Mother Daughter Relationship Important Key To HPV Vaccination

College women were more likely to be vaccinated against human papillomavirus (HPV) if their mothers communicated with them about sex and if they thought their mothers would approve of their getting vaccinated, according to new Dartmouth research.

Meg Gerrard, PhD, of Dartmouth Medical School and Norris Cotton Cancer Center, Megan Roberts, a PhD student at Dartmouth College, and their colleagues, surveyed 972 female undergraduates at a large Midwestern university between November 2007 and April 2009.

An anonymous questionnaire assessed the undergraduate’s sexual-risk behavior, knowledge of HPV, perceptions of HPV risk, communication from their mothers about sex-related topics (including HPV), and their current vaccination status.

Sixty-five percent of the women reported being sexually active, and 49 percent reported having received at least the first of the three-shot HPV vaccine series.

Those who were unvaccinated were more likely to be interested in future vaccination if they thought their mothers would approve. The young women’s perceptions of their risk of contracting HPV also contributed to their interest in getting vaccinated. Young women whose mothers had discussed values in relation to sex were, as a group, less interested in being vaccinated.

The authors concluded that “mother-daughter communication and approval of vaccination emerged as important predictors of young women’s HPV-vaccination behavior and intentions, even after the women were old enough to not require parental approval.” They also noted that college-age women “are still a very important population to target for vaccination.”

The study was published in the journal Pediatrics. For more information, visit: www.dartmouth.edu/

Study Finds Fish Oil May Reduce Risk Of Breast Cancer

A recent report in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, adds to the evidence that fish oil supplements may play a role in preventing chronic disease.

Researchers at the Fred Hutchinson Cancer Research Center in Seattle, Wash., led by Emily White, Ph.D., a member of the public health sciences division, asked 35,016 post-menopausal women who did not have a history of breast cancer to complete a 24-page questionnaire about their use of non-vitamin, non-mineral “specialty” supplements in the Vitamins and Lifestyle (VITAL) cohort study.

After six years of follow-up, 880 cases of breast cancer were identified using the Surveillance, Epidemiology and End Results registry.
Regular use of fish oil supplements, which contain high levels of the omega-3 fatty acids, EPA and DHA, was linked with a 32 percent reduced risk of breast cancer. The reduction in risk appeared to be restricted to invasive ductal breast cancer, the most common type of the disease.

The use of other specialty supplements, many of which are commonly taken by women to treat symptoms of menopause, was not associated with breast cancer risk.

This research is the first to demonstrate a link between the use of fish oil supplements and a reduction in breast cancer. Studies of dietary intake of fish or omega-3 fatty acids have not been consistent.

“It may be that the amount of omega-3 fatty acids in fish oil supplements are higher than most people would typically get from their diet,” White said.

However, White cautioned against gleaning any recommendations from the results of one study.

“Without confirming studies specifically addressing this,” she said, “we should not draw any conclusions about a causal relationship.”

Edward Giovannucci, M.D., Sc.D., professor of nutrition and epidemiology at the Harvard School of Public Health and an editorial board member of Cancer Epidemiology, Biomarkers & Prevention, agreed.

“It is very rare that a single study should be used to make a broad recommendation,” said Giovannucci. “Over a period of time, as the studies confirm each other, we can start to make recommendations.”
Still, fish oil continues to excite many, as evidence emerges about its protective effect on cardiovascular disease and now cancer.

Harvard researchers are currently enrolling patients for the randomized Vitamin D and Omega-3 Trial (also called VITAL), which will assess the impact of fish oil supplements and vitamin D on cancer, heart disease and stroke.

The researchers plan to enroll 20,000 U.S. men aged 60 years and older and women aged 65 years and older who do not have a history of these diseases and have never taken supplements.

Recruitment for this National Institutes of Health funded study began in January, and more information can be found at www.vitalstudy.org.

Women Outnumber Men 2-1 In Using Internet For Medical Self-Diagnosis

A recent survey of roughly 500 men and women each found that women outnumber men almost 2 to 1 in using the Internet for initial research on their aches and pains.

Flexcin International, a joint inflammation manufacturer, conducted the study and found 73.6 percent of all women in the survey said they use the Internet for initial research compared with 44.1 percent of men.

