Posted by on August 1, 2016 - 2:23pm

By: Nicole C. Woitowich, PhD

Over the weekend, Newsweek published an article highlighting the inequities that exist in women’s health research [1]. I think it’s fantastic that major media outlets are drawing attention to an issue that has been central to the Women’s Health Research Institute’s mission since its inception. However, as I read along, I can’t help but cringe when I come across the following mistake: sex and gender are not synonyms. 

In the opening paragraph, author Jessica Firger mentions how “biological factors beyond a patient’s control – especially gender – can determine [cancer] treatment outcome.”  But the truth is, gender is not a biological factor whereas sex is. Gender is a social construct which defines the appearance, actions, thoughts, and behaviors associated with the male or female sex and can change depending on the cultural context. Sex on the other hand, is strictly a biological construct determined by the presence or absence of the Y chromosome. To use sex and gender interchangeably, especially when discussing biomedical research, is in error.

Perhaps what’s more embarrassing, is that scientists continue to make this mistake as well (and quite frankly, they should know better). A quick search through PubMed will reveal article titles relating to “gender differences” in the context of pancreatic cancer, orthostatic hypotension, and proton pump inhibitor pharmacology, when they should have been properly attributed to “sex differences.” How can we expect the media and general public to understand the differences between sex and gender if we can’t get it right ourselves?

 So, I offer you the following Public Service Announcement from your friendly local scientist:

  1. Cell lines have a sex.
  2. Model organisms have a sex.
  3. Humans have both a sex and gender and it’s important to differentiate between the two.  

If we are to advance sex- and gender-inclusive biomedical and clinical research, it is of the utmost importance to understand these concepts.

Lastly, don’t say gender instead of sex just because you’re afraid of saying the word sex. This is a stigma we all need to get over because sex (in both definitions) is a natural, biological concept. It’s time we start attributing it as such.

 

 Source:
1. Firger, J. "Females Suffer From Gender Gap in Cancer Trials, Drug Development." Newsweek, 30 July 2016. Web.

Posted by on July 27, 2016 - 10:47am

Routine breast and cervical cancer screenings aid in the early detection and diagnosis of cancer. However, for women who face socioeconomic hardships and are under- or uninsured, preventative cancer screening may be a luxury which they cannot afford. A recent study published in the journal, JAMA Internal Medicine, suggests that patient navigators play a critical role in helping women access gynecological cancer screening.

Patient navigators are individuals who work alongside patients and assist them in making appropriate healthcare choices, provide information and education relevant to their needs, and advocate on their behalf [2]. Oftentimes, patients may need access to health information in their native language, assistance in arranging transportation to-and-from appointments, or simply someone to accompany them to their visit. In this study, patients who were overdue for routine breast, cancer, and colon cancer screening were randomized into two groups: One group of patients was provided access to a patient navigator, the other group received typical notifications of overdue screening by phone or electronic reminders. The study authors found that patients who had access to a patient navigator were more likely to complete their cancer screening than those who did not.   

Kristin Smith, a patient navigator within the Northwestern Medical Group, is not surprised by these results. She states, “Having one person to help break down the complexities of healthcare can make or break the experience that a patient has in a hospital or physician’s office.”

 “By enabling a patient through a navigator, hospital systems can more readily serve immediate patient needs,” shares Smith. Thus, integration of patient navigators within interdisciplinary healthcare teams may lead to improved quality of care for all.  

Sources:

  1. Percac-Lima et al., JAMA Intern Med. 2016. 1;176(7):930-7.
  2. American Medical Association
Posted by on July 18, 2016 - 3:30pm

Biomarkers are proteins or small molecules which can be measured in order to diagnose conditions, identify disease, track disease progression, or monitor therapeutic interventions.  Some examples of biomarkers include the hormone human chorionic gonadotropin, a biomarker for pregnancy, and the protein prostate specific antigen, a biomarker for prostate cancer. The identification of new biomarkers has beneficial clinical implications, yet it can often be challenging to discover reliable and reproducible biomarkers from the research perspective.

 Sex may play an important factor in the variability of biomarkers within a clinical setting as sex hormones, such as estrogen, progesterone, and testosterone, may alter the amount of biomarkers present in the blood. A study published in the journal Scientific Reports, analyzed the levels of over 170 protein and small molecule biomarkers in men and women with varying hormonal status [1]. This includes women in the follicular phase or luteal phase of the menstrual cycle, women who were post-menopausal, utilizing hormone replacement therapy, or taking oral contraceptives. The study authors found that concentration of 56% of biomarkers varied between men and women. Furthermore, the concentration of 38% of biomarkers varied between female hormonal status.  Together, these results call into question the validity and reproducibility of these biomarkers in a clinical context.

