Prolapse Hinders Quality of Life
Advanced pelvic organ prolapse negatively affects body image and quality of life, Dr. Erik Jelovsek reported at the annual meeting of the American Urogynecologic Society.
In a case-control study with 47 case patients and 51 controls, a validated body image scale showed that case patients were less likely to feel physically attractive (adjusted odds ratio 11.3), sexually attractive (adjusted OR 4.8), and feminine (adjusted OR 4.0), than controls, said Dr. Jelovsek, of the Cleveland Clinic Foundation.
Although body image has been shown to be important in quality of life and the effect of advanced organ prolapse on body image might seem obvious, no one has specifically assessed this or the relationship between body image and quality of life in these patients, he noted.
These findings indicate that there is indeed a condition-specific decrease in quality of life among women with advanced pelvic organ prolapse and suggest that women seeking treatment for this condition might also be seeking an improvement in body image and quality of life.
Digital Mammography Best for Some
A large, head-to-head comparison of digital and film mammography found no overall difference in diagnostic accuracy, but digital mammography seems to have better diagnostic accuracy in some subgroups.
Digital mammography was significantly more accurate among women under age 50, women with heterogeneously dense or extremely dense breasts, and premenopausal or perimenopausal women, Dr. Etta D. Pisano of the University of North Carolina at Chapel Hill and colleagues reported.
The study included data from 42,760 women for whom the investigators had all relevant information (N. Engl. J. Med. 2005;353:[Epub ahead of print] doi10.1056/nejmoa052911,
All women underwent digital and film mammography, independently interpreted by two readers. Readers rated the mammograms on a 7-point malignancy scale and used the classification of the Breast Imaging Reporting and Data System.
Biopsy or aspiration of the suspicious lesion was performed if either reader recommended it. These patients received follow-up mammograms a mean of 455 days following their initial screening. A total of 335 cancers were detected.
Results indicated no advantage in the accuracy of digital mammography for women 50 and older, women with fatty breasts or scattered fibroglandular densities, or postmenopausal women.
But there were other advantages to digital: easier access to images and to computer-assisted diagnosis; improved image transmission, storage, and retrieval; and a lower average dose of radiation without compromised diagnostic accuracy.
Digital mammography costs up to four times more than film imaging.
Deformities Rare in Osteopenia
Moderate to severe vertebral compression deformities are rare in postmenopausal women with osteopenia but no history of fragility fracture, Dr. Angela M. Cheung reported in a poster session at the annual meeting of the International Society for Clinical Densitometry.
In what she said is the first study to describe the prevalence of such deformities in healthy postmenopausal women with osteopenia, Dr. Cheung and her associates conducted a cross-sectional analysis of 439 women in the ongoing 2-year Evaluation of the Clinical Use of Vitamin K Supplementation in Postmenopausal Women with Osteopenia (ECKO) trial.
Of the 48 deformities detected in the study, 45 (94%) were grade 1.
“How does that mild, grade 1 vertebral compression deformity translate to future fracture risk?” Dr. Cheung, osteoporosis program director for University Health Network, Toronto, said. “We'll take a look at that. It's an ongoing study.”
Exclusion criteria included being on an osteoporosis medication, having a clinical fragility fracture, or having a T score of less than −2.0 at the lumbar spine, total hip, or femoral neck. Densitometry was used to measure bone mineral density and to perform a vertebral fracture assessment.
Mean patient age at baseline was 58 years (range 40–82 years), and mean body mass index was 26 kg/m
Dr. Cheung said she and her colleagues were surprised to see vertebral compression deformities in women from all age groups. “While we do see a higher percentage of [older] people [with] vertebral compression deformities, we see it in young people, too,” she said.
Study limitations were a cross-sectional design and a lack of lateral spine x-rays for comparison.
However, vertebral fracture assessment “has been validated by different groups, and the performance of the test is excellent for grades 2–4 deformities.”