By Karla Gale
NEW YORK (Reuters Health) - When breast cancer develops during pregnancy, its diagnosis and treatment of are often delayed. As a result, the woman's long-term survival may be jeopardized, doctors at the University of Texas M. D. Anderson Cancer Center report.
"Pregnancy-associated breast cancer is the most frequent cancer associated with pregnancy," Dr. George H. Perkins told Reuters Health, but it is low on the list of possible diagnoses that most doctors consider.
Furthermore, pregnancy can mask symptoms of breast cancer, making it more difficult to recognize, he noted.
The team identified all the cases of breast cancer associated with pregnancy that were treated at their institution between 1973 and 2006; 51 developed during pregnancy while 53 occurred within a year after pregnancy.
Women with pregnancy-associated breast cancer had more advanced tumors than similar young women who were not pregnant, indicating delayed diagnosis. Nevertheless, outcomes were similar in the two groups, the researchers report in the medical journal Cancer.
That's probably because most women were given a course of chemotherapy before undergoing surgery, Perkins said.
Among the 51 women who developed breast cancer during pregnancy, 25 received no treatment until after delivery. There was a trend toward worse 10-year survival rates with deferred treatment compared with treatment during pregnancy.
In addition to timely treatment, the research team also urges thorough diagnostic evaluation of breast symptoms that occur during pregnancy, using ultrasound or, with proper shielding of the fetus, mammography.
Showing posts with label Pregnancy. Show all posts
Showing posts with label Pregnancy. Show all posts
Monday, February 9, 2009
Thursday, February 5, 2009
Fertility Drugs and Ovarian Cancer Not Linked, Study Says
One of the largest studies to explore whether fertility drugs increase a woman’s risk of ovarian cancer found “no convincing association” with the cancer, though researchers said they would continue to follow tens of thousands of Danish women to see if their risk increased with age.
The generally reassuring results were consistent with several other recent studies, which have tempered an initial panic set off in the 1990s when reports suggested that the widely used fertility drugs might lead to a surge in a cancer that is relatively uncommon but often fatal.
The new study, published online Thursday in the British Medical Journal, did not rule out a cancer link altogether. It suggested that the risk of one form of ovarian cancer may be elevated after use of the popular drug clomiphene (brand name Clomid), though researchers said the finding could have been a statistical aberration.
“The message to give clinicians and patients is that over all these data provide further evidence that fertility drugs do not increase the risk of ovarian cancer to any great extent,” said Allan Jensen, an assistant professor of cancer epidemiology at the Danish Cancer Society and the first author of the paper. The senior author was Susanne Krüger Kjaer.
Dr. Jensen added, “You should always balance a possible small increase in ovarian cancer risk with the physical and psychological benefits of pregnancy made possible only by use of these drugs.”
As part of the study, the researchers followed 54,362 women who had been referred to Denmark’s fertility clinics between 1963 and 1998. They gathered information about the women from Denmark’s birth, cancer and hospital discharge registries, seeking more detailed information on medications from individual medical records of a subgroup of 1,241 of the women.
Among the 54,362 infertile patients followed for an average of 15 years, there were 156 cases of ovarian cancer. The average age of the women by the end of the study was 47.
Medical records were used to analyze the relative incidence of ovarian cancer in women who had taken either gonadotropins, clomifene citrate, human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone, compared with ovarian cancer rates of women who had not taken each of the individual drugs (but may have been treated with one of the other medications).
After adjusting for risk factors, the researchers concluded there was no increase in ovarian cancer risk associated with the drugs, nor was there an increased risk for women who underwent 10 or more cycles of treatment or for women who never became pregnant despite treatment.
The only statistically significant increase was seen in an analysis looking at different types of ovarian cancer tumors; in that analysis, women who had taken clomiphene citrate had a 67 percent increase in serous ovarian cancer tumors.
A separate analysis comparing women who had used a fertility drug with women who had not used any of the drugs also found no significant differences, Dr. Jensen said, but those figures were not included in the paper. There was also no difference in risk for women who had used a combination of fertility drugs.
