Cancer Treatment Must Address Carcinogens

10 Ways To Fight Off Cancer

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Penile Cancer and Sexually Transmitted Diseases

Although the risk of penile cancer appears to occur more frequently in uncir-cumcised men, the condition is rare, affecting only about 1 in 100,000 males in the United States. Whether there is an increased risk of cervical cancer in the sexual partners of uncircumcised men is also uncertain.

16 Effects and manifestations

During the fetal period, the manifestations from toxicological interference arc growth restriction, some forms of structural malformations, fetal death, functional impairment, and transplacental carcinogenesis. The period of organ and system maturation extends beyond the period of organogenesis, and even beyond the prenatal period. Therefore, the susceptible period for the induction of insults that may lead to functional deficits is much longer than that for the induction of gross structural defects. Functions shown to be affected by pre- and early postnatal exposure to chemicals include behavior, reproduction, endocrine function, immune competence, xenobiotic metabolism, learning capacity, and various other physiological functions. Fetal tissues are intrinsically highly vulnerable to carcinogens because of their high rate of cellular proliferation. This phenomenon has been demonstrated in rats, mice, hamsters, rabbits, pigs, dogs, and monkeys. About 25 compounds and groups of...

Fetal Risk Summary

Despite widespread usage, no reports linking the use of acetazolamide with congenital defects have been located. A single case of a neonatal sacrococcygeal teratoma has been described (4). The mother received 750 mg daily for glaucoma during the 1st and 2nd trimesters. A relationship between the drug and carcinogenic effects in the fetus has not been supported by other reports. Retrospective surveys on the use of acetazolamide during gestation have not demonstrated an increased fetal risk (5,6).

Veronica Johnson Roffey BAHons Rgn Rm Rhv Fetc Dip Infection Control

Veronica has worked in the NHS for 30 years. After general nurse training she trained and practised as a midwife and later health visitor and consequently has worked both in hospital and the community. During her career she has also worked at Great Ormond Street Children's Hospital and also specialised in cancer genetics, public health and infection control. While a public health nurse she undertook her honours degree in Health and Social Policy at Warwick University. Currently she is lead nurse for infection control.

Frequently Asked Questions

Depending on the underlying causes, varying treatment modalities may be offered. In cases of anovulation, drugs that enhance ovulation e.g. clomiphene may be prescribed to help the couple conceive. This can result in minor side effects such as nausea and bloatedness, multiple pregnancies (5-10 chance of twins) and may increase the risk of ovarian cancer in cases of prolonged and unregulated usage. Therefore, clomiphene is usually prescribed for only six ovulatory cycles.

Toxic chemicals metals and minerals

The adverse effects of ingestion and inhalation of even low levels of toxic chemicals, metals and minerals can lead to a huge range of conditions, including cardiovascular disease, renal and metabolic disease, immune dysfunction, lethargy, depression, cancer, recurrent infections, behavioural and learning difficulties and developmental abnormalities. Some specific effects are as follows.

Considering the physical exam

At your first prenatal visit, your practitioner examines your head, neck, breasts, heart, lungs, abdomen, and extremities. She also performs an internal exam (see Figure 5-3). During this exam, your practitioner evaluates your uterus, cervix, and ovaries, and performs, if due, a PAP test (cervix cancer and pre-cancer screening). If you feel you also should be tested for the possibility of sexually transmitted diseases, inform your physician because the PAP test doesn't screen for all of them.

276 Human Papilloma Virus HPV vaccine

In )une 2006 the US FDA licensed the first vaccine developed to prevent cervical cancer and other diseases in females caused by certain types of genital human papillomavirus (HPV) types (6, 11, 16 and 18), responsible for 70 of cervical cancers and 90 of genital warts. The duration of the protection is unclear. Current studies (with 5-year follow-up) indicate that (he vaccine is effective for at least 5 years (Anonymous 2006), The vaccine has not been causally associated with adverse outcomes of pregnancy or adverse reactions to the developing fetus. However, data on vaccination in pregnancy are limited.

2612 Metronidazole and other nitroimidazole antibiotics

Because metronidazole is mutagenic in bactcrial tests and carcinogenic in some animals (review by Dobias 1994), it was feared that it could also be mutagenic and carcinogenic in huinans. Such cffects have not been reported. A 20-year ongoing study gave no indication of an elevated risk for malignancies after metronidazole therapy (Beard 1988). In a retrospective study, no increased risk of childhood cancer associated with in utero exposure to metronidazole was found only a non-significant association with neuroblastoma was observed (Thapa 1998). Metronidazole does not appear to have teratogenic effects in the human, according to considerable experience (Caro-Paton 1997, Burtin 1995, Piper 1993). A recent prospective controlled study on 228 women exposed to metronidazole in pregnancy, 86 of whom with first-trimester exposure, confirmed these findings (Diav-Citrin 2001).

Breast Feeding Summary

Karp GI, Von Oeyen P, Valone F, Khetarpal VK, Israel M, Mayer RJ, Frigoletto FD, Garnick MB. Doxorubicin in pregnancy possible transplacental passage. Cancer Treat Rep 1983 67 773-7. 7. Awidi AS, Tarawneh MS, Shubair KS, Issa AA, Dajani YF. Acute leukemia in pregnancy report of five cases treated with a combination which included a low dose of Adriamycin. Eur J Cancer Clin Oncol 1983 19 881-4. 8. Turchi JJ, Villasis C. Anthracyclines in the treatment of malignancy in pregnancy. Cancer 1988 61 435-40. 10. Blatt J, Mulvihill JJ, Ziegler JL, Young RC, Poplack DG. Pregnancy outcome following cancer chemotherapy. Am J Med 1980 69 828-32. 11. Evenson DP, Arlin Z, Welt S, Claps ML, Melamed MR. Male reproductive capacity may recover following drug treatment with the L-10 protocol for acute lymphocytic leukemia. Cancer 1984 53 30-6. 12. Green DM, Hall B, Zevon MA. Pregnancy outcome after treatment for acute lymphoblastic leukemia during childhood or adolescence. Cancer 1989 64 2335-9. 13....

2132 Classification of the drugs used for chemotherapy

The agents used in cancer chemotherapy are divided into four groups. Since cancer during pregnancy is fortunately rare, and antineoplastic therapy is usually conducted as combination chemotherapy following established standard protocols, it is difficult to determine the teratogenic potential of individual cytostatic drugs in the human. Apparently, antimetabolites possess the strongest teratogenic potential after transrctinoic acids such as tretinoin (see Chapter 2.17).

