News for Your Practice

With more than 1,000 diseases for which genetic testing is available, and with the completion of the Human Genome Project, more patients are requesting genetic testing and more clinicians are utilizing such testing; it has become mainstream.¹ This increased utilization has resulted in increased cost as well, say Ruzzo and colleagues, who presented research on genetic testing costs and compliance with clinical best practices at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists (ACOG).² But, according to previous research say Ruzzo and colleagues, these costs can be quelled by involving genetic counselors in the test-ordering process.

Just how much cost savings can be achieved? In their quality improvement project, the investigators found that 38.6% of 44 genetic tests reviewed were inappropriately ordered—either they were not indicated (21%), misordered for false reassurance (7%), or inadequately ordered (10.5%). If the tests were ordered as appropriately recommended, a cost savings of $20,912.58 would have been realized, according to the researchers.

Ruzzo and colleagues reviewed 114 charts over a 3-month period for adherence with published clinical practice guidelines. All of the charts were associated with a genetic test billing code for common tests ordered through LabCorp (for cystic fibrosis, BRCA mutation, factor V Leiden, prothrombin, alpha-thalassemia, hemochromatosis, and cell-free DNA).

The researchers concluded that genetic counselor review or involvement in genetic test ordering can decrease inappropriate spending and improve patient care. They pointed out that the 114 charts reviewed represent a fraction of genetic tests ordered at their institution, and further study should broaden the research scope to determine the full extent of the problem.

Ruzzo and colleagues were awarded first prize for their research as presented at ACOG.
 

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

With more than 1,000 diseases for which genetic testing is available, and with the completion of the Human Genome Project, more patients are requesting genetic testing and more clinicians are utilizing such testing; it has become mainstream.¹ This increased utilization has resulted in increased cost as well, say Ruzzo and colleagues, who presented research on genetic testing costs and compliance with clinical best practices at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists (ACOG).² But, according to previous research say Ruzzo and colleagues, these costs can be quelled by involving genetic counselors in the test-ordering process.

Just how much cost savings can be achieved? In their quality improvement project, the investigators found that 38.6% of 44 genetic tests reviewed were inappropriately ordered—either they were not indicated (21%), misordered for false reassurance (7%), or inadequately ordered (10.5%). If the tests were ordered as appropriately recommended, a cost savings of $20,912.58 would have been realized, according to the researchers.

Ruzzo and colleagues reviewed 114 charts over a 3-month period for adherence with published clinical practice guidelines. All of the charts were associated with a genetic test billing code for common tests ordered through LabCorp (for cystic fibrosis, BRCA mutation, factor V Leiden, prothrombin, alpha-thalassemia, hemochromatosis, and cell-free DNA).

The researchers concluded that genetic counselor review or involvement in genetic test ordering can decrease inappropriate spending and improve patient care. They pointed out that the 114 charts reviewed represent a fraction of genetic tests ordered at their institution, and further study should broaden the research scope to determine the full extent of the problem.

Ruzzo and colleagues were awarded first prize for their research as presented at ACOG.
 

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

With more than 1,000 diseases for which genetic testing is available, and with the completion of the Human Genome Project, more patients are requesting genetic testing and more clinicians are utilizing such testing; it has become mainstream.¹ This increased utilization has resulted in increased cost as well, say Ruzzo and colleagues, who presented research on genetic testing costs and compliance with clinical best practices at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists (ACOG).² But, according to previous research say Ruzzo and colleagues, these costs can be quelled by involving genetic counselors in the test-ordering process.

Just how much cost savings can be achieved? In their quality improvement project, the investigators found that 38.6% of 44 genetic tests reviewed were inappropriately ordered—either they were not indicated (21%), misordered for false reassurance (7%), or inadequately ordered (10.5%). If the tests were ordered as appropriately recommended, a cost savings of $20,912.58 would have been realized, according to the researchers.

Ruzzo and colleagues reviewed 114 charts over a 3-month period for adherence with published clinical practice guidelines. All of the charts were associated with a genetic test billing code for common tests ordered through LabCorp (for cystic fibrosis, BRCA mutation, factor V Leiden, prothrombin, alpha-thalassemia, hemochromatosis, and cell-free DNA).

The researchers concluded that genetic counselor review or involvement in genetic test ordering can decrease inappropriate spending and improve patient care. They pointed out that the 114 charts reviewed represent a fraction of genetic tests ordered at their institution, and further study should broaden the research scope to determine the full extent of the problem.

Ruzzo and colleagues were awarded first prize for their research as presented at ACOG.
 

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Up to 80% of women who are of reproductive age have uterine fibroids that cause heavy and prolonged bleeding.¹ Additional concerns include infertility and pain, says James Simon, MD, Clinical Professor at George Washington University in Washington, DC. Black women are more likely than white women to undergo hysterectomy for uterine fibroids. They also are more likely to experience severe or very severe symptoms from fibroids and report that these symptoms interfere with physical activities, relationships, and work.²

Current medical treatments include on- and off-label use of oral contraceptives, gonadotropin-releasing hormone (GnRH) receptor agonists, and progestins. Data on investigational oral GnRH antagonists and oral selective progesterone-receptor modulators (SPRMs) were presented at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists.

Details of VENUS I

In the phase 3, randomized, controlled VENUS I trial, investigators assessed the efficacy and safety of ulipristal acetate (UPA), an SPRM, by race and body mass index (BMI) in premenopausal women (aged 18 to 50) with symptomatic uterine fibroids.¹

Simon and colleagues randomly assigned participants to UPA 5 mg, UPA 10 mg, or placebo once daily for 12 weeks, followed by a 12-week treatment-free follow-up period. UPA, at 5 and 10 mg, was significantly more efficacious than placebo in rate of and time to amenorrhea (P<.0001). The superiority was observed regardless of race and BMI. In addition, women taking UPA versus placebo reported significantly less impact on activities due to uterine fibroids. The study authors concluded that “UPA treatment provides effective control of bleeding and improvement in physical and social activities for women with symptomatic uterine fibroids, regardless of race and BMI.”¹

Establishing the ideal treatment period for UPA to avoid progesterone-associated endometrial changes (in this study it was 12 weeks of once-daily therapy) is a current goal, said Simon.

Details of elagolix phase 2b study

Simon also presented data on another investigational drug, elagolix, an orally administered GnRH antagonist, which has an inhibiting effect on luteinizing hormone and follicle-stimulating hormone secretion. This in turn reduces production of estradiol and progesterone. Elagolix also is being studied for the treatment of endometriosis.³

In the uterine fibroids study, a 24-week, multicenter, double-blind, randomized controlled, parallel group trial, 567 premenopausal women aged 18 to 51 with heavy menstrual bleeding of >80 mL of blood loss were assigned to placebo or elagolix 300 mg twice per day or 600 mg once per day alone or in combination with add-back therapy (with estradiol/norethindrone acetate) to prevent bone loss and menopausal symptoms.⁴

Compared with placebo, women treated with elagolix with or without add-back therapy had significant reductions from baseline in mean menstrual blood loss. Women treated with elagolix also had significant increases in hemoglobin concentration from baseline to month 6 compared with placebo.⁴

Adverse effects were similar to menopause symptoms: bone loss, hot flashes, night sweats, headaches, and disturbed sleep, said Simon. With the add-back treatments, adverse effects were mitigated in a dose-dependent fashion, he pointed out, and were most likely tolerable compared with the heavy bleeding experienced by women at the start of the study.

