Speaking of Women's Health
The Speaking of Women's Health Podcast is excited to bring you credible women's health information from host and Executive Director, Dr. Holly L. Thacker. Dr. Thacker will interview guest clinicians discussing relevant women's health topics and the latest news and tips.
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Speaking of Women's Health
The Top Women's Health Highlights from 2024
Happy New Year and welcome to Season 3 of the Speaking of Women's Health Podcast! Join Host Dr. Holly Thacker as she walks through the 2024 women's health highlights and advances.
Hear about groundbreaking advances in women's health treatments, particularly the management of menopausal symptoms. This episode explores all you may have missed in 2024 in women's health.
And Dr. Thacker gives a sneak peek into what is coming in Season 3, including interviews with experts in anti-aging. Don’t miss out and be sure to rate, share, and subscribe!
Welcome to the Fit, Healthy and Happy Podcast hosted by Josh and Kyle from Colossus...
Listen on: Apple Podcasts Spotify
Welcome to Season 3 of the Speaking of Women's Health podcast. On today's new podcast, I'm going to talk about all the women's health highlights from 2024, as well as some of the things that you can look forward to in 2025 from Speaking of Women's Health, which is a nonprofit dedicated to empowering women to be strong, be healthy and be in charge and be in charge For the first order, of the first item of the brand new year. I want to thank you, our loyal listeners, for continuing to support this podcast for the last two seasons, and I really would like to welcome any new listeners and if you're not already subscribed to the podcast, please consider subscribing now. It's free and we produce new, fresh content every week that can be helpful to both you and your family and your loved ones. Many times I'm in the office seeing patients and they'll ask me a question and I'll think, oh gosh, I don't have time to give them a full 30 minutes on this, and I realized I just had done a podcast, maybe last season or two seasons ago, and I'll mention, oh, are you listening to our free Speaking Women's Health podcast? And the woman will say, well, I started to, but then I just somehow stopped and I think that's because a lot of people don't hit the notify for new episodes and so certainly maybe not all episodes pertain to you or your interest, but many of them will, and what I've classically done either at the end of the year or the beginning of the brand new year is kind of like a look back. You know some people do what are the top 10 songs, the top 10 movies of the year, top 10 sports highlights? So, along that vein, I want to do the top highlights, medically, of things that we thought were important to you that are posted on our website under the news section, and if you're perusing our website, it's always kind of good to check on updated news. Sometimes we'll be putting it out on various social media channels, but there's a lot that everyone is bombarded with information-wise.
Holly Thacker, MD:So one of the things that was a big deal medically in 2024 was that there were new germline genetic testing guidelines for patients with breast cancer, testing guidelines for patients with breast cancer, and we certainly have a lot of breast content on our website and our podcast and social media. October is classically breast cancer awareness month. You see all the pink ribbons and it's very important when there's new advances and an expert panel has developed new guidelines for germline testing in patients with breast cancer and we've had lots of podcasts on breast cancer, also on genetic testing and the implications of genetic testing and from a insurance legal standpoint insurance legal standpoint. Now all patients with newly diagnosed breast cancer with either stage 1 through 3 de novo or stage 4 metastatic disease who are age 65 or younger should be actually offered BRCA1 and 2 testing. All newly diagnosed breast cancer with stage 1 to 3 de novo cancer or stage 4 metastatic cancer who are over age 65 should also be considered for bracket one and two testing if they are candidates for the polyADP ribose polymerase, also known as PARP, inhibitor therapy for early stage or metastatic disease.
