Abstract
The US Preventive Service Task Force has recommended against screening for ovarian cancer routinely in women who are asymptomatic and have no genetic mutations.
The announcement that the US Preventive Service Task Force has recommended against routine ovarian cancer screening in asymptomatic women reaffirms the force's guidelines from 2004. The recommendation was recently published in Annals of Internal Medicine and follows on from a review of the literature in 2008 that found there was no new evidence regarding the benefit of ovarian cancer screening.
At present there are only two methods of ovarian cancer screening, transvaginal ultrasound and a blood test for the CA-125 protein, a tumor marker. Speaking about the recommendation, Task Force member and chair Virginia Moyer (US Preventive Services Task Force, MD, USA) said that “a high percentage of women who undergo screening experience false-positive test results and consequently may be subjected to unnecessary harms, such as major surgery” and that there is “a critical need to develop better screening tests for ovarian cancer”. The recommendation is grade D and the group said that the benefits of ovarian cancer screening do not outweigh the risks for asymptomatic women without genetic mutations such as in BRCA1 and BRCA2 that would put them at high risk for the disease.
Following on from the 2008 review, a ‘bridge search’ to 2011 using evidence from three major clinical trials found that published results on mortality were consistent with the current guidelines on ovarian cancer screening. Two of the studies used have not published results on mortality; however, these are expected in the future and could be helpful for the US Preventive Service Task Force to consider further down the line.
The recent recommendation is in line with guidelines used by other medical and public health bodies such as the American Cancer Society and the American Congress of Obstetricians and Gynecologists, who recommend not to screen for ovarian cancer in asympotomatic, average-risk women. When putting together this recommendation the task force takes into consideration only the risks and benefits of the screening, not the costs.
– Written by Claire Attwood
Sources: US Preventive Service Task Force news bulletin: www.uspreventiveservicestaskforce.org/bulletins/ovarcancerbulletin.pdf; Moyer VA; on behalf of the US Preventive Services Task Force. Screening for ovarian cancer: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. Ann. Intern. Med. doi:10.7326/0003-4819-157-11-201212040-00539 (2012) (Epub ahead of print).
Progestogens have the potential to reduce risk of preterm birth in specific groups
A pregnant woman's levels of progesterone increase during early pregnancy and progestogens are commonly prescribed to women at the beginning of their second trimester for 37 weeks of gestation or until the baby is born. They are prescribed for many different reasons; one which is to reduce the risk of preterm birth.
A recent systematic review and meta-analysis published in Obstetrics and Gynecology, led by Frances Likis (Vanderbilt University, TN, USA) and colleagues has assessed the use of progestogens in pregnant women to reduce preterm birth. The results of 34 randomized controlled studies between 1966 and 2011 were assessed. The reviewers demonstrated that in women who had singleton pregnancies and had had a preterm birth previously, progestogens were able to reduce the risk of preterm births by 22%; however, the medication was unable to reduce the risk of prematurity or neonatal death in women carrying twins. In addition, there was little evidence from the analysis to suggest that preterm birth could be reduced in women with prematurity, preterm labour or a short cervix either, all indications for which women may be prescribed progestogens in current practice.
Very little is known about the pharmacological effect of progestgens and why the addition of extra progesterone during pregnancy helps a woman to stay pregnant. The authors warned that “the use of progestogens is extending to groups that lack clear evidence of benefit … evidence supporting giving progestogens for all other uses is insufficient to guide clinical care”.
In addition to this study, a further document has recently been published by the Vanderbilt University looking at other questions surrounding this area, such as the mode of administration of progestogen and its effects on outcome. Longer-term information is needed regarding the long-term outcomes for the baby and the long term risks of the use of progestogens in different groups, which will warrant comparative effectiveness trials.
– Written by Claire Attwood
Sources: Vanderbilt news room: http://news.vanderbilt.edu/2012/09/study-tracks-hormones-role-in-reducing-preterm-birth-risk; Likis FE, Edwards DR, Andrews JC et al. Progestogens for preterm birth prevention: a systematic review and meta-analysis. Obstet. Gynecol. 120(4), 897–907 (2012).
