Faculty Bibliography

Objective: While the incidence of cervical cancer has declined in the United States, cervical cancer continues to be a significant source of morbidity and mortality among specific subsets of women. In a recent study published in Cancer, black women over the age of 85[1] were found to have the greatest mortality from cervical cancer. Importantly, cervical cancer screening guidelines do not extend to this age group, highlighting the importance of gaining a comprehensive understanding of these at risk populations. The objective of this study was to define the characteristics, risk factors and clinical course of patients treated for cervical cancer at a large urban public hospital. [1] Beavis, AL, Gravitt, P Rositch, A, Hysterectomy Corrected Cervical Cancer Mortality Rates;Cancer:2017:-1044-50. Design: A review of patients treated for cervical cancer by gynecologic oncologists at Bellevue Hospital between 2007- 2015. Results: One-hundred and fifty-nine patients were treated for cervical cancer by gynecologic oncologists at an urban academic institution during the specified time period. The median age at diagnosis was 51 years (range 28- 80), with 26 (16.4%) patients over 65 years. Sixty-nine (43.4%) patients identified as Hispanic or Latina, 36 (22.6%) as Black or African-American, 25 (15.7%) as Asian, 17 (10.7%) as Caucasian, and 12 (7.5%) were unknown. Seventy-six (47.8%) patients originated from the United States, while 57 (36%) patients reported their region of origin elsewhere - 24 (15.1%) from Asia, 16 (10.1%) South America, 5 (3.1%) Africa, 12 (7.5%) Europe, and 26 (16.4%) were unknown. The vast majority of patients had public insurance (71.1%), or were uninsured (20.8%). One hundred and seven (67%) patients presented with stage IB2 or higher disease, and the predominant stage at diagnosis was IIB (40, 24.2%). Only 34 (21.4%) patients had a known history of dysplasia, with HSIL being the most common cervical cytology prior to diagnosis. Forty-two (26.4%) patients were smokers, only 1 (0.6%) patient was HIV positive on antiretroviral therapy, and 5 (3.1%) had a history of radiation or chemotherapy from a prior cancer diagnosis. One hundred and eighteen (74.2%) underwent chemotherapy and radiation, while 55 (34.6%) were treated surgically, and 3 (1.9%) did not undergo treatment. At the most recent encounter, 85 (53.5%) patients had no evidence of disease, 67 (42.1%) were alive with disease, and 6 (3.8%) had died of their disease. Conclusion: Despite advances in detection and treatment, cervical cancer remains a significant women's health care issue among at-risk patient populations in the United States. These findings draw attention to how the new screening guidelines may affect the care of women over 65 years of age

OBJECTIVE: Vertebral fracture is the most common clinical manifestation of osteoporosis and is significantly associated with an increased risk of future fractures.1 Bone mineral density has traditionally been the best predictor of fragility fractures, however, lean mass may have a greater contribution to the risk of fracture than previously understood. Dual-energy X-ray absorptiometry (DXA) allows for highly accurate measurements of bone mass as well as both fat and lean body mass. The primary objective of this study is to determine if there is an association between lean body mass and the incidence of vertebral fragility fractures in postmenopausal women. The presence of an association between number of vertebral fractures and T-score, Z-score, body mass index (BMI), muscle mass index (lean mass (kg)/ height (m²)), and fat mass are secondary outcome measures. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All women between the ages of 40 and 100 years, who underwent body composition and bone density testing using DXA scan at the NYU Bone Density and Body Composition Unit from May 2011 to November 2014 were identified. All indications were included. Patients with DXA that did not include a lateral vertebral assessment were excluded. Parametric variables were confirmed by Shapiro-Wilk testing and compared by analysis of variance (ANOVA). Chi-square testing was used for nominal variables. RESULTS: A total of 358 women met inclusion criteria. The average age was 70.2 years +/-10.3 (Range 46 to 93 years), average weight was 139.6lbs +/- 25.9 (Range 90 to 267 lbs) and average body mass index (BMI) was 25.0 +/- 4.5 kg/m² (Range 16.7 to 42.3). A total of 124 vertebral fractures were identified in 85 patients (23.7%), with an average of 0.35 (+/- 0.7) vertebral fractures per patient. Both lean body mass and Z-score were noted to have an inverse association with number of vertebral fractures (p=0.03 and p=0.02, respectively). Women without vertebral fractures had an average lean mass of 62.4 lbs (+/-8.5) (average BMI 24.9 +/-4.5), while women with 3 vertebral fractures had an average lean mass of 59.5 lbs (+/-8.7) (average BMI 26.0 +/-4.5). Women with at least one vertebral fracture were more likely to have an average T-score of at least -0.8 (+/-1.5), but T-score was not found to be significantly associated with number of fractures (p=0.26). Additionally, fat mass (p=0.82), BMI (p=0.19), and muscle mass index (p=0.36) did not prove to be predictive of vertebral fracture in this population. CONCLUSIONS: Irrespective of BMI, a lean mass of greater than 62.4lbs was associated with lower incidence of vertebral fracture in our population. These results suggest the importance of assessing lean mass in postmenopausal women, as it is a modifiable risk factor for osteoporotic fractures

The Women's Health Initiative (WHI) assessed the long-term effects of hormone therapy (HT) in postmenopausal women. The WHI started HT treatment on women aged 50-79 years in order to ascertain these effects. The study was ended early, due to findings of increased risk of coronary heart disease, breast cancer, stroke, and thromboembolic complications in women receiving estrogen plus progestin, compared to placebo. An increased risk of thromboembolic complications was also demonstrated in the estrogen only component of the WHI. The WHI results were initially reported for all subjects, and showed little difference when data were not analyzed by age. New WHI sub-analyses stratifying results by age, and an extended follow-up of the WHI offer a more complete picture of the effects of HT, revealing that starting HT in postmenopausal women less than ten years from last menstrual period appears to have less risk. In addition, hysterectomized women treated with estrogen only in the WHI have showed less risk of adverse outcomes than women in the estrogen plus progestin group. In this paper, we review data supporting the use of HT administered to postmenopausal women, showing it to have more benefit than risk for symptom control, prevention of bone mineral loss and fracture, and improvement of the metabolic profile in women who began HT when they were less than 60 years of age and had their last menstrual period less than ten years previous. In hysterectomized women treated with estrogen only, a reduction in breast cancer risk was noted in all age groups. The WHI raised many important questions. Ten years later, some have been answered, including confirmation that HT for most newly menopausal women is safe and effective. The treatment of the aging woman, including hormone treatment after menopause, should remain one of our highest research priorities. This article is part of a Special Issue entitled 'Menopause'.