Up to 80% of women who are of reproductive age have uterine fibroids that cause heavy and prolonged bleeding.¹ Additional concerns include infertility and pain, says James Simon, MD, Clinical Professor at George Washington University in Washington, DC. Black women are more likely than white women to undergo hysterectomy for uterine fibroids. They also are more likely to experience severe or very severe symptoms from fibroids and report that these symptoms interfere with physical activities, relationships, and work.²

Current medical treatments include on- and off-label use of oral contraceptives, gonadotropin-releasing hormone (GnRH) receptor agonists, and progestins. Data on investigational oral GnRH antagonists and oral selective progesterone-receptor modulators (SPRMs) were presented at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists.

Details of VENUS I

In the phase 3, randomized, controlled VENUS I trial, investigators assessed the efficacy and safety of ulipristal acetate (UPA), an SPRM, by race and body mass index (BMI) in premenopausal women (aged 18 to 50) with symptomatic uterine fibroids.¹

Simon and colleagues randomly assigned participants to UPA 5 mg, UPA 10 mg, or placebo once daily for 12 weeks, followed by a 12-week treatment-free follow-up period. UPA, at 5 and 10 mg, was significantly more efficacious than placebo in rate of and time to amenorrhea (P<.0001). The superiority was observed regardless of race and BMI. In addition, women taking UPA versus placebo reported significantly less impact on activities due to uterine fibroids. The study authors concluded that “UPA treatment provides effective control of bleeding and improvement in physical and social activities for women with symptomatic uterine fibroids, regardless of race and BMI.”¹

Establishing the ideal treatment period for UPA to avoid progesterone-associated endometrial changes (in this study it was 12 weeks of once-daily therapy) is a current goal, said Simon.

Details of elagolix phase 2b study

Simon also presented data on another investigational drug, elagolix, an orally administered GnRH antagonist, which has an inhibiting effect on luteinizing hormone and follicle-stimulating hormone secretion. This in turn reduces production of estradiol and progesterone. Elagolix also is being studied for the treatment of endometriosis.³

In the uterine fibroids study, a 24-week, multicenter, double-blind, randomized controlled, parallel group trial, 567 premenopausal women aged 18 to 51 with heavy menstrual bleeding of >80 mL of blood loss were assigned to placebo or elagolix 300 mg twice per day or 600 mg once per day alone or in combination with add-back therapy (with estradiol/norethindrone acetate) to prevent bone loss and menopausal symptoms.⁴

Compared with placebo, women treated with elagolix with or without add-back therapy had significant reductions from baseline in mean menstrual blood loss. Women treated with elagolix also had significant increases in hemoglobin concentration from baseline to month 6 compared with placebo.⁴

Adverse effects were similar to menopause symptoms: bone loss, hot flashes, night sweats, headaches, and disturbed sleep, said Simon. With the add-back treatments, adverse effects were mitigated in a dose-dependent fashion, he pointed out, and were most likely tolerable compared with the heavy bleeding experienced by women at the start of the study.

Up to 80% of women who are of reproductive age have uterine fibroids that cause heavy and prolonged bleeding.¹ Additional concerns include infertility and pain, says James Simon, MD, Clinical Professor at George Washington University in Washington, DC. Black women are more likely than white women to undergo hysterectomy for uterine fibroids. They also are more likely to experience severe or very severe symptoms from fibroids and report that these symptoms interfere with physical activities, relationships, and work.²

Current medical treatments include on- and off-label use of oral contraceptives, gonadotropin-releasing hormone (GnRH) receptor agonists, and progestins. Data on investigational oral GnRH antagonists and oral selective progesterone-receptor modulators (SPRMs) were presented at the 2017 Annual Clinical and Scientific Meeting of the American College of Obstetricians and Gynecologists.

Details of VENUS I

In the phase 3, randomized, controlled VENUS I trial, investigators assessed the efficacy and safety of ulipristal acetate (UPA), an SPRM, by race and body mass index (BMI) in premenopausal women (aged 18 to 50) with symptomatic uterine fibroids.¹

Simon and colleagues randomly assigned participants to UPA 5 mg, UPA 10 mg, or placebo once daily for 12 weeks, followed by a 12-week treatment-free follow-up period. UPA, at 5 and 10 mg, was significantly more efficacious than placebo in rate of and time to amenorrhea (P<.0001). The superiority was observed regardless of race and BMI. In addition, women taking UPA versus placebo reported significantly less impact on activities due to uterine fibroids. The study authors concluded that “UPA treatment provides effective control of bleeding and improvement in physical and social activities for women with symptomatic uterine fibroids, regardless of race and BMI.”¹

Establishing the ideal treatment period for UPA to avoid progesterone-associated endometrial changes (in this study it was 12 weeks of once-daily therapy) is a current goal, said Simon.

Details of elagolix phase 2b study

Simon also presented data on another investigational drug, elagolix, an orally administered GnRH antagonist, which has an inhibiting effect on luteinizing hormone and follicle-stimulating hormone secretion. This in turn reduces production of estradiol and progesterone. Elagolix also is being studied for the treatment of endometriosis.³

In the uterine fibroids study, a 24-week, multicenter, double-blind, randomized controlled, parallel group trial, 567 premenopausal women aged 18 to 51 with heavy menstrual bleeding of >80 mL of blood loss were assigned to placebo or elagolix 300 mg twice per day or 600 mg once per day alone or in combination with add-back therapy (with estradiol/norethindrone acetate) to prevent bone loss and menopausal symptoms.⁴

Compared with placebo, women treated with elagolix with or without add-back therapy had significant reductions from baseline in mean menstrual blood loss. Women treated with elagolix also had significant increases in hemoglobin concentration from baseline to month 6 compared with placebo.⁴

Adverse effects were similar to menopause symptoms: bone loss, hot flashes, night sweats, headaches, and disturbed sleep, said Simon. With the add-back treatments, adverse effects were mitigated in a dose-dependent fashion, he pointed out, and were most likely tolerable compared with the heavy bleeding experienced by women at the start of the study.

Monica Saini, MD, a radiologist in Santa Fe, New Mexico, and JoAnn Pushkin, executive director of the nonprofit educational website DenseBreast-info.org, engaged ObGyn attendees on “Breast density: Why it matters and what to do” at the American College of Obstetricians and Gynecologists (ACOG) 2017 Annual Clinical and Scientific Meeting (May 6–9, 2017) in San Diego, California. The program was sponsored by GE Healthcare.

DENSE BREASTS ARE A RISK FACTOR FOR CANCER

Breast density is the second largest risk factor for breast cancer after radiation treatment to the chest, so it is important to identify patients with dense breasts, according to Dr. Saini. The American College of Radiology’s Breast Imaging Reporting and Data System (BI-RADS) classifies breast density into 4 groups: 1) almost entirely fatty, 2) scattered fibroglandular densities, 3) heterogeneously dense, and 4) extremely dense. A woman whose mammograms show heterogeneously dense or extremely dense breasts is considered to have “dense breasts.”