2133 Vinca alkaloids and structural analogs

Three children aged 2 and 3 years whose mothers were treated for breast cancer with vinorelbine plus 5-fluorouracil during the second and third trimesters developed normally (Cuvier 1997). Another pregnancy with vinorelbine and trastuzumab (see section 2.13.16) in the third trimester was complicated by an oligohydramnios, which was thought more likely to be a side effect of trastuzumab (Fanale 2005). Cyclophosphamide is an alkylating agent used in cancer chemotherapy and as an immunosuppressant for the treatment of, for example, lupus erythematodes. Animal studies using rats, mice, rabbits, monkeys, and chicken showed malformations of the CNS, the craniofacial area and the skeleton (cf. Enns 1999). Knowledge regarding the treatment of pregnant women with cyclophosphamide during the first trimester is based on a small cases series (Aviles 1991) and retrospective case reports. In total, there are reports on more than 30 women treated during the first trimester, including one twin...

2138 Cytotoxic anthracydine antibiotics

A case report (Nakajima 2004) showed again that cytotoxic therapy (doxorubicin and ifosfamide) during the second third trimester may lead to healthy but growth-restricted children. This applies also to a study of 57 pregnant breast cancer patients who were treated with FAC (5-fIuorouracil, doxorubicin, cyclophosphamide) (Hahn 2006). However, doxorubicin is known to have cardiotoxic side effects there are three case reports of young pregnant women who had received doxorubicin treatment in their childhood or youth and, although their cardiac function appeared normal prior to pregnancy, they were decompensating at the end of pregnancy (Pan 2002).

2139 Other cytotoxic antibiotics

During the second third trimester were apparently healthy (Han 2005) or with minor problems (Molegi 2007). Normal growth and development was found in a group of 22 children who were prena-tally exposed to bleomycin. In 11 of them, maternal chemotherapy for cancer had begun in the first trimester (Aviles 1991).

21310 Folate antagonistic antimetabolites

Chemotherapy for cancer using MTX Ten articles describe pregnant women who had received methotrexate as part of cancer therapy during the first trimester. It is notewor thy that 16 healthy children were bom in this high-risk group (Zemlickis 1992, Aviles 1991, Feliu 1988, Dara 1981, Pizzuto 1980) 1 child had inguinal hernia (Giannakopoulou 2000), there was 1 spontaneous miscarriage (Giacalone 1999), and 1 stillbirth without malformations (Peres 2001). Only 1 child had characteristic malformations (Bawlc 1998) this child's mother had been treated for breast cancer with a weekly dose of 80 mg MTX from weeks 8-29. Moreover, she had received irradiation treatment from weeks 16-25, with the fetal dose estimated at 14 rad.

21316 Enzymes and antibodies exerting antineoplastic effects

Asparaginase is a bacterial enzyme that is typically used in combination with other antineoplastic agents, to interfere with the availability of the amino acid asparagine to rapidly growing cancer cells. There have been seven case reports of pregnant women exposed to asparaginase during the second trimester (Turchi 1988, Scheuning 1987, Awidi 1983, Karp 1983, Okun 1979, Khurshid 1978). In each case, asparaginase was administered in combination with a number of other chemotherapeutic agents in the treatment of acute leukemias. No birth defects were noted in the offspring of these women, but two infants had transient bone marrow hypoplasia. One child was found to have chromosomal gaps and a ring chromosome. Trastuzumab is a monoclonal antibody which blocks the human epidermal growth factor 2 protein and has an estimated half-life of 12 days. Waterstone (2006) reported on an uneventful prcgnancy and the delivery of a healthy girl whose mother conceived 3 days after her second cyclc of...

21317 Antineoplastic drugs with endocrine effects

The hormone antagonist tamoxifen is used for the treatment of breast cancer. Its effect on the endometrium might indirectly pose a risk to prenatal development. In 37 pregnancies collated by the manufacturer, 19 newborn babies were healthy and 2 children had craniofacial deformities. Two other case reports describe a child with anomalies resembling Goldenhar syndrome (Cullins 1994), and a newborn girl with indifferent genital development (Tewari 1997). An adenoma of the vagina was diagnosed in a girl aged 2 years whose mother had taken tamoxifen until the fourth month of pregnancy. There are also reports of apparently normal pregnancies (Andreadis 2004, Isaacs 2001, Lai 1994). Nine pregnancies following induction of ovulation with tamoxifen resulted in newborn babies that had no malformations (Ruiz-Velasco 1979). There is, however, insufficient data for a discriminative risk evaluation. Alegre A. Chunchurreta R, Rodriguez-Alarcon et al. Successful pregnancy in acute promyelocytic...

2151 Hypothalamic releasing hormones

Releasing hormones are responsible for regulating the synthesis and secretion of FSH and LH. Many synthetic human GnRH agonists are marketed, including buserelin, gonadorelin, goserelin, leuprore-lirt, nafarelin, and triptorelin. Cetrorelix and ganirelix are inhibitors of GnRH. In women, GnRH agonists have been used to treat estrogen-dependent breast cancer, endometriosis, hirsutism, and polycystic ovarian syndrome, but the widespread use of protocols using GnRH agonists antagonists in assisted reproductive technologies has led to an increasing number of pregnant women being exposed to these types of drugs. Most of the data concerning the safety of the GnRH analogs have not demonstrated serious side effects, such as increase in the incidence of miscarriage, birth defects, or fetal growth restriction, in human pregnancies exposed to GnRH (Tarlatzis 2004,

21514 Diethylstilbestrol

Diethylstilbestrol (DES) is a synthetic nonsteroidal estrogenic drug that was used therapeutically in the USA in the 1970s for threatened miscarriage and for maternal diabetes mellitus. The discovery of increased rates of vaginal clear-cell adenocarcinoma in adolescence among daughters whose mothers had received DES during pregnancy produced an international sensation (Herbst 1975). This drug provides the only proven example in human beings of prenatally-caused cancer (transplacental carcinogenesis). At least 25 of those young women who had prenatal exposure in the first trimester were born with vaginal, uterine, or fallopian tube anomalies. With male offspring, there appears to be an increased risk for ciyptorchidism, testicular hypoplasia, and abnormal semen cell morphology (Bibbo 1981).

2177 Coal tar and slate oil preparations

Coal tar as treatment for neurodermatitis has not been suspectcd of having a teratogenic effect. A retrospective study of 23 exposed women revealed nothing notable (Franssen 1999). Experimentally, coal tar products have, to some extent, demonstrated mutagenic or carcinogenic properties, but there has not yet been any indication of this in the longstanding and well-tried use of the group of substances employed therapeutically in humans.

