Ductal carcinoma in situ (DCIS) is an early form of a non-invasive breast cancer that begins as abnormal cells inside the milk ducts in the breast. It typically doesn't show signs or symptoms and it's estimated that up to 40% of cases eventually become invasive if not treated.

The current standard treatment is to perform a lumpectomy or a mastectomy in more extreme cases. Clinical trials are underway to determine if some patients with ductal carcinoma in situ might be able to avoid surgery.

"In addition to considering proton therapy to target the cancer, Mayo Clinic is conducting a clinical trial that involves a vaccine that could boost immunity against the HER2 receptor," says Dr. Amy Degnim, a surgeon with the Mayo Clinic Cancer Center. "HER2 is a protein that in some cases is on the outside of cancer cells and for women with ductal carcinoma in situ, these receptors are present in about 50% to 60% of the cases."

In this Mayo Clinic Q&A podcast Dr. Degnim, and one of her patients, Helen Gagoud, discuss receiving a ductal carcinoma in situ diagnosis and determining treatment, as well as the hopeful vaccine research at Mayo Clinic.

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date.  

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

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Research is advancing a regenerative solution for a quality of life-limiting complication of mesh-based surgical repairs for stress urinary incontinence and pelvic organ prolapse in women. While mesh-based surgical treatments are durable and provide symptom relief for a great number of patients, there is a risk of mesh complications following surgery, such as mesh exposure. In this situation, many patients require an additional surgery to revise their implant. Mayo Clinic research, supported by the Center for Regenerative Medicine, is testing a regenerative approach to restoring form and function without additional corrective surgery in the setting of vaginal mesh exposure.

Vaginal prolapse is a medical term for a condition that leads to bulging of the pelvic organs, such as the bladder, uterus or rectum. It happens when ligaments and muscles on the pelvic floor stretch and weaken, no longer providing adequate support. Those internal organs slip down, bulging through the vagina wall, causing prolapse. Alternatively, women can also experience accidental leakage of urine with activity or cough, laugh and sneeze. This is termed stress urinary incontinence. Often linked to child birth, obesity or aging, incontinence and prolapse affect many women.  

Women with vaginal prolapse or urinary incontinence may choose to undergo placement of mesh if they have failed conservative therapies. Mesh is used in gynecology surgery to lift and support the pelvic organs, typically the bladder or uterus, relieving the pressure that caused the pelvic floor defect. However, like all surgery, there are potential risks. The mesh sometimes wears through the vaginal walls, causing vaginal discharge and possibly discomfort for women and their partners. Therein lies the dilemma: should there be another surgery to remove the mesh or would the patient prefer to live with the symptoms?

Mayo Clinic researchers are studying a new regenerative option, called purified exosome product (PEP) to treat a complication of the use of mesh in gynecologic surgery. Research, currently in animal models, is looking at whether PEP could promote regeneration of tissue that would grow over the mesh and restore the vaginal wall.

“While gynecological mesh is a viable option for many women, we wanted to create a non-surgical reparative option for our patients,” says John Occhino, M.D., clinician-scientist in gynecologic surgery with specialty training in urogynecology and pelvic reconstructive surgery. “We are studying the use of PEP to correct one of the most common side effects of mesh placement, the exposure of mesh through the vaginal wall after surgery.”

Exosomes are small membrane-bound vesicles secreted into the body’s cellular environment. Imagine bubbles carrying a signal that tell the body to regenerate and renew. For example, when the skin is scratched, exosomes are sent to repair the skin. By delivering a high dose of purified exomes, researchers can recruit numerous cells and pathways to help heal the tissue back to its original state.

“Our research injects an exosome gel into the vaginal tissues of a preclinical model of mesh exposure,” says Cassandra Kisby, M.D., female pelvic medicine and reconstructive surgery fellow. “Four weeks after treatment we saw the vaginal tissues had repaired and covered the prior mesh exposure.”

The regenerated tissues were physiologic, adds Dr. Kisby, meaning there were new blood vessels, the tissues had normal amounts of collagen, and there was minimal scaring.

While this research is currently only being done in animal models, Drs. Occhino, Kisby and team are working to develop a phase 1 clinical trial to test the safety of PEP in humans within the next year.