Cancer is often difficult to identify with mammography in dense breasts because masses or lumps appear as white on a white (dense tissue) background; by contrast, a tumor in a nondense (fatty) breast would appear as white on a dark, fatty tissue background. Approximately one-third of cancers in dense breasts have a delayed diagnosis on mammography, and 70% of cancers occur in dense breasts, said Dr. Saini.

Having dense breasts is not an abnormal condition, however, and is actually common—about 40% of women aged 40 or older have dense breasts.

Supplement mammography with other screening modalities

While screening mammograms can save lives, mammography should not be viewed as a one-size-fits-all modality. Screening for breast cancer should be personalized, based on, among other factors, a woman’s personal and family history, age, genetic risk, lifestyle factors, and breast density.

Key point. Women with dense breasts should continue to have screening mammograms. In addition, mammography for these patients should be supplemented with other technologies, such as 3D mammography (digital tomosynthesis), handheld ultrasound, or automated breast ultrasound (ABUS). In women at higher risk (presence of BRCA1 or BRCA2 gene mutation, strong family history of breast cancer, or radiation treatment to the chest) magnetic resonance imaging (MRI) may be considered.

Data on adjunct screening modalities. Dr. Saini discussed the results of the ASTOUND trial, a prospective multicenter study that compared ultrasound and tomosynthesis for the detection of breast cancer in mammography-negative dense breasts.¹ Among the 3,231 asymptomatic women included in the trial, 13 breast cancers were detected with tomosynthesis (incremental cancer detection rate [CDR], 4 per 1,000 screens; 95% confidence interval [CI], 1.8–6.2) and 23 were detected with ultrasound (incremental CDR, 7.1 per 1,000 screens; 95% CI, 4.4–10.0), P = .006. There were 107 false-positive results: 53 with tomosynthesis and 65 with ultrasound, a difference that was not statistically significant. The study authors noted that while ultrasound had better incremental breast cancer detection than tomosynthesis, and at a similar false-positive recall rate, tomosynthesis did detect more than half of the additional breast cancers in these women.¹

Make screening easier for the patient

Dr. Saini noted that for women with dense breasts, performing mammography and adjunctive screening at the same visit is convenient for the patient. Physicians can also write prescriptions for follow-up based on density findings, for example, “3D mammography if available, if dense, order ultrasound.”

Read how to answer patient questions about breast density

ARE YOU READY TO ANSWER PATIENT QUESTIONS ABOUT BREAST DENSITY?

That is the question JoAnn Pushkin, executive director of DenseBreast-info.org, asked in her presentation. You should discuss with patients exactly what it means to have dense breasts, breast density as an independent risk factor for cancer, the breast imaging technologies available for screening (mammography, tomosynthesis, ultrasound, contrast-enhanced MRI), the risks and benefits of each screening modality, and surveillance intervals for women with dense breasts. Good communication with the patient’s radiology team assists in formulating an individualized screening strategy.

Patients may have concerns about the information provided—or not provided—in their state’s breast density notification letter after a mammogram. Currently, 31 states mandate some type of breast density notification, while 4 states have efforts for density reporting or education that do not require notification. The information given to patients and how they will be informed varies by state. Some states, for example, require that patients who have heterogeneously or extremely dense breasts be informed of this by letter, while other states require that all patients receive the same notification with information about dense breasts but does not tell them whether or not they have dense breasts.

A go-to resource for ObGyns and patients

The website of the nonprofit DenseBreast-Info.org (http://densebreast-info.org/), co-founded by Wendie Berg, MD, PhD, who serves as Chief Scientific Advisor to the organization and is Professor of Radiology at the University of Pittsburgh School of Medicine/Magee-Women’s Hospital of UPMC, provides an interactive US map that features state-by-state breast density reporting guidelines so you can stay up-to-date on notification legislation in your area.

Sections for patients offer comprehensive and clearly written information on categories of breast density, a patient risk checklist, screening test descriptions, frequently asked questions, educational videos, and a patient brochure in English and Spanish.

For health care providers, resources include:

• a screening decision support tool flowchart to help assess which patients need more screening
• a table summarizing the cancer detection rates for mammography alone and mammography plus another screening modality (tomosynthesis, ultrasound, MRI)
• a comparison of breast cancer screening guidelines from various medical societies, including the American College of Radiology/Society of Breast Imaging, the American Cancer Society, the American College of Obstetricians and Gynecologists, and the US Preventive Services Task Force.

A special section covers screening technology, and each page includes descriptions, benefits, and considerations for use. Photos of the equipment and images of breast scans with explanatory captions enhance understanding.

Screening for high-risk women

Ms. Pushkin noted that for high-risk patients with dense breasts, mammography plus MRI annually would be an appropriate option.

Monica Saini, MD, a radiologist in Santa Fe, New Mexico, and JoAnn Pushkin, executive director of the nonprofit educational website DenseBreast-info.org, engaged ObGyn attendees on “Breast density: Why it matters and what to do” at the American College of Obstetricians and Gynecologists (ACOG) 2017 Annual Clinical and Scientific Meeting (May 6–9, 2017) in San Diego, California. The program was sponsored by GE Healthcare.

DENSE BREASTS ARE A RISK FACTOR FOR CANCER

Breast density is the second largest risk factor for breast cancer after radiation treatment to the chest, so it is important to identify patients with dense breasts, according to Dr. Saini. The American College of Radiology’s Breast Imaging Reporting and Data System (BI-RADS) classifies breast density into 4 groups: 1) almost entirely fatty, 2) scattered fibroglandular densities, 3) heterogeneously dense, and 4) extremely dense. A woman whose mammograms show heterogeneously dense or extremely dense breasts is considered to have “dense breasts.”

Cancer is often difficult to identify with mammography in dense breasts because masses or lumps appear as white on a white (dense tissue) background; by contrast, a tumor in a nondense (fatty) breast would appear as white on a dark, fatty tissue background. Approximately one-third of cancers in dense breasts have a delayed diagnosis on mammography, and 70% of cancers occur in dense breasts, said Dr. Saini.

Having dense breasts is not an abnormal condition, however, and is actually common—about 40% of women aged 40 or older have dense breasts.

Supplement mammography with other screening modalities

While screening mammograms can save lives, mammography should not be viewed as a one-size-fits-all modality. Screening for breast cancer should be personalized, based on, among other factors, a woman’s personal and family history, age, genetic risk, lifestyle factors, and breast density.

Key point. Women with dense breasts should continue to have screening mammograms. In addition, mammography for these patients should be supplemented with other technologies, such as 3D mammography (digital tomosynthesis), handheld ultrasound, or automated breast ultrasound (ABUS). In women at higher risk (presence of BRCA1 or BRCA2 gene mutation, strong family history of breast cancer, or radiation treatment to the chest) magnetic resonance imaging (MRI) may be considered.

