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  • August 15, 2017 7:48 AM | Deleted user

    Recommendations for breast cancer screening in average risk women have been included in the Practice Bulletins for the  American Congress of Obstetricians and Gynecologists. The recommendations for screening mammography state the following: "Updated recommendations include that average-risk women be offered screening at age 40, or no later than 50 years. Screening should be continued every one or two years until at least age 75." ACOG encourages shared decision making for all about breast cancer screening decisions. A comparison of breast cancer screening recommendations in average risk women as developed by several recommending bodies can be found here:

    The U.S. Preventative Services Task Force issues a statement in July recommending against ovarian cancer screening in women without symptoms, stating that clinicians "should not screen for ovarian cancer in women who have no signs or symptoms of the disease". This reaffirms their statement from 2012. This recommendation does not apply to women with BRCA I/II mutations. 

  • August 14, 2017 7:48 AM | Deleted user

    Improve safety, quality, and access in women's healthcare

    AAPA seeks a volunteer to represent AAPA on a Facility Standards Development Initiative of the American College of Obstetricians and Gynecologists (ACOG). Potential candidates must be available to attend an in-person meeting at ACOG headquarters in Washington, D.C., on Wednesday, Dec. 13 (10 a.m. –5 p.m.), and Thursday, Dec. 14 (8:30 a.m.–2 p.m.). Representatives also would be expected to review draft documents and supporting materials prior to the meeting and remain engaged as ACOG staff revises drafts based on discussions at the December meeting. Applications are due Aug. 18.

    Learn More

  • August 03, 2017 11:49 AM | Deleted user
    Significant reduction in postmenstrual spotting, dysmenorrhea, and discomfort related to spotting 

    TUESDAY, Aug. 1, 2017 (HealthDay News) -- Laparoscopic niche resection is associated with improvement in niche-related symptoms and/or fertility-related problems in women with a large niche (residual myometrium [RM] <3 mm) in the uterine cesarean scar, according to a study published online July 13 in BJOG: An International Journal of Obstetrics and Gynaecology.

    Anke Vervoort, M.D., from the VU University Medical Center in Amsterdam, and colleagues conducted a prospective cohort study involving women with a large niche and complaints of postmenstrual spotting, dysmenorrhea, intrauterine fluid accumulation, and/or difficulties with embryo transfer due to distorted anatomy.

    The researchers found that in 79.2 percent of the 101 women who underwent a laparoscopic niche resection, the main problem was improved or resolved. There was a significant reduction in postmenstrual spotting by seven days at six-month follow-up compared with baseline. Significant reductions were also seen in dysmenorrhea and discomfort related to spotting. At follow-up, there was a significant increase in RM. For 86.9 percent of the women with intrauterine fluid at baseline, the intrauterine fluid was resolved. Overall, 83.3 percent of women reported being (very) satisfied. There was an increase in the physical component of quality of life, while no change was seen in the mental component.

    "A laparoscopic niche resection reduced postmenstrual spotting, discomfort due to spotting, dysmenorrhea, and the presence of intrauterine fluid in the majority of women and increased the RM," the authors write.

    Full Text
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    Copyright © 2017 HealthDay. All rights reserved.

  • July 24, 2017 8:56 AM | Deleted user

    Adapted Media Release

    A new test is the best-to-date in differentiating Zika virus infections from infections caused by similar viruses. The antibody-based assay, developed by researchers at UC Berkeley and Humabs BioMed, a private biotechnology company, is a simple, cost-effective way to determine if a person's infection is from the Zika virus or another virus of the same family, such as dengue and West Nile viruses.

    Zika is a mosquito-borne disease and is linked to severe congenital birth defects. Assays already exist to detect Zika virus infection, but they either work only shortly after infection or are poor at differentiating Zika from other flaviviruses. The limited ability of assays to detect Zika virus has led to difficulty in determining the prevalence of Zika virus infections, the incidence of congenital Zika syndrome and the frequency of neurological complications associated with Zika virus infections.

    The new assay has very high sensitivity (91.8 percent) and specificity (95.9 percent) for identifying Zika virus infections. The assay is currently in the licensing process and researchers hope it will be available to the medical community soon.

    "The whole world has been in urgent need of a serological method to distinguish dengue virus from Zika virus infections, and this the first to have such high sensitivity and specificity in dengue-endemic regions," said Eva Harris, study co-author and UC Berkeley professor in the Division of Infectious Diseases and Vaccinology at the School of Public Health.

