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Recently Released Journal Articles Report On Miscarriage, PGD; Others On Diagnosis Second Opinions, Racial Disparities In Breast Cancer

Article Date: 12 Dec 2006 - 15:00pm (PST)
The following highlights recently released journal articles on women's health issues.

Pregnancy & Childbirth

• "Risk Factors for First Trimester Miscarriage -- Results From a U.K.-Population-Based Case-Control Study," Cancer: Noreen Manconochie, a senior lecturer at the London School of Hygiene and Tropical Medicine, and colleagues surveyed 603 British women ages 18 to 55 who had miscarried within three months gestation and compared them with 6,000 women whose pregnancies proceeded beyond 12 weeks gestation (von Radowitz, Independent, 12/4). The study found that women who had body mass indexes of less than 18.5 were 72% more likely to miscarry during the first three months of pregnancy than other women. The study found an approximate 50% reduced risk of miscarriage among women who took vitamin supplements, compared with women who did not; a 40% reduced risk among women who planned their pregnancy, compared with women who had unplanned pregnancies; a 70% reduced risk among women who experienced nausea or sickness, compared with women who did not; and a reduced risk among women who ate fresh fruits or chocolate daily, compared with women who did not. Among women who had planned pregnancies, women who became pregnant after more than a year of trying to do so were twice as likely to miscarry as women who became pregnant within three months (BBC News, 12/4).

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• "Reducing Racial/Ethnic Disparities in Female Breast Cancer: Screening Rates and Stage at Diagnosis," American Journal of Public Health: Franco Sassi, a researcher at the London School of Economics and Political Science, and colleagues examined cancer registry data from five U.S. states from 1990 through 1998, as well as federal data on mammography during the same time period. Researchers found that although screening rates improved among black women during the period studied, black women were still less likely than white or Hispanic women to be diagnosed in the early stages of the disease. Screening for the disease doubled the chances of early diagnosis for white and Hispanic women, compared with a 70% increase for black women, the study found. According to Sassi and colleagues, the reasons for the difference in diagnosis rates likely involve a "complex interplay" of factors, including that black women are more likely to be obese, that some black women at higher risk of developing breast cancer are not being screened, and that black women might be less likely to have a follow-up visit after abnormal results (Norton, Reuters Health, 12/4).
  
  
• "Changes in Surgical Management Resulting From Case Review at a Breast Cancer Multidisciplinary Tumor Board," Cancer: Michael Sabel, a surgical oncologist at the University of Michigan's Comprehensive Cancer Center, and colleagues over a one-year period examined the medical records of 149 patients who were referred to the Cancer Center's multidisciplinary tumor board for a second opinion after a breast cancer diagnosis. The study found that 52% of the patients were advised to make one or more changes in their treatment (Reuters, 11/29). Reinterpretations of images accounted for a change in surgical procedures for 11% of the patients, and differences in interpreting microscopic views of tissue drawn from biopsies resulted in changes for 9% of patients. Researchers also found that five of the patients originally recommended for mastectomy were good candidates for breast conservation surgery and that two women recommended for breast conservation would be better treated with mastectomy. According to the study, alternate recommendations for 32% of the women were based on differing interpretations of the standards for care endorsed by the National Comprehensive Cancer Network. Six of the 149 study participants were found to have no breast cancer on second opinion (Bakalar, New York Times, 12/5).

• Preimplantation Genetic Diagnosis, Fertility and Sterility: Susannah Baruch, director of reproductive genetics at Johns Hopkins University's Genetics and Public Policy Center, and colleagues gathered data from an online survey of 190 fertility clinics about practices and opinions regarding preimplantation genetic diagnosis, the New York Times reports. The study found that about 3% of fertility clinics that offer PGD -- which is used during in vitro fertilization to allow physicians to test the embryo for chromosomal abnormalities -- reported having intentionally used the procedure "to select an embryo for the presence of a disability." According to the Times, some parents are undergoing PGD for the purpose of having children with defective genes, the Times reports. Many parents "don't view certain genetic conditions as disabilities but as a way to enter into a rich, shared culture," according to the Times. Many PGD providers do not perform such procedures. Robert Stillman of the Shady Grove Fertility Center in Rockville, Md., denies requests to use PGD for selecting deafness and dwarfism. "In general, one of the prime dictates of parenting is to make a better world for our children," Stillman said, adding, "Dwarfism and deafness are not the norm." Yury Verlinsky of the Reproductive Genetics Institute in Chicago said, "If we make a diagnostic tool, the purpose is to avoid disease." Both Stillman and Verlinsky said they would not oppose sending parents to other doctors who might consent to using PGD to select defective genes (Darshak/Sanghavi, New York Times, 12/5).
  
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