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UC clinical trial compares effectiveness of 2D vs. 3D mammograms

Radiologists at the University of Cincinnati are offering a clinical trial comparing the two types of digital mammography available for breast cancer screening.

The randomized study, led locally by Lawrence Sobel, MD, assistant professor in the Department of Radiology at the UC College of Medicine and director of breast imaging for UC Health, will compare the use of 2D images to 3D images, known as tomosynthesis to determine that 3D tomosynthesis is more effective in the diagnosis of breast cancers.

“We are enrolling healthy women, ages 45 to 74, who are already planning to get routine mammograms,” Sobel says. “By taking part in the trial, the 165,000 planned participants nationally will provide critical information that will help researchers learn how to most effectively screen women for breast cancer and help women make informed decisions about screening tests in the future. This is the first, randomized trial to compare these two types of mammography; this study aims to confirm that 3D technology reduces a woman’s risk of developing an advanced cancer in comparison to 2D.”

Researchers are collecting data on the results of every mammogram, whether the imaging shows no sign of cancer, suspicious areas or a breast cancer, and medical follow-up, such as additional imaging or biopsies, is also being reported. Researchers involved in the study intend to follow all participants for breast cancer status, treatment and outcomes until the end of the study (at least until 2025). Most women enrolled in the trial undergo annual screening, but postmenopausal women with no high-risk factors will be screened every two years.

Sobel adds that researchers are also analyzing tissue collected from women who have biopsies during the trial, which will help in learning more about the biology of breast cancers detected through screening.

“In addition, the trial is building a biorepository for future research on genetic markers for breast cancer by asking all participants to voluntarily submit blood samples and swabs of cells from inside the mouth,” he says. “This data could, in the future, help women and their doctors decide the best ways to screen for breast cancer by evaluating their individual risk factors for developing the disease.

“We hope this trial will provide new insights into the way we screen for breast cancer to provide better outcomes for patients and prevent the disease in its earliest stages.”

*Photo of 3D mammography machine above/Credit: Colleen Kelley

Eligible women who are patients at UC Health and are due for a mammogram will be contacted shortly before their scheduled screening study to discuss possible enrollment. For more information, call 513-584-3135. 

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UC researchers say early puberty in girls may be the new big...

Wed, July 10, 2019

CINCINNATI—Adolescent girls who reach puberty at an earlier age may also have a greater chance of developing migraine headaches, according to new research from investigators at the University of Cincinnati (UC) College of Medicine. “We know that the percentage of girls and boys who have migraine is pretty much the same until menstruation begins,” says Vincent Martin, MD, professor in the Division of General Internal Medicine and director of the Headache and Facial Pain Center at the UC Gardner Neuroscience Institute. “When the menstrual period starts in girls, the prevalence goes way up, but what our data suggests is that it occurs even before that.” The findings will be presented by Martin at the American Headache Society 61st Annual Scientific Meeting Saturday, July 13, in Philadelphia. Nationally, about 10 percent of school age children suffer from migraine, according to the Migraine Research Foundation (MRF). As adolescence approaches, the incidence of migraine increases rapidly in girls, and by age 17, about 8 percent of boys and 23 percent of girls have experienced migraine, the MRF reports. Martin and a team of researchers were part of a longitudinal study looking at 761 adolescent girls from sites in Cincinnati, New York and the San Francisco Bay area. The girls ranged in age from 8 to 20 and study took place over a 10-year period beginning in 2004. Girls enrolled in the study at age 8-10 were examined during study visit every six to 12 months. Researchers determined when they showed initial signs of thelarche (breast development), pubarche (pubic hair growth) and menarche (start of menstrual periods). Girls answered a headache questionnaire to find out if they suffered from migraine headache, no migraine or probable migraine—the latter is defined as meeting all the diagnostic criteria for migraine except one. The average age at which they completed the survey was 16. Of those surveyed, 85 girls (11 percent) were diagnosed with migraine headache while 53 (7 percent) had probable migraine and 623 (82 percent) had no migraine, according to Martin, also a UC Health physician specializing in migraine. Researchers found that girls with migraine had an earlier age of thelarche (breast development) and the onset of menarche (menstrual periods) than those with no migraine. On average breast development occurred four months earlier in those with migraine while menstruation started five months earlier. There was no difference in the age of pubarche (pubic hair development) between those with migraine and no migraine. “There was a 25 percent increase in the chance of having migraine for each year earlier that a girl experienced either thelarche or menarche,” says Susan Pinney, PhD, professor in the UC Department of Environmental Health and lead investigator on the study. “This suggests a strong relationship between early puberty and the development of migraine in adolescent girls.” The age of onset of thelarche, pubarche or menarche did not differ between those with probable migraine and no migraine, says Pinney. Previous research suggests that migraine often starts with the onset of menstrual cycles during menarche in adolescent girls. But this study looks at earlier stages of puberty such as thelarche and pubarche, explains Martin. “To suggest the origins of migraine may occur actually before menstrual periods begin is pretty novel,” says Martin. “At each of these stages, different hormones are starting to appear in girls. During pubarche, testosterone and androgens are present, and during thelarche, there is the very first exposure to estrogen. Menarche is when a more mature hormonal pattern emerges. Our study implies that the very first exposure to estrogen could be the starting point for migraine in some adolescent girls. It may be the Big Bang Theory of migraine.” So is there anything that one can do to prevent an early puberty? “Studies suggest that childhood obesity is associated with early puberty,” says Martin, who is also president of the National Headache Foundation. “Keeping your weight down might prevent the early onset of puberty. Future studies will need to be done to determine if strategy will decrease also the likelihood of developing migraine.” Other co-investigators in the study include Frank Biro, MD, UC professor in the Department of Pediatrics and Cincinnati Children’s pediatrician, Jun Ying, PhD, professor in the UC Department of Environmental Health, and Hao Yu, biostatistician, UC Department of Environmental Health. Funding for this research came grant U01ES026119 from the National Institute of Environmental Health Sciences and grant 1R03HD094236 of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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