Clinical Abstracts from Overseas

By Stanton R. Mehr
Published: Friday, Jun 18, 2010
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UNITED KINGDOM

The Pill’s Anti-Ovarian Cancer Effect Lasts for Decades


Do oral contraceptives’ prophylactic benefits outweigh their risks? The controversy continues to rage on, with new evidence revealing that women who stop taking the pill after long-term use continue to experience some preventive effects against ovarian cancer, for perhaps much longer than anticipated.

Researchers from the United Kingdom conducted a meta-analysis of 45 studies from around the world, which comprised more than 23,000 women with ovarian cancer and 87,000 controls. Slightly more than one-third of all of the study participants had been taking oral contraceptives (of varying estrogen–progestin doses and potencies). The mean duration of oral contraceptive use was five years.

The researchers found that if women did not take oral contraception, 1.2% would be expected to develop ovarian cancer. Of those using the pill, the incidence dropped by a third, to 0.8%. They also found that for women who were using oral contraceptives for 15 years and then stopped, their risk of ovarian cancer seemed to be 15% less than those who never used the pill even 30 years later.

Based on these results, it is possible that use of oral contraception may have prevented approximately 200,000 ovarian carcinomas and perhaps 100,000 deaths globally.


Collaborative Group on Epidemiological Studies of Ovarian Cancer: Ovarian cancer and oral contraceptives: Collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. The Lancet 2008;371:303-314.





THE NETHERLANDS

Catheter-Related Infection Prevention Improves With Specialized Rinse


Patients with hematologic malignancies who require central venous catheters tend to experience fibrin build-up at the point of insertion. This increases the risk of staphylococcus infection, particularly of the coagulase-negative variety. Physicians from Leiden University, the Netherlands studied whether the use of a urokinase-containing rinse, which breaks up the fibrin, would reduce the risk of infection associated with the in-dwelling catheter.

In this controlled double-blind study, patients were randomly assigned to receive the urokinase or saline rinse three times each week. The dose of urokinase used in the rinse was 5 mL in each 5,000 U/mL.

The investigators found that 42% of the patients given the placebo rinse had a positive staph culture, compared with 26% of those given the urokinase rinse (relative risk, 0.61). The actual infection rates were 14.1% and 1.2%, respectively, meaning that patients using the rinse had a 91% lower relative risk of coagulase-negative staph infection associated with the catheter use compared with those receiving placebo. This translated into a far lower rate of staphylococcal-associated effects, and also thrombosis associated with the catheter (likely because of the thrombolytic activity of the urokinase). They did not note any serious bleeding related to the use of the urokinase rinse.

These results indicate that while not perhaps fully preventing the presence of staphylococcus, this intervention greatly reduces the likelihood of infection and its associated complications in patients with hematologic cancer.

  Relative risk of staphylococcal presence in

  culture and infection


  Presence

of Staph in

Culture
Staph

Infection
Relative

Risk With

Urokinase
  Urokinase  rinse

  group
26% 1.2% 61%
  Placebo group 42%
  1. 14.1%
9%



Van Rooden C, Schippers ER, Guiot HFL, et al: Prevention of coagulase-negative staphylococcal central venous catheter–related infection using urokinase rinses: A randomized, double-blind controlled trial in patients with hematologic malignancies. J Clin Oncol 2008;26:428-433.






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