Outcomes For Robotic-Assisted Hysterectomy Similar To Conventional Laparoscopy, Study Finds

Two methods of performing a minimally invasive hysterectomy -- either by a surgeon alone or with assistance of robotic equipment -- produced similar, positive outcomes in women with endometrial cancer, according to a study in the journal Obstetrics & Gynecology, Reuters reports. The study's authors said both methods proved superior to the traditional open procedure, which involves a relatively large abdominal incision.

More than 40,000 women are diagnosed with endometrial cancer in the U.S. every year. Treatment usually involves a hysterectomy -- the surgical removal of the uterus -- and often the removal of lymph nodes to determine the stage of the cancer.

The conventional minimally invasive procedure is performed through laparoscopy, using a small incision and a video camera, but it requires intensive training on the part of the surgeon. The robot, though adding a few thousand dollars to the procedure's price, provides better vision, improves range of motion and uses more intuitive movements.

The study found that both minimally invasive techniques resulted in longer operations but shorter hospital stays, compared with the open procedure. The robotic surgery caused about half as much blood loss as the standard laparoscopy. There were no differences in complications among the three techniques.

"Robotics increases the chance that a hysterectomy can be done by laparoscopy," Tommaso Falcone of the Cleveland Clinic said. "However, if the surgeon is skilled enough to do the hysterectomy without the robot by laparoscopy, then the outcomes will be similar," he said (Peeples, Reuters, 11/29).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families.


© 2010 National Partnership for Women & Families. All rights reserved.

Federal Judge Rejects Motions To Dismiss Trial Against Convicted Murderer Kopp

U.S. District Judge Richard Arcara on Thursday rejected all defense motions to dismiss the upcoming federal trial against convicted murderer James Kopp and ruled that Kopp cannot discuss his antiabortion views during the trial, the AP/Jackson News-Tribune reports (Thompson, AP/Jackson News-Tribune, 12/7). Kopp in 2003 was convicted under state second-degree murder charges and sentenced to 25 years to life in prison for murdering Buffalo, N.Y., abortion provider Barnett Slepian in 1998. In the upcoming trial, he faces charges of violating the federal Freedom of Access to Clinic Entrances Act. The federal charges could carry a sentence of life in prison without parole. Kopp's former attorney, John Humann, had filed a motion to suppress Kopp's confession to the murder despite Kopp's objection. Kopp subsequently made a request to represent himself, which Arcara granted in May. Prosecutors had asked Arcara to prohibit buttons or T-shirts displaying abortion-related slogans in the courtroom. They also attempted to prevent Kopp from explaining his reasons for opposing abortion, describing the experiences of former abortion patients and how fetuses develop or showing the jury pictures of aborted fetuses (Kaiser Daily Women's Health Policy Report, 7/19). Arcara ruled that Kopp cannot discuss his antiabortion views or offer abortion-related photographs or testimony because they are irrelevant (AP/Jackson News-Tribune, 12/7). Arcara has tentatively scheduled the federal trial for Jan. 3, 2007 (Kaiser Daily Women's Health Policy Report, 7/19).

"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Partner Assistance Allows ADPH To Continue Serving Women At High Risk Of Breast And Cervical Cancer

Thanks to the generosity of the Joy to Life Foundation and the Susan G. Komen for the Cure,
North Central Alabama Affiliate, the Alabama Department of Public Health can continue to fund
the screening of high-risk women for breast and cervical cancer through June 30.


In the past seven months the Alabama Breast and Cervical Cancer Early Detection Program
has served 10,000 women, the number of women ordinarily served during an entire year. All
program appropriations have been depleted because of this unprecedented demand for
services. To avoid completely suspending the program, the two nonprofit organizations have
stepped forward to provide funding for screening high-risk women.


"We are very appreciative of the donation of private funds by the Joy to Life Foundation and the
Susan G. Komen for the Cure, North Alabama Affiliate," said Dr. Donald Williamson, state
health officer. "We would have been forced to suspend services were it not for their donations
that will carry the program through the next five months. Last year alone more than 150
medically underserved women were diagnosed with breast and cervical cancer through this
program, and more than 1,700 women have been diagnosed since this program began in 1996."


