Uterine Fibroids: Q&A With an Expert

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Uterine Fibroids: Q&A With an Expert | Johns Hopkins Medicine

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  • Ebola virus disease – Democratic Republic of the Congo … Thu, 14 May 2020 From 6 to 12 May 2020, no new cases of Ebola virus disease (EVD) have been reported from North Kivu Province, Democratic Republic of the Congo (Figure 1). Since the resurgence of the outbreak on 10 April 2020, seven confirmed cases have been reported from Kasanga, Malepe and Kanzulinzuli Health Areas in Beni Health Zone. Of these, one is receiving care at the Beni Ebola treatment centre (ETC), one who was receiving care at the ETC recovered and was discharged, and one remains in the community, 35 days after symptom onset. Efforts to locate this individual are being undertaken to test and provide care for this person. Four of the people confirmed to have Ebola died, including two community deaths and two deaths in the ETC in Beni. So far, no definitive source of infection has been identified. As of 12 May, 90 contacts are currently under surveillance, of which 41 are high-risk contacts who had direct contact with body fluids of the last confirmed case. All contacts have exited their high-risk period (seven to 13 days after last exposure). Contacts from the previous six cases reported in April have exited their follow-up period. Of the 41 high-risk contacts, 37 have been vaccinated. A total of 1486 people have been vaccinated in Beni and Karisimbi since 10 April 2020.
  • Measles – Burundi… Wed, 06 May 2020 Burundi has been experiencing an increase in the number of confirmed cases of measles since November 2019. This outbreak initially started in a refugee transit camp (Centre de transit de Cishemere, Cibitoke Health district), whose inhabitants had arrived from measles-affected provinces of the Democratic Republic of Congo. Refugees spend 21 days in the Transit Camp of Cishemere before they are sent to permanent camps in Nyankanda and Bwagiriza refugee camps in Butezi, Kavumu camp of Cankuzo, Garsowe camp of Muyinga and Mulumba camp at Kiremba. The outbreak was identified when suspected measles cases had been reported by the local residents in the surrounding areas, highlighting pockets of under-vaccinated populations. According to WHO/UNICEF 2018 estimates, measles first dose vaccination coverage is relatively high (88%), and slightly lower for the second dose (77%). However, this does not reflect the vaccination coverage of incoming refugees.

More at www.who.int/feeds/ent

  • Watch – Yellow Fever in Ethiopia… Thu, 23 Apr 2020 There is an outbreak of yellow fever in the Southern Nations Nationalities and Peoples Region (SNNPR) of Ethiopia. Travelers going to Ethiopia should receive vaccination against yellow fever at least 10 days before travel and should take steps to prevent mosquito bites while there.

More at /wwwnc.cdc.gov/travel

L'assistant clinique de voyage (Travel Clinical Assistant – TCA) est du Département de la santé de la Géorgie.

Rapport hebdomadaire de la morbidité et de la mortalité (MMWR) du CDC:

More at /www.cdc.gov/mmwr/ind

Source: https://repository.netecweb.org/etreajour

Center for Uterine Fibroids

Uterine Fibroids: Q&A With an Expert | Johns Hopkins Medicine

The following are a list of helpful links that may connect you to various fibroid-related resources. All links are provided as a courtesy and are not meant to replace the relationship between doctor and patient. The Center for Uterine Fibroids does not endorse any of these links, but merely provides them as a convenience.

Get Connected to Clinical Care

Find a provider at Brigham and Women's Hospital.

Find a provider outside the Boston area:

Physicians and Women's Forums

Pose individual questions to physicians at these forums:

  • OBGYN.net Women's Health Forum
  • NetWellness Ask an Expert

To discuss fibroid-related issues with other women:

  • Talk to Women About Fibroids

Uterine Artery Embolization

  • Society for Cardiovascular and Interventional Radiology

Online Health Journals

  • Journal Watch Online
  • Pub Med National Library of Medicine

Books

These should not be used to replace the relationship between patient and physician, but may contain useful supplemental information about fibroids and women's health.

