Baby Born from 20-Year old Embryo

It appears to be the new record for a cryopreserved embryo-birth.

In 1990 a couple underwent In Vitro Fertilization. They eventually had a healthy baby. They also, as is common, had a number of microscopic embryos that hadn’t been implanted, but were viable. They decided to anonymously donate them. Now, one of those embryos has produced a little boy, 20 years after being created. (via NPR)

In related embryo-news, Colorado has another personhood rights bill on the ballot for November.

As used in sections 3, 6, and 25 of Article II of the state constitution, the term “person” shall apply to every human being from the beginning of the biological development of that human being.

So here’s my question – under the proposed Colorado amendment, would this kid be legal to drink on his first birthday? I’m just sayin’…

Seriously, Colorado, just say no to proposition 62. Its proponents plan to use it to try and outlaw birth control pills and IUD’s.

O’Hare Airport Flu Shot Booth

A smart idea for busy travelers with a little down time before the flight. At $35 a shot, thirty to fifty travelers a day are taking advantage of the convenience.

I would have gotten one myself, but I’ll be getting mine free at work.

Someone Finally Did the Math…


Breaking news from what is being called the most comprehensive survey of American’s sexual behavior in two decades –

85 percent of the men said their latest sexual partner had an orgasm, while only 64 percent of the women reported having an orgasm in their most recent sexual event.

Or, as Sally said to Harry –

It’s just that all men are sure it never happened to them and most women at one time or another have done it – so you do the math.

Join the World’s Largest Virtual Choir

Composer Eric Whitacre, who rocked You Tube earlier this year by conducting an online choir of 185 singers from over 20 countries, is now recruiting singers for his next virtual choir.

Between now and December 31, singers can videotape themselves singing Whitacre’s composition “Sleep”, using sheet music uploaded from the composer’s website and conducted by him in an online video. Uploading your video to YouTube will then allow Whitacre to grab it and compile the choir for a performance sometime next year.

Whitacre hopes to break the current virtual choir record of 900 singers held by The Amplichoir, a marketing campaign in which singers uploaded themselves singing “Lollipop” in hopes of winning free tickets to the 2009 MTV Music Awards.

There are no freebies being offered for Whitacre’s virtual choir members, other than the chance to be a part of something incredibly special. I’ve signed on and am currently learning “Sleep” , with plans to upload it sometime in October. (You can listen here to some of the videos already submitted to You Tube.)

You needn’t be a professional singer or have the world’s most perfect voice to join this virtual choir. In fact, Whitacre says that he has yet to turn a singer away  –

Just the act of learning the music, singing a take that’s 5 minutes long and uploading it on You Tube to an entire world community, generally weeds out most of the people that would’t make it anyway.  But…one of the great things about choral music, and one of the things that I like – not being a great singer – is that the mass of voices tends to blend out those that aren’t so beautiful.

So if  you love to sing, as I do, I hope you’ll join in the music. It’s going to me amazing!

Topical Hormones Used by Adults May Expose Children and Pets

The FDA is warning that estrogen exposure may occur when children and pets come into contact with the skin where women have used a topical estrogen spray. The warning comes on the heels of adverse event reports of premature puberty, nipple swelling and breast enlargement in children exposed to Evanmist, a spray-on estrogen preparation used to treat menopausal symptoms. Pets exposed to Evamist may exhibit signs such as mammary/nipple enlargement and vulvar swelling.

While the FDA warning applies only to Evanmist, other topical estrogen preparations, including lotions, creams and gels, have been implicated by veterinarians after animals presented with sometimes dramatic signs of exposure to topical estrogen used by their owners.

The North American Menopause Society is compiling a nationwide registry of possible topical estrogen exposure to children and pets –

NAMS asks your help in compiling cases of secondary estrogen exposure in pets or in persons. We’ve established a dedicated email address at NAMS (nams@menopause.org) for you to submit case reports. We also encourage you to report cases directly to the FDA (FDA MedWatch Adverse Event Reporting Form FDA 3500 for persons;6 Form FDA 1932a for pets available online.7 )

In the meantime, if you use topical estrogens, wash your hands after applying and before handling food or touching animals or small children. Make sure lotions, sprays, gels and creams are allowed to dry thoroughly , and cover involved skin before coming into contact with small children or pets. Do not let your pet lick estrogen exposed skin.