All respondents were between the ages of 35 and 60 living throughout different parts of the country. The survey revealed that many women prefer the Internet for initial research because they’ve grown tired of the frustrations in trying to see their primary care physician. The majority of men said they aren’t always sure how to describe the ailment when using the Internet for self-diagnosis.

“Although the Internet doesn’t replace your doctor, I think these results speak to the fact that both women and men are very frustrated with the healthcare industry,” said Tamer Elsafy, CEO and founder of Flexcin.

“If you have general aches and pains or a case of the sniffles, people today are more inclined to research the Internet rather than wait several days to see a doctor and then pay the high cost of prescriptions,” he said.

Women who said they turn to the Internet first said they’re comfortable doing so because they aren’t looking for answers to life-threatening illnesses but rather information on general aches and pains. Men said they’d like to use the Internet more but don’t trust their ability to describe their ailments on their own.

For more information visit http://flexcin.com.

Awakening Desire: Understanding Female Sexual Dysfunction

Many women experience problems in the bedroom at one time or another. Female sexual dysfunction (FSD) is not uncommon and although some women and healthcare providers have difficulty discussing it, it has been recognized by the medical community for decades. In fact, for the last twenty years, it has been listed in the Diagnostic and Statistical Manual of Mental Disorders, a manual published by the American Psychiatric Association, used to classify and diagnose psychological disorders.

FSD can develop at any age, but many women report sexual problems at times of hormonal fluctuation; for example: post-pregnancy or during menopause. FSD encompasses several conditions that can have an effect on a woman’s health and cause concern and suffering. These symptoms include:

- The desire to have sex is low or absent.
- An inability to maintain arousal during sexual activity, or become aroused despite a desire to have sex.
- An inability to experience an orgasm.
- Pain during sexual contact.

Hypoactive sexual desire disorder (HSDD) affects roughly 1 in 10 women and is the most common sexual dysfunction among women of all ages. It is sometimes difficult to diagnose because a woman’s sex drive varies tremendously from person to person. And the factors causing a lowered sex drive can range from psychological to biological. But some women underestimate what an important role sexual health plays in their overall health and well-being. And if the lack of desire becomes distressing in any way or interferes with her overall quality of life, she may have HSDD.

Many women suffer in silence and some even feel that a decline in sexual desire is a normal part of aging. According to Sheryl A. Kingsberg, PhD, a clinical psychologist and Professor in the Department of Reproductive Biology at Case Western Reserve University School of Medicine in Cleveland, Ohio: “Women should not be expected to accept a distressing loss of sexual desire any more than they should be expected to simply accept arthritis, acid reflux, or any other condition often associated with aging.”

Unfortunately, HSDD in women is not as well recognized as erectile dysfunction (ED) in men. There are many medications available for the treatment of ED, but currently, there are no US FDA approved medications for women with HSDD.

“The problem is further compounded by a lack of attention and interest in women’s sexual satisfaction in many cultures,” said Kingsberg. And as a result, “some women may feel that it is not appropriate to seek help for a sexual problem.”

There are options available. An important step in getting help for FSD is realizing that there is a problem. Too many women ignore their symptoms or are unable to recognize that they have a treatable issue.

Kingsberg suggests that: “Women should speak to their partners about the problem and (they may consider) seeing a professional for guidance; this professional may be a counselor, a sex therapist, a physician or nurse practitioner, or some other trusted person.”

Psychotherapy or sex therapy can be very effective in uncovering the different components that may contribute to the problem. There are a few medical treatments which include hormonal therapies that may help some women. “A number of other very exciting new approaches to the treatment of low sexual desire in women are under development,” said Kingsberg, “and may be available soon.”

The Society for Women’s Health Research (SWHR), a national non-profit organization based in Washington D.C., is widely recognized as the thought leader in women’s health research, particularly how sex differences impact health. SWHR’s mission is to improve the health of all women through advocacy, education and research. Visit SWHR’s website at swhr.org for more information.

Late-Stage Ovarian Cancer Therapy Shows Promise In Phase I Trial

The combination of decitabine and carboplatin appears to improve the outcome of women who have late-stage ovarian cancer.

