October is Breast Cancer Awareness Month!
Posted by on October 13, 2009 - 9:06am

You may have noticed the NFL players wearing their pink gloves and shoes for Breast Cancer Awareness Month.  But did you know that breast cancer is the leading cause of cancer-related deaths in American women?  It is caused by abnormal cell growth in the breast tissue, usually beginning in the milk-producing ducts.  The abnormal growth may spread (metastasize) through your breast to your lymph nodes, or other parts of your body.
Picture 3The most common symptom of breast cancer in both men and women is a lump in the breast, which is usually painless.  Most breast lumps are non-cancerous, but it is still important to have any lumps evaluated by a physician.  Other symptoms of breast cancer include clear or bloody discharge from the nipple, change in breast size or shape, retraction or indentation of the nipple and skin around the breast. Treatment for breast cancer often involves surgery, radiation therapy, and/or chemotherapy.  A variety of surgical techniques are available depending on the size of the lump or tumor.

The good news is there are many resources for breast cancer treatment and research at Northwestern!

The Lynn Sage Cancer Research Foundation in partnership with Northwestern Memorial Hospital and the Robert H Lurie Comprehensive Cancer Center has established the Lynn Sage Breast Cancer Program to provide women with access to the latest advances and technology in breast cancer treatment.  The center offers clinical, diagnostic, rehabilitation and counseling services at a single location.

Northwestern Memorial Hospital also offers breast reconstruction surgery for patients who have undergone lumpectomy or mastectomy or who have other cancer-related deformities.  Dr. Neil Fine, a plastic surgeon at NMH has developed an innovative technique as an alternative to total mastectomy.  The technique involves repositioning portions of the latissimus dorsi into the breast where a tumor has been removed.  Only a handful of other hospitals across the country are offering this procedure.

http://www.nmh.org/nmh/home.htm

IWHR Highlighted Researcher
Dr. Seema A. Khan M.D., is the Bluhm Family Professor of Cancer Research at Northwestern University’s Feinberg School of Medicine.  She is also the Director of the Bluhm Family Breast Cancer Early Detection and Prevention Program at Feinberg.  She received her medical degree from Dow Medical College in Pakistan and a Master’s in Epidemiology from the Harvard School of Public Health.  Dr. Khan is a board-certified surgeon whose research interests involve prevention, early detection and treatment of breast cancer. Currently she has multiple active clinical trials including a study designed to identify biomarkers for breast cancer risk in benign breast tissue.  Similarly, she is investigating the level of estrogen in nipple fluid as a marker for breast cancer risk.  Other recent studies include the development of a topical treatment for non-invasive breast cancer and the multi-center evaluation of a preventive breast cancer therapy for post-menopausal women taking Hormone Replacement Therapy.

Other Useful Links and Resources:
http://www.breastcancer.org/
http://www.cancer.gov/cancertopics/types/breast
http://www.nlm.nih.gov/medlineplus/breastcancer.html
http://www.komen.org/

“Illinois Women’s Health Registry: A Catalyst for Innovative Research”
Posted by on October 6, 2009 - 2:56pm

Institute for Healthcare Studies Seminar Series presents:

“Illinois Women’s Health Registry: A Catalyst for Innovative Research”

Sarah Bristol-Gould, PhD

Director of Research Programs

Institute for Women’s Health Research at Northwestern University

October 8th , 2009 from 12pm to 1pm.

Room 421, Wieboldt Hall, 340 E. Superior Street, Chicago, IL

This event is free and open to the public. (Lunch provided for attendees)

At the conclusion of this activity, participants will be able to:
1.       Describe why research needs to be designed to study and sex- and gender-determinants of health and disease.
2.       Understand how the Illinois Women’s Health Registry serves as an access point for information exchange between the research environment and community women.
3.       Explore how the Illinois Women's Health Registry serves as a catalyst for clinical research.

ACCREDITATION STATEMENT:  Northwestern University’s Feinberg School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.  Northwestern University’s Feinberg School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

DISCLOSURE:   Speaker does not intend to refer to products of a commercial company with which he/she is affiliated.