Holly Thacker, MD:Any woman with triple negative breast cancer, regardless of age, and even in a woman over age 65 who has any personal or family history that is suggestive of a pathogenic variant. Also if they are males, male breast cancer is pretty rare, so that's a red warning sign. Also, anybody over age 65 with Ashkenazi, jewish ancestry or if they're a member of a population that has a known increased prevalence of these so-called founder mutations, and any male or female undergoing BRCA1 and 2 testing should also be offered testing for other cancer predisposition genes as suggested by their personal or family history, and it's so important to have a clinician who is experienced in genetic clinical counseling help guide this decision making. And we've had molecular medicine and cancer geneticist my son Stetson Thacker on our podcast. In the past we've had medical breast expert and kind of the founder of the medical breast program at the Cleveland Clinic, dr Holly Peterson, on our podcast and we're expecting also genetic counselor Ryan Noss talking about the GINA law on our upcoming podcast and being empowered with information and informed consent before getting genetic counseling is important and informed consent before getting genetic counseling is important.
Holly Thacker, MD:But any patient that has recurrent breast cancer, either locally recurrent or metastatic throughout the body who might be a candidate for PARP inhibitor therapy should be offered BRCA1 and 2 testing regardless of family history. So these are really big new guidelines that came out. We also want to offer BRCA1 or 2 testing if someone has a secondary primary cancer in the contralateral or even the same ipsilateral breast. All patients with a personal history of breast cancer diagnosed under age 65 who are without active disease should be offered BRCA1 and 2 testing if the result will inform their own personal risk management or their family's risk assessment. Who have a personal or family history that suggest the possibility of a pathogenic variant, as well as males with breast cancer, as well as those persons with triple negative breast cancer because you really think about BRCA1. And anyone of Ashkenazi Jewish ancestry or those that have that are a member of a population that has been known to have an increased risk of these so-called founder mutations.
Holly Thacker, MD:Now, testing for high penetrance genes beyond BRCA1 and 2, which include PLBA2, tp53, p10, stk11, and CDH1, could also inform medical therapy, influence the surgical decision making and refine the estimates of secondary primary cancers, as well as inform estimates and risk assessment for any family members that are biologically related, and so this really represents a significant testing expansion. Now, testing for moderate penetrant breast cancer genes currently offers no benefit for the treatment of the index breast cancer, but certainly does inform the risk of secondary primary cancers, as well as family risk assessment, and that also may be the reason to offer it if you're already undergoing BRCA1 and 2 testing and when that's done. It's called a multi-gene panel, so it looks at more than just one gene panel. So it looks at more than just one gene, and the decision about what to test should be taken into account the person's medical history, their family history and having a consultation with a clinical geneticist, and that can be very helpful in selecting the right specific multi-gene panel as well as interpreting the results. Now, patients undergoing genetic testing should obviously be given sufficient information to give informed consent about whether they want to undergo the testing, and patients with pathogenic variants need to be provided with very specific, individualized post-test genetic counseling, as well as being offered referral to a clinician who's experienced in clinical cancer genetics. Now, variants of unknown significance VUSs because your test is either normal or it's positive, abnormal for the pathogenic variant or something different that may not be abnormal and certainly could be normal, we just don't have enough information is called a VUS and that should not alter management, and patients need to understand that VUSs can later be reclassified as something of concern, pathogenic and may need periodic follow-up, and they also may be, with more information, classified as just a benign variant, and that's why having access to clinical cancer geneticists is very helpful and patients who don't have a pathogenic variant can still benefit from counseling if there's a significant family history of cancer.
Holly Thacker, MD:Next, on, some of our big medical news of last year was that the FDA approved pembrolizumab plus chemo radiation for high-risk cervical cancer. So pembrolizumab, also known as Keytruda, is first-line immunotherapy approved for the intent-to to treat population of women who are diagnosed with high risk locally advanced cervical cancer, and pembrolizumab has already been approved in 17 different cancer types and it has at least 38 indications and seems to be growing. At least 38 indications and seems to be growing. The recommended dosing interval for pembrolizumab or Keytruda is 200 milligrams via IV infusion every three weeks or 400 milligrams every six weeks until disease progression or unacceptable toxicity or up to two years of treatment. Toxicity or up to two years of treatment. Now, if you have not heard our podcast on cervical cancer awareness with Dr Sutherland that we've previously done, that is an important one to revisit because we're seeing some increased risk just because the interval for low-risk women over age 30 with negative HPV has been expanded to five years. That's kind of like the Bayer basement recommendation. It's not necessarily the ceiling or higher level optimal that you may want for yourself, and certainly people who've had abnormal PAPs, abnormal tests, symptoms, bleeding need more frequent evaluations.
