Two Hot Treatment Approaches Show

Promise in Ovarian Cancer

Nick Mulcahy
WASHINGTON, DC Two of the hottest treatmet a!!roaches i ocolo"y
immuothera!y a# ati$o#y%#ru" co&u"ates offer the !romise of im!ro'e# outcomes i
#ifficult(to(treat a#'ace# o'aria cacer, accor#i" to ) stu#ies !resetatios here at the
America Associatio for Cacer *esearch +,-th Aual Meeti".
The immuothera!y for o'aria cacer is actually a )(ste! !rocess, which, for the first time
e'er, com$ies #e#ritic cell 'acciatio a# a#o!ti'e T(cell thera!y, sai# /aa 0a#alaft,
1harmD, 1hD, from the O'aria Cacer *esearch Ceter i the 1erelma School of Me#icie
at the 2i'ersity of 1esyl'aia i 1hila#el!hia.
I a !hase + trial, ), of 3+ !atiets 45567 with sta"e III8I9 o'aria cacer who were treate#
with the first ste! 4'accie aloe7 ha# either sta$le #isease 4 : +;7 or !artial res!ose 4 :
37. <e'aci=uma$ 4Avastin, *oche8Geetech7 was a#miistere# #uri" $oth treatmet ste!s.
The ++ !atiets who recei'e# the 'accie $ut still ha# resi#ual #isease mo'e# o to the
seco# ste! 4immuothera!y7, a a#o!ti'e T(cell thera!y. Of this "rou!, ;36 e>!eriece#
$eefit? ; !atiets ha# sta$le #isease a# + ha# a com!lete res!ose.
This cliical trial has ha# oe es!ecially #ramatic result, sai# Dr. 0a#alaft #uri" a meeti"
!ress $riefi". A !atiet who ha# ) recurreces a# ha# u#er"oe #e$ulki" sur"eries
recei'e# the 'accie aloe 4ste! +7 a# has ha# -@ moths of !ro"ressio(free sur'i'al.
A#'ace# o'aria cacer re!resets a area of hu"e umet me#ical ee#, sai# Dr. 0a#alaft.
AMost !atiets with o'aria cacer are #ia"ose# at a a#'ace# sta"e? may of those rela!se
withi ) years a# most #ie withi @ years. Gi'e these "rim outcomes, there is #efiitely a
'ast umet ee# for the #e'elo!met of o'el, alterate thera!ies,A she sai# i a !ress
statemet.
The )(ste! treatmet !rocess use# i this stu#y was #e'elo!e# at the 1e O'aria Cacer
*esearch Ceter.
Birst, a 'accie is !re!are# $y e>!osi" immue cells, kow as #e#ritic cells, isolate# from
the $loo# of each !atiet, to her ow tumor tissue, which was collecte# #uri" #e$ulki"
sur"ery. The 'accie is #eli'ere# i a series of @ i&ectios o'er a 3(moth !erio#.
Seco#, T(cells, ow A'accie !rime#,A were remo'e# from the !atietCs $loo#. /a$oratory
!rocesses are use# to stimulate a# e>!a# these immue cells, which are the rei&ecte# ito
the !atiet.
I the )(ste! !rocess, the #e#ritic cells act as As!iesA a# collect iformatio a$out tar"ets.
The s!ies retur to the lym!h o#es the Ahea#DuartersA where they iform the T(cells
the Asol#iersA which the "o a# Acom$at the tumor,A Dr. 0a#alaft e>!laie#.
I effect, the seco# ste! of the !rocess, the a#o!ti'e trasfer of T(cells, am!lifies the
atitumor immue res!ose. This is e>!lais why there were more !atiets with sta$le
#isease8res!o#ers i the "rou! that u#erwet $oth ste!s tha i the "rou! that u#erwet
oly the first ste! 4;36 's 5567.
AntibodyDrug Conjugate for Patinum!"esistant Disease
At the same !ress $riefi", aother i'esti"ator !resete# results from a !hase + stu#y of a
e>!erimetal a"et that tar"ets o'aria tumors e>!ressi" the M2C+5 !rotei.
Ei"hty !ercet of all o'aria cacers e>!ress the M2C+5 !rotei, sai# lea# author Foyce B.
/iu, MD, M1H, from the Daa(Bar$er Cacer Istitute a# Har'ar# Me#ical School i
<osto, Massachusetts.
