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  • July 05, 2016 9:37 AM | Ashley Monson (Administrator)

    When a woman is diagnosed with the earliest stage of breast cancer, how aggressive should her treatment be? Will the non-invasive cancer become invasive? Or is it a slow-growing variety that will likely never be harmful?

    The technique combines imaging and mathematics. It's called biomarker ratio imaging microscopy, or BRIM.Researchers at the University of Michigan developed a new technology that can identify aggressive forms of ductal carcinoma in situ, or stage 0 breast cancer, from non-aggressive varieties.

    "A patient with DCIS is typically treated as if she has invasive disease, which is easy to understand. When women hear breast cancer, they're petrified. And physicians are keenly concerned about outcomes as well," says study author Howard R. Petty, Ph.D., professor of ophthalmology and visual sciences and of microbiology and immunology.

    "But, DCIS is not the same disease for everyone. If we can identify potentially non-aggressive lesions, perhaps those women don't need aggressive treatment."

    BRIM combines traditional pathology techniques and fuses it with mathematical analysis to determine the relative levels of certain biomarkers in a tumor.

    Petty and co-author Andrea J. Clark looked at biopsy samples from 23 patients with DCIS. They used fluorescence imaging, in which tumors are stained to identify key biomarkers. Each biomarker was stained a different color. The stained samples were then entered into a computer program that determines the ratio of biomarker in each pixel.

    Some biomarkers are highly expressed in cancer; others have very low expression. With BRIM, researchers take the ratio of expression. This means high and low do not cancel each other out, but rather combine to form an image of improved contrast.

    Using this technique, researchers could separate the DCIS patient samples into those with a lot of cancer stem cells - which are highly aggressive - and those that resembled benign tumors. They found 22 percent of the samples had low scores suggestive of very slow-growing, non-aggressive disease.

    "This approach is going to be a new and powerful one. It works because we're looking at it mathematically," Petty says. The results are published in the Nature journal Scientific Reports.

    Ratio imaging microscopy was used in the 1990s to look at calcium signals. Here, the researchers resurrected this technique and applied it using antibodies and biomarkers.

    Biomarkers were selected based on an extensive literature search. The researchers suggest that another advantage to BRIM is that it combines multiple biomarkers, rather than relying on a single marker.

    Rates of ductal carcinoma in situ have increased since screening mammography became common. Some experts believe that DCIS can become invasive breast cancer, but this has not been proven. Currently, there is not a way to stratify the disease based on aggressiveness.

    The researchers suggest that in addition to preventing overtreatment, BRIM could be used to help more broadly with  treatment decisions. As the biomarker literature becomes more expansive in other cancer types, the researchers say they will expand their work to other forms of cancer.

    They plan to conduct a large retrospective study correlating BRIM scores to patient outcomes.

    Explore further: Potential for prediction of progression for early form of breast cancer

    More information: Andrea J. Clark et al, Identification of lesion subtypes in biopsies of ductal carcinoma in situ of the breast using biomarker ratio imaging microscopy, Scientific Reports (2016). DOI: 10.1038/srep27039 


  • July 01, 2016 10:39 AM | Ashley Monson (Administrator)

    The following training resources on the Zika virus and related topics are provided for health professionals. This list is not inclusive of all resources, but instead highlights key CDC training opportunities and websites.

    Clinician Outreach and Communication Activity (COCA) Calls/Webinars

    Morbidity and Mortality Weekly Reports (MMWR)

    This button links to a page on the MMWR website with a list of all published Zika-related reports. Continuing education is available for all MMWR reports.

     CDC MMWR Zika button

    Zika Video Resources

    Doctor Cono's interview on Platform Q Health: A CDC Update for Clinicians on Zika Virus Disease

    A CDC Update for Clinicians on Zika Virus Disease

    Dr. Joanne Cono, MD, ScM, Director of the Office of Science Quality of the CDC gave a live presentation regarding the latest Zika information available and answered a myriad of questions from your fellow health care practitioners.