The following sponsor this Seminar Series:
● Institute for Healthcare Studies
● NorthShore/Center on Outcomes, Research and Education (CORE)
● The Buehler Center on Aging
● VA Center for Management of Complex Chronic Care (CMC3)
● RIC, Center for Rehabilitation Outcomes Research

This presentation will also be telecast to Hines VA, Bldg. 1, Room C-207.
For more information on this lecture, please contact Allan Doeksen at a-doeksen@northwestern.edu

Telomeres, grad students, and the Nobel Prize...?
Posted by on October 6, 2009 - 11:11am

At first glance, the items in the title of this entry don't make any sense together - what could lowly grad students possibly have to do with the Nobel Prize?!  But dig a little further and the connections become clear...

Yesterday, it was announced that a group of American scientists had received the Nobel Prize in medicine for their work on telomeres and their associated proteins.  Telomeres are short, repetitive DNA sequences that bind different proteins and essentially acts like a protective lid or a cap for the chromosomal ends.  As cells divide, telomeres become shorter - and when they become too short, the cell initiates its own death.  Therefore, telomeres are of great interest to scientists studying the process of aging and also cancer.  Drs. Elizabeth Blackburn and Jack Szostak were the first to discover telomeres, and Dr. Blackburn and her former graduate student, Dr. Carol Greider, identified the enzyme (telomerase) that makes new telomeres.  All three were awarded with the Nobel Prize.

As a woman in science, this event was also notable because it was the first time that more than one woman had received the Nobel Prize.  The pioneering research began in the late 1970s and 1980s, at a time where there were still few women in science.  I especially enjoyed this quote in the CNN article:

She also said telomere research has a higher proportion of women than other fields because in its early days, the lead researchers brought women into the field. She called it a situation in which "you have someone that trains a lot of women and then there's a slight gravitation of women to work in the labs with other women."

She added, "I think actively promoting women in science is very important because the data has certainly shown that there has been an underrepresentation. And I think that the things that contribute to that are very many ... subtle, social kinds of things."

In regards to women's health, telomeres have been of great interest to those developing and practicing assisted reproductive technologies (ARTs).  The chromosomes of a woman's eggs are capped by telomeres like any other cell.  In a study looking at IVF success rates, it was shown that there was a positive correlation between successful pregnancy and telomere length.  There may also be a link between telomeres and the age-related decline in a woman's fertility.  For example, artificially shortening telomeres in mice led to chromosomal defects identical to those that occur in eggs from women of an older age.  We have yet to see any therapeutic solutions come out of telomere research in a fertility context, but it is promising to know that scientists have gained a better understanding of why our eggs go "bad" as we get older.  Perhaps soon, it won't be such a burden to delay childbirth (for those who desire biological children) for the sake of establishing our lives and careers before starting a family!

Women's Health : Does Sex Matter? - A Seminar from Dr. Teresa Woodruff
Posted by on September 29, 2009 - 6:18pm

The Women’s Leadership and Mentoring Alliance, sponsored by the Institute for Women's Health Research presents:

"Women's Health -- Does Sex Matter?"

Wednesday, October 28, 2009, 5:00-6:00 pm

A reception will be held 30 minutes prior and following the discussion

Prentice Women’s Hospital, Harris Family Foundation Atrium - Third Floor

250 E. Superior Street Chicago, Illinois

Please join WLMA in welcoming Dr. Teresa K. Woodruff, PhD - Professor of Obstetrics & Gynecology at the Northwestern University Feinberg School of Medicine and Founder and Director of the Institute for Women’s Health Research.  Dr. Woodruff will discuss women’s health and the sex and gender dynamic that affects women and our relationship with medicine.

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Photo: Huge Galdones

Current knowledge about the interaction between sex and gender on health and disease is imperfect and only now evolving.  We now know that a person’s biological sex plays a predominant role in the cause, origin, beginning and subsequent progression of disease. In addition, gender, or one’s behavioral, cultural or psychological traits, influences risk profiles, symptom recognition, disease severity, and access to health education and quality care. We must ensure that sex and gender are studied at the most basic cellular and molecular level so that when studies are translated into clinical human studies, we already know the potential for different responses in men and women.  For example, unforeseen side effects can result when we introduce new drugs and treatments to humans without adequately studying them in both male and female animal models. Dr. Woodruff will share specific examples of why sex matters and we will learn what this means to us as patients, mothers, daughters, wives and caregivers.  We will have the opportunity to learn firsthand what is being done in the world of medical research to improve the lives of women.

Please join us and our esteemed speaker in this riveting discussion on women’s health. This event is free and open to the public.