The ew a"et, kow as DM2C@;@-A 4*oche8Geetech7, is a ati$o#y%#ru" co&u"ate,
which is a ew class of #ru", the $est kow of which is trastu=uma$ emtasie or T(DM+
4Kadcyla, *oche8Geetech7, use# i metastatic HER2(!ositi'e $reast cacer.
I the first(i(huma trial, more tha ),6 of -- !atiets with a#'ace#, recurret, !latium(
resistat o'aria cacer e>!eriece# a res!ose to DM2C@;@-A, Dr. /iu re!orte#.
Amo" the stu#y !artici!ats, there was + com!lete res!ose a# - !artial res!oses 4more
tha 3,6 shrika"e of tumor7. All @ of these res!oses occurre# i !atiets whose cacer
cells e>!resse# hi"h le'els of M2C+5 a# who were treate# with the ).- m"8k" #ose.
DM2C@;@-A is a com$iatio of a ati$o#y a# a !otet to>i. The ati$o#y i#etifies a
!rotei, M2C+5, which is hi"hly e>!resse# i o'aria cacers, a# tar"ets the to>i to kill
the cacer cells. The ati$o#y%#ru" co&u"ate releases the to>i with relati'e selecti'ity to
M2C+5(!ositi'e cacer cells. This allows #eli'ery of #ru"s that woul# otherwise $e too to>ic
for treatmet, accor#i" to Dr. /iu.
AIf the acti'ity of this #ru" is cofirme# i a##itioal trials, this will re!reset a o'el ty!e of
thera!y for o'aria cacer that is Duite #ifficult to treat,A she ote#.
Curret thera!ies for !latium(resistat o'aria cacer are Alimite# i their effecti'eess a#
ty!ically short li'e#,A she tol# re!orters.
The wome i the trial were hea'ily !retreate#? they recei'e# a a'era"e of ; !re'ious
chemothera!y treatmets.
The a"et has Aa acce!ta$le safety !rofile,A sai# Dr. /iu.
Duri" the stu#y, ) #ose(limiti" to>icities occurre#G + case of "ra#e - eutro!eia a# +
case of "ra#e - uric aci# icrease, which occurre# at the ma>imum a#miistere# #ose of
3.) m"8k". Gra#e 3 a#'erse e'ets iclu#e# fati"ue i H6 of !atiets a# eutro!eia i H6
of !atiets.
Bati"ue was the most commo "ra#e 38- a#'erse e'et at all #ose le'els. O'erall, fati"ue
occurre# i @;6 of !atiets. Other commoly re!orte# a#'erse e'ets were ausea, 'omiti",
#ecrease# a!!etite, #iarrhea, a# !eri!heral euro!athy.
How #o you fi# time to $alace school with a $usy ursi" careerI
Our ursi" alumi $alace# school, work, a# family.
Bi# out how our accre#ite# !ro"rams fit your sche#ule
Iformatio from I#ustry
The results see with DM2C@;@-A #emostrate that ati$o#y%#ru" co&u"ates are the real
#eal as a class of #ru", a# that T(DM+ is Aot a oe(off e>am!le of a #ru" that works,A sai#
/ouis Weier, MD, from the Geor"etow /om$ar#i Com!rehesi'e Cacer Ceter i
Washi"to, DC, who mo#erate# the !ress $riefi".
AThis is a thera!eutic coce!t that matters a# makes sese. Jou ca take a ati$o#y that
will tar"et a im!ortat ati"e o a tumor cell surface. Jou ca #eli'er a cytoto>ic !oiso to
the iterior of that cell...kill it, a# make !eo!leCs cacers "et $etter,A he sai#.
Dr. Kandalaft 's immunotherapy study was funded by a National ancer !nstitute "varian
#peciali$ed %ro&ram of Research E'cellence &rant( the National !nstitutes of Health( and the
"varian ancer !mmunotherapy !nitiative. Dr. Kandalaft and Dr. )iu have disclosed no
relevant financial relationships.
America Associatio for Cacer *esearch 4AAC*7 +,-th Aual Meeti"G A$stracts /<(
33@, !resete# A!ril +,, ),+3? A$stract /<()H,, !resete# A!ril H, ),+3.
#inorities $ait %onger for &reast Cancer
Surgery
A!r )-, ),+3

<y Gee'ra 1ittma
NEW JO*0 4*euters Health7 A!r )- ( Amo" you" wome #ia"ose# with $reast cacer,
$lack a# His!aic !atiets were more likely to wait weeks for treatmet i a ew stu#y i
Califoria.
*esearchers fou# treatmet #elays were also more commo amo" !oor wome a# those
without !ri'ate isurace ( a# that a womaCs chace of sur'i'i" at least fi'e years after
cacer sur"ery was lower whe it was !ut off.