The research in this area is complicated by the fact that infertile women appear to be at higher risk for ovarian cancer to begin with, which is why this study compared infertile women with one another rather than with other women in the population. In addition, because ovarian cancer is quite rare, large populations must be studied to obtain meaningful results.
The scientists cautioned that the women in the study would have to be followed for many more years to see if their risk increased over time. The mean age for diagnosis of ovarian cancer in women is 63.
“This is the largest study to look at ovarian cancer and they’re right, it’s a major strength of the study,” said Louise Brinton, the chief of the National Cancer Institute’s hormonal and reproductive epidemiology branch, adding that she was surprised the authors played down the finding of an association between Clomid and serous ovarian cancer, which may be more influenced by hormonal factors than some other tumors. Clomid is one of the older drugs in use.
Dr. Roberta Ness, dean of the University of Texas School of Public Health and the author of an earlier analysis that found no association between the drugs and cancer, said that finding might have been an aberration. “When you’re doing multiple analyses and splitting this way, that way and the other, the likelihood this is just a spurious finding is greater than the likelihood it’s real.”
source: nytimes.com
The generally reassuring results were consistent with several other recent studies, which have tempered an initial panic set off in the 1990s when reports suggested that the widely used fertility drugs might lead to a surge in a cancer that is relatively uncommon but often fatal.
The new study, published online Thursday in the British Medical Journal, did not rule out a cancer link altogether. It suggested that the risk of one form of ovarian cancer may be elevated after use of the popular drug clomiphene (brand name Clomid), though researchers said the finding could have been a statistical aberration.
“The message to give clinicians and patients is that over all these data provide further evidence that fertility drugs do not increase the risk of ovarian cancer to any great extent,” said Allan Jensen, an assistant professor of cancer epidemiology at the Danish Cancer Society and the first author of the paper. The senior author was Susanne Krüger Kjaer.
Dr. Jensen added, “You should always balance a possible small increase in ovarian cancer risk with the physical and psychological benefits of pregnancy made possible only by use of these drugs.”
As part of the study, the researchers followed 54,362 women who had been referred to Denmark’s fertility clinics between 1963 and 1998. They gathered information about the women from Denmark’s birth, cancer and hospital discharge registries, seeking more detailed information on medications from individual medical records of a subgroup of 1,241 of the women.
Among the 54,362 infertile patients followed for an average of 15 years, there were 156 cases of ovarian cancer. The average age of the women by the end of the study was 47.
Medical records were used to analyze the relative incidence of ovarian cancer in women who had taken either gonadotropins, clomifene citrate, human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone, compared with ovarian cancer rates of women who had not taken each of the individual drugs (but may have been treated with one of the other medications).
After adjusting for risk factors, the researchers concluded there was no increase in ovarian cancer risk associated with the drugs, nor was there an increased risk for women who underwent 10 or more cycles of treatment or for women who never became pregnant despite treatment.
The only statistically significant increase was seen in an analysis looking at different types of ovarian cancer tumors; in that analysis, women who had taken clomiphene citrate had a 67 percent increase in serous ovarian cancer tumors.
A separate analysis comparing women who had used a fertility drug with women who had not used any of the drugs also found no significant differences, Dr. Jensen said, but those figures were not included in the paper. There was also no difference in risk for women who had used a combination of fertility drugs.
The research in this area is complicated by the fact that infertile women appear to be at higher risk for ovarian cancer to begin with, which is why this study compared infertile women with one another rather than with other women in the population. In addition, because ovarian cancer is quite rare, large populations must be studied to obtain meaningful results.
The scientists cautioned that the women in the study would have to be followed for many more years to see if their risk increased over time. The mean age for diagnosis of ovarian cancer in women is 63.
“This is the largest study to look at ovarian cancer and they’re right, it’s a major strength of the study,” said Louise Brinton, the chief of the National Cancer Institute’s hormonal and reproductive epidemiology branch, adding that she was surprised the authors played down the finding of an association between Clomid and serous ovarian cancer, which may be more influenced by hormonal factors than some other tumors. Clomid is one of the older drugs in use.