Holly Thacker, MD:Another big blockbuster study and something that we're keeping our eye on for 2025 is another new non-hormonal candy neuron inhibitor, so elazinatant, which we talked about early on in season one in early 2023, under the CME podcast that I do for physicians and healthcare clinicians was under study then and is under study now. But in 2024 met all primary and key secondary endpoints in the pivotal OASIS 1 and 2 phase 3 studies. We have phase 1 studies, 2 and 3 and then usually after the FDA reviews, all the data is when it's assessed for FDA approval and then to hit the market available for patient use. So Bayer announced a year ago that they were having positive top line results in this pivotal phase three study, oasis-1 and 2, evaluating the efficacy and safety of the investigational compound elezatant versus placebo, and elizanatant successfully met all four primary endpoints in both studies, showing that there were significant reductions in both frequency and severity of moderate to severe vasomotor symptoms, also known as hot flashes or hot flushes. Looking at baseline of the study, four weeks into the study and then 12 weeks compared to placebo. So it's the randomized placebo-controlled trial study and it's the first dual neurokinin 1,3 NK1,3 receptor antagonist. We already have an NK3 antagonist, afezolinatant, also known as Viosa, which hit the market in May of 2023. So it's been in use for over a year, being an excellent option at treating hot flashes, but it's nice to have additional options as well as targets that this new compound may affect. The safety profile of elizanatant in the Phase 3 OASIS-3 study looking at the long-term safety of elizanetant versus placebo, and it met all the primary endpoints demonstrating statistically significant reduction in the frequency of moderate to severe hot flashes from baseline to week 12. And this was a 52-week study and it is consistent with the previously conducted studies and the published data. So it looks like that the company is in the process of getting approval for marketing of the authorizations of Elazenatant for the treatment of moderate to severe vasomotor symptoms associated with menopause. And menopause and hot flashes are not good for your health when you're symptomatic, and so it's so nice to have expanding options in the non-hormonal as well as the hormonal options, because the more that we can individualize therapy and target symptoms and concerns of the individual woman, the more we can empower her to be strong and be healthy and be in charge, which is our motto.
Holly Thacker, MD:Speaking of hormone therapy, that might also help manage depressive symptoms. A study looked at depression and other mood-related symptoms, which we know can strike women at any age. It's more common in the 30s in women raising young children, but with prolonged perimenopause, there can be mood symptoms. Now we already know that hormone therapy is recognized as the most effective treatment option for estrogen hormonal deficiency, such as hot flashes, bone loss. But a study from February of 2024 suggested that the hormone therapy can help manage depressive symptoms, and it further documented a decent rate of depression occurring during menopause, but especially likely during and immediately after perimenopause. Especially likely during and immediately after perimenopause. And this was a study of 170 women who were seen in a menopause clinic in Ontario, canada, where 62% of the women scored positive as being depressed. And although many of these symptoms didn't quite reach the severity of what would be diagnosed as a major depressive disorder, they still can affect the quality of life, relationships and general functioning. So to date, the effectiveness of hormone therapy to manage hot flashes, technically known as VMS, vasomotor symptoms, is very well documented, but it doesn't have specific indication for mood-related symptoms. But this study, the researchers attempted to determine whether the stage of menopause contributed to an increased risk of depression. They didn't find an association, but they did find out that those who had reached lower educational attainment, like high school or less, and those of younger age at the time of symptoms did show some correlation.