 Some of the biomarkers analyzed in this study are proposed to diagnose cancer, schizophrenia, and major depressive disorder. Therefore, the observed sex and hormonal status differences found in this study highlight the necessity to incorporate sex-specific controls when developing clinical markers in order to prevent false positive or negative results.  Taking sex-based differences and hormonal status into account in any research endeavor will lead to better clinical translation and efficacy for all. 

 Source:

  1. Ramsey et al., Scientific Reports. 2016; 6:26947.
Posted by on July 13, 2016 - 2:47pm

by Nicole C. Woitowich, PhD

I am what you might stereotype as a “girly girl.” I love everything that comes in pink, I have seen the movie Legally Blonde more times than I would like to admit, and whatever Taylor Swift song is popular at the moment is probably my “jam.”

 I am also a biochemist.

 Are these things mutually exclusive? Do women need to hide their love for bold colors, high heels, and pop culture in order to be taken seriously as a scientist? Apparently so, according to many blogs and articles written by other female scientists. Their advice ranges from keeping makeup natural, to wearing dark colors to look more authoritative, or adding “soft touches” such as scarves if you must feel “feminine.”

 The worst part is, their advice isn’t entirely wrong. A recent study by Dr. Sarah Banchefsky and colleagues at the University of Colorado Boulder asked participants to rank photos, unbeknownst to them of real scientists, on their gendered appearance (masculine or feminine) and career likelihood (scientist or early childhood educator). They found that the more feminine a woman appeared, the less likely she was deemed to be a scientist.

 Together with the current climate in the scientific workforce where women are under-represented in leadership roles and tenured faculty, I almost understand why women would want to “tone it down,” and adopt the dress and social behaviors of their male peers.

 Banchefsky, lead author of the study, provides some insight, “We all, to a certain degree, adapt and conform to fit into the environment around us and avoid having people ask questions or look at us askance. I think women do this to be taken seriously, to avoid being asked, ‘Are you really a scientist?’”

 Furthermore, she adds, “…men serve as the power holders and gate-keepers in [STEM] fields, so women work hard to and want to be a part of their circle. Unfortunately, women’s assimilation reinforces the masculine culture in STEM.”

 Hiding or limiting femininity may impart damaging consequences on young and aspiring scientists as well. According to Banchefsky, “If [young women] have in their mind that first, women aren’t typically in science, and when they are, they need to be gender-neutral or non-feminine -  they may worry that they won’t be able to express part of who they are [through] their gender identity in a science field.”

  “I think it’s important to highlight that it just doesn’t have to be this way,” Banchefsky states, and I completely agree.

 To this end, I will continue to match my pink goggles to my outfit and wear pink nitrile gloves because it makes me feel more like “me.” So when young women visit the laboratory they can see that a scientist can be whomever she wants to be.

 Source: Banchefsky et al., Sex Roles. 2016; Epub ahead of print. 

 

Posted by on July 11, 2016 - 8:35am

A recent study published in the American Journal of Emergency Medicine found that sex-differences exist in emergency room evaluation and treatment times for patients presenting with a heart attack [1]. The retrospective study conducted at the University of Pennsylvania analyzed treatment times for over 250 patients with confirmed heart attacks. The study authors found that women, on average, wait 3 minutes longer to receive an initial EKG than men. Additionally, women wait 7 minutes longer than men for a heart attack treatment protocol to be activated, with the total average time being 25.5 minutes for women and 18.5 minutes for men. Current recommendations suggest that anyone presenting with a suspected heart attack should be evaluated and a treatment protocol initiated in less than 20 minutes [2]. Thus, women may be subject to additional heart damage as time passes without intervention.

According to the American Heart Association, women may experience a wide variety of symptoms during a heart attack which can include:

  • Chest pain
  • Shortness of breath
  • Sweating
  • Pain in the arms, jaw, back or stomach
  • Nausea or vomiting

 However, the most common symptom is chest pain or discomfort which is experienced by both men and women. It may be possible that sex-based bias exists in the initial diagnosis of heart attacks as evidence by this research. Additional studies which explore sex-differences within evaluation, diagnosis, and treatment of heart attacks and other cardiovascular disease may promote enhanced survival for both men and women.

 To learn more about the signs and symptoms of heart attacks in women check out the following video by the American Heart Association which was directed by, and stars Elizabeth Banks: It’s Just a Little Heart Attack.  

