plates to ensure that the whole breast is viewed. Two X-rays of each breast are taken from different angles, top to bottom and side to side. Mammogra-
One out of seven women will develop breast cancer in her lifetime. Up until now, a mammogram has been the best hope for early detection.
But mammograms can be uncomfortable and difficult to read. Now, new technology may change all that.
For most women, the prospect of getting a mammogram is scary. "I think for many radiologists, the prospect of interpreting mammography is a very scary thing," said Elizabeth Rafferty, a radiologist at Massachusetts General Hospital. That's because 50-percent of women have dense breast tissue and on a mammogram, that density looks similar to cancer. "It's really like a
'Where's Waldo.' I'm trying to find the thing I'm interested in, but it looks like everything else in the sea of normal structures," Rafferty said. But a new technology called tomosynthesis is helping radiologists pinpoint cancer as small as two millimeters. ToDigital tomosynthesis is a new phy is a good imaging technique, but it has some limitamosynthesis builds on digital mammography by taking multikind of breast imaging that is anticipated to replace regular tions. It is uncomfortable for women, making some relucple images. An x - r a y t u b e mammography because it tant to get the test regularly. It makes breast cancers easier to also causes overlapping of the moves in an arch find in dense breast tissue, and a r o u n d t h e makes the procedure much breast tissue, which can hide a cancer. Mammography also breast at different angles. A more comfortable. The technique is currently being recomputer then viewed by the FDA and should combines the information into a 3-D image.
"The radiologists can look at it like pages of a book, looking at one area of the breast in isolation," Rafferty said. Traditional mammograms only take two angles of the breast. Another bonus -- tomosynthesis uses less compression than traditional mammograms be commercialized within the year. In digital tomosynthesis, the breast is positioned the same way as with a conventional mammogram, but only a little pressure is applied -- just enough to keep the breast in a stable position during the procedure. Breast cancer is denser than most healthy nearby breast tissue, and will appear on the image as irregular white areas. only provides a limited number of views. Although it is not a substitute for regular tests by your doctor, women can perform a basic breast self-exam at home. In fact, more than 90 percent of all breast lumps are found by the women themselves. Breast tissue is shaped like a comma with the tail curving up toward the armpit, and normally has a lumpy feel. Bring to the attention of your doctor any changes in your breasts that and that means less pain for the patient. The cost of the test is
With conventional mammography, the breast is pulled away last over a full month's cycle, or seem to get worse or more expected to be about the same as a traditional mammogram. from the body, compressed, and held between two glass obvious over time.
Emily Blackwell was born in Bristol, England in 1826. Her family moved to New York City in 1832, and then, after incurring financial losses in the Panic of 1837, the Blackwells moved to Cincinnati, Ohio. Emily applied for admission to study medicine at the Geneva Medical College in Geneva, New York, from which her older sister, Elizabeth Blackwell, had graduated. Her application was denied, however. The school was not ready to accept more women students just yet, although Elizabeth Blackwell, whose admission was treated as a practical joke, graduated at the top at her class. It took six years of trying before she was finally accepted in 1852 by Rush Medical College in Chicago. Although she successfully completed the first year of her medical school, Rush Medical College refused to accept her for the second year in response to pressure applied by the Illinois physicians.
Emily then completed her medical school training in 1854 at Case Western Reserve University in Cleveland, Ohio. After graduating with the highest honors, she went to Europe for two years to do postgraduate work in England, France and Germany. In 1856, Drs. Emily Blackwell and Marie Zakrzewska joined Dr. Elizabeth Blackwell in New York City and together they opened The New York Infirmary for Indigent
Women and Children, at 64 Bleecker Street. This was the first American hospital for women and staffed entirely by women. Elizabeth was a professor of hygiene, while Emily taught obstetrics and women's diseases. Within two years, she was solely in charge of the clinic after her sister went to Europe for a year and Dr. Zakrzewska moved to Boston. In 1868, Elizabeth and Emily opened the Women's Medical College of the New York Infirmary and Emily accepted additional duties of teaching and educational administration. Despite many difficulties, her establishment continued to expand and by the 1870's she moved it into a converted mansion, where over seven thousand patients were treated annually. The medical college also expanded from a two year program to three and then to four years. This was ahead of many male medical schools which, at the time, were still offering two year medical training. Her medical college trained more than 350 physicians during its thirty-one year existence. It was closed in 1899 when Cornell University started admitting women students to their medical program. The infirmary still exists today as Beth Israel Medical Center. Dr. Emily Blackwell retired at the turn of the century and spent the next ten years at her summer home in Maine. She died in 1910, a few months after Elizabeth's death in England.
V OLUME 5, I SSUE 4 A PRIL 2009