Indiana University researchers report 4 of 10 patients who participated in a phase I clinical trial had no disease progression after six months of treatment. One patient experienced complete resolution of tumor tissue for a period of time.

Advanced ovarian cancer is often diagnosed too late for treatment to be effective. Patients are often told they have virtually no chance of recovery and only months to live.

Women participating in the study were between 51 and 71, and had previously exhausted all approved treatments for ovarian cancer. They enrolled in an Indiana University Melvin and Bren Simon Cancer Center clinical trial designed to increase their sensitivity to the commonly prescribed ovarian cancer drug, platinum-based carboplatin.

Women with ovarian cancer usually survive less than one year after they become resistant to carboplatin and their cancer recurs, said co-principal investigator Daniela Matei, M.D., an associate professor of medicine at the Indiana University School of Medicine. Matei led the clinical portion of the trial.

“Carboplatin is the most efficient drug therapy for ovarian cancer,” Matei said. “Unfortunately, patients with recurrent disease become resistant to the drug after one or two rounds.”

Decitabine was first used to treat the study patients intravenously daily for five days followed on the eighth day with carboplatin. After a month, the regimen begins again.

Six months after the trial began, four of the patients had no disease progression. At eight-and-a-half months, seven patients were alive. Cancerous tissue in one of the patients shrank completely.
Adverse reactions to the treatment regiments were mild, including nausea, fatigue and neutropenia.

Encouraged by the results of the phase I trial, which determined the safety of two different dosing regimens, a phase II trial is now under way with 17 patients already enrolled. Phase II trials are primarily focused on assessing the effectiveness of a drug or treatment protocol.

The study’s other co-principal investigator, Kenneth Nephew, geneticist in the IU Medical Sciences Program-Bloomington, led the report’s biochemical and DNA analysis.

In a bid to resensitize patients to carboplatin, Nephew and Matei and co-investigator Jeanne M. Schilder, M.D., associate professor of obstetrics and gynecology in the Division of Gynecologic Oncology at the IU School of Medicine, turned to the DNA demethylating agent, decitabine.

Why trial patients were responsive to the combination of decitabine and carboplatin is not yet known, but based on the literature and an analysis of biopsy tissue and blood samples, Nephew and Matei suspect decitabine reactivates tumor suppression genes that are turned off in ovarian cancer cells.

One of the hallmarks of ovarian cancer is the aberrant methylation of cytosine, one of DNA’s four nitrogenous bases. Methylation prevents DNA readers from expressing genes. Some of the silenced genes won’t be terribly important, but some, like tumor suppression genes, are. Decitabine is a known methylation inhibitor that can help return tumor suppression genes to an active state, and also improve cells’ susceptibility to anti-cancer drugs like carboplatin.

“Our hypothesis is that decitabine isn’t just targeting active ovarian cancer cells, but also cancer stem cells that seem to survive the first treatments,” Nephew said. “By keeping tumor suppression genes from being methylated, carboplatin and other platinum-based treatments for ovarian cancer have a better chance of success in the late stages.”

The researchers also reported that decitabine appears to have caused six of the 10 patients to become hypersensitive to carboplatin (a mild allergic reaction, treatable with steroids). While Nephew and Matei say that the effect may not be observed in a larger patient population, the scientists say they are intrigued by the phenomenon.

The two-drug treatment protocol is not approved for general use. The IU Simon Cancer Center is the only site for this clinical study.

Also contributing to the report were Fang Fang (lead author), Curt Balch, Timothy Breen, Shu Zhang, Changyu Shen, Lang Li, Carol Kulesavage, and Anthony Snyder. It was funded by the National Cancer Institute, Phi Beta Psi, and Ovar’coming Together.

The study was published in the journal, Cancer. More information can be found by visiting: www.indiana.edu.

Psychologist Wins Grant To Reduce Risky Sexual Behavior Among African American Girls

Developing and evaluating a faith-based, HIV-prevention program for African-American mothers and their daughters is the focus of Dr. Chisina Kapungu’s $795,000 career development grant from the National Institute of Mental Health.

Kapungu, assistant professor of obstetrics and gynecology at the University of Illinois at Chicago, is a clinical psychologist who has worked on HIV prevention programs, conducted research on the multi-systemic factors of HIV risk in African-American adolescents, and counseled HIV-infected women and kids.