 Sources:

  1. Choi et al., Am J Emerg Med. 2016; EPub ahead of print.
  2. McCabe et al., Circ Cardiovasc Qual Outcomes. 2012; 5(5):672-9.
  3. American Heart Association
Posted by on June 29, 2016 - 7:53am

This year, the Summer Olympics are scheduled to be held in Rio De Janeiro, Brazil, throughout the month of August. However, several athletes, coaches, staff, and journalists have decided to stay home this year, citing concerns for Zika virus infection. Brazil is currently experiencing a Zika virus outbreak with over 148,00 suspected cases of Zika virus disease as of May 2016 [1]. According to the Centers for Disease Control (CDC), the Zika virus disease is spread through the bite of an infected mosquito and can cause symptoms such as fever, rash, and joint pain. While in a healthy individual, Zika virus disease may only cause a mild illness, less is known about its effects in the elderly, immunocompromised, and those with underlying health problems. Perhaps most concerning is the risk of associated birth defects, such as microcephaly, which can occur if a pregnant woman is infected with Zika virus. Furthermore, it has recently been shown that Zika virus can be transmitted through sexual contact. This has left many individuals scheduled to travel to Brazil concerned for the health of themselves and their families.

Savannah Guthrie, a TV journalist who is currently pregnant, has reported that she will not be attending the Olympics due to concerns for the Zika virus [3]. Additionally, professional golfer Rory McIlroy has stated the same [4]. Those who do plan on traveling to the Olympic games, such as U.S. men’s volleyball coach John Speraw, are taking numerous precautions to avoid Zika virus. Speraw plans wearing long sleeves, staying indoors, and as an extra measure of precaution, he will freeze his sperm prior to the Olympics in the event that he contracts the virus while in Brazil [5].

The CDC recommends that all individuals traveling to Brazil practice enhanced precautions which include:

  • Covering all exposed skin with long sleeved shirts and pants
  • Applying insect repellent containing DEET
  • Pre-treating clothes with the repellant permethrin
  • Staying indoors in air-conditioning

To date, no mosquito-borne transmission of Zika virus has been reported in the United States. However, as of June 22nd, there are 820 confirmed cases of individuals living in the U.S. who have contracted the virus while travelling abroad. If you plan on travelling abroad or to other U.S. territories this summer, check with the CDC for travel health notices and updates for local precautions.

 Sources:

  1. Pan American Health Organization Epidemiological Update
  2. Centers for Disease Control and Prevention
  3. New York Times
  4. ESPN
  5. New York Times
Posted by on June 27, 2016 - 8:33am

For some women, the onset of menopause can be fraught with unpleasant symptoms such as hot flashes, night sweats and vaginal dryness. If a woman wishes to avoid or is not a candidate for hormone replacement therapy, lifestyle and dietary modifications may provide some relief. Last week, an article published in the Journal of the American Medical Association analyzed the results of over 62 studies which examined the use and effectiveness of plant-based therapies on menopausal symptom relief [1]. The authors found that use of phytoestrogen-containing foods and dietary supplements may reduce hot flashes and vaginal dryness but not night sweats.

Phytoestrogens are naturally-occurring compounds found in plants which have a similar chemical structure to the hormone estrogen. When ingested, phytoestrogens can mimic, albeit to a lesser extent, the actions of estrogen since they “look alike” to our bodies. Phytoestrogens can be found in various fruits, vegetables, and even wine. Soybeans, in particular, have a high phytoestrogen content. For some individuals, there is increasing evidence that consuming soy-based products may provide relief from menopausal symptoms [1,2].

 Because phytoestrogens have estrogen-like properties, it was thought that consuming food which contained high amounts of phytoestrogens, such as soy, could increase your risk for breast cancer. However, there is no concrete evidence which suggests that this is true. So if you are looking for a natural approach to curb your menopause symptoms, increasing phytoestrogen-rich foods in your diet may be a safe and healthy alternative.

 

Sources:

  1. Franco et al., JAMA. 2016; 315(23):2554-2563.
  2. Patisaul and Jefferson, Front Neruoendcrinol. 2010; 31(4):400-419. 
Posted by on June 17, 2016 - 9:14am

Recently, the use of talcum powder has become a controversial issue as growing evidence suggests that its use may be related to an increased risk of ovarian cancer. Talcum powder, also known as talc, is a mineral composed of the elements magnesium, silicon, and oxygen. As a common household product, talcum powder can be used as an antiperspirant or in the application of cosmetics. Because of its ability to absorb moisture it may be applied to sensitive areas of the body, such as the genitals, to prevent chaffing.

A new study published in the journal Epidemiology, analyzed the use of talcum powder in over 4,000 women with and without ovarian cancer. The authors found that use of talcum powder in the genital region may increase a woman’s risk for ovarian cancer by 33%, especially in instances where the powder was used daily.

More research is necessary to determine how talcum powder causes cancer. In the meantime, the American Cancer Society suggests that it may be prudent to avoid or limit use of products containing talc, if you are concerned about developing ovarian cancer.  