Data on adjunct screening modalities. Dr. Saini discussed the results of the ASTOUND trial, a prospective multicenter study that compared ultrasound and tomosynthesis for the detection of breast cancer in mammography-negative dense breasts.¹ Among the 3,231 asymptomatic women included in the trial, 13 breast cancers were detected with tomosynthesis (incremental cancer detection rate [CDR], 4 per 1,000 screens; 95% confidence interval [CI], 1.8–6.2) and 23 were detected with ultrasound (incremental CDR, 7.1 per 1,000 screens; 95% CI, 4.4–10.0), P = .006. There were 107 false-positive results: 53 with tomosynthesis and 65 with ultrasound, a difference that was not statistically significant. The study authors noted that while ultrasound had better incremental breast cancer detection than tomosynthesis, and at a similar false-positive recall rate, tomosynthesis did detect more than half of the additional breast cancers in these women.¹

Make screening easier for the patient

Dr. Saini noted that for women with dense breasts, performing mammography and adjunctive screening at the same visit is convenient for the patient. Physicians can also write prescriptions for follow-up based on density findings, for example, “3D mammography if available, if dense, order ultrasound.”

Read how to answer patient questions about breast density

ARE YOU READY TO ANSWER PATIENT QUESTIONS ABOUT BREAST DENSITY?

That is the question JoAnn Pushkin, executive director of DenseBreast-info.org, asked in her presentation. You should discuss with patients exactly what it means to have dense breasts, breast density as an independent risk factor for cancer, the breast imaging technologies available for screening (mammography, tomosynthesis, ultrasound, contrast-enhanced MRI), the risks and benefits of each screening modality, and surveillance intervals for women with dense breasts. Good communication with the patient’s radiology team assists in formulating an individualized screening strategy.

Patients may have concerns about the information provided—or not provided—in their state’s breast density notification letter after a mammogram. Currently, 31 states mandate some type of breast density notification, while 4 states have efforts for density reporting or education that do not require notification. The information given to patients and how they will be informed varies by state. Some states, for example, require that patients who have heterogeneously or extremely dense breasts be informed of this by letter, while other states require that all patients receive the same notification with information about dense breasts but does not tell them whether or not they have dense breasts.

A go-to resource for ObGyns and patients

The website of the nonprofit DenseBreast-Info.org (http://densebreast-info.org/), co-founded by Wendie Berg, MD, PhD, who serves as Chief Scientific Advisor to the organization and is Professor of Radiology at the University of Pittsburgh School of Medicine/Magee-Women’s Hospital of UPMC, provides an interactive US map that features state-by-state breast density reporting guidelines so you can stay up-to-date on notification legislation in your area.

Sections for patients offer comprehensive and clearly written information on categories of breast density, a patient risk checklist, screening test descriptions, frequently asked questions, educational videos, and a patient brochure in English and Spanish.

For health care providers, resources include:

• a screening decision support tool flowchart to help assess which patients need more screening
• a table summarizing the cancer detection rates for mammography alone and mammography plus another screening modality (tomosynthesis, ultrasound, MRI)
• a comparison of breast cancer screening guidelines from various medical societies, including the American College of Radiology/Society of Breast Imaging, the American Cancer Society, the American College of Obstetricians and Gynecologists, and the US Preventive Services Task Force.

A special section covers screening technology, and each page includes descriptions, benefits, and considerations for use. Photos of the equipment and images of breast scans with explanatory captions enhance understanding.

Screening for high-risk women

Ms. Pushkin noted that for high-risk patients with dense breasts, mammography plus MRI annually would be an appropriate option.

Monica Saini, MD, a radiologist in Santa Fe, New Mexico, and JoAnn Pushkin, executive director of the nonprofit educational website DenseBreast-info.org, engaged ObGyn attendees on “Breast density: Why it matters and what to do” at the American College of Obstetricians and Gynecologists (ACOG) 2017 Annual Clinical and Scientific Meeting (May 6–9, 2017) in San Diego, California. The program was sponsored by GE Healthcare.

DENSE BREASTS ARE A RISK FACTOR FOR CANCER

Breast density is the second largest risk factor for breast cancer after radiation treatment to the chest, so it is important to identify patients with dense breasts, according to Dr. Saini. The American College of Radiology’s Breast Imaging Reporting and Data System (BI-RADS) classifies breast density into 4 groups: 1) almost entirely fatty, 2) scattered fibroglandular densities, 3) heterogeneously dense, and 4) extremely dense. A woman whose mammograms show heterogeneously dense or extremely dense breasts is considered to have “dense breasts.”

Cancer is often difficult to identify with mammography in dense breasts because masses or lumps appear as white on a white (dense tissue) background; by contrast, a tumor in a nondense (fatty) breast would appear as white on a dark, fatty tissue background. Approximately one-third of cancers in dense breasts have a delayed diagnosis on mammography, and 70% of cancers occur in dense breasts, said Dr. Saini.

Having dense breasts is not an abnormal condition, however, and is actually common—about 40% of women aged 40 or older have dense breasts.

Supplement mammography with other screening modalities

While screening mammograms can save lives, mammography should not be viewed as a one-size-fits-all modality. Screening for breast cancer should be personalized, based on, among other factors, a woman’s personal and family history, age, genetic risk, lifestyle factors, and breast density.

Key point. Women with dense breasts should continue to have screening mammograms. In addition, mammography for these patients should be supplemented with other technologies, such as 3D mammography (digital tomosynthesis), handheld ultrasound, or automated breast ultrasound (ABUS). In women at higher risk (presence of BRCA1 or BRCA2 gene mutation, strong family history of breast cancer, or radiation treatment to the chest) magnetic resonance imaging (MRI) may be considered.

Data on adjunct screening modalities. Dr. Saini discussed the results of the ASTOUND trial, a prospective multicenter study that compared ultrasound and tomosynthesis for the detection of breast cancer in mammography-negative dense breasts.¹ Among the 3,231 asymptomatic women included in the trial, 13 breast cancers were detected with tomosynthesis (incremental cancer detection rate [CDR], 4 per 1,000 screens; 95% confidence interval [CI], 1.8–6.2) and 23 were detected with ultrasound (incremental CDR, 7.1 per 1,000 screens; 95% CI, 4.4–10.0), P = .006. There were 107 false-positive results: 53 with tomosynthesis and 65 with ultrasound, a difference that was not statistically significant. The study authors noted that while ultrasound had better incremental breast cancer detection than tomosynthesis, and at a similar false-positive recall rate, tomosynthesis did detect more than half of the additional breast cancers in these women.¹

Make screening easier for the patient

Dr. Saini noted that for women with dense breasts, performing mammography and adjunctive screening at the same visit is convenient for the patient. Physicians can also write prescriptions for follow-up based on density findings, for example, “3D mammography if available, if dense, order ultrasound.”

Read how to answer patient questions about breast density

ARE YOU READY TO ANSWER PATIENT QUESTIONS ABOUT BREAST DENSITY?

