over mammography screening recommendations for younger women, believing that cost containment rather than evidence of health benefits was the issue at stake, a recent survey suggests [Arch Intern Med. 2000;160:1434-1440]. The NIH consensus panel involved in the debate had explicitly not considered costs while examining the medical evidence.

While 95% of the surveyed women paid attention to the debate about whether mammography screening reduces breast cancer mortality in women aged 40 to 49, only 24% said the discussion improved their understanding of breast cancer screening. Of those surveyed, 83% believed that screening mammography unquestionably benefits women aged 40 to 49, despite the arguments of some experts in the debate. Thirty eight percent even believed it to have proven benefits for women 18 to 39 years of age, a position clearly unsupported by evidence.

With these survey results in mind, the authors of the study suggest that to more effectively communicate medical messages to the public, it is necessary "to recognize that society may perceive any recommendation other than an unqualified endorsement for a test or treatment as a mechanism for cost containment rather than a conclusion of objective scientific study." They point out this may be relevant for the ongoing debate on testing for cancer susceptibility genes such as BRCA1.

Decline of heart disease in women

It seems that women are listening when it comes to quitting smoking, eating a healthier diet, and taking hormones after menopause: The incidence of coronary heart disease (CHD) among women is declining due to these changes, but the decline is not as great as it could be because obesity has increased at the same time [N Engl J Med. 2000;343:530-537].

Researchers found that the incidence of CHD declined by 31% from 1980 to 1994 among approximately 86,000 participants in the Nurses' Health Study. These women are between the ages of 34 and 59 and have no previous diagnosis of cardiovascular disease or cancer. During this time, the use of postmenopausal HRT increased by 175%, accounting for a 9% decline in CHD; smoking declined by 41%, accounting for a 13% reduction in CHD; and diet improved substantially, accounting for a 16% decline. The prevalence of overweight went up by 38%, however, partially reversing the trend by causing an increase in CHD.

The grim facts on extremely preterm birth

A large-scale study reports that 79% of pregnancies ending between 20 and 25 weeks' gestation result in stillbirth or death of the infant before admission to a neonatal intensive care unit. Death before discharge accounts for another 12%. Fewer than 1% of the babies die after discharge, but of those who survive for at least 30 months, approximately half are disabled and the disability is severe in half of these [N Engl J Med. 2000;343:378-384].

The study involved all children born at 25 or fewer weeks' gestation in the United Kingdom and Ireland between March and December of 1995. At 30 months of age, 19% of preterm children had severe developmental delay, scoring more than three standard deviations below the mean on the Bayley Mental and Psychomotor Development Indexes. Another 11% scored between 2 and 3 SD below the mean. Ten percent had severe neuromotor disability, 2% were blind or could perceive only light, and 3% had hearing loss. Boys were more likely to be disabled than girls. An accompanying editorial favors "increasing families' access to individualized information on risk" in making decisions about the treatment of preterm infants.

A separate study found that even babies born at 32 to 36 weeks' gestation are at higher relative risk for death during infancy and contribute substantially to the infant death statistic in the United States [JAMA. 2000;284:843-849]. This population-based cohort study of singleton live births and infant deaths during a 10-year period found that the relative risk for death from all causes among singletons born at 32 to 33 weeks was 6.6, compared to infants born at term. At 34 to 36 weeks' gestation, this risk was 2.9. These mildly and moderately preterm infants were at substantially higher risk for death due to infection, SIDS, and external causes, including abuse and maltreatment.

 

Chidem Kurdas. Updates. Contemporary Ob/Gyn 2000;11:116, 119.