Abstract
A group of endocrinologists have devised a new model for assessing hirsutism, or excessive hair growth, in women by noninvasive examination of the chin and abdomen. The research was led by Ricardo Azziz, President of Georgia Health Sciences University (Augusta, GA, USA).
The hormonal etiology of hirsutism in women is usually excess androgens in the body, such as testosterone. Women with hirsutism are often overweight, with menstrual dysfunction and diminished fertility. It is not considered a disease in itself, but rather a symptom of potentially serious conditions such as polycystic ovary syndrome, diabetes or heart disease. It is, therefore, important that the symptom is well detected by clinicians for early intervention to treat other diseases. Azziz discusses the significance of examining women for hirsutism, “If you do the math, at least half the women with excess hair growth will be at increased risk for insulin resistance, metabolic dysfunction, diabetes and heart disease. That is why this is such an important marker.”
“…at least half the women with excess hair growth will be at increased risk for insulin resistance, metabolic dysfunction, diabetes and heart disease.”
In addition, the cosmetic concerns of hirsutism warrant investigation of the cause for excessive hair growth in women. Azziz explains, “Excessive hair growth strikes at the femininity of women. We are talking about terminal hairs that are harder, more pigmented and thicker than the usual soft hairs you see … You cover yourself up at the beach. You don't want your partner to see you nude. It can be very damaging to your psychosocial well-being.”
The current procedure for diagnosis is complex, involving history and physical examination, quantifying hair growth, measuring androgens, and oral glucose tolerance tests to determine the degree of insulin excess and risk of diabetes. The Ferriman–Gallwey score is the gold standard method used to evaluate and quantify hirsutism. This traditionally assessed 11 body areas, which was later reduced to nine areas. Azziz and colleagues have proposed that modifying this method by scoring hair growth on just the chin and abdomen is a simple and reliable predictor of total body hirsutism.
The study examined 1951 female patients presenting symptoms of androgen excess. The researchers assessed the extent of terminal hair growth in all of the traditional nine body areas and then established a regression model using these, which indicated that the combination of the abdomen and chin provided the most accurate predictor of hirsutism quantification.
“We wanted to find a way to identify this problem in women that was as non-intrusive and accurate as possible … We believe this approach is approximately 80% accurate and will be less traumatic for women in many situations than the full body assessments currently used” said Azziz.
The authors of the study have stated that the modified Ferriman–Gallwey score requires further evaluation as a diagnostic procedure, and also as a method to monitor the success of hirsutism treatment.
– By Sam Rose
Source: Cook H, Brennan K, Azziz R et al. Reanalyzing the modified Ferriman-Gallwey score: is there a simpler method for assessing the extent of hirsutism? Fertil. Steril. 96(5), 1266–1270 (2011).
Have some groups of women been excluded from improvements in breast cancer detection and treatment?
Elderly women may not be benefiting from new advances in breast cancer treatment
A new study published in the Journal of Clinical Oncology has claimed that over the last three decades, not all women have benefited from breast cancer treatment. It appears that older women suffering from this form of cancer show a poorer survival rate when compared with younger groups. The authors of the study proposed that this difference may be due to elderly patients not experiencing the new treatments and detection methods that have become available.
The research, performed at The University of Texas MD Anderson Cancer Center (Houston, TX, USA), utilized data collected between 1980 and 2007 from the National Vital Statistics Report published by the Centers for Disease Control and Prevention to examine age-related data in groups of women suffering from breast cancer. This was combined with another set of data from The Surveillance, Epidemiology and End Results registry (collected 1980–1997), which was used to assess the risk of breast cancer death at different ages.
The results of the analysis indicated that during the 1980s, breast cancer deaths remained stable in women ages 20–64 years. However, an increase in deaths was seen in women aged 65 and over. In addition to this, a difference between decreases in death rate was observed between young and older sufferers during the 1990s. Women aged 20–49 years showed the largest decrease in death rate (2.4% per year). However, sufferers over the age of 75 years showed the smallest decrease (1.1%). The researchers suggested that these improvements in death rate were probably due to advances in treatment, such as the use of endocrine therapy and adjuvant chemotherapy. However, it is clear from this analysis that elderly women were not experiencing the same level of improvement as younger women. To reinforce this, analysis also showed that during the 1980s, women over 75 had the lowest risk of 10-year breast cancer death (24%), and that by 1995–1997, this had decreased to 17.3%. However, a much greater improvement was seen in women below the age of 75 years, who had a 30% risk of 10-year breast cancer death in the 1980s, which significantly decreased to 16% by 1995–1997.
In addition, the researchers found that, like the elderly, black women are also not experiencing improvements in outcome; in 2008 the absolute death rate for this group was 38% higher than in white women.
Benjamin Smith, an author of the study, claims that many factors could account for the contrast seen across different groups of women suffering from breast cancer. Some of these causes may include a limited knowledge of optimal treatment or chemotherapy toxicity. Smith believes that research targeting the former could aid oncologists in treating elderly patients: “We really need to focus research exclusively on developing optimal treatments for older women with breast cancer, evaluating how we can predict which older women can tolerate treatments, and develop new treatments that work better.”
