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Study reveals a hidden risk after cervical cancer

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Women who have survived cervical cancer face nearly double the risk of developing anal cancer later in life compared with the general population, new research shows.

The study analysed data from more than 85,000 women diagnosed with cervical cancer and followed them over two decades to track secondary diagnoses.

Researchers at MUSC Hollings Cancer Center found the risk increased with both age and time, with the highest rates among women aged 65 to 74 who were more than 15 years beyond their first diagnosis.

At present, anal screening is recommended for certain high-risk groups, including people living with HIV, organ transplant recipients and women with a history of vulvar cancer.

No clear guidelines exist for women who have survived cervical cancer.

Ashish Deshmukh is co-leader of the cancer prevention and control research programme.

The researcher said: “We’ve known for a long time that both cervical and anal cancers are caused by HPV, the human papillomavirus.

“But what hasn’t been well-understood is how that shared risk might connect the two diseases over a woman’s lifetime.”

HPV is a common virus that can lead to several cancers, including cervical and anal. Cervical screening and HPV vaccination have made cervical cancer largely preventable, with survival rates above 90 per cent when detected early, but guidelines do not address long-term risks for survivors.

The team used the National Cancer Institute’s SEER (Surveillance, Epidemiology and End Results) programme, which tracks cancer diagnoses across the US.

For women aged 65 to 74, rates of anal cancer diagnosis exceeded thresholds typically used to recommend routine screening.

Researcher Haluk Damgacioglu, PhD said: “Our study shows that the risk doesn’t go away – it actually increases with age and over time.”

This delay occurs because HPV-related cancers can take years or decades to develop.

The virus may remain dormant or spread from another part of the body.

Deshmukh said: “It’s a slow process, and that’s part of why it’s been so hard to detect. By the time symptoms show up, the cancer is often advanced.”

Screening methods do exist, including anal cytology (similar to a cervical smear test) and anoscopy (a visual examination using a scope), but access is limited.

In South Carolina, for example, there is only one provider trained to perform high-resolution anoscopy.

“Damgacioglu said: “These results tell us that women who had cervical cancer years ago should be considered for routine anal cancer screening.

“Right now, that’s not happening.”

Deshmukh and colleagues are expanding the work with a new project to evaluate the best screening approaches for this group, in collaboration with MD Anderson Cancer Center and the Icahn School of Medicine at Mount Sinai.

The study will look at frequency and methods of screening.

Pregnancy

Early miscarriage care could prevent 10,000 pregnancy losses a year, study finds

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Early miscarriage care after a first loss could prevent about 10,000 pregnancy losses a year in the UK, according to a new study.

The study by Tommy’s National Centre for Miscarriage Research and Birmingham women’s hospital involving 406 women found a 4 per cent reduction in the risk of future miscarriage for women on the graded model of care compared with usual care.

Women in England, Wales and Northern Ireland currently become eligible for specialised NHS care for early baby loss only after they have had at least three miscarriages.

Tommy’s has called for women to become eligible after one miscarriage, saying this could reduce the risk of future miscarriages and improve health outcomes for mothers.

Researchers said that would translate to 10,075 fewer miscarriages a year across the UK.

Kath Abrahams, chief executive of Tommy’s, said women were being “left without early access to services that could help prevent future losses and reduce the debilitating feelings of isolation and hopelessness that we know affect so many who experience pregnancy loss”.

She said: “Our pilot study indicates that providing support after a first miscarriage, with escalating care after further losses, is not only effective but achievable without significant additional workload for NHS teams who are already working extremely hard to deliver good care.

“Put simply, it is the right thing to do. We will do all we can to drive that change across the UK so that more women and families are supported after every miscarriage.”

The graded model of miscarriage care proposed by Tommy’s is already available in Scotland, and the charity is calling for it to be introduced across the whole of the UK.

The graded model includes nurse-led support after one miscarriage, with advice on reducing risk factors such as low vitamin D, folic acid intake, alcohol consumption and caffeine use.

Women who received the specialised care were 47 per cent more likely to have a risk factor identified and receive relevant advice to help prevent future miscarriages than women receiving usual care, the study found.

Among women who had experienced two miscarriages and received the specialised care, one in five were found to have thyroid dysfunction or anaemia, both conditions that can affect pregnancy outcomes.

About one in four pregnancies ends in miscarriage, most often within the first 12 weeks of pregnancy.

The report comes ahead of the long-awaited final findings of the government’s investigation into maternity care in England. Interim findings uncovered a range of failures, including claims that NHS hospitals that caused harm to women and babies during childbirth often resorted to a “cover-up” of their mistakes, falsified medical records and denied bereaved parents answers.

Women’s health minister Gillian Merron said: “Pregnancy and baby loss can have a devastating impact on women and families, who too often feel they have been left without the care and support they need.

“I welcome the findings of this important report, and this will be carefully considered as part of our ongoing work to make sure women get the high-quality, compassionate NHS care they deserve.”

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Pregnancy

Home blood pressure checks could lower heart risks for new mothers – study

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Home blood pressure checks after hypertensive pregnancy could cut the risk of heart attack, stroke and potentially early death, research suggests.

Women who regularly monitored their blood pressure in the weeks after giving birth, and had doctors tailor their medication if needed, had better functioning arteries nine months later than those who received routine care.

When the medication was adjusted to account for blood pressure changes, the women ended up with less stiff arteries, an effect researchers estimated could reduce the future risk of heart attack or stroke by 10 per cent.