The same advice applies to men using topical testosterone gels, which have been known to cause virlization in women and children exposed inadvertently to these hormones from contact with the skin of males using these preparations.

Preventing Breast Cancer Deaths – How Much Credit Does Mammography Get?

Much less, it appears, than we’ve been giving it.

So say researchers who measured breast cancer mortality before and after the introduction of routine mammography screening in Norway. They compared breast cancer death rates between two groups of women in their 50’s – those who were offered routine mammograms and those who were not – between 1996 and 2005.

Their thinking goes something like this – If mammography prevents breast cancer mortality, then women who were offered mammograms should have fewer breast cancer deaths now compared with historical rates before mammogram screening was offered. And they did – about 7 less deaths per 100,000 person-years (the so-called screening effect in that chart up  there).

But here’s the rub – women who did not have screening mammography also had less deaths than their historical counterparts – about 5 less per 100,000 person-years. (The so-called time effect)

This means that the mortality reduction credited to mammograms is about 2 per 100,000 person years, or about a 10% reduction in breast cancer deaths. The lion’s share of mortality reduction appears to be due to advances in breast cancer treatment and possibly medical care in general, something researchers have long suspected but have been unable to prove.

What do the Critics Say?

Experts at the American Cancer Society have criticized some aspects of this study. They point out that while mammography had little impact on mortality in early stage breast cancer, the impact on stage 2 disease mortality was significant. They also criticize the very short follow up period of the study – an average of 2.2 years. Finally, they cite the lack of control of subject behavior (or “contamination” as women may have accessed mammograms outside the national program), and the fact that Norway’s mammogram screening program coincided with a national program of multidisciplinary breast cancer treatment that is not in place in the United States, making mammography potentially more important here.  The ACS continues to recommend annual mammgraphy in average risk women starting at age 40.

The accompanying editorial in the New England Journal of Medicine takes a a different tack, and suggests that the decision to preform screening mammography is, in fact, “a close call”, but stops short of actually making the call.  (I encourage you to read the editorial – it summarizes well the results, strengths and limitations of the Norwegian study.)

My Take

I’m not sure that we should use the results of this population-based data to refute the results of randomized trials, which have shown mammography to reduce mortality by about 25% in women ages 50-59.  In evidence-based medicine, the randomized trials tend to win out.

Still, the data presented make a compelling argument that on a national scale, mammograms may have had limited impact compared with advances in and coordination of breast cancer treatment.

I’ve raised the question before as to whether mortality should be the only bar against which we measure mammography. I wonder if women who get diagnosed with breast cancer on screening mammography have more very early stage disease, more options for localized therapy instead of mastectomy, or less use of chemotherapy than women who do not have mammgorams routinely? I’ve yet to see much discussion on this issue among the decision makers on mammography, but suspect it’s an important consideration for women.

What I’m Doing in My Practice

I’m continuing to recommend screening mammography in women ages 50 and above, and in high risk women at an appropriate age depending on family history. This study is raising important questions for that group, and is sure to generate a few phone calls and fuel some discussions during office hours, but I’m not changing my recommendations just yet in this age group.

For average risk women under age 50, I’ve recently begun to have individualized discussions about the screening mammography, and learning that it’s not an easy discussion to have. To that end, I initiated a project with my colleagues here at Cornell and at Memorial Sloan Kettering Cancer Center to begin to develop tools to assist women and their clinicians in having informed discussions about mammography. We just got a small pilot grant – wish us luck!
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Don’t Blame Me – A Virus Made Me Fat

Finally – the answer to the obesity epidemic.

It’s a virus!

New evidence indicates that children who are exposed to a virus called adenovirus-36 are more likely to be obese than those who are not exposed to it, and to be heavier than other obese kids who were not exposed to it, researchers said this week. The virus… is one of 10 bacteria and viruses that have been associated with a propensity for putting on plural poundage.

Maybe this explains why I and 2 of my sisters all became fat in the same year.

Well, that, combined with the fact that we had just moved to a new neighborhood where there were no kids we knew to play outside with, and we started taking a bus to school instead of walking, and Dark Shadows had just started, leading us to spend every afternoon after school in front of the TV snacking.

