Key molecular regulator of uterine fibroids

Uterine leiomyomas, also called uterine fibroids, are benign tumors that originate from the smooth muscle of the uterus. Fibroids are the most common non-cancerous tumor of the female genital tract, affecting 80% of all women during their lifetime. More than half of women develop fibroids during their reproductive years, often complicating pregnancy. Fibroids are a major source of heavy uterine bleeding, pain, and reduced fertility, resulting in reduced quality of life and significant stress for many women. 

Treatments for fibroids consist of surgery, including hysterectomy or myomectomy, hormonal modulators, such as gonadotropin-releasing hormone agonists, and uterine arterial embolization (UAE), which blocks the blood supply to the tumor. The only true cure is surgical resection, with hormonal approaches and UAE estimated to shrink tumors by 30-40%. Bleeding and pain can also be significantly reduced by these treatments. However, results vary, and many women do not derive benefit from available procedures. Progress in designing new treatments has been slow, largely because we have a poor understanding of the biology of fibroids.

A new study recently identified a molecule that is expressed at abnormally high levels in fibroids. The molecule, H19, belongs to a class of molecules called long noncoding RNAs. H19 was found at increased levels in fibroid tissues from 30 women, including 20 premenopausal, compared with normal uterine myometrium tissues from the same women. High expression of H19 caused fibroid cells to double in number faster, whereas getting rid of H19 actually slowed down growth. Importantly, H19 also drove expression of molecular profiles that have previously been linked to fibroid development and growth. Thus, H19 may function upstream as a key regulator of fibroids. Estrogen and progesterone are thought to influence fibroid growth. This new study showed that combined exposure to estrogen and progesterone increased H19 expression and other fibroid-promoting genes. When H19 was eliminated, the effects of estrogen and progesterone were abolished. 

Although these results are preliminary, they are exciting for several reasons. We know so little about fibroids, and options for women who suffer from this debilitating chronic medical condition are limited. Fibroids receive little attention from the research community. The few studies that have been published in recent years are mostly preclinical in animal models and do not generally include patient samples. This new study used matched human fibroid and normal myometrium tissue from the same patients. This study also explored molecular mechanisms and biology, demonstrating cause and effect and not purely correlative findings.

Further studies are urgently needed to confirm the role of H19 and to identify other major mechanisms promoting fibroids. Identification of key regulators of fibroid development and growth moves us one step closer to understanding this disease and improving therapeutic options for women.

Reference: Cao T et al. Oncogene 2019 May 15

Simple health and wellness tips: screening and education

“No one is without knowledge except he who asks no questions.” ~ Ancient Proverb

You play an incredibly powerful role in dictating the course of your health. As discussed in the last post, 80% of chronic illnesses can be prevented through the lifestyle choices you make each day. But making informed decisions requires deliberate self-awareness and honesty. In addition to paying attention to diet and exercise, you can build self-awareness through active health screening and education. A major key to being proactive about your health is understanding your unique medical profile.

Know your body and your health risks. Routine medical, dental, and visual screenings help create a baseline profile of what’s normal for you. They may also help catch problems at early stages, when they are often easier to treat. Recommended evaluations may monitor blood pressure, cholesterol, glucose, body mass index, colorectal, breast, cervical, and/or prostate health (1). These tests are not just for primary prevention; they can help you follow ongoing concerns, so you can control progression of existing conditions. Staying up to date on immunizations, and practicing protective skin care are also important strategies for preventing serious medical problems. How frequently you decide to visit your doctor depends on your underlying health status and personal needs.

Medical visits should not be restricted to physician visits. Dental appointments are also important for your overall health. Gum disease, or periodontal disease, is diagnosed in more than 3 million people each year in the US (2). This bacterial infection is associated with poor dental care, resulting in swollen, red gums, loose teeth, and increased oral sensitivity. There is an increased risk of gum disease if you smoke or have diabetes, so dental care is especially important in these cases. Perhaps surprisingly, periodontal disease is not just an issue for your mouth. It increases your risk of developing serious systemic problems, including rheumatoid arthritis and heart disease (3). This occurs because the bacteria that cause gum disease can move through your blood, affecting blood vessels in the heart and creating harmful blood clots.

Outside of scheduled appointments, self-examination and an ongoing awareness of your physical and emotional wellness are critical. Recommended monthly self-exams include breast, testicular, and skin checks. Any sudden or persistent changes, such as lumps, pain, color, swelling, or rashes, can help identify problems early, increasing the probability of treating and curing an illness. As an example, if a woman feels a lump in her breast, she should act immediately and see a doctor. If a cancer is diagnosed and restricted to the breast, her chance of surviving 5 years is almost 99% based on statistics for women in the US (4). However, the 5-year survival from cancer that has spread from the breast to distant organs falls to 27%. These statistics vary patient to patient but emphasize the importance of early detection. Detecting the cancer before it spreads makes a significant difference in survival.

Despite the tremendous benefits of healthy lifestyle choices, our genetics are intimately tied to our risk profile of developing medical conditions. Therefore, to truly know your health risks, you must know your family history. It’s particularly important to keep a record of medical problems among first-degree relatives, meaning your parents, siblings, and children, since you share substantial genetic overlap. The National Institutes of Health actually recommends keeping a medical record for three generations of your family (5). The idea is to be aware of medical patterns in your family, including diseases for which you may have increased risk. It does not mean that you are going to develop the disease, but it does suggest that you should be proactive about taking steps to reduce your risk.

