One battle over, but not the war

The US Supreme Court this week ruled unconstitutional a 2013 Texas law requiring hospital-grade facilities in abortion clinics and hospital admitting privileges for their physicians within 30 miles of the clinic citing “an undue burden on women abortion access” guaranteed under the constitution.  In his comment, Justice Stephen Breyer noted that the law did not offer evidence that it protected women’s health or led to better treatment.  Justice Ruth Bader Ginsburg opined that it was “beyond rational belief“ that these provisions were designed to protect women’s health, let alone withstand careful judicial scrutiny under Roe v. Wade.  The Court also rejected appeals from Wisconsin and Mississippi that sought to overturn lower court rulings blocking restrictions on doctors who perform abortions.   

In an attempt to restrict abortions, a number of states have instituted measures such as banning certain types of procedures, prohibiting abortions after a certain number of weeks of gestation, requiring parental consent or notification for minors seeking abortions, and enforcing waiting periods, mandatory counseling, transvaginal ultrasounds, and listening to the fetus's heartbeat.  Whether the Court’s most recent ruling will encourage pro-choice activists to challenge these and other restrictive state laws or motivate the pro-life community to develop new strategies to limit abortions remains to be seen.  But, if history is any guide, both sides in this controversial issue will likely continue to battle it out.

                                                                                                                 Photo credit:     KEVIN LAMARQUE / Reuters

         Judith Wolf, MD

         Associate Director, WHEP          

                                                                                               

Talcum Powder and Ovarian Cancer – Even More Complicated?

The recent $55 million judgment against Johnson & Johnson over the death of an African American woman with ovarian cancer not only revives previous concerns about the potential link between talcum powder and ovarian cancer but also raises important new questions about risk to African American women in particular.   As far back as 1971, researchers in the UK noted talc particles in ovarian tumors, and in 2006 the International Agency for Research on Cancer (IARC) classified talcum powder as a “possible human carcinogen” if used in the female genital area.   Although a number of observational studies have linked use of talcum powder to increased risk of ovarian cancer, others have not, and a direct cause-and-effect relationship has never been proven.  These observational studies may have suffered from recall bias and included mainly white women.  The Food and Drug Administration has stated that there has been no conclusive evidence to establish causality, though it is plausible that talc may elicit a foreign-body-type inflammatory reaction. In some exposed women, this could potentially play a role in the development of ovarian cancer. 

African-American women historically have reported higher use of feminine hygiene products, including powder, than their white counterparts.  According to documents made public in recent lawsuits, in the 1990s, Johnson and Johnson focused their advertising efforts toward African American and Hispanic women.  And yet, until now, there have been very little data in this population.

A recently published epidemiology cancer study* from the University of Virginia of more than 1300 African American women from 11 different states reported that regular genital powder use was associated with a greater than 40 % increased risk of ovarian cancer, with a dose-response relationship based on frequency and duration of use.  Non-genital powder use also carried an increased risk of more than 30 %, suggesting risk regardless of the route of application. 

Although not definitive proof, these kinds of observations give us pause.  According to the American Cancer Society, in 2016 more than 22,000 women will be diagnosed with ovarian cancer and over 14,000 will die from it.  There are no good tests for finding ovarian cancer early.  It accounts for about 3% of cancers among women, but causes more deaths than any other cancer of the female reproductive system.  If indeed there could be any increased risk of cancer associated with the use of baby powder, especially in African American women, perhaps we should think carefully about our use of these products.   At the very least, women should be informed.

* Schildkraut JM, Abbott SE, Alberg AJ, et al.  Association between Body Powder and Ovarian Cancer: the African American Cancer Epidemiology Study (AACES).  Cancer Epidemiol Biomarkers Prev.  Published on line first May 12, 2016.

                                                                                                                                     Judith Wolf, MD   Associate Director, WHEP

 

 

‘Tis the Season … for Ticks!

 

 

 

Lyme disease is the most frequently diagnosed tickborne illness in the US.  In the Philadelphia area, it’s estimated that almost 40% of ticks are positive for Lyme disease, and statewide the rate is ~47%.  But Lyme is not the only infection carried by ticks.  Cases of babesiosis, anaplasmosis, ehrlichiosis, and Rocky Mountain Spotted Fever (RMSF) are also reported every year.  In fact, in Philadelphia over 10% of ticks harbor more than one pathogen though this rate varies across the country.  This means that people may need to be tested for multiple illnesses if tickborne transmission is suspected.

 

What can you do to protect yourself?

• Avoid ticks by walking in the center of trails and staying away from wooded or brushy areas with high grass and leaf litter.

• Wear insect repellent that contains DEET (≥20%) or an EPA-approved natural repellent and reapply as directed. Wearing clothing and gear that has been treated with permethrin will also help repel ticks.

• Conduct a full-body tick check and shower within two hours of returning indoors.                                         Remove attached ticks with fine-tipped tweezers.

 

 

 

• Place clothes in a dryer on high heat for 5-10 minutes to kill ticks.

• Check pets for ticks daily, especially after spending time outdoors, and use tick repellent products.

 

 

 

                                                                                                                              Judith Wolf, MD

                                                                                                                              Associate Director, WHEP