Holly Thacker, MD:Interestingly, the addition of a progestin to the hormone therapy regimen did not seem to have an effect on the overall effectiveness of using hormone therapy. Clinically we certainly know some women don't tolerate certain progestins. Estrogen is more of a mood enhancer, acts as an MAO inhibitor, whereas progesterone and progestins kind of damp down the central nervous system. Sometimes it can help with sleep or anxiety, but it also can, some women, affect mood. Now, women who went through natural menopause seemed to experience significant improvement with regard to their depressive symptoms. But women who underwent what we call iatrogenic or physician-induced menopause, ie from surgery or chemotherapy, did not seem to have similar improvements. And of course that group of women many times needs to have more intensive therapy and higher dose therapy. But on the basis of this important study, the researchers concluded that hormone therapy, whether used alone or in conjunction with antidepressants, can improve not only hot flashes but also some mood symptoms associated with menopause.
Holly Thacker, MD:Now you have been listening to the Speaking of Women's Health podcast, starting season three with your host, dr Holly Thacker. I'm the executive producer of the nonprofit Speaking of Women's Health and we are talking about all the highlights of last year, the high points and what we're looking forward to in the new year. So the FDA cleared the first over-the-counter continuous glucose monitor called Continuous Glucose Monitor CGM, and the Dexacon Steloglucose Biosensor System is an integrated CGM intended for anyone ages 18 and older who does not use insulin, such as people with diabetes who are treating their condition with diet, oral medicines or just want to understand better how their lifestyle of food and exercise may impact their blood sugar. And I'm not recommending this for people who don't have any sugar issues. But I have had some patients in my practice purchase this just simply because they wanted more biometric information. So I think that focusing on and keeping track of what you're eating and how much you're exercising and what your blood pressure and pulse are and what your lab results are, maybe weighing yourself once a week or at least once a month, kind of keeping track of some of that information, as well as maybe sleep data, the quality of your sleep I would do all of that before just buying a glucose monitor if there's no diabetes in yourself or your family. But it's important to note that this sensor is not really for people that have very problematic low blood sugar or hypoglycemia, because it doesn't really alert the person to this potentially dangerous condition. It's a wearable sensor paired with an application installed on the person's smartphone or other so-called smart device to continuously measure, record and analyze and display the glucose values in those adults 18 and older who are not on insulin and who do not have problematic hypoglycemia. You can wear a sensor for 15 days before replacing it with a new one, and the blood sugar measurements trend every 15 minutes in the app and users are cautioned not to make their own medical decisions but to share the data with their healthcare clinician to make that assessment. So adverse events can include local infection, skin irritation, pain or discomfort. Certainly, we've had patients and colleagues with gestational diabetes, and it's been a big advancement for that group of women who don't want to have a baby with macrosomia or problems related to too high a sugar, and for those people that do need the feedback.
Holly Thacker, MD:The next study that we highlighted under our breaking news section was that there was a study looking at calcium and vitamin D showing that taking both of them may reduce the risk of dying from cancer. Cancer has been increasing in incidence it's the second leading cause of death in the United States but there was this concern about whether it raised the mortality for heart disease, and I actually dedicated an entire podcast last year to this study, so that is one that I would definitely suggest going back to if you've got some questions and concerns about calcium. Do you need a supplement? Maybe not Diet's best? Are you getting enough K2, also known as M7, which drives the calcium into the bones, not into your heart arteries? So the study was published in the Annals of Internal Medicine, and it found that, while women who took both supplements at the same time definitely reduced their risk of dying from cancer, there was some increase in cardiovascular disease.
Holly Thacker, MD:And this study was looking at records of more than 36,000 postmenopausal women enrolled in the infamous Women's Health Initiative, a program funded by the United States Department of Health and Human Services that has been running since 1992. So for about seven years, half the participants took 1,000 milligrams of calcium carbonate, which is about 400 milligrams of elemental calcium, and only 400 international units of vitamin D3, a form of vitamin D that humans can produce naturally if exposed to sun. The rest took a placebo. Now, if you've been a faithful listener of Speaking of Women's Health, you know from my third podcast in the first season on everything about vitamin D, which is not a vitamin, it's a pro-sterile hormone that 400 units is pitifully low. So unfortunately, this study had too much calcium and not enough vitamin D, which is not a vitamin, it's a pro-sterile hormone. That 400 units is pitifully low. So unfortunately, this study had too much calcium and not enough vitamin D.