AThis stu#y a##s to a um$er of other stu#ies that ha'e also #ocumete# treatmet #elays that
are !attere# $y race or socioecoomic status,A sai# Sam Har!er, who has stu#ie# racial
#iffereces i $reast cacer #ia"osis a# sur'i'al at McGill 2i'ersity i Motreal.
AWhat the stu#y #oes i#etify is that there are #iffereces... the stu#y really caCt tell us much
a$out why thatCs occurri",A he tol# *euters Health.
Bor e>am!le, Har!er sai#, itCs !ossi$le miority !atiets are sicker tha whites, o a'era"e,
a# treatmet is #elaye# for 'ali# reasos. Or !oor wome may ha'e more trou$le taki"
time off from work a# "etti" to their a!!oitmets.
AOf course, thereCs the !otetial for #iscrimiatio i treatmet,A sai# Har!er, who wasCt
i'ol'e# i the ew research. AI thik thatCs whatCs most coceri" a$out fi#i"s like this.A
Bor their stu#y, Dr. Ho#a Ato(Cul'er from the 2i'ersity of Califoria, Ir'ie, a#
collea"ues aaly=e# Califoria Cacer *e"istry #ata o K,K5, wome a"es +@ to 3H who
were #ia"ose# with $reast cacer i +HH; throu"h ),,5. Althou"h cacer is rare i that a"e
"rou!, itCs ty!ically more a""ressi'e tha i ol#er wome, the researchers ote#.
They fou# the time $etwee #ia"osis a# treatmet ( whether sur"ery or chemothera!y (
was #elaye# more tha si> weeks i K6 of white wome a# +@6 of $oth His!aic a# $lack
wome.
/ikewise, rou"hly +,6 of !ri'ately(isure# wome ha# their treatmet #elaye# more tha si>
weeks, com!are# to +K6 of those who ha# o isurace or were co'ere# $y Me#icai#.
A# for wome treate# with sur"ery, i !articular, outcomes were su$statially worse after a
lo" #elayG K,6 of those wome li'e# at least fi'e years after sur"ery, com!are# to H,6 of
!atiets who waite# less tha two weeks for treatmet.
Dr. Ato(Cul'er sai# you"er wome are a uiDue "rou! $ecause theyCre ofte i $etwee
isuraces or i $etwee &o$s.
AOur healthcare system #oes ot allow for access to healthcare $y all !eo!le i the same
maer,A she tol# *euters Health. AWithout ha'i" a real sta#ar# of care 4for ty!e of
treatmet a# time to treatmet7 that the healthcare system is accouta$le for, you will see
those #iffereces.A
I aother stu#y !u$lishe# cocurretly i FAMA Sur"ery, researchers from the 2i'ersity of
Tole#o Me#ical Ceter fou# wome with early(sta"e $reast cacer ha# lar"er tumors at
#ia"osis, a# were more likely to u#er"o mastectomy, if they were co'ere# $y Me#icai#.
What ca you #o to further your e#ucatioal "oals as a urseI
/o" o a# lear critical lea#ershi! skills ee#e# to ehace your ursi" career.
Disco'er how our "ra#uate #e"ree !ro"rams ca hel! you meet your e#ucatioal "oals
Iformatio from I#ustry
Si>ty !ercet of those wome ha# a mastectomy, com!are# to 3H6 of !atiets with !ri'ate
isurace. The Natioal Istitutes of Health e#orses $reast(coser'i" sur"ery ( rather tha
mastectomy ( for early(sta"e $reast cacer, the team le# $y Dr. /i#a A#e!o&u ote#.
The stu#ies are cosistet with !rior research which has show, for e>am!le, that $lack
wome are more likely to #ie of $reast cacer ( i !art #ue to se"re"atio a# lower
ei"h$orhoo# a# family icomes 4see *euters Health story of March )+, ),+)7.
Howe'er, with so may Duestios a$out the !otetial causes $ehi# #is!arities i cacer
treatmet a# outcomes, itCs har# to kow where to "o e>t, Har!er ote#.
AIt really shoul# !ush us to try to "et at some of those Duestios for u#ersta#i"G how much
of these #iffereces may $e #ue to #iscrimiatio, or where !eo!le li'e a# access to
treatmetIA he sai#.
SO2*CESG htt!G88$it.ly8++lt2,o a# htt!G88$it.ly8++lt2,o
FAMA Sur"ery ),+3.