  • “A Gynecologist's Second Opinion : The Questions and Answers You Need To Take Charge of Your Health” by William H. Parker, MD
  • “Fibroid Tumors and Endometriosis” by Susan M. Lark,MD
  • “Fibroids : The Complete Guide to Taking Charge of Your Physical, Emotional, and Sexual Well-Being” by Johanna Skilling
  • “Healing Fibroids : A Doctor's Guide to a Natural Cure” by Allan Warshowsky, MD and Elena Oumano, PhD
  • “It's a Sistah Thing : A Guide to Understanding and Dealing with Fibroids for Black Women” by Monique R. Brown
  • “Sex, Lies, and the Truth About Uterine Fibroids: A Journey From Diagnosis to Treatment to Renewed Good Health” by Carla Dionne
  • “The Fibroid Book” by Francis L. Hutchins, MD
  • “The First Year — Fibroids : An Essential Guide for the Newly Diagnosed” by Johanna Skilling
  • “The No-Hysterectomy Option : Your Body — Your Choice” Revised and Updated by Herbert A. Goldfarb, Judith Greif (contributor)
  • “The Official Patient's Sourcebook on Uterine Fibroids : A Revised and Updated Directory for the Internet Age” by James N. Parker, MD and Philip M. Parker, PhD
  • “Uterine Fibroids : What Every Woman Needs to Know” by Nelson H. Stringer, MD
  • “What Your Doctor May Not Tell You About Premenopause: Balance Your Hormones and Your Life from Thirty to Fifty” by John R. Lee, Virginia Hopkins, Jesse Hanley
  • “Women's Bodies, Women's Wisdom: Creating Physical and Emotional Health and Healing” by Christiane Northrup, MD

Source: http://www.fibroids.net/links.html

Cervical Cancer Death Rates Higher Among Older and Black Women

Uterine Fibroids: Q&A With an Expert | Johns Hopkins Medicine

Home > News > News Releases > 2017 > Cervical Cancer Death Rates Higher Among Older and Black Women

January 23, 2017

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A woman’s risk of dying of cervical cancer is higher than long believed, particularly among older and black women, new Johns Hopkins Bloomberg School of Public Health-led research suggests.

The researchers found that black women in the United States are dying from cervical cancer at a rate 77 percent higher than previously thought while white women are dying at a rate 47 percent higher. The new figures reflect a change in how mortality rates are calculated.

By excluding women who have had hysterectomies, which typically involves the removal of the cervix and therefore reduces the risk of developing cervical cancer to zero, the researchers say these data paint a more accurate picture of who is getting cervical cancer – and can be used to better understand how to prevent it.

Meanwhile, many of those who are dying are over the age of 65, a cutoff point where guidelines no longer recommend women with cervixes be regularly screened for cervical cancer. With routine screening, cervical cancer is preventable. In the United States, there are 12,000 cases of cervical cancer each year and around 4,000 deaths.

The findings, published Jan. 23 in the journal Cancer, highlight the need to understand the risks associated with cervical cancer in older and black women and determine both the best screening and treatment options for these women.

“This is a preventable disease and women should not be getting it, let alone dying from it,” says study leader Anne F. Rositch, PhD, MSPH, an assistant professor in the Department of Epidemiology at the Bloomberg School.

“Since the goal of a screening program is to ultimately reduce mortality from cervical cancer, then you must have accurate estimates within the population targeted by those programs — adult women with a cervix.

These findings motivate us to better understand why, despite the wide availability of screening and treatment, older and black women are still dying from cervical cancer at such high rates in the United States.”

Excluding women with a history of a hysterectomy, something that has not been done in previous calculations, makes a sizable difference since one in five women in the United States have had a hysterectomy, with the number slightly higher in black women than white women. Current guidelines do not recommend cervical cancer screening after the age of 65, since it was believed that older women were at much less risk. These new findings suggest the risk remains – and even increases – in older women.

“These data tell us that as long as a woman retains her cervix, it is important that she continue to obtain recommended screening for cervical cancer since the risk of death from the disease remains significant well into older age,” Rositch says.