Holly Thacker, MD:But even that little bit of vitamin D it had, it showed reductions in cancer and the study ended in 2005. And the Researchers tracked participants until December of 2020, and they found a 7% lower risk of dying from cancer compared to placebo, but a 6% chance of more cardiovascular disease than those who didn't take much calcium and not enough M7 or K2,. You're going to get calcium deposited in places besides the bone, places you don't want it. So I think you can have your cake and eat it too, although we don't recommend cake for heart disease or diabetes. But my point is you can reduce your risk of cancer and bone disease and potentially heart disease, but at least not increase heart disease, by having the right balance of calcium primarily in the diet, vitamin D at an adequate level to get your vitamin Ds at least 50.
Holly Thacker, MD:One of my pet peeves is I have patients who've had low vitamin Ds off and on for years. Who've had low vitamin Ds off and on for years fibromyalgia, joint pain, fatigue, elevated blood sugar, thin bones, more osteoarthritis, complaining about dry, brittle hair that they can't grow their hair a whole myriad of symptoms, more infection, multiple sclerosis, autoimmune conditions. And you finally get their vitamin D to a good level and then some well-meaning but uninformed healthcare person tells them you're toxic because it's just over the lab range. Well, the lab range is based on just average people. It's not necessarily optimal and lifeguards have values of 150 in the summer and levels go up and down and most people over 40 don't make very much vitamin D in their skin, so I'm not really concerned if the levels are over 125 to maybe 150. So the researchers did admit that the study had some limitations and it just showed an association, not necessarily cause and effect. It didn't uncover the formula that had the most vital link to mortality.
Holly Thacker, MD:So I try to encourage my patients to get calcium in the diet and unless you're lactose intolerant or really on a restricted diet, most people can do that. They're recommended daily allowance for calcium for women over age 50 is about 1200 milligrams, especially if the woman's not on estrogen. If she's on a good dose of estrogen and vitamin D, you can usually just in just a thousand milligrams, like three servings of a 300 milligram dose. But I think this study really underscores the need to bring in all your prescriptions, your supplements, your information about your biometrics, your diet, so that you can get the appropriate advice. And the only way to really check your calcium balance is a 24-hour urine calcium Balance is a 24-hour urine calcium.
Holly Thacker, MD:Now, a big blockbuster study that was published in April of 2024 in the Journal of Menopause, which I dedicated a whole entire podcast to. It's actually one of my most favorite podcasts that I've done, I think in part because it had a lot of medical data. So I think maybe physicians and healthcare professionals would enjoy it because it was more like a journal club, but I think we were able to convey the information so that the average woman, who doesn't necessarily have a super duper medical background, can understand. And that podcast posted last October of 2024, because October is also Menopause Awareness Month and it looked at a huge database for 13 years of almost 11 million senior United States Medicare women from the period of time 2007 to 2020.
Holly Thacker, MD:And it strongly suggested that using hormone therapy beyond the age of 65, looking at different types, routes and doses, is completely in line with the position statement of the Menopause Society that says there's no reason you have to stop hormones just because someone's over 65. It's a reasonable option to continue, particularly with indications, and, moreover, if a woman is at higher risk as she gets older for various conditions, lower doses or transdermal can be used, although that doesn't necessarily mean that's what's indicated for that individual woman. It frustrates me when well-meaning but less informed clinicians, who haven't really done maybe their due diligence in understanding menopausal hormone therapy, try to just always use the lowest dose and only transdermal and not tailor it to the individual woman. Because what other medicines you're on, what your conditions are, what your levels are, what your bone status is, what your indications, side effects and sensitivities really affect a lot of these variables, and simply going with the lowest dose and being stingy might work well for some patients, but many times not for others. So by looking at every single diagnosis code and medical visit, including the final outcome of death, the researchers concluded that, compared with never use or discontinuation of hormone therapy before the age of 65, the use of estrogen therapy beyond age 65 was associated with significant reductions in death in breast cancer, lung cancer, colorectal cancer, heart failure and even venous thromboembolism, atrial fibrillation, acute heart attack and dementia. Oh my goodness, like talk about great news.