The &road Scope of Heath 'ffects (rom
Chronic Arsenic ')posure
Update on a Worldwide Public Health Problem
Abstract and Introduction
Abstract
&ac*ground+ Cocers for arseic e>!osure are ot limite# to to>ic waste sites a# massi'e
!oisoi" e'ets. Chroic e>!osure cotiues to $e a ma&or !u$lic health !ro$lem
worl#wi#e, affecti" hu#re#s of millios of !ersos.
Objectives+ We re'iewe# recet iformatio o worl#wi#e cocers for arseic e>!osures
a# !u$lic health to hei"hte awareess of the curret sco!e of arseic e>!osure a# health
outcomes a# the im!ortace of re#uci" e>!osure, !articularly #uri" !re"acy a# early
life.
#ethods+ We sythesi=e# the lar"e $o#y of curret research !ertaii" to arseic e>!osure
a# health outcomes with a em!hasis o recet !u$licatios.
Discussion+ /ocatios of hi"h arseic e>!osure 'ia #riki" water s!a from <a"la#esh,
Chile, a# Taiwa to the 2ite# States. The 2.S. E'irometal 1rotectio A"ecy
ma>imum cotamiat le'el 4MC/7 i #riki" water is +, L"8/? howe'er, cocetratios of
M 3,,,, L"8/ ha'e $ee fou# i wells i the 2ite# States. I a##itio, e>!osure throu"h
#iet is of "rowi" cocer. 0owle#"e of the sco!e of arseic(associate# health effects has
$roa#ee#? arseic lea'es essetially o $o#ily system utouche#. Arseic is a kow
carcio"e associate# with ski, lu", $la##er, ki#ey, a# li'er cacer. Dermatolo"ical,
#e'elo!metal, eurolo"ical, res!iratory, car#io'ascular, immuolo"ical, a# e#ocrie
effects are also e'i#et. Most remarka$ly, early(life e>!osure may $e relate# to icrease#
risks for se'eral ty!es of cacer a# other #iseases #uri" a#ulthoo#.
Concusions+ These #ata call for hei"htee# awareess of arseic(relate# !atholo"ies i
$roa#er cote>ts tha !re'iously !ercei'e#. Testi" foo#s a# #riki" water for arseic,
iclu#i" i#i'i#ual !ri'ate wells, shoul# $e a to! !riority to re#uce e>!osure, !articularly
for !re"at wome a# chil#re, "i'e the !otetial for life(lo" effects of #e'elo!metal
e>!osure.
Introduction
O"oi" e>!osures to to>ic chemicals such as arseic cotiue to !ose a si"ificat threat to
!u$lic health. The Worl# Health Or"ai=atio 4WHO7 estimates that M ),, millio !ersos
worl#wi#e mi"ht $e chroically e>!ose# to arseic i #riki" water at cocetratios a$o'e
the WHO safety sta#ar# of +, L"8/ 4WHO ),,K7 4 Ta$le + 7. Arseic is a metalloi# elemet
that is ecoutere# !rimarily as arseical com!ou#s. Withi these com!ou#s, arseic
occurs i #ifferet 'alece states, the most commo of which are As
III
4arseites7 a# As
9

4arseates7. Arseic i #riki" water is ty!ically fou# i the ior"aic form, either as As
III

or As
9
, whereas arseic i foo# is fou# i the or"aic a# ior"aic forms, #e!e#i" o the
s!ecific foo# NA"ecy for To>ic Su$staces a# Disease *e"istry 4ATSD*7 ),,;? Euro!ea
Boo# Safety Authority 4EBSA7 ),,HO Sources of arseic cotamiatio iclu#e atural
#e!osits as well as athro!o"eic sources such as mii" a# electroics maufacturi"
!rocesses a# metal smelti" 4ATSD* ),,;7.
Arseic hol#s the hi"hest raki" o the curret 2.S. ATSD* ),++ su$stace !riority list
4ATSD* ),++$7 4 Ta$le ) 7. ATSD* raks chemicals usi" a al"orithm that traslates
!otetial !u$lic health ha=ar#s ito a !oits(scale# system $ase# o the freDuecy of
occurrece at Natioal 1riority /ist 4N1/7 Su!erfu# sites as well as to>icity a# !otetial
for huma e>!osure. Arseic to!s the list i s!ite of the fact that this raki" #oes ot iclu#e
full cosi#eratio of e>!osure from #riki" water, #iet, co!!er(chromate# arseic(treate#
woo#, coal( a# woo#($uri" sto'es, arseical !estici#es, a# homeo!athic reme#ies
4ATSD* ),,;, ),++$? Akter et al. ),,@? EBSA ),,H? *ose et al. ),,;7. Therefore, the threat
to huma health !ose# $y arseic is e'e "reater tha its to! ATSD* raki" woul# su""est.