“This technology opens the door for numerous applications in gynecology, including birth injury and repair, urinary incontinence, and fistulas.” says Dr. Kisby. “Our goal is to create a women’s health regenerative medicine program to help expedite the research and translation of this technology into clinical  practice.”

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The Center for Regenerative Medicine recognizes Michael S. and Mary Sue Shannon for their generosity and support in advancing regenerative women’s health research.

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ROCHESTER, Minn. — Mindfulness may be associated with fewer menopausal symptoms for women, according to a Mayo Clinic study recently published in Climacteric: The Journal of the International Menopause Society. Researchers discovered that being mindful may be especially helpful for menopausal women struggling with irritability, anxiety and depression.

“In this study, we found that midlife women with higher mindfulness scores experienced fewer menopausal symptoms,” says Mayo Clinic general internist and women's health specialist Richa Sood, M.D., the study's lead author. “These findings suggest that mindfulness may be a promising tool to help women reduce menopausal symptoms and overall stress.”

Mindfulness involves focusing attention on the present moment, and observing thoughts and sensations without judgment. Prior research has shown practicing mindfulness can reduce stress and improve quality of life.

Every day, an estimated 6,000 women in the U.S. reach menopause. By 2020, the number of women age 55 and older is expected to top 46 million. A woman is considered to be in menopause if she has gone one year without a menstrual cycle. Commonly experienced symptoms of menopause can include hot flashes, night sweats, vaginal dryness and mood changes.

The study involved 1,744 women ages 40 to 65 who received care at Mayo Clinic's Women's Health Clinic in Rochester between Jan. 1, 2015, and Dec. 31, 2016. Participants completed questionnaires that rated their menopausal symptoms, perceived level of stress and mindfulness. Researchers found women with higher mindfulness scores had fewer menopausal symptoms. The higher a woman's perceived level of stress, the greater the link between higher mindfulness and reduced menopausal symptoms.

One surprising outcome of the study is that higher mindfulness scores were not associated with lower hot flash and night sweat symptom scores, Dr. Sood says. One theory as to why is that the amount of distress experienced from night sweats and hot flashes may have more to do with individual personality traits rather than the symptoms themselves. An exciting finding in the study, according to Dr. Sood, was the association of higher mindfulness scores and lower symptom scores for irritability, depression and anxiety in middle-aged menopausal women.

“While more studies need to be done, doctors can consider discussing mindfulness as a potential treatment option for menopausal women,” Dr. Sood says.

Fortunately, mindfulness is a skill that can be learned.

“Essentially, the first step in being mindful is to become aware that our minds are on autopilot most of the time,” Dr. Sood says. "The goal during mindful moments is not to empty the mind, but to become an observer of the mind's activity while being kind to oneself. The second step is to create a pause. Take a deep breath, and observe one's own space, thoughts and emotions nonjudgmentally. The resulting calm helps lower stress.”

Co-authors of the study are Carol Kuhle, D.O.; Ekta Kapoor, M.B.B.S.; Jacqueline Thielen, M.D.; Karla Frohmader Hilsaca, Ph.D.; Kristin Mara; and Stephanie Faubion, M.D. — all from Mayo Clinic.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network.

Media contact:

• Heather Carlson Kehren, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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ROCHESTER, Minn. — The percentage of women who are screened for cervical cancer may be far lower than national data suggests, according to a Mayo Clinic study recently published in the Journal of Women’s Health. Less than two-thirds of women ages 30 to 65 were up-to-date with cervical cancer screenings in 2016. The percentage is even lower for women ages 21 to 29, with just over half current on screenings. Those figures are well below the 81 percent screening compliance rate self-reported in the 2015 National Health Interview Survey.

“These cervical cancer screening rates are unacceptably low,” says Mayo Clinic family medicine specialist Kathy MacLaughlin, M.D., the study’s lead author. “Routine screening every three years with a Pap test or every five years with a Pap-HPV co-test ensures precancerous changes are caught early and may be followed more closely or treated.”

In addition to lower-than-expected screening rates, Mayo Clinic researchers also found racial inequities in terms of who is getting screened.