Her proposed research project will work with two Chicago churches to pilot a faith-based HIV prevention program for community-based educators to administer to women and their daughters, ages 13 to 16.

The project, while still in the development stage, is “going to be very collaborative, very much based on principles of community-based participatory research, with shared decision-making throughout the process,” said Kapungu, who developed the project while completing a post-doctoral fellowship at UIC’s Institute for Health Research and Policy.

The intervention is based on two existing HIV prevention programs — one developed by the Religious Coalition for Reproductive Choice in Washington, and the other an evidenced-based program, Sisters Informing, Healing, Living, and Empowering, recommended by the U.S. Centers for Disease Control and Prevention and proven effective among African-American women and girls.

Kapungu plans to integrate the two programs and customize the curriculum based on the needs of the community, to include information about parental monitoring, assertive communication, and negotiating safe sexual practices.

“The goal of the intervention is to decrease sexual possibility situations and delay the onset of sexual debut,” said Kapungu, who describes the intervention as not focused on condom usage.

Research has shown that family factors such as parental monitoring, communication, and parental attachment are associated with delays in sexual intercourse among adolescents, Kapungu said. “There really hasn’t been empirical work in implementing faith- and family-based HIV interventions.”

Although African Americans are 13 percent of the U.S. population, they experience 59 percent of the HIV/AIDS cases in the country, according to the CDC.

“The church has been an untapped resource within the HIV prevention field and can have a potentially important role in educating young people about sexuality and HIV,” Kapungu said. “Worldwide, faith-based organizations have focused on secondary prevention, counseling and support for infected individuals and peer education groups, but less on primary prevention.”

UIC ranks among the nation’s leading research universities and is Chicago’s largest university with 26,000 students, 12,000 faculty and staff, 15 colleges and the state’s major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.

For more information, visit www.uic.edu

Articles Reveal Fetal Surgery Continues To Advance

Fetal surgery is becoming more popular with the advantages it provides: repairing birth defects in the womb; inserting a tiny laser into the mother’s uterus to seal off an abnormal blood flow and save fetal twins; and advancing the science that may allow doctors to deliver cells or DNA to treat sickle cell anemia and other genetic diseases before birth, are a few of the benefits.

“Fetal surgery is a unique field in maternal-fetal medicine,” said pediatric surgeon N. Scott Adzick, M.D., medical director of the Center for Fetal Diagnosis and Treatment (CFDT) at The Children’s Hospital of Philadelphia. “Detecting birth defects prenatally has allowed physicians to provide better perinatal care,” said Adzick, “but many of these babies were already too sick for us to treat them successfully after they were born. This dilemma led to the development of fetal surgery.”

“Some of the fetal anomalies we treat are so rare that a physician may encounter them only once or twice in a career,” continued Adzick, who is surgeon-in-chief at Children’s Hospital. “However, as prenatal diagnosis continues to improve, along with surgical techniques and tools of molecular biology, we have an expanded range of conditions for which we may devise ways to intervene before birth with clear benefits.”

The CFDT, which marks its 15th anniversary this year, is a premier program, one of a handful worldwide to offer a full range of fetal procedures. Since the center opened in 1995, more than 10,000 parents have used its services, from all 50 U.S. states and from 46 other countries.

Internationally prominent as a pioneer in fetal surgery, Adzick edited the an issue of the journal Seminars in Fetal & Neonatal Medicine. That issue is entirely devoted to advances in fetal surgery. Adzick and other practitioners at The Children’s Hospital of Philadelphia describe innovative surgeries, high-tech procedures, and the prospect of prenatal gene therapy and stem cell treatments in a collection of articles reviewing the current state of the science in fetal therapy.

These are the articles:

Open fetal surgery to remove abnormal masses or patch an opening
Open fetal surgery involves cutting into the mother’s abdomen and uterus in order to operate on the fetus. In his article on open fetal surgery, Adzick describes the multidisciplinary team and sophisticated imaging technologies used to assess patients referred to the center, the only such facility that includes a Special Delivery Unit for mothers carrying babies with known birth defects. Adzick describes fetal surgeries for two life-threatening defects: lung masses, which may compress the developing heart, leading to heart failure, and sacrococcygeal teratomas, large tumors attached to the fetus’s tailbone, which can lead to heart failure or a fatal hemorrhage before birth. Fetal surgery, he adds, places special demands on caregivers to ensure safety for two patients — the mother and the fetus.