Early detection of these cancers saves lives. Breast cancer screening services include clinical
breast examinations and mammograms. Cervical cancer screening services include pelvic
exams and Pap smears. If an abnormality is detected, diagnostic testing for both cancers may
include an ultrasound, biopsy or colposcopy.


To be eligible for screening, the individual must be female, have an income at or below 200
percent of the federal poverty level, and have no insurance or be underinsured. In addition, the
patient must be age 40-64 and have an abnormal clinical breast exam, or age 50-64 and never
had a mammogram in her lifetime, or have not had a Pap smear in the past five years
Funding for screening services is provided by the Centers for Disease Control and Prevention,
State of Alabama, and the National Breast Cancer Foundation. Aside from provision of new
funds, Joy to Life and Komen have been providing funding for mammograms to women under
50 years of age for several years.


Program services are provided by more than 400 contracted physicians, surgeons, radiologists
and facilities across the state committed to providing services to underserved women. These
providers agree to accept a reduced rate for their services, they also agree to submit required
data regarding services they provide for submission to the CDC.


In addition to the Joy to Life Foundation and Susan G. Komen for the Cure, North Alabama
Affiliate, other partners include the American Cancer Society, Deep South Network, REACH US/
REACH 2010 Coalition, the University of Alabama at Birmingham's Comprehensive Cancer
Center, the University of South Alabama Mitchell Cancer Institute, Southeast Alabama Regional
Medical Center, Avon Foundation's Butterfly Project, and many others.


Source:

Alabama Department of Public Health

Human Papilloma Virus Vaccine Effective In Women Aged 24-45 Not Previously Exposed

An article published Online First and in an upcoming edition of The Lancet reports that women aged between 24 and 45 can be protected by the human papilloma virus (HPV) vaccine, if they have not been already infected by the virus. The report is the work of Dr Nubia Mu?±oz, from the National Institute of Cancer, Bogot??, Colombia, and collaborators.


Over the last thirty years, sexual behavior has changed. The age of the first marriage is rising, divorce rates are augmenting. As a result, premarital intercourse and having a new sexual partner around middle-age are common behaviors. The HPV virus is transmitted through sexual intercourse and can lead to cervical cancer or other cervical disease. It could be beneficial for older women to receive vaccination against the HPV virus. The women who participated in the randomized trial did not have a history of cervical disease or cancer or genital warts, caused by HPV types 6, 11, 16 and 18. The first group of women received the quadrivalent HPV vaccine and the second group received placebo (at day 1 and months 2 and 6).


There were a total of 1911 women in the first group and 1908 in the second group. The first endpoint for assessment was infection for six months or more, and cervical and external genital disease due to HPV 6, 11, 16, 18. The second was the same but genital disease was due to HPV 16 and 18 only. The average of follow-up time was of 2.2 years. No further data was analyzed at the end of the four year trial. Among the women, specific populations were analyzed.


The per-protocol population of ideal participants included 1615 women who were given the vaccine and 1607 receiving placebo. From day 1 and up to month seven, they all tested negative for the appropriate vaccine HPV type. Within one year, they all had to receive three vaccine doses. They were required to have one or more follow-up visits after month seven. Research showed that there were four cases of infection or disease in the vaccine group compared to forty one in the placebo group. Researchers observed the vaccine proved to have 91 percent effectiveness against all four virus strains (the percent reduction in incidence rate in the vaccine group compared to the placebo group). In the evaluation of the HPV 16 and 18 only, four cases occurred in the vaccine group compared with 23 in the placebo group (vaccine efficiency of 83 percent). When women who had not been completely vaccinated and had already existing HPV infection were included in the analysis, vaccine efficacy against all four HPV types was lower (31 percent). Effectiveness was of 24 percent when it was specifically against types HPV 16 and 18.