But I like to think it was a virus.

Olallie Berry Jam

Thanks to Victoria for this wonderful jam she brought us from Santa Cruz when she stayed with us a while back. I think it is the best jam I have ever eaten – tasty, not too sweet, and with the tiny berries still identifiable in the spread.

I’d never heard of an Olallie Berry before, probably because it is native to the West Coast. It’s the mutt of the berry world, part Loganberry and part Youngberry, which are themselves crosses of Raspberry, Blackberry and Blueberries. Apparently, the Olallie looks like a blackberry, but the flavor is really a wonderful cross between all three.

The Olallie was actually created in Oregon as part of a USDA-Oregon State University cooperative cross breeding program in the 1930’s. I’d say it’s genetic engineering at it’s best.

Can the NBCC End Breast Cancer by 2020?

They think  so.

The National Breast Cancer Coalition (NBCC) is setting a deadline: End breast cancer by 2020. Breast Cancer Deadline 2020. It is time.

Taking a “just do it” approach, the NBCC has decided that by setting a deadline, they can make it happen.

In setting this ambitious goal, the NBCC criticizes the incremental advances in oncologic research that may take a drug to market but not actually impact long term survival from cancer or prevent it in the first place. (For example, Avastin, which is making billions for its manufacturer while not saving a single life from breast cancer to date.)

Researchers and the media often celebrate small accomplishments. We have been conditioned to believe that a drug that may extend life a few months is a breakthrough, that a 2% reduction in mortality is promising, that tumor regression or stabilization are cause for celebration, even though at that point there is no way to determine if anyone’s life was actually prolonged. We have settled for these limited, incremental changes along with the platitude “early detection saves lives” for too long.

While not doubting the integrity, sincerity and dedication of researchers, the NBCC appears to have lost patience with the system that creates and supports them and the industries that benefit from their discoveries.

More than 40 years and billions of dollars have not ended breast cancer. It has, however, created a robust cancer industry that thrives on raising awareness and producing drugs, screening devices and genetic tests. It has also created an academic system that generates hundreds of thousands of articles about breast cancer and builds careers for thousands. Although there is no doubt individual researchers sincerely want to end breast cancer, every system is perfectly designed to achieve the results it gets. The current system is perfectly designed to be lucrative, cautious and incremental.

They appear to be looking for an “outside the box” approach to breast cancer prevention and treatment that bypasses the conventional research and pharmaceutical industrial complex, and focuses solely on the eradication of breast cancer in a decade.

Their first initiative is the development of a breast cancer vaccine.

As our first project in the campaign we are currently working with a diverse group of stakeholders to create a five-year strategic plan to catalyze the development of a preventive breast cancer vaccine that could revolutionize breast cancer prevention.

My take

While I sympathize with the NBCC’s frustration with the research and pharmaceutical infrastructure, and with the lack of significant progress towards a cure for breast cancer, this 10 year goal is looking a bit pie in the sky to me.

They make comparisons with the eradication of polio. But they forget that we knew what caused polio – a single virus. We don’t even know yet what causes breast cancer –  so developing a vaccine against it seems premature. Even if we were to develop a vaccine, the long lead time to development of breast cancer mandates much longer than a 5-10 year project to prove efficacy. And let’s not forget subject safety – we can’t throw caution to the winds here, folks, or we risk losing even more lives to the race for the cure.

They recall John F Kennedy’s race to the moon – a goal that was clearly defined and visible in the night time sky to any child, and the path to which could practically be drawn with one’s hand. But the multi-factorial nature of breast cancer means that there are dozens of moons, in solar systems we cannot even see, with hundreds of possible paths to get there, and thousands of dead ends on the way.

We just may not be close enough to get there in 10 years.

I am reminded…

The NBCC ultimatum reminds me of two women I know who gave their longtime live-in boyfriends a deadline of New Year’s Eve to propose or get out.  That first one gave her ultimatum over 25 year ago, and it worked – they are still married today. The other gave hers just last year, and well, you can guess the outcome – he moved out.

While a 10 year deadline may have worked years ago – when science was simpler and the problems less complex –  such an approach may be a bit outdated today. After all, we have pretty much tackled the simple stuff and are on to the complicated things like cancer, drug resistant infections, HIV and the multi-factorial problems of hypertension, obesity and dementia.