Adzick’s second article concerns fetal surgery for open spina bifida, referred to as myelomeningocele. A defect in which part of the spinal cord remains unprotected by skin and tissue, it may result in hydrocephalus, mental retardation, bowel and bladder problems, and lifelong paralysis. While usually non-lethal, it is a relatively common cause of major disability, affecting one in 2,000 live births.

To repair a myelomeningocele, fetal surgeons shield the developing spinal cord by closing the defect with the fetus’s own tissue. Definitive results of outcomes after fetal surgery are expected from a randomized clinical trial sponsored by the National Institutes of Health.

The Management of Myelomeningocele Study (MOMS), which began in 2003, is expected to conclude treatments in the trial in 2011 at three fetal surgery centers, The Children’s Hospital of Philadelphia, Vanderbilt University and the University of California-San Francisco.

Laser treatment shuts off dangerous twin-to-twin connection
Another application of fetal surgery is for twin-twin transfusion syndrome, occurring in 10 to 15 percent of identical twins. In this condition, one fetus grows at the expense of its twin because of abnormal blood vessel connections in their shared placenta. Michael Bebbington, M.D., of the CFDT, reviews current therapies for this condition, noting that the scientific evidence favors selective laser photocoagulation. In this procedure, using a viewing instrument called a fetoscope, the fetal surgeon employs a laser to seal off the blood vessels that carry hazardous blood flow between the two fetuses.

Prenatal stem cell and gene therapy moving toward clinical use
The greatest future impact of fetal treatments probably lies in non-surgical approaches — prenatal stem cell therapy and gene therapy. In contrast to the relatively rare anatomical defects addressed in fetal surgery, cell and gene therapy offer the possibility of treating many genetic diseases before birth, including sickle cell anemia, immune deficiency disorders and some types of muscular dystrophy.

These potential therapies are reviewed by Alan W. Flake, M.D., and his colleagues at the Center for Fetal Research at Children’s Hospital. Now in his third decade of investigating fetal surgery, Flake pioneered fetal bone marrow transplantation in 1996, successfully treating severe combined immunodeficiency disease (SCID) in utero.

In-utero hematopoietic stem cell transplantation (IUHCT) focuses on stem cells that develop into all the types of cells found in the blood. The keystone of this approach is the fetal immune system’s unique tolerance of transplanted cells. Flake’s strategy involves using prenatal stem cell transplants to achieve tolerance of foreign cells, which are incorporated into the fetal circulation. This sets the stage for postnatal transplant of therapeutic blood cells from the same donor that will not be rejected by the infant’s immune system.

The specific characteristics of SCID make this disease uniquely amenable to a prenatal stem cell approach. Now, says Flake, research in animal models is progressing toward using IUHCT to treat other immune deficiency diseases, the hemoglobin disorders sickle cell anemia and thalassemia, and lysosomal storage diseases (genetic disorders in which the lack of an enzyme causes metabolic chemicals to accumulate to toxic levels in cells).

Some diseases that progress to irreversible organ damage may offer targets for prenatal gene therapy — in which physicians deliver therapeutic DNA to correct a genetic defect. Proof-of-principle studies in animals have produced preclinical successes for prenatal gene therapy in cystic fibrosis, Duchenne’s muscular dystrophy, Pompe disease and the lysosomal storage disease Sly syndrome. There have also been promising animal studies in types of hemophilia. As with postnatal gene therapy, important safety issues remain to be solved before prenatal gene therapy can be offered in the clinic. “Fetal gene therapy is still in the early experimental stage,” said Flake, while noting great progress in this field.

EXIT procedure — a partial delivery buys time for fetal surgery
Other articles in the special issue discuss fetal treatments for congenital diaphragmatic hernia, thoracic and bladder shunts, fetal anesthesia, and the ex-utero intrapartum therapy (EXIT) procedure. The EXIT procedure is a “partial delivery” in which the fetus is partially removed from the uterus but remains attached to the circulation carried by the umbilical cord and placenta so that surgeons can correct airway blockages before performing a full delivery. Clinicians at Children’s Hospital have the world’s most extensive experience in performing the EXIT procedure.