P AGE 2 V OLUME 5, I SSUE 4
Lack of access to adequate women's health care puts rural women in the US at a greatly increased risk of poor health outcomes compared with women in urban areas. The physician shortage in rural areas, limited resources at small community hospitals, and patient factors such as lack of insurance or the need to travel long distances to receive care all contribute to major disparities that rural women face, according to a Committee Opinion released today by The American College of Obstetricians and Gynecologists (ACOG). "Rural communities are home to 17% of all females 15 and older in the US, and 18% of all US births take place there," said Alan G. Waxman, MD, chair of ACOG's Committee on Health Care for Underserved Women. "Unfortunately, nearly one-third of rural women live in counties with no ob-gyn at all. Location is a serious health disadvantage for these women." Rural women are more likely to have a cesarean delivery, low-birth-weight infant, and neonatal and postneonatal mortality and are less likely to be offered a vaginal birth after cesarean
(VBAC). Teenagers in the rural South have the highest adolescent birth rate in the country. Racial and ethnic disparities in health care may also be amplified in rural settings. In rural hospitals, black women on Medicaid have been shown to be at greater risk of experiencing potentially avoidable maternity complications than white women on Medicaid. "When compared with their urban counterparts, US rural women experience higher rates of cervical cancer, and they receive fewer preventive screenings such as mammograms, Pap tests, and colorectal screening. They are also less likely to have received at least one family planning service in the past year and have an increased risk of receiving inadequate, late, or no prenatal care," said Eliza Buyers, MD, a committee member who helped develop the document.
"Without enough health care facilities and clinicians to provide basic women's health care, these women are at a higher risk of developing problems that could be prevented. "Their reproductive health care is also in jeopardy," Dr. Buyers continued. "Many of the leastpopulated communities do not have publicly funded family planning clinics, severely limiting a woman's contraceptive options." Attracting physicians to rural, sometimes remote, areas is a challenge for local communities. Numerous hospitals in rural and sparsely populated counties have closed their obstetric units due to low volume of deliveries, financial vulnerability from a high proportion of Medicaid patients, medical liability concerns, or difficulty finding staff, including ob-gyns, anesthesiologists, and family physicians, for the obstetric units. Some states, university medical centers, and health agencies are making efforts to improve services to rural women. Oregon offers financial incentives such as an income tax credit and medical liability insurance assistance for obstetricians that practice in rural areas.
Pregnant women and infants in Wyoming-a state with few pediatric specialists and tertiary care centers-can apply Medicaid benefits to out-of-state providers. The ob-gyn department at the University of Texas Medical Branch in Galveston runs a program that services geographically underserved women at 37 off-site clinics and provides transportation and electronic medical records to uphold continuity of care. "It's encouraging to see the positive changes that are slowly happening, but we need more efforts like these in rural communities everywhere. Clearly, we have a lot more ground to cover," Dr. Waxman added. The Committee Opinion suggests ways in which ob-gyns can help increase access to women's health services in nonurban areas:

Collaborate with state maternal-child and rural health agencies to identify health needs of rural women and barriers to care. Join a task force or advisory committee focused on improving the health of rural women

Reinvigorate the implementation of regionalized perinatal care in underserved, rural areas. Share network resources and clinical expertise

Encourage and participate in efforts to utilize effective telemedicine technologies to expand and improve services for rural women

Advocate for comprehensive medical liability reform to facilitate the practice of providers in rural areas

Conduct further research to understand acceptable conditions for performance of VBAC and study the effect of VBAC delivery policies on access to care for rural women
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Advocate for increased access to contraceptive methods and emergency contraception

Advocate for availability of safe, legal, and accessible abortion services
"Ob-gyns have the ability to help improve health care for rural women," Dr. Waxman said. "ACOG encourages ob-gyns to get involved in the process because every woman deserves to be cared for, no matter where she lives."
Committee Opinion #429 "Health Disparities for Rural Women" is published in the March 2009 edition of Obstetrics & Gynecology.
The American College of Obstetricians and Gynecologists is the national medical organization representing over 53,000 members who provide health care for women.

