HEALTH BULLETIN .CO

Wednesday, February 4, 2015

A fear of the Pill, condoms and coils leads to 15 million unwanted pregnancies worldwide each year

15m of 16.7 million unwanted pregnancies a year 'could easily be avoided'

'Health concerns' was the most common reason given for not using various forms of contraception, World Health Organisation study found

Around 20% of women vastly underestimated the risk of pregnancy

Millions of women worldwide endure unwanted pregnancies each year because they are fearful of modern forms of contraception, a report has claimed.

In fact, 40 per cent of women who avoid contraception do so because they worry about the side effects and health implications of methods such as the Pill, coils and condoms.

And almost 20 per cent don't use protection because they vastly underestimated the risk of pregnancy, the World Health Organisation study found.

As a result of such attitudes, there are 15 million unwanted pregnancies worldwide each year.

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Unexpected: World Health Organisation figures show there are 15 million unwanted pregnancies each year

Researchers who analysed figures from 35 low and middle income countries found 15 million out of 16.7 million unwanted pregnancies a year could easily be avoided.

The findings apply to a third of the global population, with many who become unintentionally pregnant facing disease, and poorer work prospects.

The researchers also warned that lack of proper contraception can result in unwanted abortions.

They looked at contraceptive use among 12,874 women aged 15 to 49 who became pregnant unintentionally.

They compared them with 111,301 sexually active women who were neither pregnant nor wanting to be from 35 countries.

The researchers then calculated the number of undesired pregnancies and the proportion that were attributable to not using modern contraception, including the Pill, male and female condoms, the coil, sterilisation and injectable contraceptives.

THE IMPACT OF USING - OR NOT USING - CONTRACEPTION

The World Health Organisation researchers calculated the number of undesired pregnancies and the proportion that were attributable to not using modern contraception, including the Pill, male and female condoms, the coil, sterilisation and injectable contraceptives.

It was also revealed that traditional methods, including withdrawal, and trying to time sex outside the fertile period of a woman's menstrual cycle, made it 2.7 times more likely a woman would end up with an unwanted pregnancy.

And using no contraception at all made it 14.5 times more likely they would end up pregnant.

It was also discovered that the poorest and least well educated women were the least likely to use modern contraception.

Of the 14,893 who did not use contraception and did not want to get pregnant, the main reason given for non-use was fear of side-effects and health concerns, with 5,559 women (a surprising 37 per cent) saying it put them off.

Another 17.6 per cent were found to underestimate the risk of pregnancy.

And 2.4 per cent said contraception was too expensive, with the same number saying they didn't know where to get contraceptives.

Study author Dr Howard Sobel, from the World Health Organisation's Western Pacific Regional Office, said: 'This study has many implications.

'For instance, "health concerns" was the most common reason given for not using modern contraception, yet these concerns are not backed up by evidence.

Learn how the Pill works in this Howcast vid on birth control

Worries: 40 per cent of women who had avoided contraception did so because they feared the side effects and health implications of methods such as the Pill, coils and condoms

'Health workers have an important role to play in reassuring, educating, treating symptoms and finding the methods that best suits an individual.

'However, frontline health workers need the skills to do this, and our experience has been that many have the same misconceptions.

'We could prevent the overwhelming majority of pregnancies if we could debunk the myths and misperceptions about modern methods and use long-term methods of contraception, such as implants and intrauterine devices.'

He added: 'National strategies need to be put in place to address unfounded health concerns, fear of side-effects, opposition and underestimated risk of pregnancy.

'These need to be coupled with good quality contraception that is available and affordable.'

The findings were published in the journal Human Reproduction.

Tuesday, February 3, 2015

What REALLY raises your risk of breast cancer? From alcohol to obesity, deodorant to HRT, leading doctor answers questions regularly posed by her patients

Breast cancer does run in the family - if your mother or sister is diagnosed your risk of developing the disease doubles

One in eight women are diagnosed with the disease, Dr Sally Norton said

It is one of the most common forms of cancer in women but most patients are post-menopausal - around a fifth are under 50 at diagnosis

Smoking, being obese and excess alcohol increase the risk of the disease

There has been a lot of media focus on cancer recently – with latest research suggesting the disease is down to bad luck rather than lifestyle.