    The article will be published online in the journal Proceedings of the National Academy of Sciences. The research was supported, in part, by grants from National Institutes of Health.

    Utilizing its proprietary CellClone discovery technology, Humabs generated a new human antibody to the Zika virus, which the company then used to develop the assay. The assay is based on a well-established approach to detecting viral infections, but the new antibody and protocol give the assay superior sensitivity and specificity, two key assay metrics.

    The assay was implemented in five countries and tested using a large number of clinical samples from travelers and patients living in areas with a high level of exposure to Zika virus and other flaviviruses. The new assay was highly sensitive, specific and robust, according to the study data. When the assay was run on patients infected with Zika virus and also on a control group of 540 patients infected by other flaviviruses or other viruses, plus healthy donors, the specificity was 95.9 percent.

    The assay was developed using detailed patient samples from Harris's collaborative studies in Nicaragua, a large step forward over previous studies. These samples included multiple, longitudinal samples from Zika patients, with or without prior exposure to dengue virus, and samples from dengue patients infected either once or more than once with different types of the dengue virus. The samples were obtained from a 14-year study of a cohort of children whose previous viral infection histories were well documented. These samples were key to the research, because prior dengue virus infections can cross-react and confound many current Zika antibody-based assays; having a thoroughly analyzed pool of patient samples helped the research team characterize and avoid this cross-reactivity.

    "These results support that the antibody-based assay that we have developed is highly effective in detecting both recent and past Zika virus infections and in discriminating Zika from other flavivirus infections," said Davide Corti, senior vice president and chief scientific officer of Humabs BioMed. "This novel assay has the potential to become an effective, simple and low-cost solution for Zika surveillance programs, prevalence studies and clinical intervention trials in flavivirus-endemic areas."

    The assay is cost effective and easy to use, the researchers say, and additional studies are ongoing to further simplify the assay protocol.

    Article: Antibody-based assay discriminates Zika virus infection from other flaviviruses, Davide Corti et al., Proceedings of the National Academy of Sciences, doi: 10.1073/pnas.1704984114, published online 17 July 2017.

  • July 21, 2017 10:55 AM | Deleted user
    Case report describes 51-year-old man who primarily presented with multiple nodules on his scalp 

    WEDNESDAY, July 19, 2017 (HealthDay News) -- A rare case of secondary syphilis which primarily presented with multiple nodules on the scalp has been detailed in a case report published online July 17 in the Journal of Dermatology.

    Fan Li, from Sichuan University in Chengdu, China, and colleagues reported the case of a 51-year-old man who presented with a two-month history of multiple nodules on his scalp. The skin lesions had initially developed as groups of small nodules over the parietal area; in the following weeks, they increased in size and number.

    According to the authors, multiple, rounded yellow-red to dull-red non-tender nodules and masses measuring 0.5 to 3 cm in diameter were observed scattered over the patient's scalp; some of these were scaly and some were crusted due to scratching. A well-defined, firm painless subcutaneous mass was seen on the left cervical region. The results of routine blood, urine, and stool samples and of chest computed tomography and abdominal and pelvic cavity ultrasound were normal. An enlarged lymph node was identified with normal structure in the left neck; the diagnosis remained indefinite. The patient was referred one month later with papillary nodules at his right nasolabial fold and bilateral nasal vestibules, with condyloma lata around the anus. Nodular secondary syphilis was eventually diagnosed.

    "Secondary syphilis, also termed the 'great imitator,' has extremely diverse manifestations, with cutaneous involvement in most cases," the authors write. "Clinicians must be aware of syphilis because of its prevalence and diversity of clinical manifestation."

    Full Text (subscription or payment may be required)

    Copyright © 2017 HealthDay. All rights reserved.

  • July 20, 2017 11:34 AM | Deleted user

    Women looking for birth control other than pills, implants or sponges can turn to their cell phones for help, with many apps offering to predict when they can and can’t get pregnant.

    One app in particular is getting lots of attention.

    Natural Cycles, which was developed by a pair of married physicists, bills itself as the world’s only app to be certified for the use of contraception. It was approved as a medical device by a German-based certification organization, classifying it as a contraceptive in the European Union, the company announced in February.

    World's first approved birth control app debuts: Will it push out the Pill?