Nonpregnancy Treatment And Care

Often investigation of biliary disorders may require endo-scopic retrograde cholangiopancreatography (ERCP). This may also form part of the treatment. However, the majority of gall bladder cancers are treated palliatively2. Acute and chronic pancreatitis is usually treated conservatively, with the exception of pancreatic cancer, which may be treated surgically.

21817 Biphosphonates and other osteoporosis drugs

In one study, there was no major congenital anomaly among 24 pregnancies with pre-pregnancy or early pregnancy exposure to alendronate (Ornoy 2006). Another case report describes a healthy newborn, with normal bone structure and uneventful development until the age of 1 year, who was exposed to 10 mg per day throughout pregnancy (Rutgers Aferhagc 2003). Another report was on a woman receiving zoledronic acid during the second and third trimesters, after chemotherapy for breast cancer during the first trimester. The child was born at 35 weeks' gestation, and was followed until the age of 1 year, during which time development was normal (Andreadis 2004).

2201 Xray examinations

The mutagenic or transplacental carcinogenetic risk of ionizing radiation is more difficult to evaluate than the teratogenic risk. Mutagenic effects are stochastic events, and no threshold can be established for this kind of risk. Point mutations often occur spontaneously. Estimations have been made that a dose of 100-200 rads may induce a doubling of the point mutation rate (Brent 1999, Neel 1999). On the one hand, a doubling of the mutation rate of a given gene does not mean a doubling of the disease frequency on the other hand, insufficient knowledge regarding the possible effects on later generations prevents definition of safety limit values of exposures for a population (Brent 1999), The dose capable of increasing the cancer risk, especially the risk of childhood leukemia following prenatal exposure, is also not well established. In a case-control study on neuroblastoma, Patton (2004) found no consistent exposure -response gradient based upon the number of maternal or paternal...

2207 Radioactive isotopes

According to larger studies covering in total several hundred women exposed to I131 for thyroid carcinoma or hyperthyroidism before becoming pregnant, the results have revealed no evidence that exposure to radioiodine affects the outcome of subsequent pregnancies and offspring (Bal 2005, Chow 2004, Read 2004, Schlumberger 1996). Several children were observed until adulthood without indications for an increased risk of carcinogenesis or mutagenic insults. The observed increase of miscarriages in those women who were treated within 1 year before the index pregnancy could be related to gonadal irradiation or to insufficient control of the hormonal thyroid status (Schlumberger 1996). Read (2004) found no birth defects among 36 infants fathered by men with an I131 treatment history.

2213 Tobacco and smoking

Nicotine crosses the placenta unimpeded, and causes the fetal heart frequency to increase. Elevated placental levels are noted for the heavy metal cadmium (see Chapter 2.23), and also for the organochlorine pesticide hexachlorbenzene (HCB) and polychlori-nated biphenyls (PCBs). Potential carcinogens - such as benzo(a) pyrene and - were detected in the serum of newborns before the first oral feed (Lackmann 2000, 1999). The respective differences in concentrations among children of active and passive smokers, as well as women from non-smoking households, were statistically significant. The possible carcinogenic action on the children of mothers who smoke during pregnancy has been studied in different ways. The results do not indicate a high risk (Brooks 2004). There arc, however, indications of an association with childhood brain tumors, leukemia, and lymphoma. Some studies assign a relative risk of this of 1.5-2 or beyond (surveyed in Sasco 1999). Other studies (such as Brondum 1999)...

5 Maternal Marijuana

To let users inhale active cannabinoids by heating marijuana to a temperature just below the point of combustion where smoke is produced (37). Vaporizer users may mistakenly believe that, because little or none of the carcinogenic tars and noxious gases found in marijuana smoke are emitted, it is therefore safe for use during pregnancy. Although the use of vaporizers may decrease some of the pulmonary toxicity, there is no evidence that their use is safe during pregnancy.

31 The advantages of breastfeeding versus the risks of maternal medication

The other well-documented advantages of human milk are the infection-protection qualities that protect the breastfed infant from respiratory infections, otitis media, gastrointestinal infections, and even urinary tract and meningeal infections (Hanson 2004). The study of the immunologic properties of human milk has shown that infants who are exclusively breastfed for at least 4 months have a reduced risk of childhood onset diabetes, Crohn's disease, celiac disease, and childhood-onset cancers - especially leukemia. Hundreds of articles testing the allergy protection of human milk have shown a clear advantage in being breastfed for potentially allergic children. There are many advantages to breastfeeding for the mother herself The process facilitates the rapid recovery postpartum, with a reduccd loss of blood and the prompt involution of the uterus to its pre-pregnant state (Labbok 2001). Further breastfeeding prevents post-partal depression (Groer 2005), and reduces the long-term risk...

184 exercise and lactation

Physical activity at any stage of the life cycle is associated with a decreased prevalence of cardiovascular disease, colon cancer, type 2 diabetes, and overweight, and it decreases mortality rates from all causes. Specifically in lactation, regular activity improves cardiovascular fitness, plasma lipid levels, and insulin response 14 . Regular activity also has the potential to benefit psychosocial well-being in lactation, such as improving self-esteem and reducing depression and anxiety. Other potential benefits include promotion of body weight regulation and optimizing bone health. Engagement in regular activity by the mother may also encourage the same in her offspring, promoting a healthy lifestyle and body weight management for the entire family.

Explanation Of Condition134

Breast cancer is most commonly associated with postmenopausal women but is increasingly affecting women of child-bearing age. The classic presentation is with a painless, slow growing and palpable mass. Other symptoms include nipple discharge and breast skin changes. Breast cancer once diagnosed is attributed a 'stage' in order to guide treatment decisions. Stage 0 - non-invasive breast cancer with no invasion of surrounding tissue Stage I - invasive breast cancer in which the tumour measures < 2 cm and there is no lymph node involvement Stage II - the tumour measures at least 2 cm but < 5 cm or cancer has spread to the lymph nodes in the axilla on the same side as the affected breast Stage IIIB - tumour has spread to the breast skin, chest wall or internal mammary lymph nodes includes inflammatory breast cancer

Preconception Issues And Care

Women with a previous history of breast cancer who are contemplating pregnancy should seek advice from their obstetrician, breast surgeon and oncologist. In general, a delay of two years post cancer treatment is recommended to allow for early recurrences to be detected5. Younger women (< 33 years) may be advised to wait three years before conception as they have a higher relapse rate6. Women with a poor prognosis may be advised to avoid further pregnancy. Pregnancy does not appear to affect long-term survival after breast cancer, but women with a poor prognosis are likely to die while they have young children. Women with previous early stage breast cancer and no signs of recurrence have a good prognosis following subsequent pregnancy, with survival rates of 71-90 7. Breast cancer is the most common cancer found in pregnancy and accounts for 3 of all breast cancers7. Pregnancy following breast cancer Pregnancy after treatment for breast cancer appears to be associated with a higher...

