Pap or HPV: Best Test for Cervical Cancer?

Pap tests or HPV or both, is the question when it comes to testing for cervical cancer. Researchers from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) say that while the merits of screening tests and screening intervals warrant further discussion, they firmly believe that increasing the number of women who participate in cancer screenings and ensuring that women are not lost to follow-up with lengthened screening intervals is more important than the choice of test to decrease rates of cervical cancer.
 

In a commentary in this week's issues of Annals of Internal Medicine, Drs. Rebecca Perkins and Elizabeth Stier provide insight into the benefits and limitations of cervical cancer screening discussing the advantages, disadvantages and questions related to screening with Pap tests only, HPV tests only, or Pap and HPV tests together.The Pap test has been considered a cornerstone of women's health for more than 60 years. In a new era of cervical cancer prevention, the FDA in 2014 approved the Cobas HPV test as the primary screening tool for cervical cancer for women aged 25 and older. However, questions remain regarding how HPV testing alone will be recommended for screening. 

The researchers say, testing with both Pap and HPV together (co-testing), detects the most cervical pre-cancer, but the improvement over HPV testing alone is small. "A single Pap test does not provide good protection against cancer, but repeat testing every three years has been shown to effectively reduce cancer rates, and it is the only method for which long term data are available," explained co-author Rebecca Perkins, MD, MSc, assistant professor of Obstetrics and Gynecology at BUSM and a gynecologist at BMC. Questions remain however regarding the cost of each test, and how often women will be asked to be screened. 

"We also must remember that the majority of cervical cancers occur in women who have not had any recent screening and that increasing HPV vaccination rates will also be important to reducing cervical cancer rates in the future," she added. 

Source:Annals of Internal Medicine, 

How much testosterone is too much for women after menopause?

CLEVELAND, Ohio (June 10, 2014)—Testosterone supplementation for women is a hot topic. A new pharmacokinetics study of a brand of testosterone cream for women approved in Western Australia has been published online in Menopause, the journal of The North American Menopause Society (NAMS). For women after menopause, it took 5 mg, the lowest dose of this product, to raise testosterone back to a premenopause level.
"In the United States we do not yet have an approved testosterone product designed for women," says NAMS Executive Director Margery Gass, MD. "As a result, American women sometimes rely on custom-compounded testosterone prescriptions that may deliver much higher doses than the Australian product and raise women's testosterone to levels higher than normal, potentially producing untoward side effects." According to Dr. Gass, there are no long-term studies of the effects of testosterone treatment on women's overall health. We do know that too much testosterone in a woman's body may result in excess body hair, acne, male-pattern hair loss, enlarged clitoris, deeper voice, liver damage, unhealthy changes in cholesterol, depression, aggression and more. And, the voice changes and clitoral enlargement may be irreversible.
Researchers from Monash University in Melbourne and the University of South Australia in Adelaide tested two different doses of the testosterone cream product known as AndroFeme (5 mg and 10 mg doses). After 21 days of daily administration, the 5-mg dose brought postmenopausal women's peak blood levels of total testosterone right into the normal premenopausal range—with a peak slightly above the upper limit of the premenopause normal and 24-hour average to slightly below the limit. The 10-mg dose raised testosterone levels to a higher peak but only somewhat higher than the norm (50%) over 24 hours.
"Since custom-compounded formulations are not FDA approved and are not routinely checked for dose content, it is difficult to know how a given formulation will affect women's testosterone levels. Women should be cautious about what dose of testosterone they are receiving and whether they really need it." advises Dr. Gass.
Source:Menopause

Study Finds No Evidence Regular Breakfast Helps in Weight Loss

Researchers at University of Alabama at Birmingham reveal they have found no evidence that regularly eating a full breakfast every day influences weight loss or weight maintenance compared to regularly skipping breakfast.
 

Past breakfast research, including an examination of 92 studies about the proposed effect of breakfast on obesity also performed at UAB, has found that, while an association exists between breakfast and weight management, the question of whether eating versus skipping breakfast causes differences in weight has not been answered by research, until now. 

The new study, published in the American Journal of Clinical Nutrition, examined the impact of a recommendation to eat or skip breakfast, and the impact of switching breakfast eating habits for the study, on weight loss in adults trying to independently lose weight. 

Study lead author Emily Dhurandhar, Ph.D., assistant professor in the Department of Health Behavior, says it was important to test the common recommendation to eat breakfast to ensure this public health message was effective and not misleading about what will and will not help with their weight loss efforts. 