    PLAY VIDEO - 3:38

    World's first approved birth control app debuts: Will it push out the Pill?

    PLAY VIDEO - 3:38

    More than 200,000 women in 161 countries are said to use the app.

    The company, headquartered in Sweden, was founded by Elina Berglund and her husband Raoul Scherwitzl, who both have PhDs in physics and “applied their mathematical techniques” to come up with a non-hormonal, non-invasive method of birth control, the company says.

    Is it a 'red' or 'green' day?

    Women have to take their temperature with a basal thermometer every morning and enter it into the app, which considers that and other factors, such as cycle irregularities and “sperm survival.”

    The algorithm then tells a woman if it’s a “red day,” when she’s likely to get pregnant and needs to use protection or abstain from sex; or a “green day,” when she’s not fertile and can have unprotected sex, if she wishes.

    Natural Cycles conducted a study of more than 4,000 women using their app and found with typical use, the app is 93 percent effective when it comes to preventing pregnancy. Oral contraceptives are 91 percent effective when measuring typical use, according to the FDA.

    But experts want more large-scale and independent research and say women should proceed with caution.

    There are about a thousand fertility and birth control apps available, but they’re not being regulated by the FDA or any other U.S. government entity at this time, said Victoria Jennings, director and principal investigator of the Institute for Reproductive Health at Georgetown University.

    “It’s a little bit of a Wild West,” Jennings told TODAY. Women impressed by the news that Natural Cycles has been certified for the use of contraception in the E.U. should be interested and somewhat skeptical, she added.

    “The entity in the European Union that has certified it is not to be confused with something like our FDA,” Jennings said.

    She and her team are currently studying another family planning app, Dynamic Optimal Timing or DOT, and they’ve found women like these digital helpers for lots of reasons, including tracking their periods and avoiding hormonal methods for birth control.

    If you are considering using an app, here’s what you should know:

    Decide what kind of app you want

    Women like the idea of being able to know their bodies and if you are interested in just tracking your cycles, lots of apps will do, Jennings said. The problem comes if you want to rely on them to prevent a pregnancy.

    “A birth control method has to be studied very carefully in a very specific type of trial,” she said. “Zero of them have been submitted to that type of scrutiny, including Natural Cycles. That’s a concern.”

    Do your homework

    Just about anybody can build a fertility app and put it out at the app store without much regulation, Jennings said.

    Read the fine print. Don’t just choose something that comes up on the first page of the search or has a nice ad. Look to see what kind of scientific literature there is to back up a company’s claims “because what you’ll see is a lot of advertisements that make claims that are simply not true,” Jennings said.

    “I’m precariously balanced here because I don’t want to say ‘Don’t use an app, they’ve not been proven, they aren’t very good’ because that’s not true. But I want to say be very careful about the app you choose,” she added.

    Consider what information you have to put in

    Are you willing to take your temperature every morning before you get out of bed, as required by Natural Cycles? Or would you prefer to only put in your period start dates, the protocol used by DOT?

    Also consider any costs associated with the app.

    Remember the limitations

    “It does not protect against STDs,” said NBC News medical contributor Dr. Natalie Azar. “That’s something that’s very important to re-emphasize to women who would choose this method.”

    Then, there’s the trust issue. When TODAY asked viewers whether they’d trust an app over traditional contraceptives, 93 percent of respondents said no.

    Follow A. Pawlowski on FacebookInstagram and Twitter.

  • July 14, 2017 10:41 AM | Deleted user

    Vitamin D deficiency in expectant mothers during pregnancy has a negative effect on the social development and motor skills of pre-school age children, a new study in the British Journal of Nutrition reports.

    Examining data gathered from over 7,000 mother-child pairs1, researchers from the University of Surrey, and the University of Bristol, discovered that pregnant women who were deficient in vitamin D (less than 50 nmol per litre in blood2) were more likely to have children with low scores (bottom 25 percent) in pre-school development tests for gross and fine motor development at age 2½ years than children of vitamin D sufficient mothers. Tests included assessments of their coordination, such as kicking a ball, balancing and jumping and their usage of fine muscles, including holding a pencil and building a tower with bricks.

    Vitamin D insufficiency in pregnancy was also found to affect a child's social development at age 3½ years. However, no associations were found between maternal vitamin D status and other outcomes at older ages (IQ and reading ability at 7 to 9 years old).