In actual fact, the study author was quick to point out that lifestyle still has a significant role to play in many cancers.

Personally, I believe that the better we look after ourselves, the luckier we get!

Breast cancer is a good example.

There is no doubt that breast cancer can run in the family.

If you have the bad luck to inherit the genes that make you more likely to get breast cancer, there is not much you can do about it.

A recent study by scientists at Johns Hopkins University School of Medicine suggested some cancers are more down to bad luck than a person's lifestyle. Dr Sally Norton told MailOnline that breast cancer (illustrated) is a good example of how lifestyle can have a big impact on the disease

In some cases those genes mean such a high risk of cancer that women choose to have mastectomies to avoid developing cancer later on, think Angelina Jolie.

In other cases, your genes may only increase your risk slightly, but how you live your life also plays a part.

So, with that in mind, I have put together some of the questions I am often asked about breast cancer.

See how much you know about breast cancer risk and how you can reduce your chances of problems in the future…

Q: How much breast cancer is down to your genes?

A: Only three in 100 cancers are due to definite gene problems – but having a close relative such as a mother or sister with breast cancer can double your risk.

If you have a lot of relatives with breast (or bowel) cancer, particularly at a young age, it is especially important to mention this to your doctor, as it may be worthwhile getting your genetic risk assessed.

Q: How many women get breast cancer?

A: One in eight. It’s the commonest form of cancer in women, and though most people are post-menopausal when they develop it, about a fifth of breast cancer sufferers are under 50.

Dr Norton outlines some of the questions patients regularly ask her about breast cancer

Q: If you have a breast lump, how likely is it to be cancer?

A: It’s unlikely, I’m pleased to say.

Breast lumps can be due to many things – general lumpiness around period time, cysts, infection or benign lumps called fibroadenomas.

These lumps can get quite large and may, or may not be tender.

Benign breast lumps can be removed if necessary, but may often improve with little, if any treatment.

However, any lump should be checked out by your doctor – particularly if it is hard and irregular, doesn’t improve after your period, causes puckering of the skin or is associated with changes in the nipple.

Q: When are you eligible for breast cancer screening?

A: In the UK, it’s between 50 and 70, but is being extended to cover women from 47 to 73.

You can still ask to be screened after this age however.

Mammograms are X-rays that are frequently used to detect tiny abnormalities in breasts but are less good at finding problems in dense breasts.

Ultrasound or MRI scans may also be used.

Q: How often should I check my breasts?

A: Once a month. It is good to get into a regular habit and monthly checks mean that you will get to know what is normal for you so will be more confident in spotting any changes.

Avoid the time around a period when your breasts are naturally more lumpy.

There are many guides on self-checking – but soapy hands in the shower are good for detecting lumps.

A check in front of a mirror with hands raised above your head and then on hips can also help identify skin changes.

One in eight women are diagnosed with breast cancer (pictured under a microscope) Dr Norton told MailOnline. It is the most common form of the disease in women, she added

Q: Does being overweight increase the risk of breast cancer?

A: Yes. Fat isn’t just stuff that spills over your waistband and sends your weighing scales in the wrong direction – it is an organ of the body that produces chemical messengers (hormones), one of which is oestrogen.

Oestrogen is thought to be a major part of the pathway leading to breast cancer so it follows that the more overweight you are, the greater your risk of breast cancer.

HOW TO CHECK YOUR BREASTS

1. Touch

Can you feel a lump, either in the breast, upper chest or armpits?

Is there a lumpy area, or an unusual thickening of the breast tissue that doesn't go away?

Is there any unusual pain, either in the breast or armpit?

2. Look

Any change in size or shape?

Any change in skin texture? Such as puckering or dimpling

Any change in colour? The breast may look red or inflamed

What about the appearance or direction of the nipple?

Any unusual discharge?

Any rash or crusting?

3. Check

Is there anything unusual? If so, get it checked out by your doctor as soon as possible.

Source: Breakthrough Breast Cancer

However, being overweight can also decrease the number of periods you have (which decreases the amount of oestrogen released from the ovaries).

This may explain the paradox that being overweight can actually decrease the risk of breast cancer before the menopause, but increases it after the menopause when fat is a more important source of oestrogen than the ovaries.

Q: How about alcohol and smoking?