Complimentary parking will be provided at the Huron/St. Clair garage, located at  222 East Huron Street.

Please RSVP for this program by Friday, October 23, 2009, by sending an email to womensleadership@mwe.com

Lynn Sage Breast Cancer Town Hall Meeting
Posted by on September 28, 2009 - 10:41am

“The Promises and Myths of Breast Cancer Research”

Sunday, October 4, 2009 from 1:00 p.m. until 4:00 p.m.

Fairmont Chicago, 200 N. Columbus Dr.

Do you have questions about breast cancer treatment options, family history, integrative medicine, diagnosis and support?  The Lynn Sage Breast Cancer Town Hall Meeting, hosted by the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, provides an opportunity to have your questions answered by experts, visit exhibits of breast cancer advocacy organizations and products, and to learn about local and national support services.

William Gradishar, M.D., Director of Breast Medical Oncology at the Lurie Cancer Center will moderate. Topics and panelists include:  Nora Hansen, MD--surgery, John Hayes, MD--radiation oncology, Virginia Kaklamani, MD--cancer genetics, Melinda Ring, MD--integrative medicine. This event is free and open to the public.

Please call 312-695-1304 or visit www.cancer.northwestern.edu to register.   Walk-ins welcome.  Discounted parking and free shuttle available from Erie/Fairbanks/Ontario Garage, 321 E. Ontario (Ontario St. exit).

Less Knee Injuries = Improved Athletic Performance for Female Adolescent Athletes
Posted by on September 23, 2009 - 11:18am
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Dr. Cynthia R. LaBella, MD

Dr. Cynthia R.  LaBella, MD, kicked-off the second year of the Women’s Health Research Monthly Forum, on September 22, 2009, by presenting her research on knee injuries in female adolescent athletes to an audience of over 150 professionals from the Northwestern community.  Dr. Labella is the Medical Director of the Institute for Sports Medicine at Children’s Memorial Hospital and Assistant Professor of Pediatrics at Northwestern University’s Feinberg School of Medicine.

The basis for Dr. LaBella’s research is that adolescent females are the fastest growing population participating in sports, but in turn are more frequently injured compared to boys and pre-pubescent girls.  The most common sites of injury for adolescent girls are the knee and ankle.  In particular, girls are 4 to 6 times more likely than boys to tear the anterior cruciate ligament (ACL).

Hormonal, anatomic, and neuromuscular control differences exist between boys and girls. These differences, have been studied, to determine why girls are at a greater risk of ACL injuries.  Hormonally, estrogen increases ligament laxity, yet this data has not been correlated with an increased risk of ACL injury.  Anatomically, females have a wider pelvis, smaller femur notch sizes, more knocked knees (genu valgum) and more inward twisting of the thigh bones (femoral anteversion), but, like the hormone data, this also has not been correlated with an increased risk of ACL injuries.

Dr. LaBella’s research focuses on the development and evaluation of neuromuscular training tasks to prevent knee injuries in adolescent girls.  Neuromuscular control is defined as muscle strength, nerve and muscle firing patterns, and the mechanics of landing and pivoting.  The neuromuscular sex differences associated with the knee appear at puberty when males begin producing increased amounts of testosterone; prior to puberty neuromuscular differences are not observed.  Research indicates that quadricep dominance, leg dominance, and ligament dominance are the significant differences between males and females that lead to a greater risk of ACL injuries in girls.

Dr. LaBella and her team of researchers at  Children’s Memorial Hospital developed and published a neuromuscular training program that included the elements of high-intensityprogressive plyometrics, proper technique feedback to athletes, and strength training.  This training program was implemented in 46 Chicago urban public high schools to study knee injuries considering the variables of race, coach compliance and injury rates. It was concluded that coaches can be trained to integrate the neuromuscular exercises into their practices.  In addition, these exercises can reduce lower extremity injuries in female soccer and basketball athletes.  This is a significant finding especially for populations who have limited access to medical care.

faurot-150wNow that Dr. LaBella has uncovered that neuromuscular exercises can prevent knee injuries, the challenge is to disseminate her findings to more high school coaches so the information can positively impact the ever-growing population of adolescent female athletes.  Dr. LaBella shared that approaching high school coaches with the notion that they will enhance the athletic performance of their athletes rather than stressing the prevention of  injuries is more convincing, and leads to better coach compliance with.respect to conducting the  neuromuscular exercises with their female athletes.  A non-ACL injured, healthy female athlete can spend more time on the field/court practicing their skills that will only contribute to a more successful team and season.