Human papillomavirus vaccination program launched in Uganda against cervical cancer
Experts call for investment in screening to run alongside the launch of vaccination program.
A collaboration between the Ugandan Ministry of Health and the pharmaceutical company Merck Sharpe & Dohme (Hertfordshire, UK) has launched a vaccination programme in 12 out of 100 districts in Uganda to give 140,000 girls aged between 9 and 12 years injections of the vaccine Gardasil® (Merck Sharpe & Dohme), to protect against human papillomavirus (HPV). HPV is known to cause cervical cancer and experts in the field have welcomed the launch of the vaccination programme and have called for investment in screening to run in parallel.
Gardasil is a quadrivalent vaccine that protects against HPV types six, 11, 16 and 18. Types 16 and 18 are known to cause 70% of cervical cancers. The incidence of cervical cancer in Uganda is three-times the global average.
Daniel Murokora, medical director of the Ugandan Women's Health Initiative, noted that screening programmes for cervical cancer currently reach only approximately 10% of the eligible population in Uganda and that the effect of the vaccine will not be seen for 15–20 years. He added “Women die from this condition, which is easy to screen and prevent for less than GB£10 per person.”
The government hopes that this will be the start of a national roll-out of the vaccine. WHO published data in 2010 showing that cervical cancer is diagnosed in around 3600 Ugandan women every year. Uganda is joining other African countries in setting up a HPV vaccine programme, including Rwanda. Rwanda launched their programme in April 2011 and has achieved a 90% coverage, according to Jules Millogo, medical director for international organisations at Merck Sharpe & Dohme.
“The government has already made plans to continue beyond the Merck donation using other partners.” He added that HPV vaccination programmes were important to women in developing countries. “Those who cannot access health facilities and those who don't have the money will be protected against the disease.”
– Written by Hardaman Baryan
Source: Gulland A. Uganda launches HPV vaccination programme to fight its commonest cancer. BMJ 345, e6055 (2012).
Overactive bladder syndrome linked to sleep apnea in women
Research presented at the European Respiratory Society's Annual Congress in Vienna suggests a potential link between sleep apnea and overactive bladder syndrome in women. The research team was lead by Nuria Grau from the Hospital del Mar in Spain.
There has been limited research aimed at investigating if there are any links between overactive bladder syndrome and sleep apnea. In general, overactive bladder syndrome is characterized by an increased frequency to urinate along with incontinence and nocturia (frequent awakening periods during the night to use the toilet).
“The findings of this study provide evidence that bladder control could be linked to sleep apnea, although we do not know whether one of the conditions causes the other.”
72 female patients referred to a sleep disorders clinic with suspected sleep apnea completed questionnaires that asked them about four symptoms associated with their bladder control; urgency and frequency of urination, incontinence, and nocturia. Furthermore, they were asked to rate their discomfort with each of these symptoms.
Analysis of the questionnaires was performed, which involved rating the results on two scales in order to evaluate both the severity of symptoms and discomfort for each of the four variables. 62 of the women were diagnosed with sleep apnea, with significantly higher scores for the prevalence of symptoms associated with bladder control, along with their discomfort with these symptoms. The symptoms within this group were rated a median average score of five out of 12, compared with a score of three out of 12 in the group not diagnosed with the condition. Furthermore, a median average score of four out of 12 was given for the discomfort with bladder control symptoms, compared with one out of 12 in those not diagnosed with sleep apnea.
Grau comments “Overactive bladder syndrome has a prevalence of 16% among people over 40 years of age in Europe and it is a difficult condition to live with, affecting a person's quality of life. The findings of this study provide evidence that bladder control could be linked to sleep apnea, although we do not know whether one of the conditions causes the other.
”The next step in our research is to investigate the role of continuous positive airway pressure therapy in these patients and its impact on the symptoms of overactive bladder.“
– Written by Hardaman Baryan
Source: News release: European Respiratory Society Annual Congress, Vienna (2012): www.erscongress2012.org/mediacenter/news-release/item/430-overactive-bladder-linked-to-sleep-apnoea-in-women.html; Overactive bladder linked to sleep apnea in women: www.sciencedaily.com/releases/2012/09/120902184917.htm