    Previous evidence from animal studies has shown that the neurocognitive development of foetuses is detrimentally affected when levels of vitamin D in the mothers are low. Researchers believe that interactions between vitamin D and dopamine in the brain of the foetus may play a crucial role in the neurological development of brain areas controlling motor and social development.

    In addition to the ground-breaking findings in this study, vitamin D, which is derived from sunlight and diet, is also proven to regulate the amount of calcium and phosphate in the body, which is vital in reducing the risk of osteoporosis. Sufficient vitamin D may also be associated with reduced risk of cardiovascular disease, infectious and autoimmune disease and diabetes.

    Lead author Dr Andrea Darling from the University of Surrey, said: "The importance of vitamin D sufficiency should not be underestimated. It is well-known to be good for our musculoskeletal systems, but our research shows that if levels are low in expectant mothers, it can affect the development of their children in their early years of life.

    "Vitamin D is found in oily fish (e.g. salmon, sardines, mackerel and fresh tuna) and in small amounts of red meat, eggs, fortified fat spreads and some breakfast cereals. However, unless a large portion of oily fish (100g) is eaten daily it is difficult to get the recommended daily intake of 10 micrograms per day from food alone.

    "Many pregnant women, especially those from minority groups with darker skin (e.g. African, African-Caribbean or South Asian), will still need to take a 10 micrograms vitamin D supplement daily, particularly in the autumn and winter when vitamin D cannot be made from the sun in the UK." However, it is important to remember that 'more is not necessarily better' and it is important not to take too much vitamin D from supplements as it can be toxic in very high doses".

    Article: Association between maternal vitamin D status in pregnancy and neurodevelopmental outcomes in childhood: results from the Avon Longitudinal Study of Parents and Children (ALSPAC), Andrea Darling et al., British Journal of Nutrition, doi: 10.1017/S0007114517001398, published online 12 July 2017.

  • July 10, 2017 8:21 AM | Deleted user
    by Michael Smith, North American Correspondent, MedPage TodayJuly 06, 2017

    Action Points

    Rising antibiotic resistance around the world is making gonorrhea harder -- and in a handful of cases so far, impossible -- to treat, the World Health Organization is warning.

    Of 77 countries with available data for the period 2009 through 2014, 66% reported finding gonorrhea cases that had decreased sensitivity to extended spectrum cephalosporins, the backbone antibiotics recommended to treat the disease, according to Teodora Wi, MD, of the WHO's Department of Reproductive Health and Research in Geneva, and colleagues.

    Also, of the 72 countries monitoring ciprofloxacin resistance and the 58 monitoring azithromycin resistance, 97% and 81% respectively reported finding resistant isolates, they wrote online in PLoS Medicine.

    But the picture is likely worse than that, Wi told reporters in a telephone briefing, since those data come from high-income countries with good surveillance and reporting systems. Many low-income countries have a toxic mix of high gonorrheal burden, inappropriate antibiotic use, and poor surveillance.

    "There are more cases of untreatable gonorrhea in those countries and they are not really being documented at this point," Wi told reporters.

    Wi said most "untreatable" cases eventually respond to medication -- but at much higher than recommended doses. But she added that the WHO knows of three cases -- one each in Japan, France, and Spain -- where even those higher doses were ineffective and the gonorrhea was not cured. One of the patients has been lost to follow-up, she added.

    Several cases of difficult-to-treat gonorrhea have been reported in the U.S., including a cluster of seven cases seen last year in Hawaii.

    In those cases, all patients were eventually treated successfully with the recommended drug combination but testing isolates showed high levels of resistance to azithromycin and reduced susceptibility -- but not outright resistance -- to ceftriaxone.

    Currently, the WHO recommends treating gonorrhea with one gram of azithromycin as a single dose, with either a single intramuscular dose of ceftriaxone (250 mg), or 400 mg of cefixime orally as a single dose.

    But resistance to cefixime has been rising and in the U.S. the CDC no longer recommends it. Instead, for uncomplicated genital, rectal, or pharyngeal gonorrhea, the agency now suggests combination therapy with intramuscular ceftriaxone, with either azithromycin or doxycycline, at 100 mg orally twice daily for seven days.

    The problem is that the extended spectrum cephalosporins are the last antibiotics known to work against the disease and very few new drugs are in the pipeline, according to Manica Balasegaram, MD, director of the Global Antibiotic Research and Development Partnership, also in Geneva.

