Hysterectomy, the second-most Popular Surgery in American Women

An astounding 40% of American women have had a hysterectomy by age 45…

image of MARGARET ARANDA, MD
An astounding 40% of American women have had a hysterectomy by age 45 says Dr. Margaret Aranda

After Cesarean Section, hysterectomy is the second-most popular surgery in American women, providing 600,000 procedures per year, and 20 million procedures to date (Keshavarz, 2012), with 55% having both ovaries removed.

In her post, Dr. Margaret Aranda mentions:

  • Gynecologists and Hysterectomy
  • Did I Consent to this?
  • Hysterectomy Second Opinion
  • In the Operating Room
  • Who will be Performing the Hysterectomy and How?
  • The Morecellator Problem
  • What about the Ovaries?
  • Making the Hysterectomy Decision

Read HYSTERECTOMY IN AMERICA, Hormones Matter, 22 July 2014.

The Phenomenon of Overdiagnosis in Cancer

Overdiagnosis triggers overtreatment, and all of our treatments carry some harm

Abstract
JNCI
This article summarizes the phenomenon of cancer overdiagnosis—the diagnosis of a “cancer” that would otherwise not go on to cause symptoms or death. Archives JNCI 2010.

This article summarizes the phenomenon of cancer overdiagnosis—the diagnosis of a “cancer” that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer overdiagnosis to occur: the existence of a silent disease reservoir and activities leading to its detection (particularly cancer screening). We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen–detected prostate cancers. We also review data from observational studies and population-based cancer statistics suggesting overdiagnosis in computed tomography–detected lung cancer, neuroblastoma, thyroid cancer, melanoma, and kidney cancer. To address the problem, patients must be adequately informed of the nature and the magnitude of the trade-off involved with early cancer detection. Equally important, researchers need to work to develop better estimates of the magnitude of overdiagnosis and develop clinical strategies to help minimize it.

Early detection has forced clinicians and researchers to contemplate a more expansive and, to many, counterintuitive definition of the word “cancer.” What most of us were taught in medical school is captured by the terse definition contained in the medical dictionary—“a neoplastic disease the natural course of which is fatal”. It was a simple definition that was largely accurate in an era when patients were diagnosed with cancer because they had signs and symptoms of the disease.

But that all changed after we became technologically able to advance the time of diagnosis and detect cancer early—before it produces signs and symptoms. Now it has become evident that the word “cancer” encompasses cellular abnormalities with widely variable natural courses: Some grow extremely rapidly, others do so more slowly, others stop growing completely, and some even regress. Clinicians are left with the realization that the word “cancer” is less a prediction about disease dynamics and more a pathological description made at a single point in time. Continued adherence to the dictionary definition of cancer, however, can lead to harm—including overuse of anticancer therapies.

Although not yet contained in medical dictionaries, recently, a new word has appeared in the medical literature to describe a side effect of our technological progress: “overdiagnosis.” This article is intended to summarize the phenomenon.

Read Overdiagnosis in Cancer, Oxford JournalsMedicine & Health JNCI,
J Natl Cancer Inst Volume 102, Issue 9Pp. 605-613, March 5, 2010.
Full PDF.

Most Women (60%) who have Mastectomy do not get Breast Reconstruction

Breast reconstruction after a mastectomy has long been an option, but a new study shows that only about 42% of women choose it

JAMA surgery background image
Access to Breast Reconstruction After Mastectomy and Patient Perspectives on Reconstruction Decision Making

Breast reconstruction after a mastectomy has long been an option, but a new study shows that only about 42 percent of women choose it.

The goal of the study was to look at how many women had the reconstruction, why some decided against it, and whether they were satisfied with their decision.

Abstract

Importance
Most women undergoing mastectomy for breast cancer do not undergo breast reconstruction.

Objective
To examine correlates of breast reconstruction after mastectomy and to determine if a significant unmet need for reconstruction exists.

Design, Setting, and Participants
We used Surveillance, Epidemiology, and End Results registries from Los Angeles, California, and Detroit, Michigan, for rapid case ascertainment to identify a sample of women aged 20 to 79 years diagnosed as having ductal carcinoma in situ or stages I to III invasive breast cancer. Black and Latina women were oversampled to ensure adequate representation of racial/ethnic minorities. Eligible participants were able to complete a survey in English or Spanish. Of 3252 women sent the initial survey a median of 9 months after diagnosis, 2290 completed it. Those who remained disease free were surveyed 4 years later to determine the frequency of immediate and delayed reconstruction and patient attitudes toward the procedure; 1536 completed the follow-up survey. The 485 who remained disease free at follow-up underwent analysis.

