In brief

An at-a-glance round-up of the latest papers of relevance to women's health

In brief
In brief

Reduction of stress in teenage girls
Greater influence over everyday life, emotional support, and cultural and recreational activities help teenage girls to withstand stress, according to the results of a dissertation undertaken at the University of Gothenburg. The research shows that stress arises at the interface between responsibility and how an individual is treated. For example, if a girl is not treated with respect, an initially voluntarily accepted responsibility can instead be perceived as something forced. The author of the study found that girls derived the strength to withstand stress from a variety of sources, including cultural and recreational activities. Furthermore, a health-promoting programme with massage and mental exercise at one school was found to reduce development of stress, especially among girls.
Haraldsson K.

Overdiagnosis of breast cancer
One in three breast cancers detected in a population offered organised screening is overdiagnosed, according to a systematic review of international data. Researchers at the Nordic Cochrane Centre analysed breast cancer trends before and after the introduction of publicly organised screening programmes in five countries including the UK. The level of overdiagnosis (detection of cancers that will not cause death or symptoms) was estimated at 52 per cent overall and for the UK, 57 per cent. An accompanying editorial suggests women need a simple tabular display of benefits and harms based on the latest evidence to make an informed choice.
Jorgensen KJ, Gotzsche PC. BMJ 2009; 339: b2587; doi:10.1136/bmj.b2587.
Welch HG. BMJ 2009; 339: b1425; doi:10.1136/bmj.b1425

Young women's contraceptive preference
The OCP remains the preferred choice for young women, despite government efforts to increase the use of long-acting reversible contraceptives. Researchers interviewed 20 women aged 20 years from eastern Scotland on their use of hormonal contraception. Women said that they liked the OCP because they were in control of its administration and they experienced regular, predictable bleeds. Only four of the women reported using alternative hormonal methods; all discontinued use because of weight gain or dislike of menstrual suppression. The researchers noted that young women were most worried about weight gain and changes to their periods as side-effects of contraceptive methods.
Williamson LM, Buston K, Sweeting H. J Fam Plann Reprod Health Care 2009; 35: 167-72

Cycles of weight loss and mortality
Repeated episodes of intentional weight loss do not increase a woman's risk of mortality, according to a prospective study. Researchers included data on 44,882 middle-aged or older women in the Nurses' Health Study who provided information on intentional weight losses between 1972 and 1992. Those who reported intentionally losing at least 9.1kg or 4.5kg three times or more were classified as severe or mild weight 'cyclers', respectively. During the 12-year follow-up, weight cyclers gained more weight than non-cyclers. However, repeated intentional weight loss was not predictive of greater all-cause or cardiovascular mortality.
Field AE, Malspeis S, Willett WC. Arch Intern Med 2009; 169: 881-6

HPV testing in routine cervical screening
Combining HPV testing with routine liquid-based cytology (LBC) screening does not improve the detection of cervical cancer compared with LBC alone, the results of a randomised trial have shown. A total of 24,510 women aged 20-64 years were involved in the trial, which was undertaken over two screening rounds approximately three years apart. Overall, combined testing with LBC and HPV did not detect more high-grade lesions (CIN 2 or 3, or worse) than LBC alone. The trial will continue through a third round of screening, six years after the initial enrolment.
Kitchener HC, Almonte M, Thomson C et al. Lancet Oncol 2009; 10: 672-82

Bisphosphonates and BMD monitoring
Monitoring bone mineral density (BMD) in postmenopausal women during the first three years of treatment with a bisphosphonate is unnecessary, researchers in Australia and the US have concluded. They analysed data from the Fracture Intervention Trial, which compared alendronate to placebo in 6,459 postmenopausal women with low BMD. Hip and spine BMD had been measured at baseline and at one, two and three years after randomisation. After three years, 97.5 per cent of women treated with alendronate showed at least a modest increase in hip BMD, which did not vary substantially between individuals. This, say the authors, makes monitoring response to treatment unnecessary. An accompanying editorial states that routine BMD monitoring in the first few years of treatment could lead to inappropriate management decisions and waste healthcare resources.
Bell KJ, Hayen A, Macaskill P et al. BMJ 2009; 338: b2266; doi: 10.1136/bmj.b2266.
Compston J. BMJ 2009; 338: b1276; doi: 10.1136/bmj.b1276

Weight loss surgery and cancer risk
Bariatric surgery may reduce cancer risk in obese women but not obese men, a study in Sweden suggests. The researchers followed up 2,010 obese patients who underwent bariatric surgery and 2,037 who received standard treatment (such as lifestyle advice) over an average 10.9 years. Weight loss surgery was associated with a substantial reduction in cancer incidence (42 per cent) in obese women, but not obese men.
Sjostrom L, Gummesson A, Sjostrom CD et al. Lancet Oncol 2009; 10: 653-62.

Better oral hygiene may reduce complications in pregnancy, UK researchers suggest.
They tested the gastric aspirates (stomach contents containing swallowed amniotic fluid) of 57 newborn babies and found 46 species of bacteria in the samples. The most prevalent species could have originated from the vagina; however, two - Granulicatella elegans and Streptococcus sinensis - were recognised as oral in origin and are not normally found elsewhere in the body. These species, which can be blood-borne, have been associated with non-oral infections such as infective endocarditis.
The research was presented at the Society for General Microbiology meeting in Harrogate earlier this year.
Gonzales-Marin C, Millar M, Spratt D et al. Abstract No HAR04/03;

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