To produce these national mortality rates, the researchers analyzed cervical cancer mortality rates using national death certificate data from the National Center for Health Statistics and from the Surveillance, Epidemiology, and End Results (SEER) national cancer registries and then removed the proportion of women who reported a hysterectomy, a number obtained from a national survey.

The rate of cervical cancer mortality among black women over the age of 20 was 5.7 per 100,000 each year and 3.2 per 100,000 each year in white women. The rate in black women jumped to 10.1 per 100,000 per year when corrected for hysterectomy, a rate similar to less developed nations, and to 4.7 per 100,000 per year in white women.

Black women are more ly to have hysterectomies, and at younger ages, compared to white women, largely because black women are more susceptible to fibroids — benign masses in the uterus — which can cause symptoms requiring surgery.

Including all women in mortality rate calculations underestimated the racial disparity in death rates between black and white women by 44 percent.

Current screening guidelines call for routine Pap smears to test for cervical cancer among women between 21 and 65. If women have had three healthy tests over the previous decade, they are no longer recommended for testing after the age of 65.

An inexpensive Pap smear can find changes in the cervix before cancer develops. It can also find cervical cancer early, when it is in its most curable stage.

Cervical cancer, which is caused by the human papillomavirus (HPV), can also be prevented by the HPV vaccine, which is offered to young people.

Rositch says it isn’t clear why older and black women are dying of cervical cancer at higher rates. Were they not properly screened? Was there no follow-up after an abnormal screening test? Was something missed during screening? Was treatment ineffective? Answering these questions are critical to identifying the most appropriate interventions that would lower these mortality rates.

Previous research suggests that black women are more ly to have their cervical cancer caught at a later stage of diagnosis and may receive different treatment than white women. One study found that black women had 50-percent lower odds of receiving surgery and 50-percent higher odds of receiving radiation compared to white women with the same stage and insurance.

While rare in the United States, cervical cancer is more common in the developing world. Worldwide, more than 500,000 women are diagnosed each year and more than 200,000 die.

GLOBOCAN, an arm of the World Health Organization, estimated in 2012 that 9.

8 women per 100,000 die of cervical cancer in less developed nations, including all of Africa, Asia (excluding Japan), Latin America and the Caribbean).

“While trends over time show that the racial disparities gap has been closing somewhat, these data emphasize that it should remain a priority area,” Rositch says. “Black women are dying of cervical cancer at twice the rate as white women in the United States and we need to put in place measures to reverse the trend.”

“Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States” was written by Anna Beavis, MD, MPH, Patti E. Gravitt, PhD, and Anne F. Rositch, PhD, MSPH. Collaborating institutions include the Johns Hopkins University School of Medicine and the George Washington University Milken Institute School of Public Health.

The work was supported in part by a grant from the Maryland Cigarette Restitution Fund.

# # #

Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu and Stephanie Desmon at 410-955-7619 or sdesmon1@jhu.edu.

Source: https://www.jhsph.edu/news/news-releases/2017/cervical-cancer-death-rates-higher-among-older-and-black-women.html

Black patients, black physicians and the need to improve health outcomes for African Americans

Uterine Fibroids: Q&A With an Expert | Johns Hopkins Medicine

Kimberly Wilson has often struggled to find doctors who understand her physical, cultural and mental health needs. Although she took advantage of booking platforms such as ZocDoc, she had visited multiple doctors to find a good match.

In 2017, that search became urgent when she landed in the emergency room due to complications from uterine fibroids. Fibroids, noncancerous growths in the uterus, are common among black women, who are three times more ly than white women to develop them during their lifetime, according to the Centers for Disease Control and Prevention.

But Wilson’s situation was unusual because of the size and amount of fibroids — she had more than 30 — and in 2018, she was in and the hospital with complications. She visited numerous doctors in New York City, the majority of whom were white men, who advised that her only treatment option was a hysterectomy, which would mean she would not be able to have children.