Exposures
Disease-free survival of breast cancer.

Main Outcomes and Measures
Breast reconstruction at any time after mastectomy and patient satisfaction with different aspects of the reconstruction decision-making process.

Results
Response rates in the initial and follow-up surveys were 73.1% and 67.7%, respectively (overall, 49.4%). Of 485 patients reporting mastectomy at the initial survey and remaining disease free, 24.8% underwent immediate and 16.8% underwent delayed reconstruction (total, 41.6%). Factors significantly associated with not undergoing reconstruction were black race (adjusted odds ratio [AOR], 2.16 [95% CI, 1.11-4.20]; P = .004), lower educational level (AOR, 4.49 [95% CI, 2.31-8.72]; P < .001), increased age (AOR in 10-year increments, 2.53 [95% CI, 1.77-3.61]; P < .001), major comorbidity (AOR, 2.27 [95% CI, 1.01-5.11]; P = .048), and chemotherapy (AOR, 1.82 [95% CI, 0.99-3.31]; P = .05). Only 13.3% of women were dissatisfied with the reconstruction decision-making process, but dissatisfaction was higher among nonwhite patients in the sample (AOR, 2.87 [95% CI, 1.27-6.51]; P = .03). The most common patient-reported reasons for not having reconstruction were the desire to avoid additional surgery (48.5%) and the belief that it was not important (33.8%), but 36.3% expressed fear of implants. Reasons for avoiding reconstruction and systems barriers to care varied by race; barriers were more common among nonwhite participants. Residual demand for reconstruction at 4 years was low, with only 30 of 263 who did not undergo reconstruction still considering the procedure.

Conclusions and Relevance
Reconstruction rates largely reflect patient demand; most patients are satisfied with the decision-making process about reconstruction. Specific approaches are needed to address lingering patient-level and system factors with a negative effect on reconstruction among minority women.

More Information:

  • Many Women Who Have Mastectomy Don’t Get Breast Reconstruction: Study, NewsHealth, August 20, 2014.
  • Access to Breast Reconstruction After Mastectomy and Patient Perspectives on Reconstruction Decision Making, JAMA Surgery, articleid=1893807, August 20, 2014.

Ovarian Cancer : know the Symptoms

Often labelled a ‘silent killer’, ovarian cancer has symptoms you should look out for. Learn to identify these and aim for early detection…

Often labelled a ‘silent killer’, ovarian cancer has symptoms you should look out for.

OPAL, the Ovarian Cancer Prognosis and Lifestyle study is Australia’s first study into lifestyle factors that may improve survival and quality of life for women with ovarian cancer.

The OPAL study is recruiting 1,200 women newly diagnosed with ovarian cancer, between April 2012 and October 2014. After this, researchers will analyse the information collected.

Ovarian Cancer Main Symptoms:

  • Persistent pelvic and/or abdominal pain
  • Increased abdominal size and/or persistent bloating
  • Needing to urinate urgently or very often
  • Difficulty eating and/or feeling full quickly

More Information:

Is it Safe?

BPA and the Struggle to define the Safety of Chemicals

Traces of BPA are widely detected in our bodies and environment. Is this chemical, and its presence in the human body, safe? What is meant by safety? Who defines it, and according to what information?

Is it Safe?

Is It Safe book cover image
BPA and the Struggle to Define the Safety of Chemicals. Sarah Vogel is Managing Director of the Health program at the Environmental Defense Fund.

We are all just a little bit plastic. Traces of Bisphenol-A (BPA), a chemical used in plastics production, are widely detected in our bodies and environment. Is this chemical, and its presence in the human body, safe? What is meant by safety? Who defines it, and according to what information?

Is It Safe? narrates how the meaning of the safety of industrial chemicals has been historically produced by breakthroughs in environmental health research, which in turn trigger contests among trade associations, lawyers, politicians, and citizen activists to set new regulatory standards. Drawing on archival research and extensive interviews, author Sarah Vogel explores the roots of the contemporary debate over the safety of BPA, and the concerns presented by its estrogen-like effects even at low doses. Ultimately, she contends that science alone cannot resolve the political and economic conflicts at play in the definition of safety. To strike a sustainable balance between the interests of commerce and public health requires recognition that powerful interests will always try to shape the criteria for defining safety, and that the agenda for environmental health research should be protected from capture by any single interest group.