That is the question JoAnn Pushkin, executive director of DenseBreast-info.org, asked in her presentation. You should discuss with patients exactly what it means to have dense breasts, breast density as an independent risk factor for cancer, the breast imaging technologies available for screening (mammography, tomosynthesis, ultrasound, contrast-enhanced MRI), the risks and benefits of each screening modality, and surveillance intervals for women with dense breasts. Good communication with the patient’s radiology team assists in formulating an individualized screening strategy.

Patients may have concerns about the information provided—or not provided—in their state’s breast density notification letter after a mammogram. Currently, 31 states mandate some type of breast density notification, while 4 states have efforts for density reporting or education that do not require notification. The information given to patients and how they will be informed varies by state. Some states, for example, require that patients who have heterogeneously or extremely dense breasts be informed of this by letter, while other states require that all patients receive the same notification with information about dense breasts but does not tell them whether or not they have dense breasts.

A go-to resource for ObGyns and patients

The website of the nonprofit DenseBreast-Info.org (http://densebreast-info.org/), co-founded by Wendie Berg, MD, PhD, who serves as Chief Scientific Advisor to the organization and is Professor of Radiology at the University of Pittsburgh School of Medicine/Magee-Women’s Hospital of UPMC, provides an interactive US map that features state-by-state breast density reporting guidelines so you can stay up-to-date on notification legislation in your area.

Sections for patients offer comprehensive and clearly written information on categories of breast density, a patient risk checklist, screening test descriptions, frequently asked questions, educational videos, and a patient brochure in English and Spanish.

For health care providers, resources include:

• a screening decision support tool flowchart to help assess which patients need more screening
• a table summarizing the cancer detection rates for mammography alone and mammography plus another screening modality (tomosynthesis, ultrasound, MRI)
• a comparison of breast cancer screening guidelines from various medical societies, including the American College of Radiology/Society of Breast Imaging, the American Cancer Society, the American College of Obstetricians and Gynecologists, and the US Preventive Services Task Force.

A special section covers screening technology, and each page includes descriptions, benefits, and considerations for use. Photos of the equipment and images of breast scans with explanatory captions enhance understanding.

Screening for high-risk women

Ms. Pushkin noted that for high-risk patients with dense breasts, mammography plus MRI annually would be an appropriate option.

Los Angeles County, California, has been identified as one of 7 areas in the nation with the highest risk of local Zika transmission by the Centers for Disease Control and Prevention (CDC), advise Adriana Ramos and colleagues from Los Angeles County Department of Public Health (DPH), Maternal, Child & Adolescent Health Programs.¹ One factor for this classification is the county’s high birth rate. According to Ramos at el the CDC recommends that, before a Zika outbreak occurs, health departments in areas with Aedes species mosquitos increase access to and use of effective contraception.¹ Long-acting reversible contraceptives (LARCs), including the intrauterine device (IUD) and the implant, are proven most effective methods.¹

In a poster presented at the American College of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting in San Diego, California, Ramos and colleagues summarized contraceptive use within LA County using data from the Los Angeles Mommy and Baby (LAMB) project, conducted by the Maternal, Child, and Adolescent Health (MCAH) Programs of the LA County DPH, which surveyed mothers who recently delivered a live baby about their preconception and perinatal experiences. In 2012, 6,893 mothers participated. In 2014, MCAH re-interviewed the 2012 LAMB respondents, excluding those with a subsequent pregnancy after the 2012 survey or who had not originally answered questions about family planning, leaving 3,175 respondents. Findings, weighted to the 2012 live-birth cohort, estimated the weighted population at 115,284 live births.¹

The study defined contraception use by efficacy, identifying no contraception use, condoms, withdrawal, and the rhythm method as less effective; oral contraceptive pills and vaginal ring as moderately effective; and LARCs and sterilization as highly effective. Unintended births account for 47% of births in LAC and more than 59% of women report using less effective contraceptive methods.¹

Results of the study

As a result of their study, MCAH researchers Adriana Ramos, Shin Chao, MD, MPH, and Diana E. Ramos, MD, MPH, conclude that educating providers to place LARC contraceptives and educating the public on the most effective contraceptive methods can decrease the neonatal Zika complication rates by preventing unplanned pregnancy. LAC is undertaking these activities to decrease the number of neonatal Zika cases.¹

Los Angeles County, California, has been identified as one of 7 areas in the nation with the highest risk of local Zika transmission by the Centers for Disease Control and Prevention (CDC), advise Adriana Ramos and colleagues from Los Angeles County Department of Public Health (DPH), Maternal, Child & Adolescent Health Programs.¹ One factor for this classification is the county’s high birth rate. According to Ramos at el the CDC recommends that, before a Zika outbreak occurs, health departments in areas with Aedes species mosquitos increase access to and use of effective contraception.¹ Long-acting reversible contraceptives (LARCs), including the intrauterine device (IUD) and the implant, are proven most effective methods.¹

In a poster presented at the American College of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting in San Diego, California, Ramos and colleagues summarized contraceptive use within LA County using data from the Los Angeles Mommy and Baby (LAMB) project, conducted by the Maternal, Child, and Adolescent Health (MCAH) Programs of the LA County DPH, which surveyed mothers who recently delivered a live baby about their preconception and perinatal experiences. In 2012, 6,893 mothers participated. In 2014, MCAH re-interviewed the 2012 LAMB respondents, excluding those with a subsequent pregnancy after the 2012 survey or who had not originally answered questions about family planning, leaving 3,175 respondents. Findings, weighted to the 2012 live-birth cohort, estimated the weighted population at 115,284 live births.¹

The study defined contraception use by efficacy, identifying no contraception use, condoms, withdrawal, and the rhythm method as less effective; oral contraceptive pills and vaginal ring as moderately effective; and LARCs and sterilization as highly effective. Unintended births account for 47% of births in LAC and more than 59% of women report using less effective contraceptive methods.¹

Results of the study

As a result of their study, MCAH researchers Adriana Ramos, Shin Chao, MD, MPH, and Diana E. Ramos, MD, MPH, conclude that educating providers to place LARC contraceptives and educating the public on the most effective contraceptive methods can decrease the neonatal Zika complication rates by preventing unplanned pregnancy. LAC is undertaking these activities to decrease the number of neonatal Zika cases.¹

Los Angeles County, California, has been identified as one of 7 areas in the nation with the highest risk of local Zika transmission by the Centers for Disease Control and Prevention (CDC), advise Adriana Ramos and colleagues from Los Angeles County Department of Public Health (DPH), Maternal, Child & Adolescent Health Programs.¹ One factor for this classification is the county’s high birth rate. According to Ramos at el the CDC recommends that, before a Zika outbreak occurs, health departments in areas with Aedes species mosquitos increase access to and use of effective contraception.¹ Long-acting reversible contraceptives (LARCs), including the intrauterine device (IUD) and the implant, are proven most effective methods.¹

