Diagnosis
Starting menopause therapy early may lower Alzheimer’s risk, study finds
Starting hormone therapy within five years of menopause could lower women’s Alzheimer’s risk by up to 32 per cent, but beginning at 65 or later may raise it, research shows.
The analysis pooled findings from more than 50 studies comparing women who used hormone replacement therapy (HRT) to those who did not.
Researchers from the Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences in India presented the results at the American Neurological Association’s annual meeting in Baltimore.
Women who started HRT around the time of menopausal transition saw a 22 to 32 per cent risk reduction.
By contrast, those starting at 65 or later had a 38 per cent higher risk, particularly with treatments containing progestin – a synthetic version of progesterone.
Lead researcher Dr FNU Vaibhav said: “Starting hormone replacement therapy early may give the brain some protection, but if a woman already has Alzheimer’s or memory problems, hormone therapy won’t slow them down.
“It’s like watering a plant: it helps when the plant is growing, but if it’s already wilting, it might be too late.”
HRT replaces oestrogen lost during menopause, easing symptoms such as hot flushes, night sweats and sleep disturbance.
It has also been linked to benefits for heart health and protection against age-related bone loss.
Just under 5 per cent of US women use HRT today, down from almost 26 per cent in 1999.
Researchers suggest that therapy begun during the transition may protect the brain by improving communication between nerve cells and reducing inflammation.
But once early Alzheimer’s changes are underway, added hormones may worsen problems by stressing blood vessels or fuelling inflammation.
Vaibhav said: “The evidence isn’t strong enough to suggest hormone replacement therapy should be taken to prevent Alzheimer’s.
“However, if a woman is planning to use it for menopause symptoms, starting soon after menopause might give her brain some protection against Alzheimer’s disease later.”
He advised that treatment should usually be limited to a few years and avoided entirely in the 60s or 70s.
AI may help speed breast cancer diagnosis for high-risk women after abnormal mammograms, a study suggests.
Women with abnormal mammograms often wait weeks to learn whether they have breast cancer.
Researchers at UC San Francisco and UC Berkeley said an AI-guided workflow could help reduce that wait by quickly identifying those most likely to have the disease. Some women could move from imaging to evaluation, and sometimes biopsy, in a single day.
Dr Maggie Chung, first author of the study, said: “This is a really an exciting time.
“This moves us closer to personalised care, where we can tailor a plan so that each patient gets the right intervention at the right time.”
The study used an open-source AI model called Mirai.
The model was trained on hundreds of thousands of mammograms linked to patients’ cancer outcomes.
A mammogram is an X-ray scan of the breast used to look for signs of cancer. A biopsy involves taking a small tissue sample to test for disease.
The AI tool is designed to detect subtle patterns in screening mammograms and predict a woman’s cancer risk.
Researchers at UC San Francisco and UC Berkeley applied the model to more than 4,100 screening mammograms at Zuckerberg San Francisco General Hospital and Trauma Center.
Mirai identified 525 women, about 12.7 per cent of screened patients, as high risk.
Those patients could receive an interpretation of their mammograms immediately after the scan and have additional diagnostic imaging for suspicious areas on the same day.
Some women who needed biopsies were also able to have them on the same day.
The researchers said Mirai reduced the wait time for diagnostic evaluation from several weeks to about an hour.
For women who were ultimately diagnosed with breast cancer, it reduced the average wait for biopsy from more than two months to fewer than 10 days.
The researchers stressed that Mirai does not replace radiologists or make diagnoses on its own.
Instead, it acts as a triage tool to help physicians identify the patients who can benefit most from accelerated care.
The team analysed more than 114,000 archival mammograms before launching the programme, to ensure the model would capture enough high-risk patients without overloading the clinic with too many expedited evaluations.
The researchers said they hope AI will support a more personalised approach to breast cancer screening tailored to each patient’s breast cancer risk.
Chung said: “Right now, many women follow the same screening schedule but their individual risk can be very different.
“AI risk assessment gives us the chance to identify the women most likely to benefit from expedited care and get them what they need.”
Adam Yala, senior author of the study and a data scientist at UC Berkeley, said: “This is a powerful example of how AI can be a collaborative partner for physicians.
“It shows how we can improve care when we bring clinicians and data scientists together to design these systems.”
Type 2 diabetes diagnoses are rising twice as fast in women under 40 as in women over 40, new data shows.
Type 2 diabetes is a serious condition and can lead to complications such as heart attacks and strokes. When it develops in younger people, it can be more aggressive and have more severe and acute effects.
Diagnoses in women under 40 rose by 47 per cent between 2017/18 and 2023/24. By comparison, diagnoses rose by 22 per cent in women aged 40 to 79.
During the same period, type 2 diabetes diagnoses in men under 40 increased by 34 per cent.
Diabetes UK said it is concerned about the follow-up care offered to women who have had gestational diabetes, also known as GDM, which increases the risk of developing type 2 diabetes after pregnancy.
Gestational diabetes is high blood sugar that develops during pregnancy and usually goes away after birth, but it raises the risk of type 2 diabetes later.
Colette Marshall, chief executive at Diabetes UK, said: “These figures should be a wake-up call. Type 2 diabetes is rising twice as fast in younger women compared to older women, and a crucial opportunity for prevention is being missed. Every diagnosis is life-changing, but when it develops in younger people, type 2 diabetes is even more aggressive.