I re"ar# to to>icity, the Iteratioal A"ecy for *esearch o Cacer 4IA*C7 #efies arseic
as a Grou! I kow huma carcio"e that also i#uces a wi#e array of other ocacer
effects, lea'i" essetially o $o#ily system free from !otetial harm 4ATSD* ),,;? IA*C
),+)? Natioal *esearch Coucil ),,+? WHO ),,K7.
Here we sythesi=e the lar"e $o#y of curret research !ertaii" to arseic e>!osure a#
health effects a# em!hasi=e the $roa#ei" sco!e of !re#icte# a# o$ser'e# im!acts of
arseic o !u$lic health. 2#ersta#i" the wi#e ra"e of these im!acts #ri'es home the
im!ortace of testi" #riki"(water sources a# moitori" foo#s for arseic. Whereas
muici!alities test !u$lic #riki"(water sources, !ri'ate wells ca "o uteste#. *ecet #ata
also raise cocers for arseic e>!osure 'ia foo#s iclu#i" rice a# or"aic $row rice syru!
NDa'is et al. ),+)? EBSA ),,H? Boo# a# Dru" A#miistratio 4BDA7 ),+)? Gil$ert(
Diamo# et al. ),++? Fackso et al. ),+)O as well as chicke feather meal !ro#ucts that are
use# i the huma foo# system 4Nachma et al. ),+)7.
E'e as assessmets of #ietary e>!osure cotiue to ufol#, #riki" water remais a ma&or
cocer for arseic e>!osure. There are kow, lar"e(scale #riki"(water cotamiatio
!ro$lems i coutries such as <a"la#esh 4Ahsa et al. ),,5? Ar"os et al. ),+,, ),+)? Smith
et al. ),,,$7. Howe'er, chroic arseic e>!osure is a cocer i may !arts of the worl# 4
Ta$le + 7. Bor e>am!le, arseic cocetratios i #riki" water from some !ri'ate wells i
the 2ite# States are as hi"h as 3,+,, L"8/, which is i the ra"e of the hi"hest
cocetratios re!orte# i <a"la#esh 4Nielse et al. ),+,? Ja" et al. ),,H7. Jet #etectio
of arseic cotamiatio e'e at these hi"h le'els remais !ro$lematic $ecause it is tasteless,
colorless, a# o#orless.
Gi'e the lar"e um$er of stu#ies that a##ress the $roa# ra"e of iformatio !ro'i#e# here,
it is im!ractical to iclu#e all !ertiet stu#ies. *ather, we !reset a sythesis of iformatio
a# cite recet stu#ies that hel! illustrate the $rea#th a# sco!e of the !ro$lems. Whe
a'aila$le, we cite curret re'iews that ca ser'e as a resource for a more com!lete listi" of
rele'at resources, most ofte focusi" o si"le health issues such as car#io'ascular #isease
4States et al. ),,H7. Detaile# #iscussios of arseic e>!osure a# health effects ca $e fou#
elsewhere 4ATSD* ),,;? EBSA ),,H? Gi$$ et al. ),++? States et al. ),++7.
As awareess of arseic e>!osure icreases, so shoul# kowle#"e of its health effects
$ecause the im!act of chroic arseic e>!osure o !u$lic health is su$statial. I a##itio to
ski lesios a# ski cacer 4ATSD* ),++a? Se"u!ta et al. ),,K? Smith et al. ),,,a7,
eurolo"ical, res!iratory, car#io'ascular, a# #e'elo!metal effects a# more are like# to
chroic arseic e>!osure 4 Ta$le 3 7 4Ar"os et al. ),+)? Smith a# Steimaus ),,H? States et
al. ),++7. Acute !oisoi"s still occur $ut are ucommo 4<rostei et al. ),++7. Arseic
re#ers its to>icity 'ia umerous mechaismsG Arseic is "eoto>ic a# has multi!le effects
o cellular si"ali", cellular !roliferatio, DNA structure, e!i"eetic re"ulatio, a#
a!o!tosis 4Blora ),++? *e et al. ),++? States et al. ),++7.