Patient Organisations

Gynae C (Gynaecological cancer) Cancer Research UK PO Box 123 Lincoln's Inn Fields London WC2A 3PX www.cancerresearchuk.org CancerHelp UK (aligned to Cancer Research UK) www.cancerhelp.org.uk Breast Cancer Care Marie Curie Cancer Care Macmillan Cancer Support Cancerbackup 3 Bath Place Rivington Street London EC2A 3JR www.cancerbackup.org.uk Breast Cancer Care (2005) Factsheet Breast cancer during pregnancy. Grosser, L. (2004) Breast cancer during pregnancy. British Journal of Midwifery, 12(5) 299-304. McEwan, A. (2002) Cancer in pregnancy. Current Obstetrics and Gynaecology, 12,307-313. Paterson, G. (2004) Cancer in the pregnant woman. British Journal of Midwifery, 12(8) 496-501. RCOG (2004) Guideline No. 12 Pregnancy and Breast Cancer. January. London Royal College of Obstetricians and Gynaecologists.

4121 General aspects of external applications cosmetics hair products sunscreens

Sunscreens have become universal at the urging of dermatologists. The absorption is considered minimal. Para-amino benzoic acid (PABA) is being removed from most preparations because of concern regarding absorption and a possible link to cancer. Current preparations can contain octocrylene 8 w w, octyl methoxycinnamate 7.5 w w, oxyenzone 4 w w, octyl salicylate 5 w w, ethylhexyl P-methoxycinnamate 7.5 w w, 2-ethylhexyl salicylate 3 w w, titanium dioxide 1.64 w w, benzophenone-3, and octocrylene.

Effects of diabetes mellitus on postmenopausal women

Diabetes mellitus (DM) was found to be associated with an increase in uterine size in postmenopausal women.34 In addition, the relative risk of endometrial cancer in diabetic women is 4-fold higher than in nondiabetic women.27,35 The risk of endometrial cancer also increases with the use of unopposed estrogen in non-hysterectomized women36 and is reduced with the use of cyclical or continuous progestins.37-39

4123 Treatments for acne and psoriasis

Systemic therapy with retinoids should not be undertaken during breastfeeding because of the toxic potential and the long halflife. This also applies to external use of coal tar preparations because of their mutagenic and carcinogenic potential. Individual doses do not require any limitation of breastfeeding. Minocycline for less than 2 weeks is probably tolerated. The other medications mentioned are acceptable unless significant absorption must be assumed due to a large area of application and regular use, and or with application under occlusive bandages.

Effect of HRT on cardiovascular risk

This risk is greater in women than in men. Many observational studies have shown that HRT reduces mortality due to coronary heart disease (CHD) by c. 50 however, this has not been confirmed in RCT. Two long-term prospective randomized studies, the HERS63 and the WHI,64 suggested that HRT may actually increase the risk of coronary vascular disease. This was particularly true during the first year after the initiation of hormonal treatment. Therefore, HRT is not currently indicated for the primary or secondary prevention of CHD. However, it is important to note, that, among younger healthy post-menopausal women, aged 50-59 years at baseline, a tendency for reduced CHD was observed during a 7-year period of CEE only treatment.65 In diabetic women specifically, there are, at present, no long-term studies. The many short-term studies infer that HRT may have beneficial effects on glucose home-ostasis, the lipid profile and fibrinolytic activity, all compatible with the prevention of CHD. A...

Congenital Heart Disease

About 3 percent of cases are associated with a disease the mother had during pregnancy, including diabetes, lupus, rubella (German measles), or phenylketonuria (PKU), a disorder involving the enzyme that processes the amino acid phenylalanine. Certain drugs taken during pregnancy, such as lithium, ethanol (alcohol), warfarin (a blood thinner), thalidomide, antimetabo-lites (such as some cancer chemotherapy drugs), and anticonvulsant (seizure) medications are also associated with an increased incidence of congenital heart defects.

Protecting Your Fertility

Many women who are concerned that their cancer treatment may cause infertility are advised to store either embryos (fertilised eggs) or eggs, before their treatment starts. Embryos and unfertilised eggs are usually frozen for up to ten years, although in some situations this can be extended until the woman reaches 55.

Talking About Your Childs Illness

Communicate medical information clearly and honestly in an age-appropriate manner. With an infant or young child, reassurance or a soothing tone of voice can help your child feel more comfortable and relaxed. If your child is older and has verbal skills, use correct medical terms so she can talk about her concerns and be understood by medical professionals. A forthright approach may seem frightening to a parent, but to a child with limited context, the words malignant or cancer are just medical words.

Collection and Storage of Eggs

Some women need to start their cancer treatment straight away and it may not be possible to delay it in order to have the ovarian stimulation. There is a risk with some cancers, such as breast cancer, that the hormones used in ovarian stimulation may also stimulate the cancer to grow. It therefore may not be advisable to have ovarian stimulation. Your doctors will be able to discuss this with you. It may be possible to collect one or two eggs without ovarian stimulation, although this reduces the chances of a successful pregnancy.

Appendices 122 and 123 Other Bacterial and Viral Infections

Rizzo JD, Lichtin AE, Woolf SH, Seidenfeld J, Bennett CL, Cella D, et al. 2002 Use of epoetin in patients with cancer evidence-based clinical practice guidelines of the American Society of Clinical Oncology and the American Society of Hematology. Blood, 100 2303 -2320

4185 Other contaminants

Synthetic musk compounds, such as musk xylol, musk ketone, musk ambrette, and others, are among the nitroaromatics. These substances have a limited acute toxicity, but, like the organochlorine compounds, they seem to accumulate in the fatty tissue and persist in the environment. Current analyses of mothers' milk have indicated a mean of about 0.1 mg kg milk fat for musk xylol. The other compounds have levels two to three times lower Synthetic musk compounds arc added to detergents and cosmctics because of their fragrance, and thus dermal absorption is a likely path for their intake. There are no indications of toxic effects as a result of intake via mothers' milk. The studies to date on genera toxicity and on mutagenic and carcinogenic potential do not permit a conclusive judgment (Liebl 2000, Riinkus 1994). Since 1993, contamination of mother's milk with musk xylol has declined in Germany to about 0.02 mg kg milk fat, following a recommendation that this substance be avoided in...