“African-American women were 50 percent less likely to be up-to-date on cervical cancer screening than white woman in 2016,” says Dr. MacLaughlin. “Asian women were nearly 30 percent less likely than white women to be current on screening. These racial disparities are especially concerning.”

Mayo Clinic researchers reviewed medical records using the Rochester Epidemiology Project database to determine cervical cancer screening rates for more than 47,000 women living in Olmsted County, Minn., from 2005 to 2016. An estimated 13,240 new cases of invasive cervical cancer were diagnosed in the U.S. in 2018, according to the American Cancer Society. Another 4,170 women died from cervical cancer last year. January is Cervical Health Awareness Month.

Dr. MacLaughlin says these study results should prompt health care providers to start considering new ways of reaching out to patients to help ensure they get screened. Ideas could include setting up Pap clinics with evening and Saturday hours, or offering cervical cancer screenings at urgent care clinics. For women who qualify for the newest screening option of primary HPV screening, clinics could explore the option of giving patients at-home testing kits.

“We, as clinicians, must start thinking outside the box on how best to reach these women and ensure they are receiving these effective and potentially life-saving screening tests,” she says.

Cervical cancer death rates have dropped dramatically in recent decades thanks to the development of the Pap test in the 1950s. That test involves collecting cells from a woman’s cervix and examining them under a microscope to look for precancerous and cancerous cells. A second type of cervical cancer screening — called the HPV test — detects the presence of high-risk HPV, which can lead to precancerous changes and cervical cancer.

In 2012, national cervical cancer screening guidelines were updated to recommend Pap testing every three years for women ages 21 to 65 or Pap-HPV co-testing every five years for women ages 30 to 65. The study results show high rates of adoption by Olmsted County health providers of the 2012 guidelines in regards to appropriate use of co-testing and in appropriately not screening women under 21 or over 65.

A limitation of this study is that Olmsted County is less ethnically and racially diverse than the U.S. population, but the county’s demographic makeup is reflective of the Upper Midwest. The study’s findings related to racial disparities in screening are consistent with several other studies from across the country. Another limitation is the potential for over counting young women as not screened who are insured by their parents and have an Olmsted County address but may have gone to healthcare providers  outside of Olmsted County for screening.

The research was supported by the Rochester Epidemiology Project, Mayo Clinic, the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the National Institute on Aging and the National Institutes of Health.

Co-authors of the study were Robert Jacobson, M.D., Carmen Radecki Breitkopf, Ph.D., Patrick Wilson, Debra Jacobson, Chun Fan, Jennifer St. Sauver, Ph.D., and Lila Rutten, Ph.D.

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About the Rochester Epidemiology Project
The Rochester Epidemiology Project is a collaboration of clinics, hospitals and other medical facilities in Minnesota and Wisconsin, and involves community members who have agreed to share their medical records for research. Using medical record information, medical scientists can discover what causes the diseases, how patients respond to medical and surgical therapies, and what will happen to patients in the future. Research studies conducted in the local community may improve the health of people both locally and globally.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network.

Media contact:

• Heather Carlson Kehren, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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Obstructive sleep apnea, the most common form of sleep apnea, is characterized by repeated stopping and starting of breathing during sleep. Besides affecting the quality of sleep, obstructive sleep apnea can lead to serious health concerns in women, including increased risks of coronary heart disease, high blood pressure and stroke.

To track this occurrence in middle-aged women, researchers used the Data Registry on Experience of Aging, Menopause and Sexuality, which contains health information on women seen in the Women’s Health Clinic at Mayo Clinic.

The team found that, of the women seen between May 2015 and December 2016, self-reported severe hot flashes and night sweats were linked to an intermediate to high risk of obstructive sleep apnea. While those who had high blood pressure and were obese were at an especially high risk, the risk also was seen even in women with a healthy body mass index.

“Obstructive sleep apnea is often thought of as a man’s disease, and men’s symptoms are more outwardly noticeable, in large part because of snoring,” says Stephanie Faubion, M.D. “However, the risk for obstructive sleep apnea in women goes up in their menopausal years. The symptoms they face – headache, insomnia, anxiety, depression, in addition to the more common symptoms of snoring and fatigue – may not be as audible or visible to others, but they pose just as much risk to overall health.”