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$nformation from $ndustry
A wealth of #ata comes from o"oi" e!i#emiolo"ical stu#ies of lar"e !o!ulatios e>!ose#
to a wi#e ra"e of arseic le'els i #riki" water i re"ios such as Taiwa, <a"la#esh,
Chile, I#ia, a# Ar"etia 4Ahsa et al. ),,5? Ar"os et al. ),+)? Che C/ et al. ),+,a?
Smith et al. ),++? Jua et al. ),+,7. I Taiwa, a sta$le !o!ulatio i a arseic(e#emic
re"io ha# $ee e>!ose# to arseic 'ia #riki" water sice the +H,,s NChe CF et al. +HKK$,
+HH)? Gi$$ et al. ),++? Tse" +H;;? 2.S. E'irometal 1rotectio A"ecy 4E1A7 ),,+? Wu
et al. +HKHO. I <a"la#esh, tu$e wells were #u" i the +H;,s as a source of #riki" water to
a'oi# micro$ial cotamiatio, oly to later lear that the tu$e wells are cotamiate# with
aturally occurri" arseic 4Smith et al. ),,,$7. *esearchers esta$lishe# a cohort i
<a"la#esh with o'er +,,,,, !ersos erolle# as !art of the Health Effects of Arseic
/o"itu#ial Stu#y 4HEA/S7 4Ahsa et al. ),,5? Ar"os et al. ),+)7. *esearchers are also
stu#yi" a !o!ulatio i Chile where some cities were e>!ose# to hi"h cocetratios of
arseic for a #efie#, limite# !erio# of time 4+H@K%+H;+7, at which !oit, systems were
istalle# to remo'e arseic from #riki" water 4<i""s et al. +HHK7. This !o!ulatio is
!articularly well suite# for stu#ies relate# to latecy !erio#s for chroic #iseases a#
susce!ti$ility #uri" #e'elo!met 4Dau!hie et al. ),++? /iaw et al. ),,K? Marshall et al.
),,;? Jua et al. ),+,7. Ma&or fi#i"s from these cohorts a# other stu#ies are #escri$e# i
the followi" sectios.
I li"ht of accumulate# research, there is icreasi" awareess that arseic e>!osure mi"ht $e
affecti" more !ersos a# cotri$uti" to more chroic #isease tha !re'iously thou"ht. I
the HEA/S cohort, a!!ro>imately )+.-6 of all #eaths a# )3.@6 of #eaths associate# with
chroic #isease coul# $e attri$ute# to arseic at M +, L"8/ i #riki" water 4Ar"os et al.
),+,7. Here we !reset a o'er'iew a# sythesis of recet iformatio o worl#wi#e
cocers for arseic e>!osures a# !u$lic health. The eormity of !otetial !u$lic health
im!acts is striki". Gi'e this !otetial, testi" a# reme#iati" arseic i #riki" water at
the le'el of si"le !ri'ate wells a# re#uci" #ietary e>!osure are critical to !rotecti" !u$lic
health.
(actors Associated $ith "esiience or
,unerabiity to Hot (ushes and -ight
Sweats During the #enopausa Transition
Ooa"h 0. Duffy, 1hD, /isa I'erse, 1hD, /ora Aucott, 1hD, 1hili! C. Haafor#, MD
Disclosures
Abstract and Introduction
Abstract
Objective. The aim of this stu#y was to e>!lore factors associate# with resiliece a#
'ulera$ility to hot flushes a# i"ht sweats.
#ethods. A total of -,-,; wome a"e# -@ to @- years who were recruite# from family
!ractices i ortheast Scotla# res!o#e# to a !ostal Duestioaire. Amo" res!o#ets
re!orti" hi"h(freDuecy hot flushes 4 : 5)K7 or i"ht sweats 4 : 5)K7, we com!are# those
with low le'els of $other 4AresilietA7 with the rest. Similarly, amo" wome re!orti" low(
freDuecy hot flushes 4 : -@H7 or i"ht sweats 4 : -@H7, those with hi"h $other
4A'ulera$leA7 were com!are# with the rest. Borwar# ste!wise lo"istic re"ressio e>amie#
social, !sycholo"ical, a# !hysical factors associate# with resiliece or 'ulera$ility to each
sym!tom.