If we knew how to do it, we would have done it by now.

All of this could change, by the way

A deadline would work, by the way, if we were to find a single necessary cause for all breast cancers – in the same way  we now know that the HPV virus causes cervical cancer.

If this were to happen, then yes, we could eradicate breast cancer – maybe not in 10 years,  but certainly in my children’s lifetime.

That same potential now exists to eradicate cervical cancer – if we could develop a vaccine that targets all the cervical cancer causing strains. Instead, we are vaccinating girls right and left with a vaccine that will certainly prevent some cervical cancers, but will never eradicate cervical cancer because it does not target the entire range of viral strains that cause cervical cancer.  It has, however, brought millions of dollars to the pharmaceutical companies that have developed it.

In this sense, I share the frustration of the members of the NBCC, who see profit-driven goals impeding the long term goal of disease eradication.

So I guess I’ll just wish them all the best in their efforts.

And send them a check.

The Threads of Circulation


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………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… As envisioned by artist Victoria May in her installation “Collateral Damage“.

Herb-Roasted Potatoes

The bad news is that our terrace herb garden went unwatered for our entire vacation, and we returned home to find everything pretty much dried out.

The good news is that rosemary, thyme and tarragon are just as good dried as fresh. Maybe even better.

Herb-Roasted Potatoes

The smaller the potatoes are cut, the faster they will cook. Try to get all the pieces the same size so they will cook evenly.

3 lbs red bliss potatoes
1/4 cup olive oil
Dried rosemary
Dried thyme
Dried tarragon
1/4 cup olive oil
1 tbsp Kosher salt
Lots of fresh ground pepper
1 tsp paprika

Take a scissor to your herb garden and bring in a bunch of herbs, about 1/4 cup total once they are stripped from the stems.

Clean, and dry the potatoes, then cut into 2 inch pieces (sixths or eights, depending on the size of the potato). Toss in a large bowl with the olive oil. Sprinkle on the herbs and spices and toss to coat evenly. Spread evenly on a large baking sheet or roasting pan in a single layer.

Roast at 425 degrees Fahrenheit for 20-30 mins, turning with a large spatula about halfway through to brown evenly. Serve hot.
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This post is my contribution to Weekend Herb Blogging, hosted this week at Anna’s Cool Finds, with four years of wonderful archives at Cook Almost Anything.

Into the Woods

Into the woods without delay,
But careful not to lose the way.
Into the woods, who knows what may
Be lurking on the journey?
Into the woods to get the thing
That makes it worth the journeying.
Into the woods!
Then out of the woods,
And home before dark!

At the end of our street in the Endless Mountains is access to a forest trail system that leads into World’s End State Park, where it joins up with the 59 mile long Loyalsock Trail.

Although we’ve owned our cottage here for 4 years now, until this summer, I’d never ventured onto the trails that link with World’s End, because, well…I was afraid of getting lost in the woods.

I think it was leftover fear from the time when I was 8 years old and actually did get lost in the woods of a Philadelphia suburb for an hour or so one sunny summer afternoon. That adventure earned me the nickname “Crow Girl” in honor of the bird cries that my Uncle, who found me, claimed led him to me. (I hated that name, by the way…)

My Local Trails

But then a few weeks ago, a kind and wonderful neighbor offered to take us on a guided tour of our local trail system. With a knowledge of the woods gleaned from a generation of hiking and daily walks with her dog, she taught us how to read the trail markers (you read them as if they were laid down on the ground)

and pointed out natural landmarks, flora and fauna,

all the while regaling us with tales of the town. The fact that there were eight of us on that hike (plus two dogs) made the whole thing a real lark and I wasn’t afraid for a moment of getting lost.

This gave Mr TBTAM and I the courage to head out on our own a day later, retracing our previous hike’s steps before venturing just a tad farther along the Yellow Trail, barely skirting World’s End before turning back towards town along the bridle trail. Now we were pointing out the landmarks to one another – spots like Table Rock

Fat Man’s Squeeze

The Pine Woodlands (where you can take the blue trail shortcut)

and The Old Rail Bed.