Psychiatric Disorders

Cancer Research UK accessed 17-06-2007 6. NICE 2006 Guidance on Cancer Services Improving Outcomes for People with Skin Tumours including Melanoma - The Manual. London National Institute for Clinical Excellence 2. www.cancerbackup.org.uk accessed 14-06-2007 5. NICE 2005 Clinical Guideline 27 Referral Guidelines for Suspected Cancer. London National Institute for Health and Clinical Excellence 7. National Cancer Institute www.nci.nih.gov cancertopics pdq page2 accessed 15-06-2007

Natural killer NK cells

These cells are part of the immune system's first line of defence against life-threatening diseases such as cancer. In pregnancy there is an abundance of NK cells in the uterine lining, which work with the fetal trophoblast to help develop the placenta (Hanna et al 2006). However, recent research from around the world has shown that an overabundance of NK cells can be toxic to the trophoblast cells and lead to cell death and early abortion (Quenby & Farquharson 2006). Further studies on the immunology of pregnancy have noted that abnormal function of NK cells during pregnancy may lead to pre-eclampsia (Le Bouteiller & Tabiasco 2006, Sargent et al 2006). The present treatment of choice for women who are tested via a blood sample and show raised levels of NK cells is oral steroid - prednisolone and or administration of intravenous immunoglobulin (IVIG) (Clark

2198 Herbs contraindicated during pregnancy

Alkaloid-containing herbs (Table 2.19.5). Alkaloids are a diverse group of chemical plant constituents that have a wide range of pharmacological impacts on the body. Some alkaloids have been shown to be hepatotoxic and potentially carcinogenic. In some instances these compounds can be very potent, and they Although there is a long history of safe use during pregnancy, there are very few studies (Gallo 2000, Mengs 1991) showing its safety. Early animal studies have failed to demonstrate evidence of mutagenicity or carcinogenicity after 4 weeks of ingestion of the expressed use of Echinacea at doses that far exceed normal human consumption. A prospective study of 206 pregnant women found no increased risk for fetal malformations when Echinacea was ingested during pregnancy, even during the first trimester (Gallo 2000). The authors of these studies suggest that gestational use of Echinacea during organogenesis is not associated with a detectable increased risk of malformations, but these...

Single nodule of the thyroid gland

Nodular thyroid disease is clinically detectable in 10 of pregnant women. In most cases, it is discovered during the first routine clinical examination or detected by the patient herself. The chances for a single or solitary thyroid nodule to be malignant are between 5 and 10 , depending on risk factors such as previous radiation therapy to the upper body, rapid growth of a painless nodule, patient age, and family history of thyroid cancer. Papillary carcinoma accounts for almost 75-80 of malignant tumors, and follicular neoplasm for 15-20 a few percent are represented by medullary thyroid carcinoma. There is a paucity of information in the literature regarding the management and timing of the work-up in the presence of thyroid nodularity.40,41 It is generally agreed that elective surgery should be avoided in the first trimester and after 24 weeks' gestation because of the potential risks of spontaneous abortion and premature delivery, respectively. In a retrospective study, a...

The incidence of GDM in China

Descriptions of DM can be seen in ancient literatures from China, India, Egypt, Greece, and Rome, although it is not necessarily the same as the 'DM' we are talking about today. In the last two decades, the Chinese economy has developed rapidly, and the disease profile of Chinese people has changed greatly because of the new way of life. Diseases due to malnutrition and infection have been greatly reduced, while cancer and chronic diseases such as cardiovascular diseases and DM are now major health problems. According to data from 1996,the incidence of DM and impaired glucose tolerance in the Chinese population above 20 years of age were 3.2 and 4.8 , respectively, and is almost 10 in large cities such as Beijing and Shanghai. The incidence of DM increased dramatically from early 1980s to the mid 1990s, and the number of DM patients increased four to five times during that period, reaching 30-40 million. The total number of Chinese people with abnormal blood glucose is now about 100...

Treatment Of Miscarriage A historical perspective

To prevent miscarriage and other pregnancy problems such as toxaemia, premature delivery and intrauterine fetal death, about six million pregnant women were exposed to diethylstil-boestrol (DES) from 1940 until 1971. Fortunately, some of the users were included in controlled studies that showed that DES was of no value to prevent miscarriage, or in preventing any of the other conditions for which it was given. On the contrary, DES carried an increased risk of the patients' developing breast cancer, and for the offspring a higher risk of genitourinary malformations, psychiatric disorders and vaginal or cervical clear cell adeno-

The Calamity Of Consensus

Preface of Dreams, Obama admits that had he known his mother would die from cancer in 1995, his book would have been about her, a celebration of the one who was the single constant in my life her joy, her capacity for wonder I know that she was the kindest, most generous spirit I have ever known, and that what is best in me I owe to her.

2825 Aldosterone antagonists

In contrast to the saluretics discusscd above, spironolactone leads to potassium retention. For this reason, a typical side effcct for spironolactone is hyperkalemia. In animal experiments, carcinogenic properties have been observed. There are, as yet, no indications of any clinical relevance of this finding for human beings. Among 31 newborns exposed in the first trimester, there were no signs of any specific birth defects (Rosa, cited in Briggs 2005). A case report describes a woman who took spironolactone during a

Ovarian Tissue Freezing

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The early years

In the 1980s, the Joslin Clinic formally surveyed the mothers known to have been treated with these hormones. No cases of gynecological cancer in their daughters or genitourinary abnormalities in their sons were reported other than cryptorchidism, which is common and may not have been related. However, anecdotal accounts of daughters having difficulty with habitual abortion and incompetent cervices have been received.

Smoking

It has long been accepted that a woman who smokes during pregnancy risks damaging her unborn baby (Himmerlberger et al 1978). Smoking may reduce birthweight, affect mental development, increase the risk of cancer to both mother and baby and increase the rate of spontaneous abortion (Chatenoud et al 1998). The incidence of low birthweight babies is higher among mothers who smoke because smoking reduces oxygen and food supply to the fetus, slowing down its growth rate and possibly causing damage to its DNA. The effects can remain with the baby for the rest of its life, as reduced resistance to infection, impaired intelligence, shorter attention span, hyperactive behaviour and an increased susceptibility to disorders of the nervous system, respiratory system, bladder, kidneys and skin. The effects of preconceptual smoking in the father are less clear. However, if both partners smoke, there is a greater risk of having a low birthweight baby than if the mother alone smokes, and the risk of...

Thrush

Candida infections can be very serious in premature infants and in children with cancer, HIV infection, or any weakness of the immune system. In these children, candida infection may spread through the blood to attack the lungs and other organs. This is called systemic candidiasis. (For more information, see Chapter 30, Childhood Infections.)

Hepatitis B Screen

Hepatitis B infection is usually asymptomatic. For the mother, it may affect the liver function and will require long term follow up for any deterioration or cancer change in the liver. This infection can be transmitted to the baby during the birth process. An immunization regime can be started for your baby to reduce this chance of transmission and help prevent your baby from being affected. This minimizes the chance of them developing liver dysfunction and cancer in later years.