     Screenshot of Matt Karwowski, MD MPHZika for Pediatricians: Critical Update

    Dr. Matt Karwowski, a pediatrician with the Pregnancy and Birth Defects Team for CDC's 2016 Zika Virus Response, reviews what we know about Zika virus and congenital microcephaly and other birth defects. He also discusses CDC's guidelines for healthcare providers caring for infants and children with possible Zika virus infection.

     Screenshot of a medscape video featuring Dr. Obuyebo.Medscape Expert Commentary: Advising Pregnant Women About Zika

    Dr. Titilope Oduyebo, an obstetrician-gynecologist from CDC’s Pregnancy and Birth Defects team, gives key insight into the Zika virus. She discusses what we know about Zika virus infection during pregnancy, and reviews CDC’s current recommendations for screening, testing, and management of women with possible Zika virus exposure.

    CDC TRAIN

    CDC TRAIN provides free access to thousands of courses, more than 1,000 of which were developed by CDC programs and funded partners. Courses in CDC TRAIN are available on a wide array of public health and health care topics and in a variety of formats, including classroom training, webinars, and online self-study options. Many offer free continuing education.

    This link  takes you to a search listing of training activities on CDC TRAIN related to Zika and other mosquito-borne viruses, including dengue, chikungunya, and malaria.

    Disclaimer: Training found through a search of the TRAIN.org website is made available as a public service. Web pages, training, and programs from non-federal organizations are provided solely as a service. These links do not constitute an endorsement by Centers for Disease Control and Prevention (CDC). Only courses offered by CDC Course Providers have been verified and approved by CDC.



  • July 01, 2016 7:52 AM | Ashley Monson (Administrator)

    BY REYNA GOBEL

    (Reuters Health) – Stretching just 10 minutes a day might help ease menopause and depression symptoms in middle-aged women, a small study suggests.

    “Light-intensity exercises such as stretching have not been previously evaluated for its impact on menopausal and depressive symptoms,” lead researcher Yuko Kai told Reuters Health by email.

    Forty Japanese women, ages 40 to 61 years, participated in the study at the Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare in Tokyo.

    Twenty of the women were randomly assigned to stretch 10 minutes a day before bedtime for three weeks. The other 20 were instructed to remain sedentary before bed.

    The research team evaluated the women’s menopausal symptoms using 10 questions about vasomotor symptoms (such as hot flashes and chills), psychological symptoms (including mood and sleep disturbances) and body aches.

    They used a separate set of questions to evaluate symptoms of depression.

    At the start, the groups were generally similar. More than half the participants were postmenopausal and nearly two-thirds had depression. Most of the women were not physically active.

    On average, the stretching group stretched about five days per week.

    Overall, the women in the stretching group had improved scores on both sets of questions after the three-week study period, compared to the group that didn’t stretch before bed.

    The frequency of hot flashes wasn’t different in the two groups, however.

    While stretching before bed isn’t a bad idea, Dr. JoAnn Pinkerton, executive director of The North American Menopause Society, told Reuters Health by email, “it is impossible to tell if the positive effect found from stretching on menopausal and depressive symptoms was due to the stretching, the increased movement, or not doing whatever they normally do during the 10 minutes before bed such as eat, smoke or drink, etc.”

    Pinkerton said the results would have been more interesting if the comparison group had been assigned a task to do before bedtime, to see if it was the stretching itself that was helpful or just the fact of doing something before bed.

    In most studies of methods for reducing hot flashes, the placebo group sees some improvement, too, she pointed out. In this trial, the comparison group had no improvement at all, which means, she said, that it was not an adequate control group.

    For more conclusive results, Pinkerton said, "this study needs to be replicated with larger, more diverse postmenopausal women with an active control group.”

    In the meantime, she added, women should remember that “being sedentary has been shown to be bad for (their) physical and mental health and to increase hot flashes. Being active every day has been shown to lessen severity of hot flashes, improve mood, coping ability and may decrease (their) risk of cognitive loss."

    Additionally, Pinkerton said, "if women were to exercise with light walking 30 minutes daily and then stretch for 10 minutes, they might improve health, menopausal symptoms, mood and cognition and, if stretching helps sleep, improve their sleep quality.”