In a poster presented at the American College of Obstetricians and Gynecologists (ACOG) Annual Clinical Meeting in San Diego, California, Ramos and colleagues summarized contraceptive use within LA County using data from the Los Angeles Mommy and Baby (LAMB) project, conducted by the Maternal, Child, and Adolescent Health (MCAH) Programs of the LA County DPH, which surveyed mothers who recently delivered a live baby about their preconception and perinatal experiences. In 2012, 6,893 mothers participated. In 2014, MCAH re-interviewed the 2012 LAMB respondents, excluding those with a subsequent pregnancy after the 2012 survey or who had not originally answered questions about family planning, leaving 3,175 respondents. Findings, weighted to the 2012 live-birth cohort, estimated the weighted population at 115,284 live births.¹

The study defined contraception use by efficacy, identifying no contraception use, condoms, withdrawal, and the rhythm method as less effective; oral contraceptive pills and vaginal ring as moderately effective; and LARCs and sterilization as highly effective. Unintended births account for 47% of births in LAC and more than 59% of women report using less effective contraceptive methods.¹

Results of the study

As a result of their study, MCAH researchers Adriana Ramos, Shin Chao, MD, MPH, and Diana E. Ramos, MD, MPH, conclude that educating providers to place LARC contraceptives and educating the public on the most effective contraceptive methods can decrease the neonatal Zika complication rates by preventing unplanned pregnancy. LAC is undertaking these activities to decrease the number of neonatal Zika cases.¹

3/28/17. DAY 3 AT SGS

Exciting presentations continue, society groups provide updates

The team from Mayo Clinic was still riding high this morning after winning last night’s armadillo race, which was part of the Texas hoedown fundraiser for SHARE.

The seventh scientific session started with a nice presentation by Cara Grimes, MD, entitled, “Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial.” Several quality presentations followed before Ike Rahn, MD, updated the society on the work of the Fellows Pelvic Research Network, a group currently celebrating its 10th anniversary.

Drs. Star Hampton and Peter Jeppson then took the stage to share the progress of the SGS Pelvic Anatomy Group as they undertake the daunting task of a systematic review of anatomic terms used in the medical literature.

Leadership transition

Surely the moment that SGS President Vivian Sung, MD, had been waiting for all week was the passing of the gavel to incoming president John Gebhart, MD. On acceptance of his role as the incoming president, Dr. Gebhart’s remarks focused on the honor of serving in that role, and he stated that Dr. Sung, in her usual fashion, set the bar for performance very high.

After the midmorning break, where attendants usually say their temporary goodbyes to friends and mentors, old and new, the eighth and final scientific session began.

Come to next year’s meeting!

If you consider yourself a gynecologic surgeon (and if you’re reading this you probably do), please consider adding attendance at the next SGS meeting to your list of “things to do” in 2018. This family-friendly meeting is filled with opportunities for surgical teaching, learning, rest, relaxation, networking, and reconnecting. Most of all, it is a place where mentoring relationships begin and are nurtured, recognized, and appreciated.

See you in Orlando!

3/28/17. DAY 2 AT SGS

Morning highlights: Prize-winning paper, presidential address

Scholarly activity continued this morning at the Society of Gynecologic Surgeons Annual Scientific meeting at the La Cantera Resort in San Antonio, Texas.  After early morning reviews and coffee with good friends, the scientific program began with a comparison of barbed and nonbarbed sutures, after which Eric Jelovsek, MD, presented the prize-winning paper for the Pelvic Floor Disorders Network, “A Randomized Trial of Uterosacral Ligament Suspension or Sacrospinous Ligament Fixation for Apical Pelvic Organ Prolapse: Five-year Outcomes.”

The highlight of the morning was almost certainly the presidential address in which Dr. Vivian Sung shared with the audience the recipe for the “secret sauce” that makes SGS a special organization:

1. Be everyday leaders and mentors. Do the little things to teach, coach, and encourage others in the field.
2. Maintain a safe environment. Allow others to be brave, be creative, and make mistakes. It will make them more effective.
3. Consider the “WHY.” Focus on why SGS exists and continue to strive for that mission.

Stimulating scientific sessions

After the fifth scientific session, where we learned that prophylactic salpingectomy at the time of vaginal hysterectomy not only is feasible but also cost-effective, participants were treated to the TeLinde Lecture. Dr. Richard Reznick, Dean of Health Sciences and Professor in the Department of Surgery at Queen’s University in Kingston, Ontario, shared exciting and intriguing data regarding competency-based learning in surgical training. The lecture, entitled “Great Expectations: The Promise of Competency-based Education,” sparked questions and conversation that could have gone on for hours. Alas, program director Rob Gutman, MD, kept the program on track and, after a brief break for lunch, the sixth scientific session was underway.

In the sixth session, Dr. Gutman moderated a lively panel discussion that set out to answer the question, “How can we increase the percentage and quality of minimally invasive hysterectomy for benign disease among low/intermediate volume gynecologic surgeons?” Panelists shared thoughts and information—from organizations and institutions around the country—outlining the data on current hysterectomy rates, trends in policymaking, learning through simulation, incremental quality improvement planning, and surgical pathways.

Afternoon fun and a Texas hoedown

The scientific meeting was then adjourned, making way for the SGS business meeting and then an afternoon of well-deserved fun in the Texas sun. 

Evening events included an old-fashioned Texas hoedown—a time for two-stepping, armadillo racing, and camaraderie to raise money for SHARE.  My money’s on the armadillo from the University of New Mexico!

3/27/17. DAY 1 AT SGS

Debate, postgrad courses, videos galore

The Annual Scientific Meeting of the Society of Gynecologic Surgeons, held in San Antonio, Texas, opened to an energetic crowd when SGS President, Vivan Sung, MD, welcomed participants from 10 countries before introducing the society’s 10 newest members. The first scientific session then quickly got underway with oral presentations and videos covering a variety of topics.

Janet Bickel, MS, a national leader in mentorship and faculty development, reinforced the meeting’s theme with her keynote lecture, “Hard Work and Talent Aren’t Enough: Mentoring and Finding Mentors across Career Stages.” She shared with attendees the keys to mentoring women and minorities before outlining the characteristics associated with both effective mentors and mentees. It turns out that many of her key points had been on display just a day earlier during the postgraduate courses in which physicians from around the country were coached by experts on surgical complications, pelvic anatomy and computer modeling, surgical teaching, and enhanced surgical recovery.

After a brief break for lunch at the beautiful La Cantera Resort, attendees returned for a lively debate between Kim Kenton, MD and Geoff Cundiff, MD entitled “Should we separate the O from the G in Obstetrics and Gynecology?” Dee Fenner, MD acted as moderator and referee as both sides passionately shared their convincing arguments. In the end, both parties agreed that this century-old debate would continue as we constantly evaluate the best approach to caring for the female patient.

Promises of popcorn brought attendees back to the meeting hall for the afternoon videofest where 13 videos were presented on a variety of surgical topics.

Specialists learn from each other

Meanwhile, the Fellows Pelvic Research Network had the pleasure a special lecture and Q&A session with Linda Brubaker, MD. Among the many pearls of wisdom she shared was an evergreen piece of advice, “Enthusiasm is good. Focus is better.” The fellows then turned their focus to the review of current projects and evaluation of proposals for new research.

Eight academic roundtables hosted by experts from across the country provided an opportunity for attendees to discuss best practices in various areas of pelvic surgery including bladder pain syndrome, chronic pelvic pain, transgender care, billing and coding, social media, and more.