On Flickr®

Bacteria Injection can help shrink Tumors ; effective as Cancer Treatment

Injecting a fairly common bacteria – Clostridium novyi – into a cancer tumor helped shrink it

Tumors shrink following bacteria injection.

In a remarkable study, researchers have shown that injecting a fairly common bacteria – Clostridium novyi – into a cancer tumor helped shrink it.

Studies were first carried out on dogs, and then, with interesting results, on a female cancer patient. Furthermore, the study suggests that the bacterial injection possibly bolstered the immune system so that immune cells continued to target tumor cells for up to two years.

The great success of the result paves the way for more studies to be conducted. Nonetheless, it should be noted that scientists have not treated enough people to be sure if the spectrum of responses seen in dogs will be fully reproduced in people.

More Information:

  • Intratumoral injection of Clostridium novyi-NT spores induces antitumor responses, ScienceMag, Vol. 6, Issue 249, p. 249ra111, Sci. Transl. Med. DOI: 10.1126/scitranslmed.3008982, 13 August 2014.
  • Tumors shrink following bacteria injection, MNT, articles/281171, 18 August 2014.
  • Bacteria Successful In Cancer Treatment, ScienceDaily, 070905201213, 9 September 2007.

The over-abundance of over-diagnosis…

Hilda Bastian is cartoonist and writer at StatisticallyFunny blog

Over-diagnosis comics
a comics by @HildaBast

Finding and aggressively treating non-symptomatic disease that would never have made people sick, inventing new conditions and re-defining the thresholds for old ones : will there be anyone healthy left at all?

On Flickr®

Watch the Diaporama, and the health comics album on  DES Diethylstilbestrol's photostream on Flickr

If you already have a flickr® account, add us as a contact
Email your photos to des.daughter@gmail.com with a short description and title :-)

Epigenetics and the Multigenerational Effects of Nutrition, Chemicals and Drugs

Video published on 11 Aug 2014 by AncestryFoundation

Speaker Jill Escher, mother of two children with autism, will also share her experience as a member of the “guinea pig generation” heavily exposed in utero to novel synthetic drugs popular in the 1960s. Learn more about the work of the Escher Fund at Germline Exposures.

  • By now most of us know gene expression can be upregulated or downregulated by molecular factors including the metabolites of drugs, chemicals and nutrition. But what are the implications of this environmentally labile landscape, not only for our somatic (body) cells, but also our germ cells, which contain our genetic and epigenetic molecules of inheritance? In this presentation by a science philanthropist (Escher Fund for Autism) who focuses on cutting-edge gene-environment interaction research, you will learn: • How genes respond to environmental cues.
    •  How evolutionary concepts are broadening to include environmental responsivity of genes and the germline.
    •  How, from a biological point of view, the human lifecycle begins about 20-40 years before conception with the dynamic, complex, and lengthy molecular phase of germline (egg and sperm) development.
    •  How, in light of the true breadth of the human lifecycle, risks of exposures are routinely underestimated.
    •  How ancestral health principles are critical to reducing pervasive and serious risks, and improve health across the generations.
    More DES DiEthylStilbestrol Resources

Make 2014 the Year to tackle Toxic Chemicals

To nation’s top retailers: get toxic products off your shelves and join the safer chemicals campaign!

Make 2014 the year to tackle toxic chemicals! Poster by @SaferChemicals
On Flickr®

The sweat-drenched Woman’s Guide to Enjoying an Unmedicated Menopause

Drugs? No thanks.
Perfectly safe? Forgive me for being skeptical

image of ROZ WARREN
Roz Warren is a DES Daughter who writes for the New York Times and the Funny Times.

Menopause came for me several years ago, when I was in my mid-fifties, and I can’t say that I’ve enjoyed the experience.

Women who proudly refer to their hot flashes as “power surges” are, I think, kidding themselves. But they’re not fooling me! There’s nothing fabulous about your body temperature suddenly rocketing upwards, leaving you dazed and sweating as you attempt to go about your business was if (Gasp!) nothing (Yikes!) is going on.

I work in a public library, which means that it’s not unusual for me to begin checking out your books as cool as a cucumber, and finish the transaction drenched, dizzy and red as a beet… 

Continue reading:
The sweat-drenched woman’s guide to enjoying an unmedicated menopause, by Roz Warren, a writer AND also DES Daughter