The authors write: "Lower effectiveness (about 30%) detected in the mixed population (susceptible women and those who have already acquired HPV infection or HPV-associated disease) suggests that the public health effect of vaccinating women aged 25-45 years will be smaller than that recorded after vaccinating susceptible adolescents. This notion will be assessed in future cost-benefit analyses."















Although there were two target outcomes of the trial, the researchers observed that in general, the women reaching the endpoint had infections, rather than cervical or genital disease. As a result, the high vaccine efficacy in the intention-to-treat population was mostly as a result of efficacy against infection.


The authors explain: "Maximum effect from prophylactic HPV vaccination programmes will be achieved in women who are susceptible to infection and disease related to vaccine HPV types (those not previously exposed). Notably, most adult women enrolled in the current study remained susceptible to vaccine HPV types at entry. Almost all women enrolled were susceptible to three or four vaccine HPV types, and about a third were positive to HPV 6, 11, 16, or 18 at baseline by serological or DNA testing; therefore about two-thirds were susceptible to all four vaccine HPV types. Most women who were HPV positive were positive to only one HPV type, meaning that the quadrivalent HPV vaccine could still potentially benefit these women via protection against vaccine HPV types with which they are not infected with."


They write in conclusion: "The quadrivalent HPV vaccine is efficacious in women aged 24??????"45 years not infected with the relevant HPV types at enrolment."


"Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine in women aged 24-45 years: a randomised, double-blind trial"

Nubia Mu?±oz, Ricardo Manalastas Jr, Punee Pitisuttithum, Damrong Tresukosol, Joseph Monsonego, Kevin Ault, Christine Clavel, Joaquin Luna, Evan Myers, Sara Hood, Oliver Bautista, Janine Bryan, Frank J Taddeo, Mark T Esser, Scott Vuocolo, Richard M Haupt, Eliav Barr, Alfred Saah

DOI: 10.1016/S0140-6736(09)60691-7

thelancet


Stephanie Brunner (B.A.)

In Postmenopausal Women Height Loss May Indicate Spinal Fracture

Loss of height in postmenopausal women may indicate a vertebral fracture, states an article in CMAJ (Canadian Medical Association Journal).



Height loss is common as people age and is associated with back pain. Causes include changes in the curvature of the spine, narrowing of intervertebral discs and vertebral fractures. Two-thirds of adults have back pain at any time. Diagnosing these treatable disorders, however, sparks controversy because it is not known if the benefits outweigh the harm of unnecessary radiographs.



Researchers from France conducted a study to compare postmenopausal women and analyze reasons for height loss. The study included 1779 randomly selected general practitioners who were each asked to recruit five female patients over the age of 60. A total of 8610 patients were included in the study.



"We observed a mean loss of height of 4.5 cm since early adulthood in a large population of postmenopausal women in primary care practices," write Dr. Karine Briot, H??pital Cochin and Universit?© Paris Descartes, Paris, France and coauthors. "We found that the risk of an existing vertebral fracture was significantly higher among patients with a height loss of at least 4 cm."



The authors conclude that measurement of height loss could be an accurate method for detecting vertebral fractures. Actual height of women was different from what the patients reported. General practitioners need to measure patients and not rely on estimates.



Source:

Kim Barnhardt

Canadian Medical Association Journal

Majority Of U.S. Residents Support Confirming Supreme Court Nominee Sotomayor, Poll Finds

Sixty-two percent of U.S. residents want Supreme Court nominee Sonia Sotomayor to be confirmed, and 55% say she is "about right" on a liberal-to-conservative scale, according to a recent Washington Post/ABC News poll, the Post reports. For the survey, pollsters randomly surveyed a national sample of 1,001 adults by telephone between June 18 and June 21. The poll has a margin of sampling error of plus or minus three percentage points.