"Previous studies have mostly demonstrated correlation, but not necessarily causation," Dhurandhar said. "In contrast, we used a large, randomized controlled trial to examine whether or not breakfast recommendations have a causative effect on weight loss, with weight change as our primary outcome." 

This multisite, 16-week trial enrolled 309 otherwise healthy overweight and obese adults, 20-65 years old. Experimental groups were told to eat or skip breakfast. The control group, consisting of breakfast eaters and skippers, was simply provided healthy nutrition information that did not mention breakfast. 

Dhurandhar says that there was no identifiable effect of treatment assignment on weight loss. 

"Now that we know the general recommendation of 'eat breakfast every day' has no differential impact on weight loss, we can move forward with studying other techniques for improved effectiveness," Dhurandhar said. "We should try to understand why eating or skipping breakfast did not influence weight loss, despite evidence that breakfast may influence appetite and metabolism." 

There were several study limitations, Dhurandhar notes. 

First, the study only measured body weight as an outcome, so she says they cannot conclude anything about the impact of breakfast recommendations on appetite or more detailed measures of body fat or metabolism. 

"In addition, our study was 16 weeks in duration, which is longer than many previous studies; but it is not clear whether an effect of the recommendation would be clearer from an even longer duration study," Dhurandhar said. "Finally, we gave subjects a recommendation of what a healthy breakfast is, but left their choices of breakfast foods up to their discretion." 

Dhurandhar says because their objective was to test the effect of breakfast very generally, they cannot conclude anything about a particular kind or quantity of breakfast food, but says there may be certain kinds of breakfast foods that are helpful. She believes future studies could consider whether more specific breakfast recommendations may be more effective for influencing weight loss. 

"The field of obesity and weight loss is full of commonly held beliefs that have not been subjected to rigorous testing; we have now found that one such belief does not seem to hold up when tested," said David Allison, Ph.D., director of the UAB Nutrition Obesity Research Center and senior investigator on the project. "This should be a wake-up call for all of us to always ask for evidence about the recommendations we hear so widely offered." 

Other study sites in addition to UAB included the University of Copenhagen, Boston Medical Center, Columbia University, and University of Colorado, Denver. 

About UAB
Known for its innovative and interdisciplinary approach to education at both the graduate and undergraduate levels, the University of Alabama at Birmingham is an internationally renowned research university and academic medical center and the state of Alabama's largest employer, with some 23,000 employees and an economic impact exceeding $5 billion annually on the state. The five pillars of UAB's mission deliver knowledge that will change your world: the education of students, who are exposed to multidisciplinary learning and a new world of diversity; research, the creation of new knowledge; patient care, the outcome of 'bench-to-bedside' translational knowledge; service to the community at home and around the globe, from free clinics in local neighborhoods to the transformational experience of the arts; and the economic development of Birmingham and Alabama. Learn more at /www.uab.edu. 

EDITOR'S NOTE: The University of Alabama at Birmingham is a separate, independent institution from the University of Alabama, which is located in Tuscaloosa. Please use University of Alabama at Birmingham on first reference and UAB on all subsequent references. 
 

Herbs that Reduce Anxiety and Depression

For every disease we know Mother Earth provides a herb to health and grow.’ 
Mother Earth has provided herbs to cope with anxiety and depression ‘diseases’ as well. Anxiety and depression are the two most commonly reported psychiatric conditions and they generally occur together in a person. Both conditions are recurring or chronic and may require long term treatment. 
Although conventional drug therapies for the disorders are easily available, financial, cultural, or personal reasons may cause the individual to seek alternative therapies. Herbs and herbal products may be slower acting than conventional drugs but they provide an inexpensive, effective way to treat the root cause of the disease rather than treat just the symptoms. 

The following herbs are effective to a certain degree in reducing (sometimes curing) anxiety and depression.
Holy basil (tulasi, Ocimum sanctum) - Holy basil soothes and calms the nerves, according to the Indian traditional medicine. Research too has confirmed the fact that basil helps with anxiety disorders. For example, a study of 35 people given 500mg per capsule of tulasi twice a day for two months showed not only a significant reduction in their generalized anxiety disorders but attenuation of its correlated stress and depression too. No wonder, tulasi is one of the ingredients in Manasamitra Vataka, an Ayurveda formulation that treats anxiety disorders.  
Kava (Piper methysticum) - Kava has also been proved effective in treating anxiety. Number of studies have shown anxiolytic (reducing anxiety) effects of kava to be superior to that of placebo. Actually, it is the only herb that is demonstrably effective in reducing anxiety. However, use it cautiously since kava has adverse effects such asliver damage. Kava is also known to interact with levodopa and alprazolam causing extrapyramidal symptoms or lethargy.

