Each January we greet our family and friends by saying, "Have a happy and healthy new year." This year, new medications and diagnostic tests have been developed that will possibly help us fulfill that wish. Here are a few of my "favorite (medical) things" that may help to enhance your health in the new year.
Ovarian cancer screen – Ova Check:
This is a newly developed blood test for detection of ovarian cancer. A small amount of blood is drawn and analyzed for the presence of a unique, minute set of proteins that have been found in the blood of women known to have ovarian cancer. This type of testing called proteomic pattern testing has been used in a "blinded" study to examine blood samples in 50 women with ovarian cancer and 63 women with non-malignant disease. The test was found to "predict" ovarian cancer, even early stage I cancer, 94 percent of the time. Whereas the blood test for ovarian cancer that has been available up to now, called the CA125, predicted ovarian cancer less than 10 percent of the time.
The Ova Check blood test is undergoing further analysis on larger groups of women. Meanwhile it will be made available by Quest Diagnostic Laboratories and Lab Corp for testing of high-risk women (women with a strong family history of breast and/or ovarian cancer, certain colon cancers or women who have a known BRCA gene mutation). This blood test will cost between $100 and $200 and will not be covered by insurance until larger studies have been published and reviewed. Many cancer specialists feel that this type of protein pattern testing will, in the future, allow for early diagnosis and successful treatment of a cancer that has been a dreaded, hidden threat to women's health and lives.
Last month, virtual colonoscopy received a virtual boost of scientific approval in an article published in the New England Journal of Medicine. Three-dimensional CT scans were performed in over 1,200 symptom-free patients who underwent bowel cleansing, swallowed a substance to tag any remaining stool (which makes it show up on x-ray), and who then had air injected into their large bowel through a small rectal catheter. The same patients subsequently underwent colonoscopy and the results were compared. Both tests were equally effective in finding polyps larger than six millimeters.
So will "virtual" replace the "real" colonoscopy procedure? Perhaps for individuals who are at low risk, especially if a previous colonoscopy showed them to be free of any precancerous polyp growths. Two issues still need to be considered: A scanning machine cannot do a biopsy so if something is detected; a second bowel cleansing and full colonoscopy will be necessary, and most centers still offer just two-dimensional scans which are not as reliable as the three -dimensional scanners.
As the latter become more available and physicians learn how to interpret the results, virtual colonoscopy will become a helpful and less expensive method for early colon cancer detection for the many individuals who either won't undergo or cannot access "real" colonoscopy.
Medical therapies for the new year:
There have been scores of medications that have received FDA approval over the past year and hundreds of previously developed drugs that have been approved for new indications. These include new medications for heart disease and hypertension, treatment of depression, irritable bowel syndrome, urinary incontinence, as well as therapies to treat cancer. Here are just a few of the meds that have or will become available that specifically impact women's health:
There are several new forms of hormone replacement therapy (HRT). Lower is now considered better and the FDA suggests that women who choose to use HRT use the lowest amount for the shortest time to reach their treatment goal. For most women and their doctors, the goal is to treat their hot flashes, night sweats, and a sense of "ill-being" that can occur in the first few years of menopause.
1. The pharmaceutical company that makes Prempro recently received approval for a low-dose Prempro containing 0.45 milligrams of Premarin and 1.5 milligrams of the progestin MPA. (The latter has been halved from the original Prempro.)
2. An estrogen ring called Femring is now available for estrogen replacement therapy. The ring, which looks like a hollow diaphragm, is placed in the vagina and left for three months until it needs to be changed. It slowly secretes a moderately low dose of the same estrogen made by the ovaries (estradiol) at a rate of 0.05 milligrams daily. But since it contains no progestin, a supplemental form of progestin has to be added for women who have not had a hysterectomy, in order to limit their risk of developing cancerous changes in the uterine lining.
3. Many researchers and physicians feel that there are benefits to giving hormones in a non-oral form (i.e. not a pill). If a hormone is slowly and consistently absorbed through the skin (or the vaginal lining), it does not initially pass through the liver. "First bypass" in the liver can increase clotting factors and heart-disease-causing fats (triglycerides). A new skin patch, called Climara Pro, has just received FDA approval and will be available in the next few months. It combines a low amount of estradiol (0.045 milligrams) with a low dose of the progestin called levonogestrel (which has been extensively and safely used in birth control pills). This is one of the simplest and most physiologic ways to get a steady dose of HRT through a single patch that is changed just once a week.
Women have frequently been told that if their HDL or "good" cholesterol was okay they really didn't have to worry about elevated LDL or "bad" cholesterol levels. Studies have shown that not to be the case. High LDL levels alone are associated with cardiovascular disease and should be treated. We now have a new type of cholesterol therapy that can help accomplish this. Zetia (ezetimbe) inhibits the absorption of cholesterol in the small intestine. Obviously if less cholesterol is absorbed, less is sent to and subsequently stored in the liver and less LDL cholesterol will get into the blood stream where it can promote atherosclerosis, heart attack and stroke; the major causes of death in women.
In clinical trials Zetia caused an additional 25 percent reduction in LDL over statin therapy alone in just two weeks. (Statins such as Lipitor, Zocor, and Pravachol are drugs that decrease production of cholesterol in the liver). Zetia is now indicated as an addition to diet for the reduction of LDL or if that does not suffice can be combined with statins to help achieve "normal" levels of total cholesterol and LDL.
Osteoporosis:Finally, I want to mention a new medication that was approved last year for women and men with severe osteoporosis who are at very high risk for osteoporotic fracture or who have failed or are intolerant of previous osteoporosis therapy. It's called Forteo (teriparatide) and is a synthetic form of parathyroid hormone that is naturally found in the human body. All other medications used to treat osteoporosis work by preventing "bone eating" cells from drilling cavities in the bone. Forteo actually encourages bone-building cells to lay down bone. The drug is given via a daily injection under the skin with a disposable pen device that can be used for up to 28 days. It increases spinal bone mineral density in most patients by five to 10 percent in just three months. After 19 months of therapy, it can reduce the risk of new vertebral fractures by 65 percent, and risk of non-spinal fractures in other parts of the body (hip, wrists, ribs ankle/foot etc.) by over 50 percent. Forteo can be taken for up to 24 months. At a cost of $600 a month, it's expensive, but over 80 percent of insurance companies now will cover it and there is a special Forteo program for needy Medicare recipients that may drop the patient cost to just $12 a month. This is certainly cheaper than the prolonged hospitalization and nursing care needed after disastrous hip and spinal fractures.
Dr. Judith Reichman has practiced obstetrics and gynecology for more than 20 years. She is a regular “Today” show contributor.