Holly Thacker, MD:Now women with a uterus or endometrium need estrogen and some sort of progestogen, so that combined therapy was found to slightly increase the diagnosis of breast cancer not death, but diagnosis. But the risk can be mitigated using lower doses or potentially natural progesterone. But you still need to reduce the risk of endometrial cancer because if you just use estrogen you will increase the risk of endometrial cancer and using the progestin also reduced ovarian cancer and heart disease and congestive heart failure. Now the users of vaginal estrogen seemed to have the lowest mortality or the biggest reduction in mortality, and I'm not sure how much of that reflects generally that's more expensive. That might imply someone is still maybe sexually active, or it could just be that there's still some minor systemic absorption of estrogen, depending on the dose. So when I have patients who don't need or want systemic hormone therapy after 65, maybe they don't have bone loss, maybe they're on something else for their bones, maybe they don't have hot flashes, or they're on a non-hormonal option for hot flashes, or they're on another medicine that's not hormonal that still reduces hot flashes I will offer them vaginal estrogen, particularly if there's any genitourinary syndrome of menopause vaginal dryness, bladder problems, recurrent bladder infections.
Holly Thacker, MD:Speaking of which, the FDA approved a brand new treatment for uncomplicated urinary tract infections. They approved PIVIA, which is PIV-miscellinamine tablets for the treatment of female adults who have uncomplicated UTIs that may be caused by susceptible bacteria of E coli, proteus mirabilis and Staph saprophyticus. So uncomplicated UTIs are bacterial infections of the bladder in women with no apparent structural abnormality of the urinary tract, and unfortunately, half of all women experience at least one UTI in their lifetime. I've certainly had many more than one. If you have more than three in six months, you do need to be evaluated. The most common side effect of PIVIA was nausea and diarrhea.
Holly Thacker, MD:Another blockbuster study looked at brain scans that could detect estrogen activity changes during menopause, and the transition to menopause is certainly marked by progressive higher density of estrogen receptors, a measure that can remain elevated in women into their mid-60s, according to a brain imaging study led by researchers at Weill Cornell School of Medicine. So this revealed new evidence of the brain's response to the major change in life. At the brain level, the study pioneers the use of positron emission tomography, so-called PET scanning, as a tool for studying estrogen activity in the brain, which was not possible to track until now and this was published in June in scientific reports and they scanned the brains of 54 healthy women ages 40 to 65 using a PET with a tracer that binds to the estrogen receptor. And estrogen receptors are found in multiple areas of the brain, especially in women, and mediate many of the cognitive and behavioral effects of the female sex hormones, estradiol, which is the most potent form of estrogen. The estrogen PET scans have been employed in prior studies of women with cancer, but never before in just healthy women's brains. And, interestingly, the scans of women that were looked at at the different stages of menopause revealed progressively higher ER density in several estrogen-regulated brain networks in perimenopausal and postmenopausal women compared to the women that were premenopausal. So this is thought to maybe be a compensatory response. If you have less estrogen circulating, you make more receptors to try to help take care of things and have as much uptake as estrogen as possible, because that brain needs estrogen. So the researchers found that the ER density was associated not only with menopausal status but with the patient's reports of menopause-related cognitive and mood symptoms like brain fog. We see so many women complaining of brain fog, so this technique looks like it's going to be a very valuable tool for studying the brain effects of menopause and estrogen therapy and to identify potential predictors of some of these common symptoms.