Two years after clinical consultation when women self-reported their hot flashes and night sweats, 65 percent of the group that demonstrated intermediate or high risk of obstructive sleep apnea still was not diagnosed with the condition.

“Hot flashes and night sweats may be overlooked as a risk of something more serious,” says Dr. Faubion. “The implementation of screening tools during evaluation can help determine what symptoms women are facing, and put us on track to detect and intervene with serious health issues, such as obstructive sleep apnea, sooner.”

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, comprehensive care to everyone who needs healing. For more information, visit mayoclinic.org/about-mayo-clinic or newsnetwork.mayoclinic.org.

MEDIA CONTACT
Kelly Reller, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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Between 40 and 60 percent of women in perimenopause and early menopause face issues with sleep because of this physical change. The majority also report hot flashes and night sweats, which can be disruptive to falling and staying asleep.

A new study published in Menopause: The Journal of The North American Menopause Society has found that low-dose hormone therapy may be effective in easing sleep issues in this population. The goal of the study was twofold: find out how two forms of hormone therapy affect sleep quality and assess the ties between hot flashes, sleep quality and hormone therapy.

“Poor sleep quality over time affects more than just mood,” says Virginia Miller, Ph.D., director of Mayo Clinic’s Women’s Health Research Center and the study’s corresponding author. “Sleep deprivation can lead to cardiovascular disease, among other health risks. There can be serious consequences — mental and physical — if you’re not getting quality sleep over a long period of time.”

The study looked at two forms of hormone therapy — oral estrogen (conjugated equine estrogen) and a patch (17 beta-estradiol) — to find out how their use affected sleep quality. The participants were part of the Kronos Early Estrogen Prevention Study, and all were recently menopausal women. The women self-reported on the quality of their sleep using the Pittsburgh Sleep Quality Index. They also recorded the intensity of hot flashes and night sweats during this time.

The women were found to have improved sleep quality over four years when using low-dose hormone therapy — twice the improvement of those in the placebo group.

Researchers also found that sleep quality improved with changes in hot flashes and night sweats, but Dr. Miller says it remains difficult to determine if the low sleep quality is caused by these symptoms or if they are a consequence of poor sleep.

“Menopause affects such a large portion of the population, so it is important to keep researching how we can best promote a woman’s overall health during this phase in her life,” says Dr. Miller.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. For more information, visit mayoclinic.org/about-mayo-clinic or newsnetwork.mayoclinic.org.

MEDIA CONTACT
Kelly Reller, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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For many women, breast pain resolves on its own over time and you may not need any treatment. However, while there is little research to show the effectiveness of these self-care remedies, some may be worth a try:

• Use hot or cold compresses on your breasts.
• Wear a firm support bra, fitted by a professional if possible.
• Wear a sports bra during exercise, especially when your breasts may be more sensitive.
• Experiment with relaxation therapy, which can help control the high levels of anxiety associated with severe breast pain.
• Limit or eliminate caffeine, a dietary change some women find helpful, although medical studies of caffeine's effect on breast pain and other premenstrual symptoms have been inconclusive.
• Follow a low-fat diet and eat more complex carbohydrates, a strategy that's helped some women with breast pain in observational studies.
• Consider using an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) — but ask your doctor how much to take, as long-term use may increase your risk of liver problems and other side effects.
• Keep a journal, noting when you experience breast pain and other symptoms, to determine if your pain is cyclic or noncyclic.

Alternative medicine

Vitamins and dietary supplements may lessen breast pain symptoms and severity for some women. Ask your doctor if one of these might help you — and ask about doses and any possible side effects:

• Evening primrose oil. This supplement may change the balance of fatty acids in your cells, which may reduce breast pain.
• Vitamin E. Early studies showed a possible beneficial effect of vitamin E on breast pain in premenstrual women who experience breast pain that fluctuates during the menstrual cycle. In one study, 200 IU of vitamin E taken twice daily for two months improved symptoms in women with cyclic breast pain. There was no additional benefit after four months.For adults older than 18 years, pregnant women, and breastfeeding women, the maximum dose of vitamin E is 1,000 milligrams daily (or 1,500 IU).