Fetal Fibronectin

Adult fibronectins are ubiquitous glycoproteins that are found in plasma and the extracellular matrix. They play major roles in many fundamental biologic processes including cell adhesion and migration, maintenance of normal cell physiology, cell differentiation, embryogenesis, and tumor genesis. fFN, also known as oncofetal fibronectin, is a unique glycosylated form expressed only in fetal tissue and cancer lines and is recognized by the FDC-6 murine antibody that recognizes the IIICS domain (17). The fibronectin molecule consists of repeating modules known as type I-III modules. The IIICS domain resides in a type III module adjacent to the carboxyl terminus. fFN, as shown by immunohistochemical studies, localizes to the uterine-placental and decidual-chori-onic extracellular matrices. In cell culture, native fFN shows adhesive properties suggesting that fFN may be trophoblast glue that results in physiologic cellular adhesion. It is believed that fFN is released into the cervix and...

297 Vitamin K

Neonatal hemostasis has not been reported convincingly to date (Anai 1993). Prenatal menadione exposure has been associated with neonatal hyperbilirubinemia. Former concerns that parenteral vitamin K application in neonates may increase the risk of childhood cancer have not been confirmed in the literature, and are generally refuted (Roman 2002).

Hepatitis B Vaccine

Hepatitis B is a virus that infects the liver people with the illness can develop serious problems such as cirrhosis (liver disease) or liver cancer. People can also become chronic carriers of the disease, infecting others. The vaccination gives children a long-term immunity to hepatitis B, reducing the increased risk of developing liver cancer and chronic liver disease that follows infection with the hepatitis B virus.

Infertility

The mother whose baby was conceived through the application of reproductive technology may have concerns about the effect of the drugs that she was given in order to maintain her pregnancy. Such worries are not entirely unfounded in view of the devastating effects of such drugs as diethylstilboestrol, which was used to prevent recurrent miscarriage and led to cases of genital cancer in babies exposed in utero, and thalidomide, which was used to treat nausea and vomiting in pregnancy and was held responsible for many severe limb defects. We await with trepidation any sequelae of assisted conception in either the mother or the fetus.

Vegetables

Along with fruit, vegetables are the next level up the Pyramid, meaning they too should be eaten in abundance. They provide rich sources of vitamins and minerals, as well as fiber and carbohydrates. People who eat lots of fruits and vegetables appear to be healthier in many ways, including having lower risks of several kinds of cancer later in life. Eating a variety of fruits and vegetables ensures a good mix of nutrients. Within vegetables, for instance, your child should eat dark leafy greens, such as spinach and collard greens deep yellow vegetables, such as carrots and sweet potatoes starchy vegetables, such as peas, potatoes, and corn and dried peas or beans. If vegetables are not on your child's short list of things he'll eat (except for French fries), check Vegetable Strategies later in this chapter for some serving suggestions.

The national

A further significant (and somewhat unfortunate) development was the adoption of X-ray techniques in order to diagnose pregnancy and determine gestational age. It is difficult to determine how widely X-rays were used for routine diagnosis certainly in some areas in the 1920s and 1930s all pregnant women were referred for radiology. Although concerns were expressed about its safety, the practice continued during the 1940s and 1950s at Queen Charlotte's Hospital the number of X-ray examinations as a proportion of patients delivered rose from 28.5 per cent in 1946 to 66.7 per cent in 1954.46In 1956, however, Alice Stewart published a study which implicated antenatal X-rays in the development of childhood cancer and this led to an immediate and rapid reduction in their use for diagnostic purposes. In any case, by the late 1950s a more sophisticated technique was being developed which would enable clinicians to monitor intra-uterine life. Ian Donald, Professor of Midwifery at Glasgow, drew...

Ann Reed Mangels

Summary A vegetarian diet, defined as an eating style that avoids meat, fish, and poultry, can be healthful and nutritionally adequate for a pregnant woman. Some vegetarians, called vegans, avoid dairy products and eggs as well as meat, fish, and poultry. Vegan diets can also be healthful and nutritionally adequate for pregnancy. Vegetarian diets can provide numerous long-term health benefits including a lower risk of cardiovascular disease, some forms of cancer, and hypertension. Key nutrients for vegetarian pregnancy include protein, iron, zinc, calcium, vitamin D, vitamin B12, iodine, and omega-3 fatty acids. Vegetarian women should also be counseled to follow standard weight gain recommendations. A vegetarian or vegan diet can meet requirements for all of these nutrients although in some instances, fortified foods or supplements can be especially useful in meeting recommendations. The nutrient content of supplements targeted to pregnant vegetarians should be evaluated to make sure...

Arsenic

Occupational exposure to arsenic occurs in mining and smelting and also in the pesticide, pharmaceutical, electronics, and chemical industries. Populations without occupational exposure may ingest arsenic via contaminated seafood and drinking water (35). Acute poisoning usually occurs after the consumption of tainted food or drink but has occurred after an industrial exposure (36). Symptoms are related to severe gastrointestinal inflammation and cardiogenic shock (37). Chronic exposure can result in a myriad of symptoms affecting multiple organ systems. It is known to be a lethal toxicant as well as a neurotoxicant and human carcinogen. Studies on the effects of arsenic on pregnant women and their developing offspring are limited, however.

Asbestos

Asbestos is a term used to describe six different fibrous mineral silicates with various biological effects (43). Demand for asbestos has decreased significantly in the United States, but worldwide production has not decreased because of less stringent regulation of its use and production in other parts of the world. Persons most at risk for developing asbestos-related disease are involved in industries in which the processed fiber is handled and maintained. Chronic exposure to asbestos leads to asbestosis, which manifests initially as dyspnea and a nonproductive cough. The disease may progress with an increase in the severity of symptoms and the development of a productive cough (44). Cor pulmonae may develop in severe cases and is a frequent cause of death from asbestosis. Asbestos is also a carcinogen responsible for adenocarcinoma and mesothelioma of the lung the former is the most common. Evidence also has been found that asbestos is associated with gastrointestinal cancers. In...

Cadmium

Like many heavy metals, cadmium has toxic effects in humans. Primary adverse effects are due to pulmonary and renal toxicity. There is evidence that cadmium may be a carcinogen, although this evidence is considerably weaker than that for other metals. Cadmium is present in the environment and may present a danger by occupational exposure. It is used in nickel-cadmium batteries, electroplating, smelting, and mining. Shellfish are a dietary source of cadmium and may contain from 100 to 1,000 mg per kilogram of this metal (65). Estimated daily intake in the United States from all sources is 10 to 40 mg per day. Cigarette smoke is another source of exposure, and it is estimated that smoking one or two packs per day doubles daily intake of cadmium (65).

