BRCA carriers' perspectives following prophylactic surgery
Campfield Bonadies D, Moyer A, Matloff ET. Fam Cancer 2010; Sep 18. doi: 10.1007/s10689-010-9384-z
Prophylactic bilateral salpingo-oophorectomy (PBSO) is being undertaken in more women at high risk of ovarian cancer, but provision of preoperative counselling regarding its implications is variable in UK hospitals. The authors analysed questionnaires completed by 98 BRCA carriers who had undergone PBSO. Mean age was 45.5 years (range 32-63 years). The five most common frequent or very frequent post-surgical symptoms were vaginal dryness (52.1 per cent), change in interest in sex (50.0 per cent), sleep disturbances (46.7 per cent), change in sex life (43.9 per cent) and hot flushes (42.9 per cent). Most of the women would have found it helpful to have more information on the impact on their sex lives (59.2 per cent), the availability of sex counselling (57.1 per cent) and the risk of CHD (57.1 per cent).
Miss Margaret Rees is reader in reproductive medicine and honorary consultant in medical gynaecology at John Radcliffe Hospital, Oxford
Fatigue in breast cancer
Gerber LH, Stout N, McGarvey C et al. Support Care Cancer 2010; Sep 12. doi: 10.1007/s00520-010-0986-7
Fatigue, which can have a significant impact on quality of life, affects 70-100 per cent of patients receiving chemotherapy and a substantial number who have completed their treatment.
These authors analysed data from 44 women from diagnosis (baseline) to nine months or more post-diagnosis, to determine whether biological and/or functional measures are likely to be associated with the development of clinically significant fatigue. Fatigue at nine months or more correlated significantly with BMI equal to or greater than 25kg/m2, abnormal WBC and increase in limb volume, and inversely correlated with vigorous activity and physical function (p <0.05). They conclude that predictors of clinically significant fatigue include high BMI and WBC, increase in limb volume and low level of physical activity. MR
Predictors of intercourse and pregnancy in teenage mothers
Lewis LN, Doherty DA, Hickey M et al. Med J Aust 2010; 193: 338-42
This study examined the determinants of pregnancy within two years of a teenager giving birth for the first time (rapid-repeat pregnancy) and resumption of sexual intercourse after birth.
Of the 147 participants, 49 (33 per cent) experienced rapid-repeat pregnancy. Sexual intercourse was independently significantly associated with using an oral contraceptive, living with the birth father, intending to become pregnant, smoking marijuana and using alcohol.
Use of long-acting reversible contraceptives (LARCs) was associated with reduced odds of rapid-repeat pregnancy (OR 0.27; 95% CI 0.12-0.62), while teenagers who used an oral contraceptive had a similar risk of rapid-repeat pregnancy compared with those using barrier methods or no contraception. Thus access to LARCs should be facilitated to reduce the rate of rapid-repeat pregnancy. MR
Alendronate and fracture risk
Abrahamsen B, Eiken P, Eastell R. J Clin Endocrinol Metab 2010; Sep 15. doi:10.1210/jc.2010-1571
The safety of alendronate is being questioned after a link was proposed to the development of atypical subtrochanteric or diaphyseal fragility fractures of the femur. The authors conducted an ageand gender-matched cohort study using national healthcare data. Patients were alendronate users without previous hip fracture.
Subtrochanteric and diaphyseal fractures occurred at a rate of 13 per 10,000 patient-years in untreated women and 31 per 10,000 patient-years in alendronate users (adjusted HR 1.88; 95% CI 1.62-2.17). The HR for hip fracture was 1.37 (95% CI 1.30-1.46). Risks of subtrochanteric/diaphyseal fracture were similar in patients who had nine years of treatment (highest quartile) and those who had stopped after the equivalent of three months of treatment (lowest quartile). Thus large cumulative doses of alendronate were not associated with a greater absolute risk of subtrochanteric/diaphyseal fractures. The authors conclude that these fractures could be due to osteoporosis. MR
Vitamin D and breast cancer
Engel P, Fagherazzi G, Boutten A et al. Cancer Epidemiol Biomarkers Prev 2010; 19(9): 2341-50
The benefits of vitamin D are extending beyond bone health. High 25-hydroxyvitamin D (25OHD) serum concentrations have been found to be associated with reduced breast cancer risk. A nested case-control study was undertaken within the French E3N cohort. Cases consisted of women diagnosed with incident breast cancer (n = 636) and 1,272 matched controls. A decreased risk of breast cancer with increasing 25OHD3 serum concentrations was noted (OR 0.73; 95% CI 0.55-0.96; p trend 0.02) among women in the highest tertile. The findings support a decreased risk of breast cancer associated with high 25OHD3 serum concentrations, especially in younger women, but a direct influence of age or menopausal status was not confirmed. The authors recommend undertaking randomised intervention trials with vitamin D supplements to confirm its benefits on breast cancer risk. MR