    "Ever since antibiotics appeared on the scene," he told reporters, "Neisseria gonorrhoeaehas been quick to develop resistance."

    Indeed, Wi and colleagues noted, "since the introduction of antimicrobial treatment, resistance has rapidly emerged to sulphonamides, penicillins, tetracyclines, macrolides, fluoroquinolones, and early-generation cephalosporins."

    And resistance can emerge quickly, she said: It took just two years from the appearance of gonorrheal resistance to fluoroquinolones to the point where the drugs could no longer be used empirically as therapy.

    Indeed, Wi told reporters, "we are still banking on ceftriaxone and azithromycin" to control gonorrhea, but resistance to azithromycin in some countries has been reported at about 30% of isolates.

    The WHO argues that when resistance rates rise above 5%, it's time to change medication guidelines. "Once we see the tip of the iceberg," Wi said, "it's only a matter of time."

    The WHO is calling for a range of measures to slow the spread of drug-resistant gonorrhea, including:

    • More vigilance. The agency argues that better surveillance will help officials get a grip on the issue.
    • Timely release of information of resistance, when it's noticed.
    • Education campaigns about safer sex.
    • Screening to find asymptomatic patients. Some 40% of men and 80% of women do not display clinical signs and symptoms immediately.
    • Tracing and treating sexual partners.
    • The development of inexpensive point-of-care tests that would help stop the practice of syndromic treatment of sexually transmitted diseases, including empiric treatment for gonorrhea.
    • The discovery and development of new antibiotics.

    But "gonorrhea is a very smart bug," she said, and new antibiotics will likely quickly go the way of older drugs. Instead, the key step would be the development of a vaccine.

    That has been difficult, Wi said, because there is no natural immunity to gonorrhea and researchers have been unable to find antigens that could be used to develop artificial immunity.

    That might be changing, she noted, with evidence that a vaccine against a related pathogen --Neisseria meningitides -- might hold clues to a vaccine for gonorrhea. When the meningitis B vaccine was deployed in New Zealand in 2004 and 2005, observers noted that cases of gonorrhea appear to fall at the same time.

    Subsequent analysis confirmed the effect, and suggested the meningitis vaccine was about 31% effective against gonorrhea, Helen Petousis-Harris, PhD, of the University of Auckland reported at the 2016 STI prevention conference in Atlanta.

    That's probably not enough to suggest simply using the same vaccine, but it might give investigators somewhere to start to develop a drug specific for gonorrhea, she said then.

    The authors said they received no specific funding for the work and declared that no competing interests exist.

    • Reviewed by F. Perry Wilson, MD, MSCEAssistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

  • June 27, 2017 3:04 PM | Deleted user

    Southern Ob/Gyn is pleased to announce our collaboration with APAOG, the national organization for Physician Assistants in Ob/Gyn. We are pleased to welcome them to the 2017 Annual Meeting and into membership in our society.

    July 12 –15, 2017

    Biltmore Estate
    Asheville, NC

    Download attendee brochure here. 

    More information on Southern Obstetric & Gynecologic Seminar can be found at:

  • June 26, 2017 9:57 AM | Deleted user

    Unclear if HPV testing prevented more cervical cancer

    • by Judy George, Contributing Writer, MedPage TodayJune 22, 2017

    Action Points

    Human papillomavirus (HPV) tests resulted in faster and more complete diagnosis of precancerous lesions than Pap smears alone, but also led to more biopsies and surgical treatment of low-grade lesions, according to a new analysis of the New Mexico HPV Pap Registry published in JAMA Oncology.

    HPV screening led to a nonsignificant 15.8% increase in detecting overall cervical intraepithelial neoplasia grade 3 or worse (CIN3+) lesions, and did so much more quickly than Pap smears alone, in a median time of 103 versus 393 days. It also detected significantly more of the less severe CIN1 and CIN2 lesions, and resulted in 55.8% more biopsies and a 20% higher rate of loop electrosurgical excision procedures (LEEP).

    "This study is the first comprehensive evaluation to date of the influence of HPV testing on the long-term outcome associated with ASC-US (atypical squamous cells of undetermined significance) cytology," wrote Cosette Wheeler, PhD, of the University of New Mexico Health Sciences Center in Albuquerque, and colleagues.