Kimberly Wilson, founder of HUED, an app that connects patients with health and medical professionals of color.Courtesy Yajhil Photography

She ultimately received a referral from a friend to a black obstetrician/gynecologist at Johns Hopkins University in Baltimore, Dr. Khara Michelle Simpson. She recommended an alternative procedure, an abdominal myomectomy.

Wilson underwent the procedure in December 2018, and it preserved her uterus and removed the majority of her fibroids.

Although she was grateful for the outcome, Wilson wondered why it took so long to connect with a black doctor — and why no other doctors recommended this option.

“I was frustrated by my experience and having to travel so far just to find a culturally competent physician,” Wilson said. She also acknowledged that she believes her experience with Simpson was better because she is also a black woman.

Research shows that health outcomes for black patients are better when they are treated by black doctors. That research is critical given that African Americans in the United States generally experience poorer health outcomes across a variety of diseases and conditions.

Currently, black men have the lowest life expectancy of any major demographic group in the United States and live on average 4.4 years fewer that non-Hispanic white men.

There is also a documented maternal mortality crisis among African American women in the United States: Black women are three to four times more ly to die as a result of complications from pregnancy, labor and childbirth than white women.

A research team led by Dr. Marcella Alsan from Stanford University’s School of Medicine published the results of a study in September 2018 that tracked the impact of diversity in the physician workforce on medical decisions and outcomes among black men.

In Alsan’s study, researchers set up a pop-up clinic in Oakland, California, and recruited over 1,300 black men from local barber shops and flea markets. The clinic was set up to provide preventive services and was staffed with 14 male doctors.

Participants were surveyed about their preference for preventive services (such as cardiovascular screening) before meeting their assigned physician and then surveyed again after speaking with their physician.

Patients who met with black physicians asked to receive more preventive services than patients who met with nonblack physicians.

Researchers attributed the findings to improved communication between black patients and black physicians. Patients were 29 percent more ly to talk with black male doctors about other health problems they were experiencing, and black physicians were 35 percent more ly to write notes about black patients than nonblack physicians.

“A medical consultation can be intrusive or stressful,” Alsan said in an interview with NBCBLK. “Our results suggest that black doctors are more ly to provide a comfortable setting to black patients, perhaps because of shared experiences or backgrounds.”

The study concluded that increasing the amount of black physicians could lead to a 19 percent reduction in the black-white male cardiovascular mortality gap and an 8 percent decline in the black-white male life expectancy gap.

Wilson’s experience with a black doctor inspired her to launch HUED Co., an app that connects patients with health and medical professionals of color. HUED’s goal is to decrease health disparities and improve health outcomes for people of color, according to its website.

“My inspiration came from a place of frustration,” Wilson said. “Frustration with the lack of access and opportunities for black and brown people — specifically when it comes down to something as simple as taking care of our health. Nobody is going to take care of us, but us.”

HUED also has an online platform that provides health information tailored to audiences of color. The company is planning to host in-person events on health topics of interest to patients of color. In April, the organization partnered with Trellis Health, a New York City-based fertility clinic, to host a conversation on fertility and egg freezing for black women.

In addition to apps such as HUED, organizations such as the Tour for Diversity in Medicine are working to increase the amount of students of color in the pipeline for medical, dental and pharmacy school.

The organization connects high school and undergraduate students with physicians, dentists, pharmacists and medical students of color and conducts biannual tours to colleges and universities around the country.

In 2004, the National Academy for Medicine published a report, In the Nation’s Compelling Interest: Ensuring Diversity in the Health Professions, that called for a diverse health care workforce as a way to reduce racial health disparities. Although African Americans comprise 13 percent of the U.S. population, they account for only about 6 percent of physicians and less than 6 percent of recent medical school graduates, according to data from the Kaiser Family Foundation.

Dr. Kameron Leigh Matthews, one of the co-directors for the tour and the deputy undersecretary for health for community care at the Veterans Health Administration, was inspired to start the organization while working as a student leader with the Student National Medical Association.