The poll found that about three-fourths of abortion-rights supporters want Sotomayor to be confirmed, compared with less than half of abortion-rights opponents. According to the poll, six in 10 U.S. residents would want the new Supreme Court justice to vote to uphold Roe v. Wade. Most Republican men would want the next Supreme Court justice to vote to overturn Roe, while Republican women were split about evenly on the issue, the poll found.

The poll also found that support for Sotomayor's confirmation was equal between men and women. In addition, nearly eight in 10 Democrats and about two-thirds of independents said they supported Sotomayor's confirmation, compared with 36% of Republicans. The poll found that most Republicans deemed Sotomayor a "more liberal" nominee than they would prefer. Among Republicans, those self-identifying as conservative Republicans were largely opposed to Sotomayor's confirmation, with more than seven in 10 conservative Republicans saying she is too liberal.

Sotomayor received support from Republicans self-identifying as moderate or liberal, with fewer than four in 10 saying she is too liberal. However, about one in five who opposed Sotomayor's confirmation said that she is not liberal enough. The poll also found that among the 33% of U.S. residents who said that Sotomayor's gender plays a role, more than twice as many said that is a positive attribute as opposed to a negative attribute (Cohen/Barnes, Washington Post, 6/28).

Sessions Requests More Information

Senate Judiciary Committee ranking Republican Jeff Sessions (Ala.) on Friday sent a letter to the White House requesting additional information on Sotomayor, the New York Times' "The Caucus" reports. According to Sessions, the Obama administration has yet to provide members of the committee with information about a number of cases that Sotomayor brought to trial while working as a district attorney in New York. In addition, Sessions requested information regarding a case that Sotomayor argued on appeal. He also requested information about her work with Latino Justice PRLDEF, formerly known as the Puerto Rican Legal Defense and Education Fund.

Sotomayor's confirmation hearing is scheduled to begin July 13. Republicans have criticized the schedule, saying it gives them insufficient time to review Sotomayor's record. Democrats have said that Republicans are seeking to create unnecessary delays and noted that the timeline is similar to that of past nominees (Herszenhorn, "The Caucus," New York Times, 6/26).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

Green Tea May Protect Against Breast Cancer

While tea has been used as an alternative medicine in China for the last
several thousand years, it is only recently that the Western hemisphere
started to take notice of the beverage??s potential health benefits,
according to University of Southern California researchers. Now, tea is
being hailed as a miracle elixir with the power to do everything from
lower
stress hormones and sooth the symptoms of PMS to protect against disease.



Although many of the claims are unproven, tea has been shown to reduce the
risk of certain kinds of cancer, says Carol Koprowski, Ph.D., R.D.,
assistant professor of preventive medicine at the Keck School of Medicine
of
USC.



??The tea that has been studied the most is green tea,?? she notes. ??It??s
one
of the few teas out there that has been shown to have antioxidants that
may protect against cell damage
Epidemiologist Anna Wu, Ph.D., professor of preventive medicine at the
Keck
School, is studying the relationship between green tea consumption and
breast cancer risk. An earlier study about breast cancer risk among
Asian-American women showed that green tea intake had a strong protective
effect, while the more commonly consumed black tea had no effect at all,
she
says.



While both green and black teas come from the same Camellia sinensis plant
native to Asia, the leaves are processed differently. Black tea leaves go
through a fermentation process that strips the plant of its natural
polyphenol compounds, which are believed to give the tea its antioxidant
properties, Wu says.


Results from a small pilot study suggest that regular green tea drinkers
had
lower blood estrogen levels, while regular black tea drinkers had higher
blood estrogen levels. Higher levels of estrogen are associated with
breast
cancer risk, Wu explains.



While green tea is gaining in popularity around the world in part due to
reports of its disease fighting properties, consumption still lags far
behind black tea in most cultures. Regardless of whether the benefits are
as
widespread as some reports claim, a few cups of either green or black tea
is
a smart addition to a diet as a replacement for high-calorie sodas and
fruit
drinks.



Wu, a life-long black tea drinker, says she hasn??t given it up but now
drinks at least one cup of green tea a day as well.


University of Southern California

usc.edu