Holly Thacker, MD:A central feature of menopause, unfortunately, is the lack of eggs, through primarily atresia and some ovulation, and therefore it wipes out most of the woman's estrogen and it's great to lead to cessation and menstruation. But having neuropsychiatric symptoms like brain fog, word finding difficulty, depression, increased anxiety, is not really a good thing. Who's not medical at all? He will talk about women that he previously you know maybe was working with professionally, who hit a certain stage of life and they just are in what he called a hormonal fog. Of course the fog is probably from lack of hormones, because estrogen is needed for neurosynaptic communication between the brain cells and there's some interesting research looking at what one's ApoE genetic phenotype is and which of those phenotypes seem to have better benefit with using estrogen, with a preservation of brain cognition, because dementia is such a terrible and common condition in women One in two by age 85 have dementia. June is Alzheimer Awareness Month and we have had podcasts on brain health, on symptoms of cognitive decline, on the MIND diet, which is recommended. On the MIND diet, which is recommended. So the findings that estrogen receptors, instead of disappearing, remain abundant up to a decade after menopause. Along with the findings that elevated estrogen receptor density is observed in perimenopause certainly strongly hints at a window of opportunity for hormone therapy, maybe greater than what was previously thought. So these two studies the one women using hormones after 65, and this study has definitely changed my menopausal practice in that I'm extending use, I am not being as insistent on using lower doses in transdermal and older women or saying well, you're already 10 years out, you know, maybe you're past the benefit because these estrogen receptors are still there.
Holly Thacker, MD:Another big advance was that there's a blood test for colon cancer screening. In August of 2024, us health regulators approved a first-of-its-kind blood test for colon cancer, offering another way to screen for a leading and increasing cause of cancer. March is Colorectal Cancer Awareness Month. We did a podcast on everything colon cancer and screening. If you didn't listen to that and you're over age 40, certainly over age 45, you should listen to that. So the test manufacturer, garden, said that the FDA administration approved its SHIELD test for adults 45 and older who have just average risk of colon cancer. So it's not a replacement for colonoscopy, particularly if you have symptoms or you've had prior polyps or a genetic mutation known to increase the risk of cancer. But it's nice to have a non-invasive approach to screening and physicians can order the shield for patients as a laboratory test, but the out-of-pocket price of it is $895 at the time that this was posted. Price of it is $895 at the time that this was posted, but it's expected that there'll be some insurance coverage by private and governmental insurance. So that's something to check on.
Holly Thacker, MD:And if you didn't hear the podcast in season one I think it was in the spring of 2023 on how to select your secondary insurance for Medicare, I mean, it's kind of a dry topic, but a heck of an important one. So if you or a loved one is approaching 65, where you have to sign up for Medicare Part A, even if you're still working and have private insurance, that's a really important one to listen to. I learned a lot. We also have a great podcast and a great column that you can read on how to save money on medicine, because even if you're not having any issues with cost of medicines, or you're not on very many medicines or none at all, chances are there's someone in your family or your circle that may be spending a lot more money than they need to for essential medications.
Holly Thacker, MD:So the SHIELD test looks for DNA fragments shed by tumor cells in precancerous growth and the test caught 83% of the cancers but very few of the precancerous growth found by colonoscopy the gold standard and it missed 17% of cancers. So it's about on par with other stool-based Cologuard-type tests. So besides spotting tumors, colonoscopy can help prevent the disease by removing these so-called precancerous polyps. And if you've had a polyp, even if you're told it's benign, get a copy, please, of the pathology report and keep it in your medical records, because not all benign polyps are the same and they have different predispositions to progressing to cancer. So the annual rate of US colon cancer screening is about 60%, but we would like it, 80% of eligible adults.