    SOURCE: bit.ly/29dLbYQ Menopause, online June 13, 2016.


  • July 01, 2016 7:52 AM | Ashley Monson (Administrator)

    THURSDAY, June 30, 2016 (HealthDay News) -- Women with a gene mutation known as BRCA1 have an increased risk for a deadly form of uterine cancer, a new study finds.

    The BRCA1 gene mutation is already well known for significantly increasing the risk of breast and ovarian cancers. In fact, the risk is so high that some women consider having both breasts, as well as their ovaries, removed to prevent breast and ovarian cancers, the researchers noted.

    This latest study is the first to find a conclusive link between the mutation and a slight increase in the odds of developing an aggressive uterine cancer, the researchers said.

    The study authors looked at data from nearly 1,100 U.S. women with BRCA1 or BRCA2 mutations. The women were from the United States and the United Kingdom. Their health was followed for a median of about five years. BRCA2 also raises the risk of breast and ovarian cancers, according to the U.S. National Cancer Institute.

    During the research period, eight of the women in the study were diagnosed with uterine cancer, a rate that's slightly higher but not statistically different than for women in the general population.

    However, five of those cancers were an uncommon and highly aggressive type called serous endometrial cancer. Four out of five of those cancers occurred in women with the BRCA1 mutation, the study showed.

    "We were surprised when we saw the data," study author Dr. Noah Kauff, head of the Clinical Cancer Genetics Program at the Duke Cancer Institute, said in a university news release.

    "This is an event that should not occur in the over 600 women with BRCA1 mutations in our study. Even if we followed these women for 25 years, you would only expect to see no more than one serous cancer," he explained.

    The study was published online June 30 in the journal JAMA Oncology.

    The findings could help women with the BRCA1 mutation and their doctors make treatment decisions, the researchers said.

    "Our findings suggest that it may be important for women with BRCA1 mutations to consider removing their uterus at the time they are considering removing their ovaries and fallopian tubes, unless they are hoping to still have children using assisted reproductive methods or have other medical reasons," Kauff said.

    But, if women have already had surgery to remove their breasts, ovaries and fallopian tubes, the benefit of having another surgery to remove the uterus is less clear, the researchers said.

    Kauff said that more studies need to be done to see whether or not a 3 to 5 percent risk of serous uterine cancer over 25 years justifies the costs and potential complications of a second surgery.

    More information

    The U.S. Office on Women's Health has more on uterine cancer.

    SOURCE: Duke University, news release, June 30, 2016

    -- Robert Preidt

    Last Updated: Jun 30, 2016

    Copyright © 2016 HealthDay. All rights reserved.


  • June 30, 2016 9:38 AM | Ashley Monson (Administrator)

    Webinar: Practical Approaches for Zika Preparedness and Response

    Join PHF and the Bio-Defense Network on Wednesday, July 27, 2016 from 1-2pm ET for a webinar focused on preparedness and response to the Zika Virus. The webinar will include information and resources from two local health departments who are addressing mosquito surveillance and control. They will share what practical and replicable efforts they are carrying out in their communities to prepare for and respond to Zika. Quality improvement methods and processes such as self-assessments, project plans, and the Vector Control Population Health Driver Diagram will also be shared. Register today

    www.phf.org


  • June 30, 2016 8:40 AM | Ashley Monson (Administrator)

    By Lisa C. Richardson, MD, MPH
    Director of CDC’s Division of Cancer Prevention and Control

    As a doctor, I am the go-to person my friends rely on when they have a medical question. A good friend recently said to me, “I’m so overwhelmed by all of the health advice out there that I tend to just tune it all out.” She went on to say that every time she turns around, she hears something else that women should do to stay healthy: get a mammogram, get your Pap smear, get a colonoscopy, don’t smoke, exercise, get more sleep, get a flu shot, eat more kale, get a whooping cough vaccine (pertussis booster vaccine)…and I think you get her point. I certainly did.