"esuts. Wome resiliet to hot flushes were those who ha# !re'iously ot $ee $othere# $y
their mestrual !erio#s? were ot e>!erieci" somatic sym!toms or i"ht sweats? a#
!ercei'e# their sym!toms as ha'i" low coseDueces o their li'es. Those 'ulera$le to hot
flushes ha# chil#re? ha# a hi"h $o#y mass i#e>? re!orte# i"ht sweats? a# !ercei'e# their
sym!toms as ha'i" hi"h life coseDueces. Wome resiliet to i"ht sweats were
osmokers? were ot e>!erieci" slee! #ifficulties? were ot usi" !sycholo"ical sym!tom
maa"emet strate"ies? a# !ercei'e# their meo!ausal sym!toms as ha'i" low life
coseDueces. Those 'ulera$le to i"ht sweats ha# low e#ucatioal attaimet? ha#
!re'iously $ee $othere# $y their mestrual !erio#s? ha# $elow(a'era"e !hysical health?
re!orte# musculoskeletal sym!toms a# hot flushes? a# !ercei'e# their meo!ausal
sym!toms as ha'i" hi"h life coseDueces.
Concusions. Bactors associate# with resiliece or 'ulera$ility #iffer $y sym!tom stu#ie#,
althou"h relatioshi!s with illess !erce!tios e>ist i all mo#els. Our results su""est that a
si"le a!!roach to maa"i" these sym!toms is likely to $e usuccessful.
Introduction
So far, most research ito meo!ausal sym!toms has focuse# o the freDuecy of 'arious
sym!toms e>!eriece# $y wome #uri" each sta"e of the meo!ausal trasitio, associate#
le'els of $other, a# use of #ifferet sym!tom maa"emet strate"ies. There is ofte
!articular em!hasis o those e>!erieci" a hi"h freDuecy of sym!toms or those usi"
!articular forms of health care 4such as hormoe thera!y NHTO7. There is, howe'er, "rowi"
iterest i u#ersta#i" why some wome seem to $e utrou$le# $y their sym!toms or
re!ort ha'i" a "oo# Duality of life #uri" the meo!ausal trasitio.
N+O
A $etter
u#ersta#i" of the !sycholo"ical, !hysical, a# social factors associate# with a!!aret
resiliece to sym!toms may hel! i#etify ew iter'etios for wome ee#i" hel!.
*esiliece is a !sycholo"ical coce!t that has $ee #escri$e# as A!atters or !rocesses of
!ositi'e a#a!tatio a# #e'elo!met i the cote>t of si"ificat threats to a i#i'i#ualCs life
or fuctio.A
N)O
Althou"h few woul# ar"ue that the meo!ausal trasitio is a si"ificat
threat to a womaCs life, it is a time whe may wome re!ort $othersome sym!toms,
N3O

which !ersist for a um$er of years
N-O
a# are associate# with health(relate# Duality of life.
N@,5O

The Stu#y of WomeCs Health Across the Natio 4SWAN7 use# #ata from the se'eth aual
iter'iew of !artici!ati" wome to e>amie factors associate# with #iscre!acies $etwee
re!orte# freDuecy of, a# $other from, hot flushes or i"ht sweats.
N;O
Wome who re!orte#
freDuet hot flushes a# low le'els of $other were more likely to $e marrie# a# less likely to
ha'e e"ati'e affect tha those re!orti" a similar freDuecy of hot flushes a# hi"h le'els of
$other. Wome who re!orte# a hi"h freDuecy of i"ht sweats $ut low le'els of $other were
more likely to $e marrie#, less likely to re!ort slee! #ifficulties, a# less likely to $e late
!erimeo!ausal tha wome re!orti" a hi"h freDuecy of i"ht sweats a# hi"h le'els of
$other. I cotrast, wome who re!orte# a low freDuecy of hot flushes a# hi"h le'els of
$other were more likely to $e Africa America 4com!are# with white wome7, more likely
to re!ort their self(rate# health as !oor, a# more likely to ha'e a lower le'el of e#ucatioal
attaimet. Wome re!orti" a low freDuecy of i"ht sweats $ut hi"h le'els of $other were
also more likely to re!ort !oor self(rate# health. These results su""est that it may $e !ossi$le
to i#etify wome who are AresilietA or A'ulera$leA to the im!act of meo!ausal
sym!toms. A recet stu#y of Ecua#oria wome fou# that lower scores o the Wa"il# a#
Jou" *esiliece Scale 4i#icati" less resiliece7 correlate# with more se'ere hot flushes.
