News in brief - Oct. 25, 2004

ACOG recommends gynecological exam for teens - Counseling helps stem alcohol use - Type of HT may determine degree of cardiovascular trouble - Injected osteoporosis drug shows effectiveness

ACOG recommends gynecological exam for teens

Adolescent girls should receive their first gynecological check-up when they are between 13 and 15 years old, according to guidelines issued by the American College of Obstetricians and Gynecologists.

That visit, which should ideally occur before sexual activity has started, should include health guidance and screening.

ACOG released the information to allay confusion that might have occurred because of a change in cervical cancer screening recommendations that push back the timing of a baseline Pap test until three years after intercourse, or by age 21.

New guidance developed by an ACOG committee notes that teens and their parents may not realize that a checkup is important whether a Pap test is administered or not since more than 60% of adolescent girls have had intercourse by age 18, putting them at risk of sexually transmitted diseases.

The committee also recommended that adolescents with abnormal Pap screening tests should be counseled and monitored closely but not treated aggressively for benign lesions because most lesions regress on their own without treatment and do not result in cervical cancer.

Counseling helps stem alcohol use

Physicians who spent only a few focused minutes counseling young patients about reducing their alcohol use were successful in reducing high-risk drinking as well as the number of motor vehicle crashes, arrests for drug or liquor violations and emergency department visits, according to research published in the September/October Annals of Family Medicine.

In a trial involving 226 young adults between the ages of 18 and 30, researchers found that among those who received counseling compared with those who did not, counseling resulted in a 40% to 50% decrease in alcohol use, 42% fewer emergency department visits, 55% fewer motor vehicle crashes and significantly fewer arrests for possession of controlled substances or liquor violations.

Given the positive results, the researchers recommended that primary care physicians make counseling for high-risk drinking a high priority.

Type of HT may determine degree of cardiovascular trouble

The version of progestin used in hormone therapy may affect the amount of heart damage experienced during a cardiovascular event, according to a study presented at the North American Menopause Society annual meeting held this month in Washington, D.C.

Researchers treated postmenopausal monkeys for one year with ethinyl estradiol combined with either norethindrone acetate or medroxyprogesterone acetate and compared them with those who were not treated. Scientists then induced a heart attack in the monkeys.

The animals that had received no therapy had 20% irreversible heart muscle damage. Those who had received the estrogen with the norethindrone had 5% damage, and those who had received estrogen plus medroxyprogesterone had 35% damage.

"We were very surprised," said J. Koudy Williams, PhD, lead investigator and a researcher with Wake Forest Baptist Medical Center. "The two progestins produced dramatically different results. If we can learn more about this mechanism we might be able to identify better hormone therapies for postmenopausal women."

HT is no longer recommended for cardiac protection on the basis of results from the Women's Health Initiative but is still used by some women for menopausal symptoms.

Injected osteoporosis drug shows effectiveness

After one year, twice yearly injections of AMG 162, an experimental compound in phase II trials, increased bone density at levels comparable to alendronate, the standard treatment for osteoporosis, according to a paper presented this month at the annual meeting of the American Society for Bone and Mineral Research in Seattle.

Researchers at the Oregon Osteoporosis Center in Portland randomized postmenopausal women with low bone density to receive either one of the drugs or a placebo. After 12 months of treatment, AMG 162 increased bone mineral density at the lumbar spine by 4% to 7%, depending on the dosage schedule. Weekly doses of alendronate increased it by 5%.

"The medical community should be very encouraged by these data that suggest AMG 162 ... may offer a promising alternative for the treatment of osteoporosis," said Michael McClung, MD, lead investigator and founding director of the center.

Amgen, AMG 162's manufacturer, will now be moving the drug to a phase III study.