Lemon balm (Mellissa officinalis) - Also known as sweet balm, this lemon-scented herb is found worldwide.   A study published in the 2004 issue of Psychosomatic Medicine revealed that lemon balm administered to people during gave short-term anxiolytic effects to them. A more recent study found that rosmarinic acid in the leaf extract gave the plant its anxiolytic and anti-depression effects. It acted by increasing the GABA levels in the brain thus reducing anxious behavior. The researchers of this study made an interesting observation; they found that the effect of lemon balm extract was significantly higher in female lab animals than in males. Males required the highest dose to have the same effect.
 Passion flower (Passiflora incarnata) - Passion flower has been used since ages to reduce stress and anxiety. The whole plant except for the roots show anxiolytic activity. However, pharmacologic work on this plant are inadequate, so it is difficult to say how the herb acts to relieve anxiety. 

Chamomile (Matricaria recutita) - Chamomile is used as a traditional herbal remedy for its calming effect since the ancient Rome and Greek period. Studies too have established its function as an anxiolytic and anti-depressive agent. The mode of antidepressant action in chamomile is unknown but it is known to be independent of anxiolytic action. Some studies suggest that the flavonoids in chamomile exert an antidepressant effect by modulating the neurotransmission of noradrenalin, dopamine, serotonin, and GABA levels. 
 
Ginkgo (Ginkgo biloba) - Also called the maiden hair plant, Ginkgo has been used in Chinese traditional medicine for treating various health disorders. The extract is particularly helpful with concentration problems, depression, anxiety, dizziness, tinnitus and headaches. The herb apparently works by dilating blood vessels to increase blood flow, reducing blood viscosity, reducing free radicals in the body, and also by modifying neurotransmitter systems. Although some studies reported beneficial effects of Ginkgo at doses of less than 200mg per day for 12 weeks with no side effects, big trials showed inconsistent results. Other studies reported no benefits as regards anxiety and depression.   

Yarrow (Achillea millefolium) - Yarrow is a medicinal plant used in traditional medicine to treat gastrointestinal disorders, inflammation, anxiety and insomnia. A study done to investigate the effect of yarrow on acute and chronic anxiety disorder indicated that the herb exerted anxiolytic effect at doses that did not alter locomotor activity. Its behavior was similar to that of diazepam. 
St. John’s wort (Hypericum perforatum) - St John’s wort is the only herb that has shown beyond reasonable doubt to be effective as a treatment for mild and moderate depression. The active ingredient for the herb is hypericin and /or hyperforin that act by inhibiting serotonin reuptake and monoamine oxidase. Five trials involving more than 2200 people showed that St John’s wort acts more or less in a similar fashion as conventional antidepressants. However, evidence suggests that the herb is safe only for people who don’t take any other medication. A study even showed that the herb can trigger psychoses in people who concomitantly take SSRIs (Selective Serotonin Reuptake Inhibitors).

Lavender (Lavendula angustifolia) - Lavender is also a promising herbal remedy for depression. Trials compared lavender with imipramine and found both to be effective in a similar way. In fact, lavender oil therapy (inhalation or massage) is a very effective way to counter depression. A trial to investigate the anti-depressive effect of lavender found that adjuvant therapy of lavender tincture (1 : 5 in 50% alcohol; 60 drops/day) and imipramine (100 mg/daily) in patients suffering from mild-to-moderate depression led to a better and earlier improvement. Side effects of imipramine, such as dry mouth and urinary retention, were observed less often when lavender was administered with impramine. Trials have also found lavender to improve mood and reduce anxiety.

Saffron (Crocus sativus) - Widely cultivated in India (in Kashmir), Iran, and Greece, saffron is a useful remedy for a number of health disorders. The active ingredient, alpha-crocin, present in the red dried stigma of the herb is known to possess not only anxiolytic and anti-depressive qualities, but also has antihypertensive, anti-inflammatory, antioxidant, and relaxant activities and some studies even found tumoricidal properties. Studies have compared saffron to the antidepressive drug fluoxetine and found that saffron performed as well as fluoxetine in treating depression
 
Borage (Echium amoenum) - A study in mice has shown that borage flowers have anxiolytic effect with lower sedative effect as compared with diazepam. Further, tolerance to the extract was not observed after one week of its use.

 
 

Researchers Identify Prostate Cancer Biomarkers in Seminal Fluid

Researchers at the University of Adelaide have discovered that seminal fluid contains biomarkers for prostate cancer.Results of a study now published in the journal Endocrine-Related Cancer have shown that the presence of certain molecules in seminal fluid indicates not only whether a man has prostate cancer, but also the severity of the cancer. 