The day ended with a delightful awards ceremony in which Dr. Sung recognized outstanding scholarly and service activity in the gynecologic surgery community. Notably, Dr. Peter Jeppson was presented with the 2017 Distinguished Service Award. Members then joined meeting sponsors and staff in the exhibit hall for an evening reception—a fitting ending to a phenomenal first day.

Click for more…

For more details about the scientific presentations and to read abstracts of presentations, videos, and posters, see the March 2017 supplemental issue of the American Journal of Obstetrics and Gynecology.

For an up-to-the minute report of the week’s events, follow the #SGS2017 hashtag on Twitter. Be sure to follow @obgmanagement, @gynsurg, and @stuboo as well.

3/28/17. DAY 3 AT SGS

Exciting presentations continue, society groups provide updates

The team from Mayo Clinic was still riding high this morning after winning last night’s armadillo race, which was part of the Texas hoedown fundraiser for SHARE.

The seventh scientific session started with a nice presentation by Cara Grimes, MD, entitled, “Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial.” Several quality presentations followed before Ike Rahn, MD, updated the society on the work of the Fellows Pelvic Research Network, a group currently celebrating its 10th anniversary.

Drs. Star Hampton and Peter Jeppson then took the stage to share the progress of the SGS Pelvic Anatomy Group as they undertake the daunting task of a systematic review of anatomic terms used in the medical literature.

Leadership transition

Surely the moment that SGS President Vivian Sung, MD, had been waiting for all week was the passing of the gavel to incoming president John Gebhart, MD. On acceptance of his role as the incoming president, Dr. Gebhart’s remarks focused on the honor of serving in that role, and he stated that Dr. Sung, in her usual fashion, set the bar for performance very high.

After the midmorning break, where attendants usually say their temporary goodbyes to friends and mentors, old and new, the eighth and final scientific session began.

Come to next year’s meeting!

If you consider yourself a gynecologic surgeon (and if you’re reading this you probably do), please consider adding attendance at the next SGS meeting to your list of “things to do” in 2018. This family-friendly meeting is filled with opportunities for surgical teaching, learning, rest, relaxation, networking, and reconnecting. Most of all, it is a place where mentoring relationships begin and are nurtured, recognized, and appreciated.

See you in Orlando!

3/28/17. DAY 2 AT SGS

Morning highlights: Prize-winning paper, presidential address

Scholarly activity continued this morning at the Society of Gynecologic Surgeons Annual Scientific meeting at the La Cantera Resort in San Antonio, Texas.  After early morning reviews and coffee with good friends, the scientific program began with a comparison of barbed and nonbarbed sutures, after which Eric Jelovsek, MD, presented the prize-winning paper for the Pelvic Floor Disorders Network, “A Randomized Trial of Uterosacral Ligament Suspension or Sacrospinous Ligament Fixation for Apical Pelvic Organ Prolapse: Five-year Outcomes.”

The highlight of the morning was almost certainly the presidential address in which Dr. Vivian Sung shared with the audience the recipe for the “secret sauce” that makes SGS a special organization:

1. Be everyday leaders and mentors. Do the little things to teach, coach, and encourage others in the field.
2. Maintain a safe environment. Allow others to be brave, be creative, and make mistakes. It will make them more effective.
3. Consider the “WHY.” Focus on why SGS exists and continue to strive for that mission.

Stimulating scientific sessions

After the fifth scientific session, where we learned that prophylactic salpingectomy at the time of vaginal hysterectomy not only is feasible but also cost-effective, participants were treated to the TeLinde Lecture. Dr. Richard Reznick, Dean of Health Sciences and Professor in the Department of Surgery at Queen’s University in Kingston, Ontario, shared exciting and intriguing data regarding competency-based learning in surgical training. The lecture, entitled “Great Expectations: The Promise of Competency-based Education,” sparked questions and conversation that could have gone on for hours. Alas, program director Rob Gutman, MD, kept the program on track and, after a brief break for lunch, the sixth scientific session was underway.

In the sixth session, Dr. Gutman moderated a lively panel discussion that set out to answer the question, “How can we increase the percentage and quality of minimally invasive hysterectomy for benign disease among low/intermediate volume gynecologic surgeons?” Panelists shared thoughts and information—from organizations and institutions around the country—outlining the data on current hysterectomy rates, trends in policymaking, learning through simulation, incremental quality improvement planning, and surgical pathways.

Afternoon fun and a Texas hoedown

The scientific meeting was then adjourned, making way for the SGS business meeting and then an afternoon of well-deserved fun in the Texas sun. 

Evening events included an old-fashioned Texas hoedown—a time for two-stepping, armadillo racing, and camaraderie to raise money for SHARE.  My money’s on the armadillo from the University of New Mexico!

3/27/17. DAY 1 AT SGS

Debate, postgrad courses, videos galore

The Annual Scientific Meeting of the Society of Gynecologic Surgeons, held in San Antonio, Texas, opened to an energetic crowd when SGS President, Vivan Sung, MD, welcomed participants from 10 countries before introducing the society’s 10 newest members. The first scientific session then quickly got underway with oral presentations and videos covering a variety of topics.

Janet Bickel, MS, a national leader in mentorship and faculty development, reinforced the meeting’s theme with her keynote lecture, “Hard Work and Talent Aren’t Enough: Mentoring and Finding Mentors across Career Stages.” She shared with attendees the keys to mentoring women and minorities before outlining the characteristics associated with both effective mentors and mentees. It turns out that many of her key points had been on display just a day earlier during the postgraduate courses in which physicians from around the country were coached by experts on surgical complications, pelvic anatomy and computer modeling, surgical teaching, and enhanced surgical recovery.

After a brief break for lunch at the beautiful La Cantera Resort, attendees returned for a lively debate between Kim Kenton, MD and Geoff Cundiff, MD entitled “Should we separate the O from the G in Obstetrics and Gynecology?” Dee Fenner, MD acted as moderator and referee as both sides passionately shared their convincing arguments. In the end, both parties agreed that this century-old debate would continue as we constantly evaluate the best approach to caring for the female patient.

Promises of popcorn brought attendees back to the meeting hall for the afternoon videofest where 13 videos were presented on a variety of surgical topics.

Specialists learn from each other

Meanwhile, the Fellows Pelvic Research Network had the pleasure a special lecture and Q&A session with Linda Brubaker, MD. Among the many pearls of wisdom she shared was an evergreen piece of advice, “Enthusiasm is good. Focus is better.” The fellows then turned their focus to the review of current projects and evaluation of proposals for new research.

Eight academic roundtables hosted by experts from across the country provided an opportunity for attendees to discuss best practices in various areas of pelvic surgery including bladder pain syndrome, chronic pelvic pain, transgender care, billing and coding, social media, and more.

The day ended with a delightful awards ceremony in which Dr. Sung recognized outstanding scholarly and service activity in the gynecologic surgery community. Notably, Dr. Peter Jeppson was presented with the 2017 Distinguished Service Award. Members then joined meeting sponsors and staff in the exhibit hall for an evening reception—a fitting ending to a phenomenal first day.