Canyon Vista Trail

By the time Paula and Tony joined us the following weekend, we were ready to venture off the local trail system and into World’s End on the Canyon Vista Trail. Paula and Tony are veteran hikers, equipped with walking sticks and Paula’s great knowledge of the outdoors, so we felt bolstered by their presence. (Long time readers will remember Paul from our Aquaduct Trail Ride, where she lectured us on the secrets of the black walnut).

The Vista Trail is actually an easy hike, although we needed two separate trail maps to follow our route. From the end of our street, take the yellow access trail to the railroad bed, then take the Red Trail to the park road, turn left onto the road for a short distance till you see signs for Canyon Vista Trail /Loyalsock Trail,

which you follow to the vista.

While at the Vista, take a short hike farther up the hills to explore the Rock Garden –

but do be careful up there as the trails are unmarked.

Fortunately, all you need to do is head downhill and you’ll find yourself in the Vista parking lot. Earlier that morning, we had left a car there to save ourselves the hike back (We had other things to do that day, like roll grape leaves with Paula. I’ll show you that in another post…)

So them’s my woods, folks.

I still would love to get me a good GPS for the fun of it, and join in on the many hikes sponsored by the Eagles Mere Conservancy and the Alpine Club. I feel like a whole world has opened up to me now that I’ve taken the plunge into World’s End, and I hope to someday know these woods like the back of my hand and teach them to my grandchildren.

One Last Thing

Oh yeah – There’s one more thing I need to tell you about my woods…

There are bears.

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Into the Woods, lyrics by Stephen Sondheim

In the Laboratory, Resveratrol Blocks Estrogen’s Beneficial Effects on Vascular Smooth Muscle

Researchers have shown that Resveratrol, in low concentrations similar to those attained with red wine consumption, actually impairs estrogen’s beneficial effects on vascular smooth muscle growth in the laboratory.

Background

One of estrogen’s beneficial actions in the body is thought to be its inhibition of the smooth muscle cell growth that occurs at the sight of vascular injury – cell growth that leads to atherosclerotic plaque formation.

Resveratrol is the substance that has been hypothesized to mediate the protective effect of red wine against heart disease. Resveratrol is said to inhibit platelet clumping, another critical step in plaque formation, as well as to have antioxidative effects.

But resveratrol also has anti-estrogenic activity and  blocks estradiol metabolism.  How might this mitigate its putative protective effects?

What they did

The researchers  grew vascular smooth muscle cells in the lab, then added both resveratrol and estrogen at levels simlar to those attained in the human body. They found that resveratrol blocked estrogen’s growth-slowing effect on the vascular cells.

These considerations imply that moderate consumption of wine or resveratrol-containing health supplements (20–500 mg) by premenopausal women or postmenopausal women on estradiol could attenuate the inhibitory effects of estradiol on VSMC growth and abrogate the vasoprotective actions of estradiol.

Interestingly, when the resarchers upped the dose of resveratrol to supraphysiolgic levels that are unattainable in the human body, they were able to override the effect on estrogen and get inhibition of growth. They tell us that it is at these unattainable levels that much of the research showing resveratrol’s protective effects on heart disease has been conducted.

Bottom Line

The effects of resveratrol are complex, have been shown only in the lab, mostly in rats at levels unattainable in humans, and may not be as beneficial as you think.

Enjoy your wine if you want, but in moderation and without expectation other than a nice palate and a little buzz. A healthy diet, a healthy weight and exercise remain the mainstays of heart disease prevention.

Could this be why we get hot flashes from red wine?

Still, it makes me wonder….

If this effect of resveratrol is real, then maybe Mother Nature is trying to keep us away from the stuff that might mitigate what little our remaining estrogen might be doing for our hearts.

Just a thought…

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UPDATE – GSK has halted research on use of a resveratrol related compound for treatment of multiple myleoma after subjects in the trial developed kidney failure.

Prophylactic Oophorectomy in BRCA Carriers Reduces Mortality

Removal of the ovaries (oophorectomy) in women who carry harmful BRCA mutations prevents both ovarian and breast cancer, and reduces overall mortality.