    This got me thinking. As a woman, an oncologist, and the director of CDC’s Division of Cancer Prevention and Control, I can help. I don’t want you ignoring anything that may help you stay healthy…and alive!  To help lighten the load, I’ve created your very own cheat sheet for cancer screenings and good health. CDC supports screening for breast, cervical, colorectal (colon), and lung cancers as recommended by the U.S. Preventive Services Task Force.

    I’ve started your cheat sheet off with the screenings (checking your body for a disease before you have symptoms) that are available for some of the cancers that most often affect women. But I challenge you to add to it with your doctor’s recommendations for further screenings or tests based on your own health, family history, and age. Download this printable fact sheet [PDF-106KB] to take to your next appointment.

    Your Cheat Sheet to Cancer Screenings and Good Health

    Type of Cancer Screening Method When to Get Screened*
    Breast cancer Mammogram If you are 50 to 74 years old, get a screening mammogram every two years.
    Cervical cancer (two choices) Pap test (Pap smear) only If you are 21 to 65 years old, you can get a Pap test every three years.
    HPV test (combined with Pap test) Or if you are 30 to 65 years old, you can get a Pap test and an HPV test every five years.
    Colorectal (colon) cancer Colonoscopy, sigmoidoscopy, or fecal occult blood testing (FOBT) If you are 50 to 75 years old, get tested. The schedule depends on the type of test used.
    Lung cancer Low-dose CT scan If you are 55 to 80 years old and are a heavy smoker or a past smoker who quit within the last 15 years, get a low-dose CT scan every year.

    *Talk with your doctor about when and how often you should be screened. Depending on your personal health history, family health history, or screening results, your doctor may recommend a different screening schedule.

    Printable Cheat Sheet for Women’s Cancer Screenings and Good Health


    Printable Cheat Sheet for Women’s Cancer Screenings and Good Health [PDF-106KB]

    I hope this cheat sheet helps you understand the different types of cancer screenings that are available to women. But remember, there’s more to your health than just cancer screenings. While I challenge you to make that mammogram appointment, I also encourage you to schedule a well-woman exam with your doctor every year. At this appointment, you can talk about your family history and ask about additional screenings or exams you may need for other diseases or conditions such as diabetes, osteoporosis, high blood pressure, or cholesterol.

    And like any good doctor, I want to remind you of some simple things you can do every day to stay healthy:

    • Maintain a healthy weight.
    • Exercise regularly.
    • Get plenty of rest.
    • Don’t drink alcohol, or limit it to one drink a day.
    • Don’t smoke.

    As I get older and watch my family and friends age beside me, I see how important good health is. It sounds so easy, right? But as a working mom, wife, and daughter, I know how many different directions you are pulled in every day. But remember, the best gift you can give the people who care about you is a healthy you.

    Put YOU at the top of your to-do list today so that you can give yourself the best chance of preventing or overcoming something that doesn’t have to overcome YOU.

    Lastly, to all of you fighting cancer or caring for someone who is fighting this battle, I encourage you to take steps to stay as healthy as you can during treatment. For more information, visit CDC’s Preventing Infections in Cancer Patients Web sitefor staying healthy during cancer treatment and 3 Steps Toward Preventing Infections During Cancer Treatment  from the CDC Foundation.



  • June 30, 2016 8:37 AM | Ashley Monson (Administrator)

    On May 31, 2016, this report was posted online as an MMWR Early Release.

    Ingrid B. Rabe, MBChB1; J. Erin Staples, MD, PhD1; Julie Villanueva, PhD1; Kimberly B. Hummel, PhD1; Jeffrey A. Johnson, PhD1; Laura Rose; MTS1; Susan Hills, MBBS1; Annemarie Wasley, ScD1; Marc Fischer, MD1; Ann M. Powers, PhD1 (View author affiliations)

    Summary

    What is already known about this topic?

    Zika virus is a mosquito-borne flavivirus closely related to dengue, West Nile, Japanese encephalitis, and yellow fever viruses. Diagnostic testing for Zika virus infection can be accomplished using both molecular and serologic methods. However, results of Zika virus antibody testing can be difficult to interpret because of cross-reactivity with related flaviviruses, which can preclude identification of the specific infecting virus, especially when the person previously was infected with or vaccinated against a related flavivirus.