Click for more…

For more details about the scientific presentations and to read abstracts of presentations, videos, and posters, see the March 2017 supplemental issue of the American Journal of Obstetrics and Gynecology.

For an up-to-the minute report of the week’s events, follow the #SGS2017 hashtag on Twitter. Be sure to follow @obgmanagement, @gynsurg, and @stuboo as well.

3/28/17. DAY 3 AT SGS

Exciting presentations continue, society groups provide updates

The team from Mayo Clinic was still riding high this morning after winning last night’s armadillo race, which was part of the Texas hoedown fundraiser for SHARE.

The seventh scientific session started with a nice presentation by Cara Grimes, MD, entitled, “Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial.” Several quality presentations followed before Ike Rahn, MD, updated the society on the work of the Fellows Pelvic Research Network, a group currently celebrating its 10th anniversary.

Drs. Star Hampton and Peter Jeppson then took the stage to share the progress of the SGS Pelvic Anatomy Group as they undertake the daunting task of a systematic review of anatomic terms used in the medical literature.

Leadership transition

Surely the moment that SGS President Vivian Sung, MD, had been waiting for all week was the passing of the gavel to incoming president John Gebhart, MD. On acceptance of his role as the incoming president, Dr. Gebhart’s remarks focused on the honor of serving in that role, and he stated that Dr. Sung, in her usual fashion, set the bar for performance very high.

After the midmorning break, where attendants usually say their temporary goodbyes to friends and mentors, old and new, the eighth and final scientific session began.

Come to next year’s meeting!

If you consider yourself a gynecologic surgeon (and if you’re reading this you probably do), please consider adding attendance at the next SGS meeting to your list of “things to do” in 2018. This family-friendly meeting is filled with opportunities for surgical teaching, learning, rest, relaxation, networking, and reconnecting. Most of all, it is a place where mentoring relationships begin and are nurtured, recognized, and appreciated.

See you in Orlando!

3/28/17. DAY 2 AT SGS

Morning highlights: Prize-winning paper, presidential address

Scholarly activity continued this morning at the Society of Gynecologic Surgeons Annual Scientific meeting at the La Cantera Resort in San Antonio, Texas.  After early morning reviews and coffee with good friends, the scientific program began with a comparison of barbed and nonbarbed sutures, after which Eric Jelovsek, MD, presented the prize-winning paper for the Pelvic Floor Disorders Network, “A Randomized Trial of Uterosacral Ligament Suspension or Sacrospinous Ligament Fixation for Apical Pelvic Organ Prolapse: Five-year Outcomes.”

The highlight of the morning was almost certainly the presidential address in which Dr. Vivian Sung shared with the audience the recipe for the “secret sauce” that makes SGS a special organization:

1. Be everyday leaders and mentors. Do the little things to teach, coach, and encourage others in the field.
2. Maintain a safe environment. Allow others to be brave, be creative, and make mistakes. It will make them more effective.
3. Consider the “WHY.” Focus on why SGS exists and continue to strive for that mission.

Stimulating scientific sessions

After the fifth scientific session, where we learned that prophylactic salpingectomy at the time of vaginal hysterectomy not only is feasible but also cost-effective, participants were treated to the TeLinde Lecture. Dr. Richard Reznick, Dean of Health Sciences and Professor in the Department of Surgery at Queen’s University in Kingston, Ontario, shared exciting and intriguing data regarding competency-based learning in surgical training. The lecture, entitled “Great Expectations: The Promise of Competency-based Education,” sparked questions and conversation that could have gone on for hours. Alas, program director Rob Gutman, MD, kept the program on track and, after a brief break for lunch, the sixth scientific session was underway.

In the sixth session, Dr. Gutman moderated a lively panel discussion that set out to answer the question, “How can we increase the percentage and quality of minimally invasive hysterectomy for benign disease among low/intermediate volume gynecologic surgeons?” Panelists shared thoughts and information—from organizations and institutions around the country—outlining the data on current hysterectomy rates, trends in policymaking, learning through simulation, incremental quality improvement planning, and surgical pathways.

Afternoon fun and a Texas hoedown

The scientific meeting was then adjourned, making way for the SGS business meeting and then an afternoon of well-deserved fun in the Texas sun. 

Evening events included an old-fashioned Texas hoedown—a time for two-stepping, armadillo racing, and camaraderie to raise money for SHARE.  My money’s on the armadillo from the University of New Mexico!

3/27/17. DAY 1 AT SGS

Debate, postgrad courses, videos galore

The Annual Scientific Meeting of the Society of Gynecologic Surgeons, held in San Antonio, Texas, opened to an energetic crowd when SGS President, Vivan Sung, MD, welcomed participants from 10 countries before introducing the society’s 10 newest members. The first scientific session then quickly got underway with oral presentations and videos covering a variety of topics.

Janet Bickel, MS, a national leader in mentorship and faculty development, reinforced the meeting’s theme with her keynote lecture, “Hard Work and Talent Aren’t Enough: Mentoring and Finding Mentors across Career Stages.” She shared with attendees the keys to mentoring women and minorities before outlining the characteristics associated with both effective mentors and mentees. It turns out that many of her key points had been on display just a day earlier during the postgraduate courses in which physicians from around the country were coached by experts on surgical complications, pelvic anatomy and computer modeling, surgical teaching, and enhanced surgical recovery.

After a brief break for lunch at the beautiful La Cantera Resort, attendees returned for a lively debate between Kim Kenton, MD and Geoff Cundiff, MD entitled “Should we separate the O from the G in Obstetrics and Gynecology?” Dee Fenner, MD acted as moderator and referee as both sides passionately shared their convincing arguments. In the end, both parties agreed that this century-old debate would continue as we constantly evaluate the best approach to caring for the female patient.

Promises of popcorn brought attendees back to the meeting hall for the afternoon videofest where 13 videos were presented on a variety of surgical topics.

Specialists learn from each other

Meanwhile, the Fellows Pelvic Research Network had the pleasure a special lecture and Q&A session with Linda Brubaker, MD. Among the many pearls of wisdom she shared was an evergreen piece of advice, “Enthusiasm is good. Focus is better.” The fellows then turned their focus to the review of current projects and evaluation of proposals for new research.

Eight academic roundtables hosted by experts from across the country provided an opportunity for attendees to discuss best practices in various areas of pelvic surgery including bladder pain syndrome, chronic pelvic pain, transgender care, billing and coding, social media, and more.

The day ended with a delightful awards ceremony in which Dr. Sung recognized outstanding scholarly and service activity in the gynecologic surgery community. Notably, Dr. Peter Jeppson was presented with the 2017 Distinguished Service Award. Members then joined meeting sponsors and staff in the exhibit hall for an evening reception—a fitting ending to a phenomenal first day.

Click for more…

For more details about the scientific presentations and to read abstracts of presentations, videos, and posters, see the March 2017 supplemental issue of the American Journal of Obstetrics and Gynecology.

For an up-to-the minute report of the week’s events, follow the #SGS2017 hashtag on Twitter. Be sure to follow @obgmanagement, @gynsurg, and @stuboo as well.