Women's Daily Update ~~ 03/09/14 ~~ Fat Buster Edition
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In the news in women's health today:
Survival among people with lung cancer has been better for women than men, and
the findings of a recent study indicate that female hormones may be a factor in
this difference. The combination of estrogen plus progesterone and the use of
long-term hormone therapy were associated with the most significant
improvements in survival.
The study was designed to explore the influence of several reproductive and
hormonal factors on overall survival of women with non-small cell lung cancer
(NSCLC). After adjusting for stage of disease at diagnosis, treatment type
(surgery or radiation), smoking status, age, race, and education level, the
only factor studied that predicted survival after a diagnosis of NSCLC was use
of hormone therapy.
Among the 485 women, the median survival time was 80 months for women receiving
hormone therapy and 37.5 months for women not receiving hormone therapy.
Combined estrogen and progesterone was associated with a slightly higher median
survival time (87.0 months) than estrogen alone (83.0 months). The findings of
the study are published in the March issue of the International Association for
the Study of Lung Cancer's journal, the Journal of Thoracic Oncology (JTO).
The use of hormone therapy for 11 years or more was associated with
significantly improved survival, and this finding remained significant among
women who took either estrogen alone or estrogen plus progesterone and among
women who had never smoked or were smokers.
"What has emerged from this study and other published findings is a complex
relationship between hormone use and lung cancer outcomes, with variation in
results based on years of use," says lead author Ann G. Schwartz, PhD, MPH, of
Karmanos Cancer Institute, Detroit, MI, and an IASLC member.
Studies on the effect of hormone use on lung cancer survival have been limited,
and the results have been inconsistent. Because of this, additional research is
needed to evaluate the significance of long-term use of hormone therapy on
outcomes in lung cancer, with better characterization of tumors in terms of
expression of estrogen and progesterone receptors.
Dr. Schwartz adds, "There is more to learn about survival differences between
men and women; hormone use may contribute to those differences. The largest
impact on lung cancer outcomes will come from successful early detection and
treatment."
Dr. Dana Gossett still remembers the unsettling and obsessive thoughts that
filled her brain after her first child was born.
She worried that the baby would roll out of bed. She fretted repeatedly that
shed fall down the stairs while carrying her daughter, now a healthy
13-year-old.
These are thoughts that come unbidden into your mind. They just appear there
and can be uncomfortable, recalls Gossett, chief of the obstetrics and
gynecology division at the Northwestern University Feinberg School of Medicine.
I had just enough psychiatry to know that this was not normal.
Gossetts scary thoughts stopped short of obsessive-compulsive disorder or OCD,
but the idea that new moms might be particularly prone to symptoms of the
psychological illness intrigued her.
Turns out, she was right. In new research released in the March/April issue of
the Journal of Reproductive Medicine, Gossett and her colleagues report that
new mothers are far more likely than others to report mild-to-moderate symptoms
of OCD after childbirth.
In fact, they found that 11 percent of women reported significant
obsessive-compulsive symptoms at two weeks and six months after childbirth.
That compares with about 2 percent to 3 percent of people with symptoms in the
general population, according to the study that is the first-large scale survey
of post-partum OCD.
We anticipated, just based on our anecdotal experience, that it would be higher
than the 2 to 3 percent, says Gossett. But 11 percent was a surprisingly high
number.
The affected moms reported classic signs of OCD, including intrusive thoughts
fears about injuring the baby or worry about germs and compulsive behaviors,
such as checking repeatedly to be sure the baby was breathing, or washing and
rewashing sterile bottles.
What a compulsion is, is a ritualized behavior that in the mind of the person
is going to allay their anxiety, Gossett explains. If I wash my hands 100
times, the baby wont die.
No one was clinically diagnosed with OCD, however. The study relied on surveys
and self-reported data from 461 moms who weighed in at two weeks and 329 of
them who provided more information at six months. Ninety-five percent of the
moms had full-term babies; 55 percent had spontaneous vaginal deliveries and 37
percent were cesarean sections. Only about 8 percent of deliveries were
emergencies and only about 8 percent of babies had to be hospitalized.
The good news is, in more than half of the mothers surveyed, the OCD symptoms
went away by six months after childbirth. But in nearly half, the symptoms
continued and in about 5 percent of the moms affected, new symptoms developed.
Many new mothers develop signs of OCD in the early weeks after birth. Being
obsessive and compulsive about caring for a newborn might actually be an
appropriate psychological development, say Gossett and her co-author Dr. Emily
Miller, a clinical fellow in maternal-fetal medicine.
Problems develop when the symptoms become severe and start interfering with
daily life. A mom whose mind is filled with terrible thoughts of drowning the
baby might avoid baths entirely, for instance. Another mom might spend so much
time checking to be sure the child is breathing that she cant complete other
tasks.
It really comes down to function, Gossett says. If its causing significant
emotional distress or if its preventing her from caring for herself or the
child.
The researchers arent clear what exactly triggers the OCD symptoms in new moms.
It could be a biological effect, perhaps related to dramatic hormone swings
after delivery, Gossett and Miller say.
About 70 percent of women in the study with OCD symptoms also suffered from
depression. Theres some debate in the field about whether postpartum depression
is just depression that happens after pregnancy or a separate disease entirely,
Miller says.
Our new study supports the idea that it may be its own disease with more of the
anxiety and obsessive compulsive symptoms that would be typical for a major
depressive episode, she says.
But an OCD and anxiety expert not affiliated with the study says he believes
postpartum OCD also may be a psychological overreaction to the shift in
responsibility that comes with having a newborn.
You go from being relatively carefree and now you have this tiny little infant
and youre so responsible. Its all on you, says Jon Abramowitz, a professor and
associate chairman of the department of psychology at the University of North
Carolina at Chapel Hill.
New parenthood is a common trigger for development of OCD symptoms and of
full-blown clinical disease, says Abramowitz, who adds that his own research
shows that new dads may be affected, too.
The good news is that postpartum OCD can be treated, Abramowitz says. Educating
new parents to understand that everyone has strange or distressing thoughts
after childbirth and providing access to therapy that addresses the thoughts
and behaviors if they become a problem can help.
We all sometimes get anxious, he says. Part of the therapy is how not to let it
get in the way of your life.