W OMEN ’ S H EALTH N EWS P AGE 3
ScienceDaily (Mar. 25, 2009) — Researchers at the VU University Medical
Center, Amsterdam and the University of
Amsterdam, The Netherlands discovered that the unfolded protein response contributes to nerve cell death in Alzheimer's
Disease. This report can be found in the
April 2009 issue of
The American Journal of Pathology . Alzheimer's disease is an incurable, degenerative, terminal form of dementia, thought to be caused in part by tangles in Alzheimer's disease patients.
They found that markers of the unfolded protein response were expressed in areas of tau accumulation in patients with Alzheimer's disease. These unfolded protein response-related proteins were expressed early, in pre-tangle neurons, but were absent in tangle neurons. This report sugthe presence of gests that "unfolded protein response acti-
"tangles" of misfolded vation occurs at an early stage of neurofiproteins. The unfolded protein response protects cells from the toxic effects of accubrillary degeneration and that the prolonged activation of the [unfolded protein response] is involved in both tau phosphorylation and neurodegeration in mulated misfolded [Alzheimer's Disease] pathogenesis. Fuproteins; however, ture studies will address the therapeutic prolonged activation of the unfolded protein response, such as in Alzheimer's disease, may lead to cell death. Hoozemans et al hypothesized that the unfolded protein response contributed to neurodegeneration in Alzheimer's disease partially though its effects on the accumulation of hyperphosphorylated tau, a major component of opportunities of this pathway for the treatment of [Alzheimer's Disease] and other tauopathies."
[Feb 20, 2009] The Rockefeller Foundation, the Vodafone Foundation and the United
HIV/AIDS and malaria ( VOA News ,
2/18). According to AFP/Google.com, a
Nations Foundation recently launched the
Mobile Health Alliance, or mHealth, in an study by the U.N. foundation and Vodafone -- called "mHealth for Development: effort to improve health care in developing countries through mobile and computer technology, VOA News reports. The announcement came during the Mobile World Con-
The Opportunity of Mobile Technology for Healthcare in the Developing World" -
- examined 51 programs in 26 countries that used technology in the health field. It gress held this week in Barcelona, Spain. found that India with 11 projects and
Claire Thwaites, head of the U.N. and Vodafone Technology Partnership, said that technology has many health applications, such as text messaging programs to improve public awareness about diseases like HIV/AIDS or malaria. She added that mobile support could be used to bolster public health campaigns, adding, "Then you get to more sophisticated
South Africa and Uganda with six projects each had made the largest advances. For example, a project in Uganda used text messages to send a quiz about HIV/AIDS to 15,000 mobile phone subscribers in a rural region, asking them to participate in the quiz to receive free air time for correct answers. The quiz also included a uses of mobile to support consultation and remote diagnosis, as well as being able to final message motivating participants to be tested for HIV at a communicate with health workers, which local health center. The number there's a huge lack of in the developing of people undergoing testing at world." Thwaites noted that mobile and computer technology could help achieve targets the local health care center increased from 1,000 to 1,400 durin the United Nation's Millennium Developing a six-week period, according ment Goals regarding diseases such as to the report (AFP/Google.com,
2/18). Adele Waugaman, a spokesperson for the U.N. foundation, said, "There are a couple of interesting benefits the project brought to light. One of them is the benefit of talking to people in their local language," adding that in countries with widespread
HIV/AIDS-related stigma, text messaging provides a "new form of access that addresses these stigmatization and privacy concerns." Thwaites told conference attendees that there is "a real need to have an alliance" between nongovernmental organizations, governments and corporations to harness these benefits, BBC Ne ws reports
(Palmer, BBC News , 2/17). Daniel Carucci, vice president of health at the U.N. foundation, said that technology could
"reduce the pressure on public health care systems" (AFP/Google.com,
2/18). The mHealth Alliance is expected to host a conference by the end of the year to invite people from both the private and public sector to participate in the program ( VOA
News , 2/18).