NKO

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$nformation from $ndustry
*utter
NHO
!oite# out that resiliece is likely to resi#e i the social cote>t as much as withi
the i#i'i#ual. Thus, social circumstaces a# su!!ort, self(esteem, a# self(efficacy are
likely to $e im!ortat #etermiats of resiliece. Other iflueces amo" wome
trasitioi" throu"h meo!ause may $e attitu#es towar# meo!ause
N+,O
a# illess
!erce!tios or re!resetatios
N++O
of meo!ausal sym!toms. The aim of this stu#y was to
#etermie factors associate# with resiliece a# 'ulera$ility to meo!ausal sym!toms, usi"
#ata from a lar"e commuity($ase# stu#y of wome li'i" i the 20. Our hy!othesis was
that wome who are a!!aretly resiliet to meo!ausal sym!toms 4ie, those e>!erieci" a
hi"h freDuecy of hot flushes or i"ht sweats $ut re!orti" low le'els of associate# $other7
woul# ha'e !ositi'e attitu#es towar# meo!ause, low le'els of a>iety or #e!ressio, hi"h
le'els of social su!!ort, a# !ositi'e illess !erce!tios. Co'ersely, it was hy!othesi=e# that
a!!aretly 'ulera$le wome 4ie, those re!orti" a low freDuecy of sym!toms $ut hi"h
le'els of $other7 woul# ha'e results for these characteristics i the o!!osite #irectio.

Prenata #icronutrient Suppementation
and Postpartum Depressive Symptoms in a
Pregnancy Cohort
<re#a MJ /eu", <oie F 0a!la, Catherie F Biel#, Su=ae Tou"h, Misha Elias=iw,
Mariel Ba&er Gome=, /i#a F McCar"ar, /isa Ga"o, a# the A1rON Stu#y Team
Disclosures
<MC 1re"acy Chil#$irth. ),+3?+34)7

Abstract
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$nformation from $ndustry
&ac*ground 1ost!artum #e!ressio is a serious !ro$lem for wome a# their offs!ri".
Microutriet su!!lemets are recomme#e# for !re"at wome $ecause of their
#ocumete# !rotecti'e effects for the offs!ri", $ut their !otetial $eeficial effects o
materal metal health are ukow. This stu#y i'esti"ate# the associatio $etwee !reatal
microutriet su!!lemetatio a# the risk for sym!toms of !ost!artum #e!ressio i a
lo"itu#ial !re"acy cohort from the Al$erta 1re"acy Outcomes a# Nutritio 4A1rON7
stu#y.
#ethods 1artici!ats came from a cohort of the first 5,, A1rON wome. Su!!lemetal
utriet itake a# sym!toms of #e!ressio 4measure# with the E#i$ur"h 1ostatal
De!ressio Scale 4E1DS77 were collecte# at each trimester a# +) weeks !ost!artum.
"esuts Of the -;@ !artici!ats who com!lete# the E1DS at least twice i !re"acy a# at
+) weeks !ost!artum, -+5 4KK67 score# P+, a# @H 4+)67 score# Q+,, where a E1DS Q+,
is cosi#ere# to $e Aat least !ro$a$le mior #e!ressioA. Mea utriet itakes from
su!!lemets were hi"her i wome with lower E1DS scores, !articularly seleium 4! :
,.,,+@7 a# ome"a(3s 4! : ,.,+7. <i'ariate aalyses showe# that se'eral #emo"ra!hic a#
social8lifestyle 'aria$les were associate# with E1DS Q+,G ot ha'i" $ee $or i Caa#a 4!
: ,.,+7, "reater um$er of chroic co#itios 4! : ,.,@7, "reater um$er of stressful life
e'ets #uri" this !re"acy 4! : ,.,)7, a# lower !reatal a# !ostatal su!!ort 4! : ,.,,-3
a# ! : ,.,,,+, res!ecti'ely7. A#&usti" for co'ariates a# utriets kow to $e associate#
with !ost!artum #e!ressio, lo"istic re"ressio showe# that ha'i" a !reatal E1DS Q +,
icrease# the o##s of !ost!artum #e!ressi'e sym!toms 4seco# a# thir# trimester O* :
3.)H, H@6 CI : +.@@ ( ;.,+, ! : ,.,,- a# O* : -.)5, H@6 CI : ).,@ ( K.K@, ! P ,.,,,+,
res!ecti'ely7, while !reatal su!!lemetal seleium 4!er +, mc", O* : ,.;5, H@6 CI : ,.;- (
,.;K, ! : ,.,,+H7 a# !ostatal social su!!ort 4O* : ,.K;, H@6 CI : ,.;K ( ,.H;, ! : ,.,,+@7
were !rotecti'e.
Concusions Multi!le factors, iclu#i" su!!lemetary seleium itake, are associate# with
the risk of !ost!artum #e!ressi'e sym!toms. Buture research o #ietary su!!lemetatio i
!re"acy with s!ecial attetio to seleium itake is warrate#.