A: Yes, sorry. Along with cutting down on food, we need to address all aspects of our lifestyle if we want to reduce our risk.

We know that smoking is a major risk factor for lung cancer – but it can increase the risk of many other cancers too, including breast, cervix, stomach, mouth, bladder and ovary.

Too much alcohol – even just a little bit over recommended limits - has also been linked with breast cancer.

Just one extra unit per day can raise the risk by around 10 per cent.

Q: Does HRT increase the risk of breast cancer?

A: Sadly, yes. Which means there is a downside to trying to reduce those hot flushes and other unwelcome consequences of the menopause.

HRT contains the hormone oestrogen, and sometimes progesterone too, which can increase the risk of breast cancer.

Probably about four in 100 breast cancers can be linked to HRT, mainly those that contain both of the hormones.

However, there is some (though limited) evidence that HRT can protect against other diseases such as osteoporosis and can certainly make the menopause bearable for women with severe symptoms – so whether or not to use it is a discussion worth having with your doctor.

Women are encouraged to check their own breasts for any changes each month

Q: Do deodorants cause breast cancer?

A: We don’t know for certain, is the short answer.

Some studies have suggested that there may be an increased risk due to the use of aluminium compounds in antiperspirants.

These compounds temporarily block sweat glands – but can build up in breast tissue and produce some oestrogen-like effects.

As we know, oestrogen can promote breast cancer growth and so there is a possible link. In contrast, other studies have not shown any increased risk.

If the risk was very high, we would know about it by now so we shouldn’t be too alarmed.

However, the increasing use of chemical products on ourselves, around the home and in our wider environment, is almost certainly causing some harmful effects and we should try to reduce them wherever possible.

Q: Do underwired bras cause breast cancer?

A: No. This is a myth that has been started and perpetuated by some poor scientific studies that have since been robustly proven wrong.

The theory was that over-tight bras could reduce the lymph drainage from the breast and therefore cause an accumulation of toxins that could then lead to cancer.

There is no proof whatsoever that this occurs. Conceivably, a wire rubbing against an already present breast lump could make you aware of it, hence the concern that the pressure may have caused it in the first place.

But fear not, it’s just coincidence, so you don’t need to rush out and burn your bra.

Getting a good bra fitting is worthwhile, though.

Many women are wearing the wrong size and a well-fitted bra can give you an instant boost in body confidence, and take pressure off the shoulders for those with a heavier chest.

In the UK women aged between 50 and 70 are eligible for breast cancer screening. There are plans to extend the programme to cover women aged between 47 and 73

Q: How common is breast cancer in men?

A: It’s rare. Only about 400 men a year get breast cancer – not surprising as they have very little breast tissue compared to women.

The bad news is that it is more likely to have spread by the time it is picked up…probably because there is less awareness.

It is more common in older men (over 60), men who have a family history of breast cancer, or men who are obese, so those man-boobs need tackling now.

Gynaecomastia is enlarged breast tissue (as opposed to just fat) that can appear as a lump behind the nipple but is non-cancerous and can be removed if needed.

The message is that men need to be aware of breast lumps too and check them out with a doctor straight away.

Though breast cancer is common, and may be down to bad genes, there are things that you can do to reduce your risk…or to ensure you pick it up early.

Nearly all cancers can be treated – but the earlier they are detected, the greater the chance of success.

Treatment options have improved significantly over the past few decades – and now almost eight in 10 women diagnosed with breast cancer will still be alive 10 years later.

So, don’t leave it purely to chance – there is a lot you can do to improve your luck.

The women having their clitorises reconstructed: Surgeon performing the operation describes how it helps victims of female genital mutilation

Operations to restore clitoral function are becoming increasingly common

Swedish surgeon reconstructed a clitoris for the first time last month

Op helps female circumcision victims feel sexual pleasure and less pain

Usually in circumcision only the visible part of the clitoris is removed

This procedure removes scar tissue and brings rest of clitoris forward

Surgery to reconstruct women the clitorises of women who have been circumcised is becoming increasingly common (file photo)

Surgery to restore function in women's clitorises is becoming increasingly common to help those who have suffered female genital mutilation.