If you try a supplement for breast pain, stop taking it if you don't notice any improvement in your breast pain after a few months. Try just one supplement at a time so that you can clearly determine which one helps alleviate the pain — or not.

If you do require treatment, your doctor might recommend that you:

• Eliminate an underlying cause or aggravating factor. This may involve a simple adjustment, such as wearing a bra with extra support.
• Use a topical nonsteroidal anti-inflammatory (NSAID) medication. You may need to use NSAIDs when your pain is intense. Your doctor may recommend you apply an NSAID cream directly to the area where you feel pain.
• Adjust birth control pills. If you take birth control pills, skipping the pill-free week or switching birth control methods may help breast pain symptoms. But don't try this without your doctor's advice.
• Reduce the dose of menopausal hormone therapy. You might consider lowering the dose of menopausal hormone therapy or stopping it entirely.
• Take a prescription medication. Danazol is the only prescription medication approved by the Food and Drug Administration for treating breast pain and tenderness. However, danazol carries the risk of potentially severe side effects, such as acne, weight gain and voice changes, which limit its use. Tamoxifen, a prescription medication for breast cancer treatment and prevention, may be recommended for some women, but this drug also carries the potential for side effects that may be more bothersome than the breast pain itself.

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On the next Mayo Clinic Radio program, Dr. Craig Sawchuk, a Mayo Clinic psychologist, will discuss mental health awareness. Also on the program, Dr. Jamie Van Gompel, a Mayo Clinic neurosurgeon, will explain how new imaging techniques, including magnetic resonance elastography, are improving neurosurgery. And May 14-20 is National Women's Health Week. Dr. Jacqueline Thielen, a women's health expert at Mayo Clinic, will discuss women’s health at every age.

Here's your Mayo Clinic Radio podcast.

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Sexual dysfunction is a common side effect for women on antidepressants, but a new article by the Women’s Health Clinic and Department of Psychiatry and Psychology at Mayo Clinic, in collaboration with Tierney Lorenz, Ph.D., University of North Carolina at Charlotte, shows promise for targeting and treating antidepressant-induced female sexual dysfunction.

The paper, published in this month’s issue of Mayo Clinic Proceedings, discusses treatment options and the research backing them for women who face sexual dysfunction while on antidepressants. Stephanie Faubion, M.D., director of the Office of Women’s Health, of Mayo Clinic, and Jordan Rullo, Ph.D., L.P., report that the onset of sexual side effects develops within one to three weeks of beginning an antidepressant regimen. However, the benefits of the antidepressants themselves do not appear until approximately two to four weeks into treatment, which may cause women to lose interest in a medication that may seem to do more harm than good.

The change in neurotransmitters, particularly serotonin, introduced by antidepressants may be the most likely reason behind female sexual dysfunction, according to the paper, but symptoms of sexual dysfunction prior to beginning antidepressants may signal another culprit.

“Depression is a significant risk factor for sexual dysfunction and vice versa,” says Dr. Rullo. “It is critical as a provider to assess a patient’s sexual function before and after she starts an antidepressant. This will help you determine if her sexual function concerns are due to depression or due to the side effect of the antidepressant, or perhaps both. The simplest assessment question is, ‘Do you have any sexual health concerns?’ and that should be asked during each subsequent visit.”

MEDIA CONTACT:  Kelly Reller, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

One study included in the article found that 15 percent of women stopped taking their prescribed antidepressant after experiencing sexual dysfunction, and half of those women did not discuss the concern with their doctor.

“There are several approaches that make sexual dysfunction fairly treatable,” says Dr. Rullo. “By communicating with your provider about your symptoms and discussing treatment options, you lessen that chance of disrupting your antidepressant regimen due to unpleasant side effects.”

The paper includes treatment options from behavioral and pharmacologic approaches, including exercise, scheduling sexual activity and adjustment of medication dosage. The first step in selecting the appropriate treatment protocol, according to the article, is to identify the domain in which the sexual dysfunction falls, which can include low desire, low arousal and orgasm dysfunction.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

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