In a landmark study published last week in JAMA, researchers followed 2343 women with BRCA1 and BRCA2 mutations for a mean of 3-6 years (range 0.5-27 yrs), and compared cancer and mortality outcomes between those who had risk-reducing surgery (172 had mastectomy and 993 had removal of the ovaries) and those who chose not to have surgery. Those who did not have surgery were offered aggressive surveillance for breast cancer (annual mammography and breast MRI) and ovarian cancer (ultrasound and Ca125 testing every 4-12 months).

In women who underwent risk-reducing salpingo-oophorectomy, 1.1% were subsequently diagnosed with ovarian cancer (ie, primary peritoneal cancer), 11.4% were subsequently diagnosed with breast cancer, and 3.1% subsequently died of any cause. In women who did not undergo risk-reducing salpingo-oophorectomy, 5.8% were subsequently diagnosed with ovarian cancer, 19.2% with breast cancer, and 9.8% subsequently died from any cause.

Ovarian cancer risks were higher in BRCA 1 (7-8%) than BRCA2 carriers (3%) who kept their ovaries. No BRCA2 carriers who had their ovaries removed got peritoneal cancer during the follow up. (This is consistent with prior literature on these mutations and ovarian cancer risks.) Nine women who had their ovaries removed had small occult ovarian cancers diagnosed in the removed ovaries.

Prophylactic oophorectomy was also protective against primary breast cancer, cutting the risk in half – from 22% to 11%. In women who had prior breast cancer, oophorectomy reduced the odds of a second breast cancer from 14% to 11%.

Prophylactic oophorectomy appears to be more effective in BRCA2 than BRCA1 carriers – there were no breast or ovarian cancer-related deaths in BRCA 2carriers who had their ovaries removed.  The surgery appeared to be of equal value in women over and over age 50.

While prophylactic mastectomy indeed reduced the risk of acquiring breast cancer (no women who had the surgery got breast cancer), it did not impact mortality.

Bottom Line

Women who carry harmful BRCA mutations have a markedly increased cancer risk ; 15-40% will develop ovarian cancer in their lifetime (compared to about 1% of the general population) and 6-% will develop breast cancer (compared to 12% of the general population of women).

While we can offer BRCA mutation carriers effective screening for breast cancer (mammogram, sonogram and MRI), we do not have an equally effective screening tool for ovarian cancer. Even the much touted ultrasound and Ca125 tests have not been shown to reduce mortality from ovarian cancer. In this study, in fact, women were offered sonograms and Ca125 testing, and although we do not know to what extent they actually availed themselves of the surveillance, it clearly did not offer them the same protection against ovarian cancer as oophorectomy.

The protective effect of oophorectomy in carriers of harmful BRCA mutations stands in marked contrast to oophorectomy in women at average risk of ovarian cancer, which has been shown to actually increase mortality when performed in women under age 65.

What are the risk factors for having a harmful BRCA mutation?

About 2% of women have risk facotrs for BRCA 1 and 2 mutations. According to the NCI, these are –

For women who are not of Ashkenazi Jewish descent :

  • two first-degree relatives (mother, daughter, or sister) diagnosed with breast cancer, one of whom was diagnosed at age 50 or younger;
  • three or more first-degree or second-degree (grandmother or aunt) relatives diagnosed with breast cancer regardless of their age at diagnosis;
  • a combination of first- and second-degree relatives diagnosed with breast cancer and ovarian cancer (one cancer type per person);
  • a first-degree relative with cancer diagnosed in both breasts (bilateral breast cancer);
  • a combination of two or more first- or second-degree relatives diagnosed with ovarian cancer regardless of age at diagnosis;
  • a first- or second-degree relative diagnosed with both breast and ovarian cancer regardless of age at diagnosis; and
  • breast cancer diagnosed in a male relative.

For women of Ashkenazi Jewish descent –

  • any first-degree relative diagnosed with breast or ovarian cancer; and
  • two second-degree relatives on the same side of the family diagnosed with breast or ovarian cancer.

Women who have none of these family history patterns have a low probability of having a harmful BRCA1 or BRCA2 mutation.

How I Will Use these Study Results

I encourage women with suggestive family histories to see a genetic counselor to discuss BRCA testing. Despite making many such referrals,  I find most women don’t follow through.  “Why should I want to know?” they ask.  “What would I do differently if I had the BRCA gene other than worry?”