Although the overall lifetime risk of developing ovarian cancer is low, it is one of the most deadly gynecological cancers. Therefore it is important to recognize some of the major signs and symptoms of ovarian cancer for early detection and diagnosis.

Signs and Symptoms

  • Lower abdominal pain or pressure
  • Weight gain or weight loss
  • Abnormal periods
  • Gas, nausea, or vomiting
  • Trouble eating or feeling “full” after eating

While these symptoms may be associated with other benign conditions, it is always important to discuss any questions or concerns you may have with your doctor.

 

Sources:
Cramer et al., Epidemiology. 2016;27: 334–346.1
American Cancer Society
National Library of Medicine

 1Two authors of the study have received compensation related to ongoing litigation regarding ovarian cancer. 

Posted by on March 29, 2016 - 2:28pm

We are well aware that cigarette smoking has a direct link to lung cancer.  Did you know that the latest Surgeon General's report identified 21 other diseases that have a causal relationship to cigarettes?

The list included 12 types of cancer, 6 categories of cardiovascular disease, diabetes, chronic obstructive pulmonary disease, and some pneumonias.  But a new report put  out by the American Heart Association, the National Cancer Institute and several major medical centers that pooled data on millions of subjects of both sexes and age 55 years and older found other concerns for smokers. In this study,  mortality was followed from 2000 to 2011.

There were 181,377 deaths overall---19% in smokers and 14% in non smokers. The study reconfirmed the increase morality due to smoking in the conditions listed above. However, 17% of the smokers with increased mortality helped identify new conditions impacted by smoking:   renal failure, intestinal ischemia, hypertensive heart disease, infections, various respiratory conditions, breast cancer and prostate cancer---conditions not part of the earlier "21".

While the study provides a more complete lists of conditions increased due to smoking, it also reinforces the fact that the rate of death from almost any cause was two to three time higher in current smokers when compared to non smokers.  While more study is needed to rule our other behaviours and determine how smoking effects treatment, the study demonstrates how important it is to reduce smoking espeically in young people.   Smoking also impacts one's  quality of life and will often cause mortality due to chronic conditions a decade earlier in smokers.  It sure makes sense to put those cigarettes away.

 

Posted by on March 3, 2016 - 2:33pm

We need a certain amount of fat in our diets to stay healthy. Fats provide needed energy in the form of calories. Fats help our bodies absorb important vitamins—called fat-soluble vitamins—including vitamins A, D and E. Fats also make foods more flavorful and help us feel full. Fats are especially important for infants and toddlers, because dietary fat contributes to proper growth and development.

“Fats are really the most concentrated source of energy in the foods we eat, and our bodies need that energy,” says NIH nutritionist Dr. Margaret McDowell. “Fats are truly an essential nutrient.” Problems arise, though, if we eat too much fat. Dietary fats have more than twice as many calories per gram as either proteins or carbohydrates like sugar and starch. Excess calories, of course, can pack on the pounds and raise your risk for diabetes, cancer and other conditions. “Some fats are better for our bodies than others,” McDowell says. “We should really aim to eat the right types of fats.”

Unsaturated fats are considered “good” fats. They’re sometimes listed as “monounsaturated” and “polyunsaturated” fat on Nutrition Facts labels. These can promote health if eaten in the right amounts. They are generally liquid at room temperature, and are known as oils. You’ll find healthful unsaturated fats in fish, nuts and most vegetable oils, including canola, corn, olive and safflower oils.

The so-called “bad” fats are saturated fats and trans fats. They tend to be solid at room temperature. Solid fats include butter, meat fats, stick margarine, shortening, and coconut and palm oils. They’re often found in chocolates, baked goods, and deep-fried and processed foods.

“When we eat too many solid fats, we put our bodies at risk. These fats tend to raise total blood cholesterol, as well as the part of cholesterol known as low-density lipoprotein (LDL) cholesterol (bad cholesterol),” says McDowell.  LDL can lead to the buildup of plaque in the arteries and cardiovascular problems.

Experts say that the total fat intake for adults ages 19 and older should be 20% to 35% of the calories eaten each day. For children ages 4 to 18, it should be 25% to 35%.  Less that 10% of our fat calories should come from saturated fatty acids.

Other NIH-funded research found that, when it comes to weight loss, the source of calories—whether from fat, protein or carbohydrate—isn’t as important as the number of calories you consume. But when it comes to risk factors for heart disease, replacing some carbohydrates with protein or unsaturated fats can greatly improve blood cholesterol. In a specialized diet designed to lower blood pressure, using unsaturated fats in place of some carbohydrates boosted blood levels of “good” cholesterol (HDL cholesterol) and caused a more healthful drop in blood pressure.

 

Source:  National Institutes of Health

 

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