Drexel University College of Medicine
Women’s Health Education Program
Women’s Health Education Program
Drexel University College of Medicine
2900 Queen Lane, Room 228
Philadelphia, PA 19129
Phone: 215-991-8450
Fax: 215-843-0253 http://www.drexel.edu/whep
Held Tuesday
Evenings,
5:30PM—7:00PM
SAC B,
Queen Lane Campus and videoconferenced to the New
College Building
(refreshments are served at both sites)
Open to anyone interested in attending.
For more information, please visit our office, call, or email.
Begun in 1993 as a vanguard innovative educational center to address holistic, contextual comprehensive care to women and girls, the Women’s Health Program of Drexel University College of
Medicine is part of a nationally designated Center of Excellence in Women’s Health. In addition to curricular efforts, community health outreach programming, and community participatory health services research, WHEP maintains an existing resource listing that includes articles, books, videotapes, and journals, that address sex and gender medicine.
If you’re interested in more information, please see our resources on the WHEP website at http:// webcampus.drexelmed.edu/whep/index.html
If you’re looking for information about girls’ or women’s health topics; information about health fairs or community activities or health education research; or just information about our bulletin boards or how to get involved, please stop by and visit us at room 228 Queen Lane, or call/email us anytime for more information.
SUNDAY, Feb. 22 (HealthDay News) -- A new scientific discovery could someday lead to medications to fight the flu as well as a vaccine that would not have to be changed every year because it could target a broad range of flu strains. "We identified new human antibodies that inactivate influenza, not just bird flu, but any of the seasonal influenza viruses that affect us in the winter," said researcher Dr. Wayne A. Marasco, an associate professor of medicine at Harvard Medical School and the Dana-Farber Cancer Institute. The antibodies recognize a new part of the influenza virus and inactivate the virus by a new mechanism, Marasco said, "so it's really a new target, new mechanism, new human antibodies." Antibodies can be used as drugs, he noted, adding that drugs derived from antibodies are commonplace in treatment for such cancers as colon, breast and lymphoma.
Drugs developed from the newly identified antibodies could, in combination with other treatments, prevent or treat certain avian and seasonal flu strains and could also lead to the development of a long-lasting flu vaccine, the researchers said. "These flu antibodies can be developed into fully human antibody drugs that could be used in the clinic," Marasco said. Such drugs would be used in the same way antiviral medications, such as Tamiflu, are used today. Antivirals generally are given to prevent a virus after exposure or to treat a virus once it develops. This year, however, the commonly circulating H1 strains of the influenza virus are resistant to Tamiflu. Resistance develops because a drug targets the large head of the flu virus, but the virus is able to quickly mutate, making it resistant to medications and vaccines, Marasco explained. That's why there is a new seasonal flu vaccine every year, he said. But the newly identified antibodies attack the stem of the virus, which is more resistant to change and "does not change amongst the various influenza viruses," he said.
"These antibodies do not replace the flu vaccine," Marasco said. "But the exciting part is, this gives us a new approach to vaccine development. This is a new area that is highly conserved, and the viruses do not appear to easily undergo change in their genetic code to escape the antibodies directed against them." The study is published in the Feb. 22 online edition of Nature Structural and Molecular Biology . In their research, Marasco and his colleagues identified 10 monoclonal antibodies that can bind with a protein in flu viruses that is needed to allow the virus to enter other cells. The antibodies effectively blocked the ability of the virus to enter other cells. In addition, the researchers showed that the antibodies protected mice from getting the N5N1 avian flu, which many scientists believe could cause a worldwide flu pandemic. The last flu pandemic occurred in 1918, killing an estimated 40 million people worldwide and 500,000 in the United States alone. The new monoclonal antibodies were also effective against the 1918 flu strain, Marasco said. More importantly, they were effective against a number of common seasonal flu strains as well. The next step is to test the antibodies in ferrets, which are commonly used to test new influenza treatments. Marasco said that drugs using these antibodies could be in human clinical trails as early as 2011. Peter Palese, chairman of the microbiology department at Mount Sinai School of Medicine in New York City and author of an accompanying journal editorial, is cautious about the immediate clinical implications of this finding. "If you have an antibody that is effective against several viruses, it could be theoretically used as a passive immunization," Palese said. "If one could also make a vaccine, one would have a universal vaccine." But Palese noted that any drug or vaccine using antibodies would have to be better than what is currently available. "This finding promises that there is a way to develop a universal influenza vaccine," he said. The antibodies are effective against about half of currently known flu strains, but the approach could be used to find additional antibodies that could work against the others, he said. Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine in New York City, also stressed that the effectiveness of the approach needs to be proven in people. "Passive immunity is not a primary treatment in a pandemic," Siegel said. "Another problem is, we don't know if it works. What works in a test tube doesn't always work in the body. We don't know that these antibodies will actually work.”