    What is added by this report?

    For persons with suspected Zika virus disease, a positive real-time reverse transcription–polymerase chain reaction (rRT-PCR) result confirms Zika virus infection, but a negative result does not exclude infection. In these cases, antibody testing can identify additional recent Zika virus infections. If immunoglobulin (Ig) M test results are positive, equivocal, or inconclusive, performing a plaque reduction neutralization test (PRNT) is needed to confirm the diagnosis. However, recent evidence suggests that a 4-fold higher titer by PRNT might not discriminate between anti-Zika virus antibodies and cross-reacting antibodies in all persons who have been previously infected with or vaccinated against a related flavivirus. Thus, a more conservative approach to interpreting PRNT results is now recommended to reduce the possibility of missing the diagnosis of either Zika or dengue virus infection.

    What are the implications for public health practice?

    All patients with clinically suspected dengue should receive appropriate management to reduce the risk for hemorrhagic medical complications. Pregnant women with laboratory evidence of a recent Zika virus infection or flavivirus infection should be evaluated and managed for possible adverse pregnancy outcomes and reported to the appropriate Zika virus pregnancy registry. Health care providers should consult with state or local public health authorities for assistance in interpreting test results.


    Zika virus is a single-stranded RNA virus in the genus Flavivirus and is closely related to dengue, West Nile, Japanese encephalitis, and yellow fever viruses (1,2). Among flaviviruses, Zika and dengue virus share similar symptoms of infection, transmission cycles, and geographic distribution. Diagnostic testing for Zika virus infection can be accomplished using both molecular and serologic methods. For persons with suspected Zika virus disease, a positive real-time reverse transcription–polymerase chain reaction (rRT-PCR) result confirms Zika virus infection, but a negative rRT-PCR result does not exclude infection (37). In these cases, immunoglobulin (Ig) M and neutralizing antibody testing can identify additional recent Zika virus infections (6,7). However, Zika virus antibody test results can be difficult to interpret because of cross-reactivity with other flaviviruses, which can preclude identification of the specific infecting virus, especially when the person previously was infected with or vaccinated against a related flavivirus (8). This is important because the results of Zika and dengue virus testing will guide clinical management. Pregnant women with laboratory evidence of Zika virus infection should be evaluated and managed for possible adverse pregnancy outcomes and be reported to the U.S. Zika Pregnancy Registry or the Puerto Rico Zika Active Pregnancy Surveillance System for clinical follow-up (9,10). All patients with clinically suspected dengue should have proper management to reduce the risk for hemorrhage and shock (11). If serologic testing indicates recent flavivirus infection that could be caused by either Zika or dengue virus, patients should be clinically managed for both infections because they might have been infected with either virus.

    Rabe IB, Staples JE, Villanueva J, et al. Interim Guidance for Interpretation of Zika Virus Antibody Test Results. MMWR Morb Mortal Wkly Rep 2016;65. DOI: http://dx.doi.org/10.15585/mmwr.mm6521e1 .

    For the full report, click here.


  • June 29, 2016 10:13 AM | Ashley Monson (Administrator)

    Two candidates provided protection after just one dose; clinical trials planned for later this year


    TUESDAY, June 28, 2016 (HealthDay News) -- Experimental studies support the effectiveness of two vaccine candidates against the Zika virus, according to research published online June 28 in Nature.

    This "critical first step" is leading to trials in monkeys and humans, "and gives us early confidence that development of a protective Zika virus vaccine for humans is feasible," said researcher Col. Nelson Michael, M.D., Ph.D., of the Walter Reed Army Institute of Research (WRAIR) in Silver Spring, Md., and one member of a team involved in the search for a vaccine against the virus.