For more information about Dr. Cynthia LaBella and the Institute for Sports Medicine, please visit, http://www.childrensmemorial.org/depts/sportsmedicine/bios.aspx.

Autoimmunity Disorders and Gender
Posted by on September 22, 2009 - 12:48pm

The NIH has a pretty cool monthly podcast called “Pinn Point on Women’s Health,” which is hosted by Dr. Vivian Pinn, director of the NIH’s Office of Research on Women’s Health. For September, the topic was Autoimmune Disease in women (NIH summary and directions for downloading the podcast can be found here.)

The topic is fascinating! Autoimmune diseases are those where the body , for whatever reason, starts fighting its own cells with an immune response in the same way it would if the cells were a foreign invader (bacteria, virus etc). Women are more likely to get a whole host of autoimmune diseases than men are, including multiple sclerosis, rheumatoid arthritis, and lupus. Apparently, out of all the people suffering from auto-immune diseases in the US, 80% are female. That’s a phenomenal bias for a condition that, on the surface at least, has no clear tie to gender. According to the research (great review here), our increased risk of getting these diseases is simply our great immune systems working against us. Apparently, our immune systems are so great that we’re less prone to infection and have a much greater antibody response to those little invaders that do get in. Unfortunately, our systems are so strong that they also tend to go into overdrive, leading to this attack of our own bodies. The culprits (or overachieving heroes, depending on how you look at it), are likely exactly what you’d expect: hormones or chromosomal influences. The hormone research actually shows that during pregnancy, women's immune systems switch to a far less aggressive regimen, likely to avoid attacking the fetus as an invader. This decreased immunity is the reason for the increased risk of pregnant women getting the flu that Alison mentioned, but it’s also the reason that many pregnant women notice a decrease in their symptoms of autoimmune disorders. I actually have/had a condition called tranverse myelitis, which is thought to be an autoimmune disorder; I also very rarely catch the normal seasonal bugs that float around the office, and I don’t think I’ve ever had the flu (knock on wood!). It’s kind of amazing to think that both the bad and the good stem from the same source: an incredibly strong immune system! Anyone else notice that same thing in his/her self, or anyone they know with autoimmune disorders?

H1N1 and pregnancy: what you should know
Posted by on September 17, 2009 - 10:08pm

The H1N1 flu, better known by its alias "swine flu," is still wreaking havoc around the world.  Everyone is understandably concerned.  Every time I am on the phone with my parents and let out something with the slightest resemblance to a cough, they command me to go see a doctor immediately and have the H1N1 test administered.   The most recent report released by the Center for Disease Control and Prevention (CDC) stated that flu activity has begun increasing again.  If you look at their actual data, however, it is a little comforting to see that the number of H1N1-positive tests has dropped in recent weeks as compared to a couple of months ago.  The fact remains that about 20% of the 5,000+ tests conducted just this week came back positive for the flu - and about 65% of those were specifically categorized as H1N1 flu.  Yikes.

Even more staggering are the statistics for pregnant women.  Women naturally have weakened immune systems during pregnancy, but the H1N1 flu appears to hit even harder than usual.  The CDC has stated that "6% of confirmed fatal 2009 H1N1 flu cases thus far have been in pregnant women while only about 1% of the general population is pregnant."  (You can read a summary of this study by CDC officials published in The Lancet, one of the leading medical journals in the world.)   History also tells us that with flu pandemics come increased numbers of spontaneous abortions and premature births.  But have no fear! The H1N1 vaccine will be distributed very soon and pregnant women are atop the priority list.  Even better, it has been reported that just one shot seems to be protective, so the current vaccine production could potentially immunize twice as many people.

It was also reported this week that the U.S. and a cohort of other nations are planning to donate a portion of their vaccine supplies for the World Health Organization (WHO) to administer in poorer countries around the world.  There will undoubtedly be grumbling by some who do not want to share, but I applaud this decision.  Why shouldn't expectant mothers in other lands receive the same protection as expectant mothers here in the U.S., to be given the best possible chance to have a healthy child, and to be alive to see them grow?  I think we should be contributing as much as we can to the global control of this illness (and countless others!).  What is your opinion on this issue?