    The Wheeler group analyzed the clinical records of 457,317 women whose average age was 39.8 (±12.5 years) from New Mexico's population-based cervical screening register from 2008 to 2012, linking Pap smears and HPV tests to pathology reports.

    The primary objective was to study 5-year outcomes after a Pap smear, with versus without HPV testing. Of the 457,317 women, 20,677 (4.5%) had an abnormal Pap smear result, and 16,648 of the 20,677 -- 80.5% -- had HPV testing.

    Over 5 years, HPV screening detected CIN3+ lesions (adenocarcinoma in situ or cancer) in 2.49% of women, compared to a 2.15% detection rate in women who did not have HPV testing (RR 1.16, 95% CI, 0.92-1.45, P=0.23). HPV triage made a difference detecting high-grade lesions especially during the first year of follow-up, when the detection rate was 1.49% versus 0.93% (RR 1.60, 95% CI, 1.14-2.24, P=0.004).

    By year 5, however, the relative risk dropped and the absolute difference decreased from 0.56% to 0.34%, indicating that most CIN3+ lesions were persistent.

    Among those tested for HPV, virtually all CIN2 and CIN3+ disease occurred in HPV-positive women. The RRs for this group always were above 10, except CIN3+ in women ages 50 to 64, where it was 7.64.

    HPV screening also detected CIN1 lesions in 11.6% of women, compared to a 6.5% detection rate in women who were not screened for HPV (RR 1.76, 95% CI 1.56-2.00, P<0.001). This increase was similar across age groups (P=0.32). Among those tested for HPV, CIN1 lesions were much more common in women who were HPV-positive (24.3% versus 2.7% after 5 years; RR 9.11, 95% CI, 8.01-10.36, P<0.001), and was detected in a median time of 61 versus 582 days (P<0.001).

    "This study shows that knowing a woman's HPV status can help determine her likelihood of needing additional procedures and prioritize immediate treatment and medical resources to the women who need them most," said Jack Cuzick, PhD, director of the Wolfson Institute of Preventive Medicine at Queen Mary University of London, who was part of the research team.

    In an accompanying editorial, Chris Meijer, MD, PhD, and Peter Snijders, PhD, of the pathology department at VU University Medical Center in Amsterdam, pointed out that although HPV triage is effective at detecting cervical disease in a shorter time, it comes at the cost of more biopsies and LEEPs.

    It's unclear whether HPV testing prevented more cervical cancer or whether the reduced time balances the risks of overtreatment, they noted. Among young women especially, an HPV-positive test may stem from a transient HPV infection, and CIN1 and a subset of CIN2 lesions often regress spontaneously without progressing to cervical cancer. CIN3 lesions -- the most advanced cervical cancer precursors -- may persist for more than 2 decades before cervical cancer eventually develops.

    "The HPV triage strategy [used in this study] detects more CIN1 and CIN2 than the algorithm without HPV testing and at present triggers considerable overtreatment of many women of reproductive age who will never develop cervical cancer," they wrote. "These unnecessary treatments are associated with a significant cervical morbidity, including preterm birth, perinatal mortality, and low birth weight."

    Other triage tests also should be considered, they wrote, adding that the latest host gene methylation assays perform well against other options and should have a low cancer risk for test-negative women.

    Because this was an observational study, HPV testing was not randomized in this research. It is possible women not tested for HPV had a different disease risk, or their clinicians used a different follow-up strategy after Pap smears. Clinics in rural areas were less likely to use HPV testing, the researchers noted, and even in urban areas, public health clinics and some federally-qualified health centers had almost no HPV testing during the study period.

    This study was funded by a grant from the Population-Based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium, which is funded by the U.S. National Cancer Institute.

    Wheeler reported relationships with the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, GSK, Merck, and Roche Molecular Systems. Dr. Cuzick disclosed relationships with Abbott, Becton Dickinson, Cepheid, Merck, Hologic, OncoHealth, Qiagen, and Trovagene. The research team reported no other relationships.

    Meijer and Snijders are minority shareholders of Self-Screen B.V., a spin-off company of VU University Medical Center with patents on human papillomavirus testing and methylation markers for cervical screening. They also disclosed relationships with GSK, Qiagen, Sanofi Pasteur-MSD/Merck, Roche Diagnostics, Menarini, Seegene, Abbott, Genticel, Crucell B.V., Diassay B.V., and Delphi Biosciences.

    • Reviewed by F. Perry Wilson, MD, MSCEAssistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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