Speaking in the lead-up to Men's Health Week (9-15 June), University of Adelaide research fellow and lead author Dr Luke Selth says the commonly used PSA (prostate specific antigen) test is by itself not ideal to test for the cancer. 

"While the PSA test is very sensitive, it is not highly specific for prostate cancer," Dr Selth says. "This results in many unnecessary biopsies of non-malignant disease. More problematically, PSA testing has resulted in substantial over-diagnosis and over-treatment of slow growing, non-lethal prostate cancers that could have been safely left alone. 

"Biomarkers that can accurately detect prostate cancer at an early stage and identify aggressive tumors are urgently needed to improve patient care. Identification of such biomarkers is a major focus of our research," he says. 

Dr Selth, a Young Investigator of the Prostate Cancer Foundation (USA), is a member of the Freemasons Foundation Centre for Men's Health at the University of Adelaide and is based in the University's Dame Roma Mitchell Cancer Research Laboratories. 

Using samples from 60 men, Dr Selth and colleagues discovered a number of small ribonucleic acid (RNA) molecules called microRNAs in seminal fluid that are known to be increased in prostate tumors. The study showed that some of these microRNAs were surprisingly accurate in detecting cancer. 

"The presence of these microRNAs enabled us to more accurately discriminate between patients who had cancer and those who didn't, compared with a standard PSA test," Dr Selth says. "We also found that the one specific microRNA, miR-200b, could distinguish between men with low grade and higher grade tumors. This is important because, as a potential prognostic tool, it will help to indicate the urgency and type of treatment required." 

This research builds on previous work by Dr Selth's team, published in the British Journal of Cancer, which demonstrated that microRNAs in the blood can predict men who are likely to relapse after surgical removal of their prostate cancer. "We are excited by the potential clinical application of microRNAs in a range of body fluids," he says. 
 Source: journal Endocrine-Related Cancer 

Deadly Diseases Overlooked for too Long in the Developing World

A study reveals that decades of neglect have allowed infectious diseases to devastate the lives of thousands of people in the developing world.
 Researchers say three diseases in particular - anthrax, brucellosis and bovine tuberculosis - have failed to receive the official recognition and funding needed to combat them effectively. 

All three impact greatly on human and animal health in developing nations, posing a major threat to safe and plentiful food supplies. 

The disorders - known as zoonotic diseases - are spread between animals and humans. They are common in societies where poverty is widespread, and where people rely on animals for their livelihood. 

Researchers at the University of Edinburgh reviewed every meeting of the World Health Organization's decision-making body since its formation in 1948. 

Their findings reveal that the diseases have been neglected because they mostly arise in developing countries. Scientists say the diseases have been eliminated or brought under control in more developed countries, as simple and effective controls are available. 

Poor healthcare infrastructure in affected countries can often mean that thousands of sufferers are left un-diagnosed. This presents huge challenges to health professionals, policy makers and researchers in their efforts to combat the diseases. 

Scientists say the adoption of a multidisciplinary One Health approach - involving experts from a range of disciplines - could improve human and animal health and help to control the diseases. 

Findings from the study, funded by the European Commission, are published in the journal PLoS Neglected Tropical Diseases. 

Professor Sue Welburn, Director of the University of Edinburgh's Global Health Academy, who led the study, said: "It is extraordinary that in the 21st century we are failing to manage brucellosis and the other neglected zoonotic diseases that impact so severely on rural communities in developing economies when, for many of these diseases, the tools to manage them are well developed." 
 Source: journal PLoS Neglected Tropical Diseases. 

Environmental Toxins may Accelerate Aging Process

A new study conducted by researchers at University of North Carolina suggests that toxins present in the environment may be accelerating the aging process.
 According to the researchers, just 30 percent of the aging process could be attributed to genetic processes, which meant that the remaining 70 percent was caused by exposure to environment factors. The researchers conducted their study on a group of mice, exposing them to the environmental factors that affect aging, or gerontogens, such as cigarette smoke, UV light etc. 

The mice were then analyzed for accumulation of senescence, a biological process in which healthy cells are damaged and lose their ability to divide. The researchers found that mice exposed to cigarette smoke and UV light displayed accelerated aging compared to those that were obese or exposed to arsenic. The study has been published in the journal Trends in Molecular Medicine. 

"The rate of physiologic, or molecular, aging differs between individuals in part because of exposure to 'gerontogens' - environmental factors that affect aging. By identifying and avoiding gerontogens, we will be able to influence ageing and life expectancy at a public health level", Dr Sharpless said. 
 Source:University of North Carolina