Women Who Give Birth After Age 30 Have A Lower Risk Of Endometrial Cancer

Dr. Enrique Jacome

Women who last give birth at age 40 or older have a 44 percent decreased risk of endometrial cancer when compared to women who have their last birth under the age of 25, according to strong evidence in a new, international study led by a researcher at the Keck School of Medicine of USC. 
Endometrial cancer strikes the endometrium, the tissue lining the uterus (womb), and is the most common gynecological cancer in the United States. 

Veronica "Wendy" Setiawan, Ph.D., assistant professor of preventive medicine at the Keck School, was the principal investigator of the study, "Age at Last Birth in Relation to Risk of Endometrial Cancer: Pooled Analysis in the Epidemiology of Endometrial Cancer Consortium," which found that risk begins to decrease after age 30 by approximately 13 percentage points for each five-year delay in last births. Compared to women who last give birth before age 25, those who have their last child between age 30 and 34 reduce their risk by 17 percent and those between age 35 and 39 reduce their risk by 32 percent. 

"While childbearing at an older age previously has been associated with a lower risk of endometrial cancer, the size of this study definitively shows that late age at last birth is a significant protective factor after taking into account other factors known to influence the disease - body weight, number of kids and oral contraceptive use," Setiawan said. 

The study, believed to be the largest of its kind, examined pooled data from four cohort studies and 13 case-control studies. Funded by the National Cancer Institute, the research examined a total of 8,671 cases of endometrial cancer and 16,562 control subjects, all derived from studies in the Epidemiology of Endometrial Cancer Consortium. Results are now available online in theAmerican Journal of Epidemiology. 

"We found that the lower risk of endometrial cancer continued for older mothers across different age-at-diagnosis groups, including under 50, 50-59, 60-69, and over 70 - which shows that the protection persists for many years," Setiawan said. "Protection also did not vary by the two types of the disease: the more common Type 1, which we think is related to estrogen exposure; and the more rare, but more aggressive and deadly, Type 2, which have been thought to develop independent of hormones." 

Setiawan noted that endometrial cancer is the fourth most common cancer diagnosed among American women. The American Cancer Society estimates that in 2012 about 47,130 new cases of cancer of the uterine body will be diagnosed, and about 8,010 women will die from such cancers. The vast majority of those cases are endometrial cancer. 

Setiawan's research also examined whether the association between age at last birth and endometrial cancer was consistent across race and ethnicity. The protective association was observed in Caucasian and Asian women, but not in the study's small subset of black women, and Setiawan suggested this warrants additional study of larger groups of black women. 

More research is necessary to determine why late age at last birth might protect against endometrial cancer, but Setiawan notes that several potential mechanisms have been suggested by other investigators, including:

• Women capable of becoming pregnant at an older age may possess a healthy endometrium or experience fewer menstrual cycles without ovulation;
• Prolonged exposure to the hormone progesterone during pregnancy may be especially beneficial at older ages, the critical period for endometrial cancer development;
• Premalignant or malignant cells of the uterine cavity's mucosal lining, which are more likely to exist with increasing age, are shed during childbirth.

"This study shows an important protective factor for endometrial cancer, and when the exact mechanism by which it protects women from getting the disease is known, it can help our understanding of how endometrial cancer develops and thus how to prevent it," Setiawan said. 

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15 Tips To Minimize Morning Sickness

Dr. Enrique Jacome

Morning sickness affects over half of all pregnant mothers. It is generally related to an increase in estrogen levels, low blood sugar counts, and a greater susceptibility to some smells. More often, morning sickness will be present in the early hours of the morning and will ease up somewhat as the day goes on.  Even though morning sickness can be extremely unpleasant, it is hardly ever severe enough to cause metabolic derangement. It is more likely to occur during the first three months of a pregnancy and in most cases will settle down by the end of the first trimester. Here are a some tips you can put in to practice to minimize unpleasant morning sickness symptoms:

1. Get plenty of rest. 
   You must ensure you get a good night´s sleep - wear a sleep mask, or even dark glasses, to block out as much light as possible. You might also consider a maternity body pillow that will properly help you support your back and stomach. Sometimes taking naps during the day may help. Avoid moving around straight after eating.
2. Get up slowly
   Don't be in a hurry to get out of bed when you wake up. Take your time.


3. Avoid some types of foods
   Avoid fatty and/or spicy foods. Avoid caffeine as well.


4. Food portion sizes - have small ones.
   It is important to always have some kind of food in your stomach, as this will lower your chances of experiencing nausea - and if you do, most likely symptoms will be milder. If the stomach is empty, the acids have nothing to workon, except for the stomach lining, resulting in worsening nausea. Have some salty crackers, peanut butter snacks, or some other protein snack before you get out of bed in the morning.
   
   At breakfast, cold apple sauce, pears, bananas or any citrus fruit will help you feel satisfied early. Baked potatoes, although, less tasty for many, are highly nutritious. The fruit's potassium may help prevent morning sickness. At night, try eating something high in protein snack/meal before going to bed, as this will help regulate your blood-glucose levels.
5. Computer monitor flicker. 
   The rapid, almost unnoticeable flickering of the computer monitor could cause morning sickness. If you are susceptible to morning sickness due to monitor flicker, try to avoid using a computer completely. If you must, you should adjust the screen by making the fonts bold and larger and changing the background to a soft tan or pink color - this will help reduce eye strain.