Dioxin

Well-conducted studies of human toxicities from dioxins have been conducted following accidental exposures involving large populations. The most notable industrial accident occurred when an explosion in Seveso, Italy, in 1976 contaminated more than 700 acres and affected more than 25,000 inhabitants. In the exposed population, an increased incidence of chloracne, polyneuropathy, and hepatomegaly occurred, and on long-term follow-up, cancer rates in the exposed population were increased (92). TCDD is a potent carcinogen in animal models (93), thought to exert its effect by tumor promotion rather than by mutagenesis.

4611 Diuretics

Spironolactone is a potassium-saving diuretic. As soon as it is absorbed it is changed into the active metabolite, canrenone, which is up to 98 bound to plasma protein. In animal studies, canrenone is carcinogenic in very high doses no such effect has been observed in human beings. The M P ratio lies between 0.5 and 0.7. With ongoing treatment of 100 mg daily, a maximum milk concentration of 0.1 mg 1 was found. For the infant, this would mean a daily intake of 0.016 mg kg - 1.2 of the maternal weight-related dosage (Phelps 1977).

Antineoplastic Drugs

Many antineoplastic drugs have been reported to be mutagenic, carcinogenic, and teratogenic in both animal and human studies. Antineoplastic drugs include multiple classes of drugs, including alkylating agents, antibiotics, hormones, antimetabolites, and antimitotic agents, each with different mechanisms of action, but most with documented reproductive toxic effects. Antineoplastic agents may have adverse effects on both male and female fertility (117). In men, oligospermia and azoospermia have been noted in cancer patients treated with a variety of agents. These changes are often reversible with cessation of therapy. Freckman and colleagues (118) discovered a loss of ovarian primordial follicles along with amenorrhea in women treated with chlorambucil for breast cancer. The alkylating agents and vinca alkaloids were the types of agents associated with the greatest effect on fertility (117).

Vitamin K

Administering vitamin K to the newborn is mentioned specifically in this chapter because women frequently ask me whether it is necessary or not. Much has been published about the possible risks. Vitamin K is necessary for the production of red blood clotting factors, and vitamin K prophylaxis was first introduced in the 1950s. There was little debate about the practice until the 1980s, when evidence was gathered to show that without vitamin K the baby has a risk of dying or of being permanently brain damaged by vitamin K deficiency. Then in May 1998 the Daily Mail reported that vitamin K injections were linked to child cancers. The Department of Health considered the matter and decided that the risk of haemor-rhagic disease was certain but that the risk of cancer was not. It therefore concluded that oral vitamin K should be given to all newborn babies. It is likely this trend will continue until more research is available however, hospitals have varying policies. Some babies...

Hepatitis Viral

How Long Symptoms Last Almost all previously healthy children with hepatitis A infection will recover fully within a few weeks or months. If symptoms develop with hepatitis B infection, they usually subside within six to eight weeks, but chronic infection with the virus can occur and can lead to liver damage and liver cancer. Chronic infection with the virus is particularly common (70 to 90 percent) in infants who acquire the infection from their mothers at birth and are not treated. Children with hepatitis C usually have no symptoms but are at risk for future liver damage due to chronic infection with the virus. Complications Although children with HAV infection almost always recover fully without specific treatment, children with chronic HBV and HCV infections are at increased risk for the development of liver damage (cirrhosis), liver failure, and liver cancer as they get older. It is important that these individuals be followed medically for signs of these complications. New...

Sterilization Media

Chemical sterilants are widely used in operating rooms, pharmacies, and laboratories. They include a number of suspected mutagens and carcinogens, including formaldehyde, propylene oxide, and glutaraldehyde, but little is known of their reproductive toxic effects. Ethylene oxide, which is used to clean plastic medical equipment, is a known mutagen and carcinogen. Occupational exposure has been linked to an increased risk of spontaneous abortions and malformed offspring (138). It is one of the few chemicals, along with dibromochloropropane and lead, that have specific OSHA standards based on reproductive effects (139).

A future scenario

Upon her weekly log in to her personal health record (PHR) she notices that the 'health maintenance' label, in the lower corner of the screen, is flashing. BA clicks on it and sees a message that 2 years have passed since her last mammogram and the system recommends her to get a mammogram. BA thinks she has recently had one and is not sure she needs it. She clicks on the message and it changes to a view of all of her mammograms over the past 5 years. It appears the system is correct she does indeed need a mammogram. By clicking on the message for the new mammogram she is able to send an electronic message to the radiology department at her local hospital and confirm an appointment for her mammo-gram next week. Using her PHRs built-in Google search engine, with its pre-defined medical search algorithm, BA 'Googles' pre-appraised high quality information regarding new methods of diagnosing breast cancer. She is particularly impressed with a short video that...

Medical

Goal 4 Improve health care by creating local, regional, national and international registries on diseases To expand capacity for research by building registries to be used by local hospitals that will be able to share and collect anonymous data from other health institutions for quality of care measurement, by adopting new technologies, using a network to monitor patients (such as diabetics, cancer, AIDS, etc.) and bring research advances and improvements faster into local medical practice.

Microwaves

The eye and developing fetus are the structures most vulnerable to the thermal effects of microwave radiation because they have the least capacity to dissipate heat (173). There are no known mutagenic or carcinogenic effects of this form of electromagnetic energy. Properly manufactured and functioning microwave equipment does not appear to present a hazard to pregnant women.

Toxoplasmosis

Symptoms Symptoms vary according to age and response of the immune system. With congenital toxoplasmosis, when a pregnant woman is infected, there is a 10 to 90 percent chance she will pass the infection on to her child, depending on the time of infection. Babies whose mothers were infected in the first trimester tend to have the worst symptoms. Although many children born with the infection have no symptoms early in infancy, others are born prematurely, have liver or bleeding problems, or may have severe birth defects. With infection in an otherwise healthy child, the child may have no symptoms or a few swollen lymph nodes (glands), usually in the neck. There also may be a general ill feeling, fever, sore throat, headache, or rash. The symptoms may resemble those of mononucleosis (see Mononucleosis in this chapter). With infection in a child with a weakened immune system because of AIDS, cancer, or other chronic disease, the infection may involve the brain and nervous system, causing...