The procedure offers hope women who have had their clitorises circumcised, and who suffer painful side effects and a loss of sexual pleasure as a result

Surgeons carrying out the procedure say the operation could stop pain, help women feel sexual pleasure and restore their identity and femininity.

Worldwide, the UN estimates that over 133 million women have been subjected to female genital mutilation (FGM).

While surgeons in the US, France, Canada and various countries in Africa offer the operation, last month a Swedish surgeon successfully reconstructed a clitoris for the first time.

The procedure can be performed because the clitoris is much larger than most people assume, Dr Hannes Sigurjónsson, the surgeon who performed the operation, told VICE News.

‘The clitoris isn't completely removed during a genital mutilation operation – only the part that is visible,’ Dr Sigurjónsson, of Karolinska University Hospital in Solna, Sweden told VICE journalist Rasmus Elfton.

‘So the point of my method is to carefully remove scar tissue and reveal the part of the clitoris that's still there, mobilise it forward and put it in its place.’

The clitoris has a 10cm long root that arches around the vagina, and when FGM is carried out, only the visible part of the clitoris is cut off.

This means surgeons are able to remove the scar tissue, pull the remaining parts of clitoris –which also feel sensation - to the front of the vagina to rebuild a working organ.

In some cases the perpetrators have performed a procedure called infibulation, Dr Sigurjónsson said.

This is where the clitoris is removed and the labia are stitched together to form a cover over the vagina. A small hole is left for urine, menstruation, childbirth and intercourse.

Therefore surgeons must first surgically open the vaginal orifice, Dr Sigurjónsson said.

While he cannot ever fully restore the genitalia to how they would have been before the woman was mutilated, plenty of parts in the genital area can be re-created, he said.

He continued: ‘We can open the vagina up again and we can recreate the clitoris and the clitoris hood.

HOW IS CLITORIS RECONSTRUCTION PERFORMED?

The clitoris isn't completely removed during a genital mutilation operation – only the part that is visible.

It is much longer than most people assume, beyond the visible tip, there is a 10cm long root that arches around the vagina beneath the surface.

This means in order to reconstruct the clitoris, surgeons remove the the scar tissue and pull the remaining parts of clitoris to the front of the vagina, stitching it up.

As the whole clitoris feels sensation - not just the tip - they are able to rebuild a working organ.

‘We can also in some cases recreate the labia minora (the inner ‘lips’ of the vagina).’

‘The method is being developed and is getting better with time, research and experience.

‘But it will always be hard to restore someone's mutilated genitals 100 per cent.’

He added that clitoral reconstruction is not just about the physical repair of the genitalia, the psychological aspect is just as vital.

He said: ‘The most important thing when treating women and girls who have been victims of female genital mutilation is for plastic surgeons, gynaecologists, sexologists and psychotherapists to work together.

‘It is only with a multidisciplinary approach that these women can see improvement in their quality of life and experience less pain.’

Dr Marci Bowes, a U.S. surgeon who has carried out hundreds of procedures since 2009, said the number one reason women undergo the operation is to restore their identity.

‘Women who have been cut feel their sense of womanhood has been stolen from them and they want that back,’ she told Washington Post journalists.

‘They want their body back and to feel more normal. It’s about not being different any more.’

The most common side effects of the procedure, according to the available research, are bleeding and infections, which affect around three to five per cent of women.

Most of the women who undergo the procedure experience less pain and more sensation in their reconstructed clitoris after the surgery.

Surgeons say the surgery can prevent pain, restore sexual function and the identity of women who have been subjected to female genital mutilation

But a minority, less than five per cent, feel less sensation afterwards – a risk Dr Sigurjónsson said he makes clear to all patients.

The technique to restore function in the clitoris was developed only a decade ago, pioneered by French urologist and surgeon Pierre Foldès.

Reconstructive surgery to repair the physical damage of FGM is not a new phenomenon, but the procedure is becoming more common as more women become aware of it.

The market for this surgery is less niche than one might assume, Dr Sigurjónsson said.

The Swedish Board of Health and Welfare estimates that 19,000 women in Sweden are in the risk zone of getting mutilated.

Dr Sigurjónsson said: ‘Worldwide, reliable sources such as the United Nations and Unicef report that over 133 million women have been subjects to female genital mutilation.

‘Three million young girls are mutilated every year. So the demand for this kind of surgery is huge.’

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