Paul Leeson, professor of cardiovascular medicine who led the study, said the findings suggested that the weeks after birth provided a “powerful and often overlooked opportunity” to protect women’s future health.

“By simply monitoring blood pressure at home, new mothers with hypertensive pregnancies can protect their bodies from future damage,” he said.

High blood pressure, in the form of gestational hypertension or pre-eclampsia, where there are signs of organ damage, affects 5 to 10 per cent of pregnant women.

The condition can damage the mother’s organs and endanger the baby’s life.

Beyond the immediate threat to mother and baby, hypertension in pregnancy can raise the risk of long-term problems, with women three times more likely to develop high blood pressure and twice as likely to have heart disease later in life.

The Oxford team recruited 220 women who developed hypertension in pregnancy. All were on blood pressure medication but were due to reduce their dosage and eventually stop taking the drugs.

In the study, 108 women had standard care in which their medication was reduced based on a few blood pressure checks in the eight weeks after giving birth.

The remaining 112 women used a monitor to check their blood pressure at home each day.

They entered the readings into an app shared with doctors who, if needed, changed their medication day to day, with the aim of giving them better control of their blood pressure.

The new approach led to much better control of the women’s blood pressure, and in tests six to nine months later the women had less stiff arteries.

Stiff arteries are less effective at expanding and contracting, which can drive high blood pressure and ultimately the formation of clots that can block blood vessels and cause heart attacks and strokes.

Trials are now under way to find effective ways of rolling out blood pressure monitoring to women after hypertensive pregnancies. One option is for specialist NHS clinics to deliver the care.

Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation, which funded the work, said the results highlighted a crucial window after birth when paying close attention to blood pressure could help protect women’s heart health for years to come.

“We now look forward to seeing results from larger studies with longer follow-up to see how this might save women’s lives,” she said.

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Diagnosis

Researchers teach AI to spot cancer risk by squeezing individual breast cells

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An AI tool could help spot breast cancer risk by analysing how individual breast cells behave when squeezed under stress, research suggests.

Researchers at City of Hope and the University of California, Berkeley, created a microfluidic platform that assesses women’s breast cancer risk at the cellular level.

The platform squeezes individual breast epithelial cells, which line breast tissue, to measure how they deform, recover and behave under stress.

Because more than 90 per cent of women do not have a known genetic predisposition to breast cancer or a family history of the disease, the researchers said the approach could help fill a key gap in risk assessment.

Mark LaBarge, professor in the department of population sciences at City of Hope, said: “For women with a known genetic risk factor for breast cancer, there are things you can do like follow a higher-risk screening protocol. For everybody else, you’re left wondering, ‘Am I at high risk?’

“By translating physical changes in cells into quantifiable data, this tool gives women something tangible to discuss with their doctors, not just risk estimates, but evidence drawn directly from their own cells.”

The researchers developed a machine learning algorithm that identifies and measures cells showing signs of accelerated ageing, generating an individual breast cancer risk score.

They said the platform uses simple electronics that could be easy and affordable to replicate on a large scale.

Lydia Sohn, chair in mechanical engineering at UC Berkeley, said: “Our team isn’t the first to measure the mechanical properties of cells; however, other approaches require advanced imaging technology that’s expensive, cumbersome and has limited availability.

“In contrast, MechanoAge uses computer chips that are simpler than an Apple Watch and ‘RadioShack parts’ that are cheap and easy to assemble, potentially making the device highly scalable.”

About 6 per cent of women who develop breast cancer carry known genetic mutations.

For women outside this group, risk is usually estimated indirectly using population models or measures such as breast density, which can both overestimate and underestimate individual risk.

The researchers said there is currently no non-genetic test that can identify women at higher risk of breast cancer.

Screening mammograms can detect cancer only once it has started to grow, but the MechanoAge platform aims to assess risk earlier by looking for physical changes in individual cells.

Using the platform, the researchers found that breast cells appear to have a “mechanical age” separate from a person’s chronological age, based on how the cells respond to stress.

They said this is the first time mechanical age has been quantified in biological cells.

Sohn said: “We learned that the older the mechanical age, as determined by how cells respond to being squeezed through our microfluidic device, the higher the risk for breast cancer.”

In this type of mechano-node-pore sensing, an electrical current is measured across a liquid-filled channel.

As cells pass through, they disrupt the current, generating measurements about their size and shape. By narrowing parts of the channel, researchers squeeze the cells and then measure how long each one takes to return to its normal shape.

The team found that cells from older women were stiffer and took longer to bounce back after being squeezed.

They also identified a subset of younger women whose cells behaved more like those from older women. These cells came from women with genetic mutations linked to a higher breast cancer risk.

The researchers then refined the algorithm to assign a risk score based on the cells’ measured mechanical and physical properties. They said it successfully identified women with known genetic risks.

The team then used it to compare cells from healthy women, women with a family history of breast cancer, and cells taken from the healthy breast of women with breast cancer in the other breast.

LaBarge said: “With accuracy, we were able to figure out which women were at high risk of breast cancer and which women didn’t seem to be.”

The work grew out of more than 12 years of collaboration between the two labs, combining engineering with cancer and ageing biology.

Sohn said: “It’s a true collaboration. We’ve learned a lot from each other.

LaBarge added: “In my view, this is what happens when you have a real collaboration that develops over a long time. This result is not what we imagined at the beginning.”

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