Understand your personal health record. A personal health record is a comprehensive set of your health information that you maintain and control. Everything about your health should be kept in this record. It may be a paper data set, electronic, or a combination. The information should be as complete as possible, including past and current illnesses, allergies, medications, health evaluations, surgeries, and family medical history. Ask your healthcare providers for records, such as images and reports, so you have them accessible when you want them. Having this record readily available is important for your peace of mind and that of your family. Simply creating the record is not enough; take steps to clearly understand everything in your record, including the side effect profiles of your medications, and how your medications interact with one another. Another advantage of having a personal health record is that you do not have to be dependent on your healthcare team for information. If you need information for work, travel, or a new doctor, you will have it available. If there’s an emergency, a family member can consult your record when contacting the hospital. Here is additional information to help you develop your personal health record.

Ask lots of questions, and know where to look for information. Our knowledge is only as deep as the quality and honesty of our questions. Ask openly about risk factors, prevention strategies, health and fitness, medications, and lifestyle changes. Even if your healthcare practitioner does not know the answer, he or she should be able to guide you to an appropriate source. If you feel that your questions are not being answered, or that you are being rushed, find a provider who will support your health enough to address your questions. If you have concerns about identifying credible written sources, ask your physician for advice. Scholarly databases, such as the National Library of Medicine, Medline Plus, and PubMed, are good places to start. Check out this site for great tips about credible sources of health information. When you read health articles online, pay attention to the affiliations, credentials and conflicts of interests of the website and author, as these may bias their advice. Medical research evolves rapidly, so check the date on your article to make sure you are reading the most recent information. It’s also useful to read articles with referenced sources, so you can go back and check the original articles. Checking multiple sites or articles for consistency of information, and consulting with your physician for advice are important steps towards ensuring that you can trust the information you are reading.

In our next post, we’ll cover simple strategies for integrating greater levels of balance and wellness into our lives.

Five ways to improve your health writing skills

Health writing is a broad field, filled with a number of smaller niches. You may be focused on fitness, nutrition, women’s health, or cancer, just to name a few. Whatever your specific interest or specialty is, getting started as a writer can be intimidating. Here are a few simple strategies that can help improve your writing.

Read content from other health writers. Writing styles differ according to author, niche, and audience. Read a variety of content from health writers. Identify articles written for the same types of audiences you want to target. Note the structure and tone of the writing. Break the article down by paragraph, and decide what purpose each paragraph fills in the article. Effective nonfiction writing is usually centered on key messages, as explained here. Identify the main teaching points in the article you are reading. What is the overall take-home message? How does the author organize these objectives and messages to create a clear, concise story? Take note of research that is cited to understand the types and numbers of sources you may need as supporting evidence to write a piece of similar length or style. The tone and voice will vary more than structure when you start comparing articles; that’s what makes each author unique. Still, there are some patterns to notice. For example, if a piece is written for a patient, how does the writer maintain a positive, helpful message, even when discussing a serious condition? What reading level does the piece appear to target, and how does that affect word choice? If a piece is written primarily for healthcare professionals or researchers, how does the author make the article interesting and engaging, rather than purely academic? Annotate each article as you go through this exercise. You’ll begin spotting patterns in health writing articles that are targeted to similar audiences. You can apply these general patterns in structure and voice to your own outlines as you build your health writing practice.

Keep up with news from your niche. This is critical. Health research moves at a ridiculously rapid pace. Understand what constitutes a credible source in your field, and read these sources regularly. For example, if your focus is oncology, read abstracts from the top-tier oncology journals on PubMed each week to identify new articles. You can set up automatic alerts based on keyword searches. Follow blogs from the major oncology associations and reputable oncology news websites daily. Many of these sources offer e-mail newsletters that can automatically be sent to you. Also, mine abstract databases from major annual oncology conferences to stay in touch with breaking news. Health writers must stay up-to-date, or their content risks becoming obsolete and irrelevant, and possibly filled with errors if something new has been learned.

Write regularly and listen to feedback. Write as many different types of content targeted to your primary audience as you can. As long as you practice consistently, you will improve. Seek feedback from clients, colleagues, mentors, and writing groups. Feedback is most effective when it highlights your strengths and weaknesses, so you know exactly what’s working, and what needs to be improved. Don’t be afraid to try new types of deliverables. There are so many possibilities in health writing; articles, blogs, book chapters, abstracts, news summaries, and medical needs assessments are just a few examples. Research and read other writers’ work. Then, try writing something new, and ask for feedback; it’s the only way to learn and become a strong health writer capable of writing diverse types of content.

Join classes and professional organizations. Formal courses, online writing programs, and professional organizations often provide resources to help improve health writing skills. Identify health writing groups or classes online or in your area, and see if they offer feedback, specialized teaching, books, or certifications that will help you grow as a writer. In addition to medical and science writing associations, there are freelance health writers who offer online courses. Check out this link for additional advice.

Write for your audience. Health writers are educators. Your content is designed to teach an audience something new about a specific health topic. Keeping your reader in mind as you write will automatically focus your attention and improve your writing. Imagine your audience as you write. What concerns do they have? As you practice writing for the same general audience a few times, you’ll learn how to address their major needs and anxieties. Targeting your writing to help your audience is one of the most effective ways to improve the tone, clarity, and quality of your health writing.

These are just a handful of easy tips to help you on your way to becoming a strong, impactful health writer. It’s a continuous process, and regardless of how senior a writer is, there is always something new to learn. Be kind to yourself, and approach writing with a growth mindset, so that you are open to learning and evolving even when new challenges present themselves.