Dr. Roberta Ness, dean of the University of Texas School of Public Health and the author of an earlier analysis that found no association between the drugs and cancer, said that finding might have been an aberration. “When you’re doing multiple analyses and splitting this way, that way and the other, the likelihood this is just a spurious finding is greater than the likelihood it’s real.”
source: nytimes.com
Monday, January 26, 2009
Octuplets' Births Surprise California Doctors
(CNN) -- A woman in California delivered what may be the nation's second live-born set of octuplets on Monday morning, surprising doctors who expected seven babies.
The first three to seven days will be critical for the infants, Dr. Mandhir Gupta said.
The six boys and two girls -- ranging in weight from 1 pound 8 ounces to 3 pounds 4 ounces -- were generally doing well in incubators following their Caesarean-section delivery at Kaiser Permanente hospital in Bellflower, California, doctors said.
Three of the babies need breathing assistance, but otherwise the eight don't appear to have serious problems, doctors said at a news conference Monday evening.
"It was a truly amazing delivery," said Dr. Karen Maples, chief of the hospital's obstetrics and gynecology department.
Doctors initially believed the mother -- whom they did not identify -- was pregnant with seven fetuses. The woman was 23 weeks pregnant when she was hospitalized seven weeks ago and ordered to bed rest.
Over a seven-week period, a team of 46 physicians, nurses and other staff prepared for the births. When they started the delivery Monday -- more than nine weeks before the babies would be full term -- they were in for a surprise.
"After we got to Baby G, we were surprised by the discovery of a Baby H," Maples said.
Getting the number correct with ultrasounds before delivery is difficult with so many babies, said Dr. Harold Henry, the hospital's chief of fetal medicine.
"It is quite easy to miss a baby when you're expecting seven," Henry said.
The hospital said the woman didn't want her personal information released to the news media, and it would not answer questions about whether she'd had fertility treatments.
Preliminary research indicates this is the second set of live-born octuplets in the United States, according to the hospital.
Eight babies believed to be the United States' first set of live octuplets were born in Houston, Texas, in 1998. One of the infants died days after birth. The seven other siblings recently celebrated their 10th birthday, the Houston Chronicle reported last month.
The first three to seven days will be critical for the California babies, said Dr. Mandhir Gupta, one of the doctors at the news conference. The infants could be in incubators for six to eight weeks and in the hospital for 10 weeks, Gupta said.
The mother is doing "very well" after the deliveries, which took about five minutes, Gupta said.
"She is very excited that she [has] all these babies and that the babies are looking good so far," Gupta said.
The first three to seven days will be critical for the infants, Dr. Mandhir Gupta said.The six boys and two girls -- ranging in weight from 1 pound 8 ounces to 3 pounds 4 ounces -- were generally doing well in incubators following their Caesarean-section delivery at Kaiser Permanente hospital in Bellflower, California, doctors said.
Three of the babies need breathing assistance, but otherwise the eight don't appear to have serious problems, doctors said at a news conference Monday evening.
"It was a truly amazing delivery," said Dr. Karen Maples, chief of the hospital's obstetrics and gynecology department.
Doctors initially believed the mother -- whom they did not identify -- was pregnant with seven fetuses. The woman was 23 weeks pregnant when she was hospitalized seven weeks ago and ordered to bed rest.
Over a seven-week period, a team of 46 physicians, nurses and other staff prepared for the births. When they started the delivery Monday -- more than nine weeks before the babies would be full term -- they were in for a surprise.
"After we got to Baby G, we were surprised by the discovery of a Baby H," Maples said.
Getting the number correct with ultrasounds before delivery is difficult with so many babies, said Dr. Harold Henry, the hospital's chief of fetal medicine.
"It is quite easy to miss a baby when you're expecting seven," Henry said.
The hospital said the woman didn't want her personal information released to the news media, and it would not answer questions about whether she'd had fertility treatments.
Preliminary research indicates this is the second set of live-born octuplets in the United States, according to the hospital.