For more information from the CDC:

  • A CDC website dedicated to all things H1N1 flu
  • The CDC's Q&A page specifically for pregnant women worried about H1N1 flu
The President's Speech On Health Care Reform
Posted by on September 11, 2009 - 12:19pm

On September 9, President Obama gave a speech to the joint houses of Congress laying out his plan for health care reform. No matter what your personal politics, the outcome of such reform regulation is going to affect us all. With that in mind, we thought it would be helpful to lay out some of the basic tenets of the President's plan, at least as it was outlined in the speech. A full transcript of the speech can be found here.

According to the President, his proposed changes will:

Photo: Whig.com

Photo: Whig.com

  • Not require the Americans who already have health insurance through their job, Medicare, Medicaid, or the VA to change the coverage or the doctor you have.
  • Make it against the law for insurance companies to deny you coverage because of a preexisting condition.
  • Make it against the law for insurance companies to drop your coverage when you get sick or “water it down when you need it the most."
  • Prevent insurance companies from placing an arbitrary cap on the amount of coverage you can receive in a given year or in a lifetime.
  • Place  a limit on how much you can be charged for out-of-pocket expenses
  • Require insurance companies to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies.
  • Creating a new insurance exchange, "a marketplace where individuals and small businesses will be able to shop for health insurance at competitive prices."
  • Provide tax credits, the size of which will be based on need for those individuals and small businesses who can't afford the lower-priced insurance available in the exchange.
  • Immediately offer low-cost coverage to Americans who can't get insurance today because they have preexisting medical conditions, in order to protect them against financial ruin if they become seriously ill.
  • Require individuals to carry basic health insurance.
  • Require businesses to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still can't afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements.
  • Not insure illegal immigrants.
  • Have no “panels of bureaucrats with the power to kill off senior citizens.”
  • Use no federal dollars to fund abortions, and federal conscience laws will remain in place.
  • Create a not-for-profit public option available in the insurance exchange that is only an option for those who don't have insurance.
  • Have a public insurance option that is not funded by the tax-payers, but is instead self-sufficient and rely on the premiums it collects.
  • Not add anything to the national deficit. There will be a provision in this plan that requires Congress to come forward with more spending cuts if the savings they promised don't materialize.
  • Cost around $900 billion over 10 years, that will be paid for by finding savings within the existing health care system, and using revenues from drug and insurance companies.
  • Charge insurance companies a fee for their most expensive policies, which will encourage them to provide greater value for the money.
  • Protect Medicare. The Medicare trust fund will be used to pay for this plan.
  • Create an independent commission of doctors and medical experts charged with identifying more in the health care system.
  • Reform current medical malpractice regulations.

So what did you think of the speech? Do you think all these goals are realistic or realizable. What would your ideal health care system entail. All comments are welcome

Mastectomies and Patient Choice
Posted by on September 3, 2009 - 10:31am

After reading Alison’s excellent blog entry regarding the efficacy of self-exams at detecting breast cancer, I’ve been thinking more about women’s choices regarding both prevention, as well as treatment, for breast cancer. I think Christina Applegate’s decision to have a mastectomy to treat her breast cancer really surprised me; it seemed such a drastic choice for a young, seemingly healthy woman, especially one who makes a living based partly on her physical appearance.

I found a study, published in the Journal of Clinical Oncology (full article can be read for free here)  that found that women who were most involved in their treatment decisions were more likely to choose mastectomy over a breast conserving surgery. This is slightly counter to the charges I’ve heard lain at physicians doors: namely that they’re responsible for increasingly invasive, and sometimes unnecessary, procedures. The study insists instead, that women are so frightened of disease recurrence that they would rather lose both breasts rather than face the possibility of the disease coming back.

That choice still seems rather odd to me, especially since, according to the American Cancer Society, white women have a 91% 5-year survival rate for breast cancer, higher than any other cancer studied (African American women have a 78% rate, which is still higher than other cancers for this group). One possible reason for the results about mastectomy choice is that the researchers used women with an average age of 60. I don’t want to sound ageist, but it seems likely that women at that age could have fewer conflicts with the idea of a mastectomy than their younger counterparts, who may still be considering childbirth and breastfeeding.

What do you guys think? Under which conditions would opt for a complete mastectomy over a more conservative option? Does knowing the high probability of surviving the disease influence your decision?

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