News
Ireland to introduce national endometriosis framework
Approximately one in ten women in Ireland suffer with endometriosis
Ireland has announced the development of a national endometriosis framework which sets out for the first time a defined clinical care pathway for women with endometriosis.
Developed by the Health Service Executive’s National Women and Infants Health Programme (NWIHP), the framework will be implemented on a phased basis, commencing this year.
It is built around the principle of “right care, right place, right time”, and its model of care proposes that women with symptoms of endometriosis be treated on the basis of presumed diagnosis.
Endometriosis is one of the most common gynaecological conditions in Ireland and affects approximately one in ten women.
It is estimated that 47 per cent of women who experience fertility issues have endometriosis and in many cases, it may be suspected or diagnosed when a woman undergoes fertility investigations.
The vast majority of cases can be managed successfully at primary care level with the assistance of GPs, says the Irish Department of Health.
Some patients will require additional multi-disciplinary support at secondary care level. This is being facilitated with the setting up of five interdisciplinary teams to support the holistic treatment of endometriosis in each of the maternity networks.
A small number of women with more complex cases will require expert treatment in two supra-regional endometriosis specialist centres which are currently in development.
“The model of care of presumed diagnosis puts women’s needs to the fore, ensuring that they receive timely, effective treatment that can have a transformative impact on their lives,” said Minister for Health, Stephen Donnelly.
“Since 2019, the Women’s Health Taskforce has heard testimony from women with endometriosis, who have described their experiences of the disease as ‘painful, isolating, misdiagnosed, lonely and dismissed.’
“This framework, along with investment in holistic treatment teams and in two supra-regional hubs for complex cases are important steps towards improving their experiences and outcomes.”
Clinical director for the National Women and Infants Health Programme, Dr Cliona Murphy, said: “This framework is a significant development in our efforts to improve endometriosis care, and it aligns with NWIHP’s overall aim of improving women’s access to quality services.
“Together with the establishment of other specialist women’s health services such as “see and treat” ambulatory gynaecology services, specialist menopause clinics and regional fertility hubs, we are delivering tangible improvements in women’s healthcare.”
Diagnosis
Lung cancer drug shows breast cancer potential
Ovarian cancer cells quickly activate survival responses after PARP inhibitor treatment, and a lung cancer drug could help block this, research suggests.
PARP inhibitors are a common treatment for ovarian cancer, particularly in tumours with faulty DNA repair. They stop cancer cells fixing DNA damage, which leads to cell death, but many tumours later stop responding.
Researchers identified a way cancer cells may survive PARP inhibitor treatment from the outset, pointing to a potential way to block that response. A Mayo Clinic team found ovarian cancer cells rapidly switch on a pro-survival programme after exposure to PARP inhibitors. A key driver is FRA1, a transcription factor (a protein that turns genes on and off) that helps cancer cells adapt and avoid death.
The team then tested whether brigatinib, a drug approved for certain lung cancers, could block this response and boost the effect of PARP inhibitors. Brigatinib was chosen because it inhibits multiple signalling pathways involved in cancer cell survival.
In laboratory studies, combining brigatinib with a PARP inhibitor was more effective than either treatment alone. Notably, the effect was seen in cancer cells but not normal cells, suggesting a more targeted approach.
Brigatinib also appeared to act in an unexpected way. Rather than working through the usual DNA repair routes, it shut down two signalling molecules, FAK and EPHA2, that aggressive ovarian cancer cells rely on. FAK and EPHA2 are proteins that relay survival signals inside cells. Blocking both at once weakened the cells’ ability to adapt and resist treatment, making them more vulnerable to PARP inhibitors.
Tumours with higher levels of FAK and EPHA2 responded better to the drug combination. Other data link high levels of these molecules to more aggressive disease, pointing to potential benefit in harder-to-treat cases.
Arun Kanakkanthara, an oncology investigator at Mayo Clinic and a senior author of the study, said: “This work shows that drug resistance does not always emerge slowly over time; cancer cells can activate survival programmes very early after treatment begins.”
John Weroha, a medical oncologist at Mayo Clinic and a senior author of the study, said: “From a clinical perspective, resistance remains one of the biggest challenges in treating ovarian cancer. By combining mechanistic insights from Dr Kanakkanthara’s laboratory with my clinical experience, this preclinical work supports the strategy of targeting resistance early, before it has a chance to take hold. This strategy could improve patient outcomes.”
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