Eight babies believed to be the United States' first set of live octuplets were born in Houston, Texas, in 1998. One of the infants died days after birth. The seven other siblings recently celebrated their 10th birthday, the Houston Chronicle reported last month.
The first three to seven days will be critical for the California babies, said Dr. Mandhir Gupta, one of the doctors at the news conference. The infants could be in incubators for six to eight weeks and in the hospital for 10 weeks, Gupta said.
The mother is doing "very well" after the deliveries, which took about five minutes, Gupta said.
"She is very excited that she [has] all these babies and that the babies are looking good so far," Gupta said.
Friday, January 23, 2009
The Dangers of Alcohol Abuse During Pregnancy
According to the Diagnostic and Statistical Manual of Mental Disorders alcohol abuse is a psychiatric diagnosis describing the use of alcoholic beverages despite negative consequences.The U.S. Surgeon General has released advisories in 1981 and again in 2005 urging women who are pregnant or may become pregnant to abstain from alcohol. The damage caused by prenatal alcohol abuse includes a range of physical, behavioral, and learning problems in babies.
Babies most severely affected have what is called fetal alcohol syndrome. These babies may have abnormal facial features and severe learning disabilities. Babies can also be born with mild disabilities without the facial changes typical of fetal slcohol syndrome.
Women giving birth to children with fetal alcohol syndrome also have a higher risk of early mortality.
A study from the Telethon Institute for Child Health Research has revealed the consequences of alcohol abuse on pregnancy. It shows the effects of alcohol abuse and demonstrates that heavy and binge levels of alcohol during pregnancy increases the risk to the baby, even if drinking is stopped in the first three months of pregnancy. The findings are sobering and should act as a deterrent to alcohol abuse during pregnancy.
The study investigated the relationship between prenatal exposure to alcohol and the effects on fetal growth and preterm birth.
A random sample of 4,719 women who gave birth in Western Australia between 1995 and 1997 took part in a survey. Data such as how often participants drank alcohol, the amount of alcohol consumed in each occasion and the types of alcoholic beverage consumed were collated.
The research team from the Institute with the National Perinatal Epidemiology Unit at the University of Oxford found that, on average, levels of alcohol intake decreased from the pre-pregnancy period to the second and third trimester.
The incidence of preterm birth was highest amongst women who binge drink (9.5%) or drink heavily, even if the mother stopped drinking prior to the second trimester (13.6%), compared with less than 6% in women who did not drink during pregnancy. There were 2.3-fold increased odds of preterm birth in women who drank heavily in early pregnancy but then stopped after taking into account maternal smoking, drug use, socioeconomic status and maternal health. Researchers suggest that a possible reason why this occurs is because the cessation of alcohol abuse before the second trimester may trigger a metabolic or inflammatory response resulting in preterm birth.
Although there was no difference in outcomes for women who drank low levels of alcohol during their pregnancy and those that abstained, the safest choice is to stop drinking alcohol during pregnancy. Drinking at any level during pregnancy should be regarded as a risk factor for the mother as well as for offspring.
Researchers noted a link between smoking and alcohol consumption; they found women who smoked during pregnancy were less likely to abstain from alcohol at any time during their pregnancy than non-smokers. Over one quarter (27.7%) of women who drank in late pregnancy also smoked, compared with 19% of women who had abstained from alcohol during pregnancy. Other factors associated with late term pregnancy drinking include: a maternal age of 30 years and above, higher income, and use of illicit drugs.
Institute researcher Colleen O'Leary said “Our research shows pregnant women who drink more than one to two standard drinks per occasion and more than six standard drinks per week increase their risk of having a premature baby, even if they stop drinking before the second trimester”. A standard drink in this analysis is the Australian standard 10gm of alcohol, eg 100ml of wine.
The risk of preterm birth is highest for pregnant women who drink heavily or at binge levels, meaning drinking more than seven standard drinks per week, or more than five drinks on any one occasion.
Health professionals should routinely screen pregnant women and all women of child bearing age for alcohol abuse or use. It's important that women should be given information about the possible risks to the baby from alcohol exposure during pregnancy.
Subscribe to:
Posts (Atom)