Holly Thacker, MD:Another study we highlighted was that a gene can cause early menopause in women and the age of menopause has a substantial effect not just on fertility but also disease risk. So this study discovered that women that were homozygous for the stop gain variant, with a long number with a minor allele frequency of about 1%, reached menopause almost a whole decade earlier than other women. Most women are between 45 and 55, with the median being 51 to 52. If you're under age 45, it's early and if you're under age 40, it's definitely abnormal and it's premature menopause, which occurs in 1% of women. So this genotype is present in about one in every 10,000 Northern European women and can lead to primary ovarian insufficiency in up to half of them. So, consequently, if you have both genes one from each parent in your so-called homozygous as opposed to heterozygous, they have fewer children and the age of their last child is about five years earlier than other women, and so having homozygosity for this CCDC201 loss of function gene has substantial impacts on your reproductive health, and homozygotes would benefit from reproductive counseling and treatment for symptoms of early menopause.
Holly Thacker, MD:Next and this is a big one and this would be something to update in my dry eye podcast that we did We've had a couple of podcasts on eyes, including one on cataract last year which is a great one to listen to with Dr Scott Wagenberg. But women over 50 frequently have dry eyes and there's now the first FDA approved treatment directly targeting the Demodex mites, and we think that these mites cause rosacea and they can affect the eyes. So a panel of experts have looked at Lotilanner ophthalmic solution, which is 0.25%, which is the first FDA-approved treatment in the eye for Demodex blepharitis, which is a highly prevalent eyelid disease that impacts approximately 25 million eye care patients in the United States. It's marketed under XDEMV and it's the first and only approved treatment to directly target those mites. The root cause of demodex blepharitis, also the cause of rosacea, and we have a great podcast on rosacea. So this demodex blepharitis impacts one out of every 12 adults and is so common, often misdiagnosed or underdiagnosed. And it can be caused by an infestation of these demodex mites, which is the most common ectoparasite found on the human skin, and it can cause redness, inflammation, missing or misdirected eyelashes, horizontal itching at the eyelid base, the presence of colorettes, which are cylindrical, waxy debris of mite waste and eggs found at the base of the eyelashes. And while Demodex follicularum are found on the skin of essentially all humans, they seem to frequently occur in greater numbers of those persons with rosacea, and there's been much debate as to whether they're increased numbers are a cause or just a result of the rosacea. But according to the National Rosacea Society, evidence seems to mount that an overabundance of demodex triggers an immune response in persons with rosacea and that the inflammation may be caused by certain bacteria associated with the mites. So that is quite a whirlwind update of kind of the top hits of 2024.
Holly Thacker, MD:And as we're coming into the brand new year 2025, ringing in the new year we are going to have many new guests. Our executive producer, lee Kleckar, is going to be interviewing an expert, dr Matthew Kampert, who was recommended by one of our senior specialized women's health fellows, dr Novick, talking about women's health and exercise. I am doing an interview with clinical geneticist Ryan Noss, talking all about genetic testing and the GINA law. We're going to have a few favorite returning guests. Uh, we're going to have a few favorite returning guests like certified nurse practitioner Dana Leslie, one of our new nurse practitioners, dr Alex um, or nurse practitioner Alex Babushkak we call her Babs, and Babs is due for her first baby, a baby girl, in January on my birthday. I'm really looking forward to that podcast.
Holly Thacker, MD:Also, my son Stetson, who has written posts on Speaking of Women's Health and is a geneticist and a molecular medicine PhD.
Holly Thacker, MD:He's out with his new podcast and I'm interviewing him about anti-aging. We also have an interesting upcoming podcast with endocrinologist and anti-aging expert, dr Christofides in Columbus, ohio, and so we have a lot of fun in store. We have recipes and social media and health calculators and treatment guidebooks, and we're on essentially every social media channel. If you don't already subscribe to us the Speaking of Women's Health channel on YouTube, the Speaking of Women's Health channel on Rumble give us a click, because then you can watch some of these interviews that we have or listen, and I just really want to profoundly thank our listeners for following us and listening to our podcast. Please give us a five-star rating, share our podcast and subscribe so you never miss a new episode, and if you have any questions or any topics that you want covered in the new year, go on speakingofwomenshealthcom on the contact us and let us know your thoughts, and we're wishing you and your loved ones a happy and healthy new year and wishing you to be strong, be healthy and be in charge.