“We noticed a need to reach students in a different manner — on their home turf, on campuses where perhaps their advising resources or exposure was not as strong or in towns that did not have immediate access to medical schools,” Matthews said in an interview with NBCBLK. “We also wanted to reach students who otherwise may not have been exposed to the mentoring and support that is available at the typical colleges that send students to medicine and dentistry.”

Since launching in 2012, the Tour for Diversity in Medicare has visited more than 40 campuses and mentored 3,500 students.

“Many students in our audiences lack role models or mentors that look themselves or come from communities their own — they feel often marginalized from other students interested in these fields,” Matthews said.

“We hear regularly of negative experiences with faculty and advisers when they seek out help or advice.

The tour seeks to motivate these students, give them insights real life experiences, and educate them on how to be a strong candidate for a future in health care.”

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Source: https://www.nbcnews.com/news/nbcblk/black-patients-black-physicians-need-improve-health-outcomes-african-americans-n1000696

Fibroids Treatment

Uterine Fibroids: Q&A With an Expert | Johns Hopkins Medicine

Fibroids may affect fertility by blocking the uterus and fallopian tubes, which can make it difficult to conceive or may put any subsequent pregnancy at risk for miscarriage or early labor.

Fibroid Treatment: Why Choose Johns Hopkins

  • Our experts at the Johns Hopkins Fertility Center specialize in the evaluation and management of fibroids in patients experiencing infertility. We tailor our treatment programs to the specific needs of women with fibroids to maximize the chances of pregnancy.

        

  • If surgical treatment is needed, we work collaboratively with the surgeons of the Johns Hopkins Division of Advanced Minimally Invasive Gynecologic Surgery, who have specialized training in minimally invasive and robotic surgical techniques to treat your fibroids while maintaining your fertility.

       

Request an appointment phone 410-847-3835

Fibroid Treatment: What to Expect

At your initial consultation, you will meet with a fertility specialist and discuss your personal health history, experience attempting to conceive and goals for fertility treatment.

We will perform diagnostic tests to determine the extent that fibroids are impacting your fertility — and rule out any other potential causes.

these results, your fertility specialist may recommend surgery prior to beginning fertility treatments.

If surgery is recommended, we will work closely with specialists in the Division of Advanced Minimally Invasive Gynecologic Surgery to determine the best course of action for managing your fibroids while also supporting your fertility goals.

When your fibroids have been properly managed and you are ready to begin your fertility treatment, we will meet with you to review the treatment options available to you and customize a treatment plan.  

Our Team of Fibroid and Fertility Specialists

Rely on the expertise of our physicians to help you manage fibroids and your fertility.

Fertility Center Experts

Professor (PAR) of Gynecology and Obstetrics Director, Division of Reproductive Endocrinology and Infertility TeLinde-Wallach Professor of Gynecology and Obstetrics Assistant Professor of Gynecology and Obstetrics Medical Director, Johns Hopkins Fertility Center Director, Third Party Reproduction Director, Fertility Preservation Director, IVF Program Division of Reproductive Endocrinology & Infertility Assistant Professor of Gynecology and Obstetrics Associate Director, Reproductive Endocrinology and Infertility Fellowships Director, Patient Education Associate Professor of Gynecology and Obstetrics Practice Director Active Staff, Johns Hopkins University School of Medicine Courtesy Staff, Johns Hopkins Bayview Medical Center Advisory Medical Director, Johns Hopkins Medicine International Professor of Gynecology and Obstetrics Director, Reproductive Endocrinology and Infertility Fellowships

Fibroid Experts

Assistant Professor of Gynecology and Obstetrics Assistant Program Director, GYN/OB Residency Program, Johns Hopkins Hospital Associate Fellowship Director, AAGL Fellowship in Minimally Invasive Gynecologic Surgery

Assistant Professor of Gynecology and Obstetrics

Assistant Professor of Gynecology and Obstetrics Fellowship Director, AAGL Fellowship in Minimally Invasive Gynecologic Surgery

Source: https://www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/fertility-center/conditions-we-treat/fibroids.html