6. Physical activity. 
   Some mothers may find it hard to move around if they feel lousy. However, being physically active has been found to improve symptoms in many people.


7. Fluid intake. 
   Being hydrated is crucial for good health, and very important during pregnancy. Some mothers with morning sickness may not feel like consuming their recommended eight glasses of water per day, especially if their stomachs seem not to let them. However, the more dehydrated you are, the more nauseated you will become.
   
   If drinking water is hard, try adding apple cider vinegar and honey. Some mothers say flat Sprite helps, or decaffeinated cola. Sucking ice cubes made from water or fruit juice is also an effective method. The colder the drink, the easier it is to consume.


8. Ginger. 
   For many years, ginger has long been publicized as a stomach soother, and studies have shown that it may help relieve nausea symptoms. Sipping cold ginger ale, or adding a slice of raw ginger to water or tea may help sooth your stomach. Snacks such as gingerbread, or ginger cookies will all effectively help prevent nausea.
9. Keep your mind occupied. 
   It is important to try to take your mind off the nauseous feelings. Finding things to do might not be easy. Reading a book, doing puzzles, watching television, playing cards, or going for short walks around the block will clear your mind and relax you. However, you must also listen to your body, and stop whenever necessary.


10. Wear loose and comfortable clothing. 
    Restrictive or tight clothing may exacerbate the symptoms of morning sickness. Studies have found that pregnant mothers with nausea who switched from tight to loose-fitting clothing reported either reduced symptoms or non at all.


11. Consider using children's vitamins instead of regular pre-natal vitamins. 
    Children's vitamins are usually easier to digest.


12. Sniff fresh scents. 
    Morning sickness is very much smell-associated - the pregnant mother becomes more sensitive to odors. Certain ugly smells, smells you cannot get away from, and potent smells such as perfumes can trigger an episode of unpleasant nausea. The most effective scents, according to self-reports, are lemon extract and/or rosemary.
13. Triggers
    There are several triggers that can bring on an episode of nausea and a general feeling of being unwell due to morning sickness. Most people will soon identify what they are. Avoid them as much as you can, and your frequency of nausea and/or vomiting will reduce, as will severity of symptoms.


14. Acid reflux
    Sometimes, the náusea and vomiting may be due to acid reflux. Taking antacid medication before going to bed may help reduce stomach acid levels, and the subsequent morning vomiting. Check with your doctor before buying any medication during pregnancy.


15. Iron pills or iron-containing multivitamins
    Some pregnant women may become nauseous because of the iron supplements they have been told to take. Talk to your doctor and ask him/her to recommend a slower-release form, or even possible a lower dosage.

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Success Of Fertility Treatment May Approach Natural Birth Rate

Dr. Enrique Jacome

A groundbreaking study of nearly 250,000 U.S. women reveals live birth rates approaching natural fertility can be achieved using assisted reproductive technology, where eggs are removed from a woman's ovaries, combined with sperm and then returned to the woman's body. 

The research, led by Michigan State University's Barbara Luke and published in the New England Journal of Medicine,highlights what factors help or hinder getting pregnant using assisted reproductive technology, or ART. The results indicate that when there are favorable patient and embryo characteristics, live birth rates with ART can approach those of natural fertility.

"This is good news for women who are trying to have a child," said Luke, a researcher in the College of Human Medicine's Department of Obstetrics, Gynecology and Reproductive Biology.

The number of ART treatments has more than doubled in the past 10 years, and live birth rates traditionally have been reported per cycle, or per one course of treatment. While that is easily calculated and is the method used by national registries across the world, Luke's team sought to estimate cumulative success rates with continued treatment.

"Women and families want to know the overall chances they will get pregnant, not necessarily whether they will get pregnant during a specific cycle," Luke said.

Data were obtained from the Society for Assisted Reproductive Technology's Clinic Outcome Reporting System for women undergoing treatment between 2004 and 2009. The system contains data on more than 90 percent of all clinics performing ART treatments in the United States.

The study of 246,740 women revealed 57 percent of women achieved a live birth via ART treatment, and 30 percent of all ART cycles resulted in a live birth. Success rates declined with increasing age for women using their own eggs, especially for those ages 38 years and older, but not for women using donor eggs.

The estimated natural fertility rate of the general population is about 20 percent per month, and estimated rates of conceiving spontaneously are 45 percent, 65 percent and 85 percent after three, six and 12 months, respectively.

The study looked at factors such as patient age, diagnosis, response to treatment, cryopreservation and the stage at which embryos were transferred. Two major factors that influence ART success are favorable patient characteristics (specifically age) and good embryo quality. Among older women, live birth rates can be substantially improved with continued treatment and a change to donor eggs.

"Although the decision to use donor eggs is a very personal one, these analyses provide information regarding the likelihood of a live birth using this option," said Luke.

These results also could guide regulations governing health insurance coverage for infertility treatment. The number of treatment cycles covered by insurance is typically limited to two or three. The findings demonstrate that when using a woman's own eggs, the success rates continue to rise beyond two to three cycles; additionally, the study may help providers and women decide when it is appropriate to change to donor eggs.

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