4102 Antineoplastics

Breast cancers Capecitabine Colon cancer Cyclophosphamide Breast cancer Breast, lung, and bladder cancer Testicular and lung cancers, bone marrow transplant Actinic keratosis, breast cancer, colorectal cancer, condylomata acuminata Metastatic breast cancer, non-small cell lung cancer, pancreatic cancer Breast cancer particularly breast cancer 2-6 weeks Stomach, breast, pancreas Cancers and multiple sclerosis Kaposi's sarcoma, metastatic breast cancer Tamoxifen Breast cancer Trastuzumab Metastatic breast cancer Vinblastine Breast cancer, Kaposi's sarcoma, Vincristine Breast cancer, Kaposi's sarcoma, Vinorelbine Advanced breast cancer, non-small cell lung cancer, non-Hodgkin's lymphoma, Hodgkin's disease, ovarian carcinoma Ben-Baruch G. Menczer , Goshen R et al. Cisplatin excretion in human milk. J Natl Cancer Inst 1992 84 451-2. Egan PC, Costanza ME. Dodion P et al. Doxorubicin and cisplatin excretion into human milk. Cancer Treat Rep 1985 69 1387-9.

Celiac Disease

Malnutrition can be a severe complication of celiac disease. Particularly if untreated for years, the disease also puts a person at increased risk for lymphoma and adenocarcinoma (two forms of cancer that can develop in the intestine), osteoporosis (in which the bones become brittle and weak), and short stature.

Lymphoedema

Lymphoedema can occur in the arm after breast cancer treatment to the armpit, or in the leg if cancer or its treatment affects nodes in the groin area or the pelvis. The affected arm or leg may become swollen, stiff, uncomfortable and awkward to move, making daily activities, such as dressing or washing, difficult. Lymphoedema can develop weeks, months or even years after cancer treatment and it is difficult to know who will be affected or how bad the lym-phoedema will be.

Pesticides

Pesticides contaminate the environment with chemical agents, many of which may have long-term effects on health and reproduction. The EPA has classified fewer than 0.1 of the active ingredients in pesticides as toxic about 25 are considered mutagenic and carcinogenic (263). Exposure to these agents is inherent not only in agricultural jobs but also for those who work in forestry and as florists, fruit handlers, or fisherman. Once pesticides that contain organic chlorine enter the food chain, they are almost impossible to eliminate and persist in soils, lake sediments, and even fish. Toxicity may result from acute high-concentration or chronic occupational exposures.

Case Study 162

A woman in her mid-20s had just given birth for the first time. She had recently married and had never lived away from her parents before. The pregnancy had been perfect in every way, giving her wonderful energy and a feeling of absolute joy she had never experienced before. However, 3 weeks after the birth she started to worry about the health of the baby. She was reassured that everything was perfect, but she found it impossible not to imagine something was wrong. A week after this she started to imagine she had breast cancer and stopped breastfeeding and also started to reject the child, passing all mothering responsibilities to her husband. As soon as she was given a clear bill of health for breast cancer, she convinced herself she had ovarian cancer. She was not depressed but rather obsessed, spending most of the day reading medical journals and researching everything she could on cancer. She was diagnosed as having a causative factor in the Earth Element (Stomach and Spleen) and...

Radiation

Ionizing radiation has been studied more extensively than any other environmental hazard (173). X-rays and gamma-rays are forms of ionizing radiation composed of short-wavelength electromagnetic waves that are highly penetrating, capable of producing ionization within living tissue that breaks chemical bonds, and can cause subsequent damage (287). Exposures to ionizing radiation can produce cell death, mutation, cancer, and developmental defects in a dose-related manner (173). Microwaves, shortwave, powerline transmissions, radiowaves, and diathermy are composed of a longer wave, low-energy form of radiation that does not possess the ability to produce ionization and should not be considered in the following discussion. The potential reproductive effects of these agents are considered elsewhere in this chapter. The evidence for potential teratogenic effects of radiation in humans comes principally from two sources. The first is from women treated with pelvic radiation for indications...

4165 Nicotine

As well as nicotine and cotinine, other toxic and carcinogenic chemicals and cadmium (Radisch 1987) also appear in the milk of smokers (Radisch 1987). Among 50 smoking mothers, a lower iodine content of the milk was found compared to a control group of 90 non-smokers. According to the authors, this could cause iodine deficiency in the infants requiring supplementation (Laurbcrg 2004).

Neoplasia

18.1 Breast Cancer breast a 5441 accessed 16-06-2007 4. Williams SF and Schilsky RL 2000 Neoplastic disorders - breast cancer in Barron WM and Lindheimer MD (Eds) Medical Disorders During Pregnancy, 3rd Ed. London Mosby Elsevier 400-401 5. Burstein H and Winer E 2000 Primary care for survivors of breast cancer. New England Journal of Medicine, 343 1086-1094 7. RCOG 2004 Guideline No.12 - Pregnancy and Breast Cancer. London Royal College of Obstetricians and Gynaecologists 8. Velentgas P, Daling JR, Malone KE, et al. 1999 Pregnancy after breast carcinoma outcomes and influence on mortality. Cancer, 85 2424-2432 9. Guinee VF, Olsson H, Moller T, et al. 1994 Effect of pregnancy on prognosis for young women with breast cancer. The Lancet, 343(8913) 1587-1589 10. Petrek JA, Dukoff R and Rogatko A 1991 Prognosis of pregnancy-associated breast cancer. Cancer, 67(4) 869-872 13. National Cancer Institute www.cancer.gov cancertopics pdq accessed 15-06-2007 14. Barthelmes L, Davidson LA, Gaffney...

Intrauterine devices

The levonorgestrel-releasing IUD has been extensively used during the past decade and provides extremely effective contraception with a 5-year cumulative failure rate of 0.71 100 women.61 The IUD provides sustained low-dose (20 mg daily) release of levonorgestrel, which inhibits pregnancy by thickening the cervical mucus,62 and by inhibiting motility and function of sperm,63 rather than by inhibiting ovulation. The high levels of levonorgestrel released into the endometrium decreases menstrual bleeding and atrophies the uterine lining.64,65 This effect would be a desirable benefit in obese, Type 2 diabetic women, who tend to be parous, older and at higher risk of endometrial cancer.

1abel s c arefully

Polychlorinated biphenyls ( PCBs) are mixtures of chemicals that are no longer used in manufacturing of electrical equipment but can still be released into the environment from h azardous waste sites or leaks. They do not break down readily. PCBs have been linked to reproductive problems and impaired development in the womb as well as to cancer.

2622 Griseofulvin

Griseofulvin is an organically derived antifungal agent it is used as an oral preparation for the treatment of dermatophytosis of skin, hair and nails. Because it is deposited in keratine, it is suitable for the therapy of nail mycoses. In animal experiments it has a teratogenic effect and, moreover, a carcinogenic effect in high doses.