“Pregnancy shouldn’t be a pathway to ill health. Yet despite facing a much higher risk of type 2 diabetes, too many women with GDM receive little or no follow-up care after pregnancy.
“As the Government turns its Strategy into action, support for women who have had gestational diabetes must not be overlooked.”
Last year, the NHS published the first national GDM audit for England in 2024/25, which revealed inconsistencies in follow-up care.
Only 57 per cent of women with GDM received an annual HbA1c test, which should be offered to every woman with GDM.
An HbA1c test measures average blood sugar levels over the previous two to three months.
Only 4.5 per cent of women had received support through the NHS Diabetes Prevention Programme.
The report also found that 11 per cent of women developed prediabetes within five years of having GDM, while 15 per cent developed type 2 diabetes within 10 years.
Prediabetes means blood sugar levels are higher than normal and a person has a higher risk of developing type 2 diabetes.
A recent survey funded by Diabetes UK also found that more than a third of women with GDM felt abandoned by healthcare services after giving birth.
If you live in England and have had gestational diabetes, you can self-refer to the NHS Diabetes Prevention Programme, which supports people at risk of developing type 2 diabetes. If you live in Northern Ireland, Scotland or Wales, you can speak to your GP about support.
Diabetes UK has written to women’s health minister Baroness Merron calling for urgent improvements to postnatal support for those diagnosed with GDM during pregnancy.
GDM affects between 10 and 20 per cent of pregnant women, but Diabetes UK said cases have long been underreported and UK-wide data on the condition has not been readily available.
The charity said poor follow-up care for women who have had GDM may be contributing to rising rates of type 2 diabetes in younger women.
It is calling for consistent postnatal follow-ups for women after GDM, more referrals to the NHS Diabetes Prevention Programme, greater accountability for improvements in postnatal care, and action on inequalities affecting women from deprived and minority ethnic communities.
A genomic test may help some women with breast cancer avoid chemotherapy, with near-identical outcomes in an international trial.
The findings suggest patients with a low test score could be treated with hormone therapy alone without increasing the risk of their cancer returning.
Researchers said the results could support more personalised treatment decisions and spare some women the side-effects of chemotherapy.
Prof Rob Stein, the trial’s chief investigator and a professor of breast oncology at UCL, said: “Optima addresses a longstanding challenge in breast cancer care: identifying who truly benefits from chemotherapy and who does not.
“Our findings show that many patients can safely avoid chemotherapy without compromising their outcomes.
“These results mark an important and significant step toward more personalised treatment.
“The trial has successfully used tumour biology to guide decisions rather than relying solely on traditional clinical features.”
Breast cancer treatment usually involves surgery to remove tumours. Chemotherapy is then often recommended if doctors believe there is a risk the disease will return.
Chemotherapy can cause side-effects including hair loss, rashes, nausea, insomnia and fatigue. Some women may also face longer-term consequences such as infertility, cognitive impairment or early menopause.
The Optima trial followed more than 4,000 patients with newly diagnosed breast cancer in the UK, Norway, Sweden, Australia, New Zealand and Thailand.
The trial was led by University College London.
One woman who took part in the trial told the Guardian that being able to skip chemotherapy felt “like Christmas”. Nine years after being diagnosed, taking the test and skipping chemotherapy, she is healthy and enjoying a full and active life.
The trial tested whether a genomic test could identify which patients need chemotherapy and which could safely avoid it.
The Prosigna test, made by diagnostics company Veracyte, analyses the activity of 50 genes in tumour tissue. It identifies the molecular subtype of the cancer and gives a score estimating the risk of breast cancer returning in the next 10 years.
The randomised trial involved 4,429 patients aged 40 or over with hormone-positive breast cancer. Hormone-positive breast cancer grows in response to hormones such as oestrogen or progesterone. It is the most common form of breast cancer, accounting for up to 80 per cent of cases globally.
Participants were assigned to one of two groups. In the standard treatment group, patients received chemotherapy followed by hormone therapy.
In the second group, patients had their tumours analysed using the genomic test. Those with a high score received chemotherapy and hormone therapy. Those with a low score received hormone therapy alone.
Radiotherapy and other treatments were given as usual in both groups.
In the second group, outcomes were very similar whether chemotherapy was given or not. Five years after treatment, 95 per cent of patients who had chemotherapy and hormone therapy were alive and free from breast cancer recurrence, while 94 per cent of those who skipped chemotherapy were also alive and recurrence-free.
The findings suggest chemotherapy offered little or no additional benefit for patients with low test scores.
Some men also took part in the study, but researchers said there were too few to draw firm conclusions for this group.
The trial received funding from the National Institute for Health and Care Research, Veracyte and cancer charities.
Prof Iain MacPherson, a co-chief investigator and professor of breast oncology at the University of Glasgow, said: “Optima provides robust, practice-changing evidence that we can safely reduce the use of chemotherapy for many patients with hormone-sensitive breast cancer.
“These findings represent a major step forward in delivering more personalised, precise care, ensuring that treatment decisions are driven by what will genuinely improve outcomes for patients, while avoiding unnecessary toxicity.
“The potential impact for both patients and health services is substantial.”
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