It’s an important question that deserves an answer. So I tell them –

We would offer prophylactic oophorectomy. That’s because we have no good screening that has been proven to reduce ovarian cancer mortality. But if we remove the ovaries, we can significantly reduce the odds of getting both ovarian and breast cancer.  With this new study, I can now tell these women that this cancer risk reduction also translates to a significant reduction in mortality. And give them some numbers to chew on as they think about what, if anything, they want to do.

The decision to proceed to oophorectomy is never undertaken lightly. Which is why BRCA testing is helpful – it may allow us to avoid surgery in women who test negative for harmful mutations. It is also why we offer oophorectomy at too young an age and certainly not until childbearing is completed in women who do carry harmful mutations. Sometime in the 40’s seems about the right age for oophorectomy in BRCA mutation carriers. The surgery can usually be done laparoscopically, with same day discharge in many cases.

The price we pay for oophorectomy, of course, is menopause. Menopause that we may not want to treat with estrogen because of your predisposition to breast cancer. However, there are non-hormonal ooptions for hot flashes that can be effective. And here it can get complicated, as some patients decide to have a hysterectomy as well as an oophorectomy, so that they can take unopposed estrogen, which (at least in the WHI) is not associated with an increased risk for breast cancer. (Not unreasonable thinking, in my opinion…) But these are just some of the things you’ll want to think about before considering prophylactic oophorectomy.

I don’t push prophylactic mastectomy, although it is certainly an option for BRCA carriers. This study makes this feel even more reasonable, because while mastectomy certainly prevented breast cancer, it did not significantly reduce mortality from breast cancer. I suspect that is because we’re pretty darned good at screening for breast cancer, and have very effective treatments. But some women will choose mastectomy regardless.

For women with suggestive family histories who choose either not ot know their BRCA status, or who opt for surveillance only, I encourage enrollment in a clinical trial of new screening methods for ovarian cancer. For those who don’t do this, I will do ca125 and sonograms, simply for the lack of anything else better to do.

One of these days, we’ll hopefully have an effective screening test for ovarian cancer. But until then, prophylactic oophorectomy remains an important option for women at increased risk for ovarian and breast cancer due to harmful BRCA mutations.

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NCI Fact Sheet on BRCA mutation testing

NCI Bulletin on this research study

Cervical Cancer Screening – The Jade Goody Effect

The Telegraph reports that the number of screening pap smears performed in the UK has declined, after an 8% blip upwards in 2009 when publicity surrounding the death of Jade Goody from cervical cancer may have led more women to have this important screening test.

NHS laboratories processed 415,497 tests in 2009-10, about 35,000 fewer than the previous year when 450,522. Miss Goody’s death in March last year prompted a 20 per cent increase in the number of Scottish women taking tests. More than 122,000 were processed between April and June last year, the statistics revealed.

The irony of course, is that British reality TV star Jade Goody did have pap smears, but chose to ignore her doctor’s recommendations for treatment when her pap smears came back abnormal.

Nonetheless, the decline in pap smears has led NHS of Scotland to initiate a campaign to reach the up to 25 % of young women who do not respond to invitations to have pap smears.

In England, women are invited to start pap smears start at age 25, while in the rest of the UK, they start at age 20. Britain’s guidelines are in line with the WHO’s, and it has been reported that Ireland may raise the start age for paps there to 25.   There are less than 60 cases of cervical cancer annually in the UK in women under age 25.  Is this enough to justify nationwide screening in women in the 21 to 25 age group?

Jade’s Mum thinks so. She has backed a local British campaign to lower the age when pap smears are initiated in Britain from age 25 to age 21 to bring it in line with the rest of the UK.

Decisions about when to initiate cervical cancer screening must weigh the risks of false positives and the risks of treatment, which can impact fertility, against the risk of missing the opportunity to prevent cervical cancer by treating precancerous changes in the cervix before cancer develops.

Here in the US, we recently upped the age for initiating cervical cancer screening  to age 21 in normal women, because cervical cancer is so exceedingly rare in women under that age unless there is some immune compromise. Abnormal pap smears in women under age 21 are almost certainly due to transient HPV infection that will never progress to cervical cancer, but which leads to thousands of unnecessary colposcopies and biopsies annually.