– By Jonathan Wilkinson
Source: Smith BD, Jiang J, Smith GL et al. Improvement in breat cancer outcomes over time: are older women missing out? J. Clin. Oncol. doi:10.1200/JCO.2011.35.8408 (2011) (Epub ahead of print).
Intraductal administration of breast cancer agents shows promising results
Scientists at Johns Hopkins Kimmel Cancer Center (Baltimore, MD, USA) have presented both preclinical and clinical findings that provide hope for direct administration of cancer therapeutics into the breast ducts. The research from both studies was recently published in Science Translational Medicine.
The advantage of intraductal administration is that most breast cancers originate in the epithelial cells lining the breast ducts, and this would therefore allow direct drug exposure to ductal cells and potentially eliminate preinvasive neoplasms. The second advantage of this route would be limiting or preventing systemic exposure to breast cancer drugs.
The preclinical studies, led by Saraswati Sukumar, Professor of Oncology at the Kimmel Cancer Center, measured the effectiveness of cancer drugs administered via the breast ducts in N-methyl-N'-nitrosoureatreated rats. The four drugs used were 5-fluorouracil (5FU), carboplatin, nanoparticle albumin-bound paclitaxel and methotrexate. All agents demonstrated protection from tumor growth. Of the drugs investigated, 5FU showed the most striking results, by shrinking established breast tumors and completely eliminating them in ten out of 14 rats. Sukumar comments on these results, “As both a preventive and a therapy, 5FU worked extremely well in these tests.”
The clinical trial investigated the feasibility, safety and dose of intraductal pegylated liposomal doxorubicin (PLD) administration. PLD is a chemotherapy drug that can be used for several cancers. Seventeen women who are awaiting mastectomy were administered with PLD or dextrose in the case of controls. Intraductal administration was successful in 15 of the women with no serious adverse events. The oncologist who supervised the trial, Vered Stearns, says “Our results support the theory that by treating the breast tissue directly we can reach a much more potent drug concentration where it is needed, with far fewer adverse effects on tissues outside the breasts.”
Sukumar speaks about the advantage of presenting both preclinical and clinical research together, “This has been a classic translational medicine collaboration between a bench researcher and a clinician scientist.” With promising animal study and Phase I findings now published, further research on the efficacy of intraductal administration of beast cancer drugs in humans may soon be warranted.
Sukumar discusses the potential clinical application of intraductal drug administration, “In principle, one could do such a procedure every ten years or so to keep one's breasts tumor-free, as an alternative to having the breasts removed.”
– By Sam Rose
Source: Stearns V, Mori T, Jacobs LK et al. Preclinical and clinical evaluation of intraductally administered agents in early breast cancer. Sci. Transl. Med. 3(106), 106–108 (2011).
Drospirenone-containing oral contraceptives may be associated with venous thrombosis
A study has suggested that birth control pills containing drospirenone put women at risk of venous thrombosis. These results are in line with previous findings that combined oral contraceptives may carry a risk of venous and arterial thrombosis. The work was recently published in the Canadian Medical Association Journal.
It is known that the risk of thrombosis varies between first-, second- and third-generation oral contraceptives. Drosperinone-containing contraceptives are a newer type of birth control, and the authors of this study sought out to assess if the thrombotic risk of these pills is higher than with older contraceptives.
The study looked at a 330,000-woman cohort identified using computerized records of the largest healthcare provider in Israel. All the women had been prescribed combined oral contraceptives between 2002 and 2008, and were followed until 2009. Multivariable analyses were carried out to compare the type of contraceptives taken with risk factors for venous thrombotic events (specifically deep vein thrombosis and pulmonary embolism) and arterial thrombotic events (specifically transient ischemic attack and cerebrovascular accident).
The researchers found that six out of 10,000 users of drospirenone-containing pills developed blood clots. An association was suggested between the contraceptive and deep vein thrombosis and pulmonary embolism, but not arterial thrombosis. Although this number is still relatively low, the risk is 43% higher than with second- and third-generation pills.
“The researchers found that six out of 10,000 users of drospirenone-containing pills developed blood clots.”
Naomi Gronich, lead author of the study and researcher at Technion-Israel Institute of Technology (Haifa, Israel), explains that “A woman already on drospirenone for four months probably shouldn't be more worried than if she were on another second- or third-generation contraceptive.” This is because the results indicated that the greatest blood clot risk was in the first few months of use.
Susan Solymoss, Associate Professor of Medicine and Oncology at McGill University (Montreal, QC, Canada) discusses the findings of this study: “It s important to remember that all oral contraceptives are associated with a risk of blood clots.” Although she also states that “pregnancy is a bigger risk for blood clots.”
This study examined data from women 12–50 years of age; however, the authors stress that age is an important factor in the risk of thrombosis, and that blood clot risk gradually increases after the age of 25 years. Gronich and Solymoss agree that women using drospirenone-containing contraceptives should not panic, but recommend discussing the risks with their doctor.
– By Sam Rose
Sourse: Gronich N, Lavi I, Rennert G. Higher risk of venous thrombosis associated with drospirenone-containing oral contraceptives: a population-based cohort study. CMAJ doi:10.1503/cmaj.110463 (2011) (Epub ahead of print).