For more information, visit: www.chop.edu.

One in Four Women Show Ambivalence Toward Pregnancy

For years, a widely held assumption was that women of childbearing age fell neatly into two camps: those trying to have children, and those not trying to have children.

A new nationwide study suggests, however, that nearly a fourth of women consider themselves “OK either way” about getting pregnant — a wide swath of ambivalence that surprised researchers, and that could reshape how doctors approach many aspects of women’s healthcare.

In a study of nearly 4,000 women ages 25 to 45 who are sexually active, about 71 percent said they were not trying to get pregnant, while 6 percent said they were. But nearly one in four, 23 percent, told researchers they were “OK either way” — they were neither trying to conceive, nor trying to prevent a pregnancy.

Among women who had no children, 60 percent said they were trying to not get pregnant, 14 percent were trying to get pregnant and 26 percent responded that they were “OK either way.”

“This finding dramatically challenges the idea that women are always trying, one way or another, to either get pregnant or not get pregnant,” said Julia McQuillan, professor of sociology at the University of Nebraska-Lincoln and the study’s lead author. “It also shows that women who are OK either way should be assessed separately from women who are intentional about pregnancy.”

The study also gave more accurate measures of women’s pregnancy intentions, which are important for estimating unmet need for contraception, building more effective family planning programs, promoting infant health and helping maternal and infant well-being.

“If healthcare providers only ask women if they are currently trying to get pregnant and women say no, then the assumption is that they are trying not to get pregnant,” McQuillan said. “Clearly, many women are less intentional about pregnancy. Yet this group should be treated as if they will likely conceive and should therefore get recommendations such as ensuring adequate folic acid intake and limiting alcohol intake.”
In addition, the study examined the attitudes and social pressures regarding pregnancy of the respondents, as well as their socioeconomic status.

Among the findings:
*Women who said they were OK either way reported the highest number when asked what the ideal number of children would be — 3.17 on average. They also tended to be slightly more religious than women who were either trying to get pregnant or not trying to get pregnant.
*Seventy-three percent of women who said they were OK either way said they would like a baby, compared with 34 percent of women who were not trying to get pregnant, and 95 percent of women who said they were trying to get pregnant.
*Those who were trying to get pregnant were more likely to report that having a child — or another child — was very important to their partner compared with women in the other two groups. Among women who had not yet had children and who said they were trying, 40 percent said it was important to their partner.
*Half of all women in the survey said their career was very important to them, while 45 percent said the same about having an adequate amount of leisure time. All three groups — women who were trying, women who weren’t trying, and women who were OK either way — reported similar attitudes about work and leisure.

The study, which is forthcoming in Maternal and Child Health Journal, was authored by UNL’s McQuillan along with Arthur L. Greil of Alfred University and Karina Shreffler of Oklahoma State University.

For more information, visit: www.unl.edu/.

Study Suggests Link Between Air Pollution and Type 2 Diabetes in Women

Traffic-related air pollution, known to raise the risk for cardiovascular disease, may also increase the risk of developing type 2 diabetes in women. Low-grade inflammation may contribute to the higher incidence of type 2 diabetes in women exposed to air pollution, according to German researchers.

Published online May 27 ahead of print in the peer-reviewed journal Environmental Health Perspectives (EHP), the study comprised German women living in highly polluted industrial areas and in rural regions with less pollution.

The researchers analyzed data from 1,775 women who were 54 or 55 years old when they enrolled in the study in 1985. Between 1990 and 2006, 187 participants were diagnosed with type 2 diabetes, which often starts in middle age. Air pollution data from monitoring stations and emission inventories run by local environmental agencies were used to estimate each woman’s average exposure levels.

Exposure to components of traffic pollution, particularly nitrogen dioxide (NO2) and soot in ambient fine particulate matter (PM), was significantly associated with a higher risk of type 2 diabetes. An increase in NO2 or PM corresponding to the difference between exposure at the 75th percentile and exposure at the 25th percentile was associated with a 15–42 percent higher risk of type 2 diabetes.

Living within 100 meters of busy roadways more than doubled the diabetes risk.