    One of the new vaccines was developed at Harvard Medical School in Boston and is partly based on a Zika strain isolated in Brazil. The other vaccine, using a strain isolated in Puerto Rico, has been developed by Michael's team at WRAIR. Both vaccines shielded mice against Zika infection with just a single dose required, the researchers said. The two vaccines are similar to others already in use against flaviviruses, which include dengue fever, West Nile, and others. Clinical trials in humans are scheduled to begin later in 2016.

    "We showed that vaccine-induced antibodies provided protection, similar to existing vaccines for other flaviviruses," senior author Dan Barouch, M.D., Ph.D., of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston, said in a center news release. "The effectiveness of these vaccines, the clarity of the antibody protection, and the similarity to successful vaccines that have been developed for other flaviviruses provide substantial optimism for a clear path forward for the development of a safe and effective Zika virus vaccine for humans."

    Full Text



    Copyright © 2016 HealthDay. All rights reserved.


  • June 29, 2016 10:08 AM | Ashley Monson (Administrator)

    THURSDAY, April 29 (HealthDay News) -- The daughters of women who suffered from a severe form of morning sickness are three times more likely to be plagued by it themselves, Norwegian researchers report.

    This form of morning sickness, called hyperemesis gravidarum, involves nausea and vomiting beginning before the 22nd week of gestation. In severe cases, it can lead to weight loss. The condition occurs in up to 2 percent of pregnancies and is a common cause of hospitalization for pregnant women. It is also linked with low birth weight and premature birth, the researchers said.

    The new study suggests "a strong influence of maternal genes" on the development of the condition, said lead researcher Ase Vikanes, a graduate student at the Norwegian Institute of Public Health in Oslo.

    "However, environmental influences along the maternal line, shared risk factors such as life styles reflected in BMI (body mass index) and smoking habits, infections and nutrition might also be contributing to the development of hyperemesis gravidarum," she added.

    The report is published in the April 30 online edition of the BMJ.

    According to Vikanes, hyperemesis gravidarum was once thought to be caused by psychological issues, "such as an unconscious rejection of the child or partner." But her team wanted to see if genetics was actually the culprit.

    For the study, Vikanes's team collected data on 2.3 million births from 1967 to 2006. They tracked the incidence of hyperemesis gravidarum in more than 500,000 mother-daughter pairs and almost 400,000 mother-son pairs.

    They found that if a mother had the condition, her daughter was three times more likely to develop it as well. However, there is no increased risk to the female partners of men whose mothers suffered through it.

    Vikanes hopes the finding adds new insight into this condition. Besides helping to illuminate possible causes, "our findings might help health care personnel who treat and counsel women with a family history of hyperemesis gravidarum," she said.

    Brad Imler, president of the American Pregnancy Association, said that "hyperemesis gravidarum is a serious condition that creates health risks for both the mother and the baby. "Research into the causes and treatments of this condition are essential for discovering ways to alleviate the condition along with the health risks related to it," he said.

    Imler cautioned that a three-fold increase in risk is not something that should cause fear among pregnant women. That "means going from 1 in 100 to 3 in 100 incidences," he noted.

    Genetics appears to have a relationship with the condition, Imler said. "However, it would be important to have further research that controlled for environmental factors, dietary intake, and lifestyle habits, which also tend to be carried on from one generation to the next," he added.

    Dr. Gene Burkett, a professor of obstetrics and gynecology at the University of Miami Miller School of Medicine, said that, "for a long time we have thought there is a familial component, and this gives us the first real information on which we can say, 'Yes, there seems to be something that we need to pursue.'"

    However, Burkett said that the results need to be replicated in different populations before one can be sure the link is genetic.

    More information

    For more information on morning sickness, visit the U.S. National Library of Medicine.


  • June 29, 2016 9:15 AM | Ashley Monson (Administrator)

    The U.S. Preventive Services Task Force seeks comments on a draft recommendation statement and draft evidence review on screening for gynecologic conditions with pelvic examination. After reviewing the evidence, the Task Force concluded that there is not enough evidence to determine the benefits or harms of performing screening pelvic exams in asymptomatic, nonpregnant adult women. The draft recommendation statement and draft evidence review are available for review and public comment from June 28 to July 25.

    Read more.

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