Measurements of C3c, a blood protein and marker for subclinical inflammation, predicted the elevated diabetes risk. Only women with the highest C3c levels at enrollment had an increased risk for type 2 diabetes related to traffic pollution during the 16-year follow-up period. Just how C3c might affect diabetes remains unknown. Immune cells in the airways may first react with air pollutants, setting off a widespread chronic inflammatory response, which in turn may make individuals more susceptible to developing diabetes.

Although the study focuses only on women, study leader Wolfgang Rathmann said, “We have no reason to assume sex differences in the association between air pollution and diabetes risk, but we do not have data on this issue.”

To the authors’ knowledge, this is the first population-based study to reveal a statistically significant association between traffic-related air pollution and type 2 diabetes. Previous epidemiologic research shows that city dwellers have a higher prevalence of diabetes than do rural residents, especially in developing countries undergoing rapid industrialization. Changes in diet and physical activity and resulting increases in obesity are believed to be the primary culprits.
These changes, however, do not totally explain the increased diabetes risk. The results of the current study suggest traffic-related air pollutants may be an unidentified environmental factor related to the development of type 2 diabetes.

Other studies have reported that people with diabetes are more vulnerable to pollution-related cardiovascular disease. Air pollutants can cause low-grade inflammation, insulin resistance, and impaired glucose metabolism. Additionally, C3c is a risk factor for diabetes, and C3c levels are higher in individuals living in highly polluted areas. The latest findings further support the role of traffic air pollutants and low-grade inflammation in diabetes risk.

Other authors of the study are Ursula Krämer, Christian Herder, Dorothea Sugiri, Klaus Strassburger, Tamara Schikowski, and Ulrich Ranft. The full article, “Traffic-Related Air Pollution and Incident Type 2 Diabetes: Results from the SALIA Cohort Study,” is available on the EHP website at http://ehponline.org/article/info:doi/10.1289/ehp.0901689.

Screening Mammograms For Younger Women Have Low Accuracy

Screening mammograms in women under age 40 result in high rates of callbacks and additional imaging tests but low rates of cancer detection, according to a study published online May 3 in the Journal of the National Cancer Institute.

Many studies have assessed mammographies for women over age 40 years, but little is known about its usefulness in younger women. Although screening mammograms are not generally recommended under age 40, about 29 percent of women between 30 and 40 reported having had one.

To determine the accuracy and outcomes of mammograms in younger women, Bonnie C. Yankaskas, Ph..D., from the University of North Carolina at Chapel Hill, and colleagues, pooled data from six mammography registries around the country. Their study included 117,738 women who had their first mammogram between the ages of 18 and 39.

The researchers followed the women for a year to determine the accuracy of the tests and their cancer detection rates. They analyzed data for both screening mammograms and diagnostic mammograms, which were performed because a woman had a warning sign or symptom, such as a lump.

No cancers were detected in women 25. Among the 73,335 women aged 35-39, the researchers found that screening mammograms had poor accuracy (sensitivity, specificity, and positive predictive value) and high rates of recall for additional tests. The cancer detection rate in this group was 1.6 cancers per 1,000 women.

For diagnostic mammograms, accuracy was better and the detection rate was 14.3 cancers per 1,000 women aged 35-39.

The authors conclude that in a theoretical population of 10,000 women having a screening mammogram between ages 35 and 39, 1,266 would be called back for further testing, 16 cancers would be detected, and therefore 1,250 women would have false positives.

In this population, they write, “our findings support a need for serious discussion about the appropriateness of mammography in women without the presence of symptoms.”

In an editorial, Ned Calonge, M.D., of the Colorado Department of Public Health and Environment, notes that this “landmark descriptive study should inform women and physicians and guide research efforts” on early detection in younger women. He emphasizes that even women in the study with a family history of breast cancer had the same detection and false positive rates as women without a known family history. This calls into question he says, the recommendation of some health groups that women with a family history start screening early.

He concludes that “the study by Yankaskas et al. is a powerful reminder that we must continue to strive for better tests and better treatments…..Furthermore, we should not be satisfied with better detection rates alone. We need evidence that early detection of these cancers translates to improvements in important health outcomes.”

Fore more information, visit: http://jnci.oxfordjournals.org/.