Women's Health Research Progress, Pitfalls, and Promise (2010) / Chapter Skim
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5 Transforming Discovery to Impact: Translation and Communication of Findings of Women's Health Research
5 Transforming Discovery to Impact: Translation and Communication of Findings of Women's Health Research
Pages 241-272
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The chapter closes with case studies of the Women's Health Initiative (WHI) , breast and cervical cancer and cardiovascular disease (CVD)
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If research findings will affect clinical practice, professional societies may develop clinical-practice guidelines. At each step, constraints associated with current practices limit the translation of findings into improved services.
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, and AHA collaborated to develop the Heart Truth campaign to increase women's awareness of their risks of heart disease (HHS, 2010)
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vaccine, which could prevent the vast majority of cervical cancers, has been slowed, in addition to concerns of parents about safety,1 because of a number of nonscientific issues. An editorial in the New England Journal of Medicine looking at the HPV vaccine highlighted the issues of access to the vaccine, high cost, and concerns focused on purported interference in family life and sexual mores (Charo, 2007)
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. Smaller decreases were seen in women in other racial or ethnic groups and in poorer areas who were less likely to have been using hormone therapy in the first place (Hausauer et al., 2009; Krieger et al., 2010)
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. For example, although research findings supported the value of breast and cervical cancer screening, many women were not being routinely screened until the Centers for Disease Control and Prevention–funded National Breast and Cervical Cancer Early Detection Program expanded coverage to low-income uninsured women (Henson et al., 1996)
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For example, the use of more sensitive tests for cervical cancer lowers the threshold for detecting cervical cancer, decreases specificity, and increases uncertainty about the likelihood of future disease and the benefits of intervention. In other words, a more sensitive test will detect abnormalities in the cervix that are less likely to develop into cervical cancer than are more advanced lesions.
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From page 248... ...
Increased investment in health research in recent times has resulted in an explosion of discoveries. However, the serendipitous nature of translation and the barriers to the adoption of new discoveries are reflected in the 15–20 years that it typically takes for discoveries to be adopted into clinical practice (Bansal and Barnes, 2008)
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Two examples are diethylstil bestrol, which resulted in a rare form of vaginal cancer in the female offspring of women who used it while pregnant (Herbst and Anderson, 1990) , and the WHI, which demonstrated that hormone therapy, which without proper trials had been in widespread use to reduce cardiovascular risk in women, was not effective in reducing cardiovascular risk and, in fact, increased the risk of breast cancer in women (Writing Group for the Women's Health Initiative Investigators, 2002)
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. One of the task force's recommendations for women aged 40–49 was that "the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms" (US Preventive Services Task Force, 2009)
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CASE STUDIES IN TRANSLATION AND COMMUNICATION The Women's Health Initiative Hormone therapy has been studied, prescribed, debated, hailed, and criticized for more than 70 years (Rymer et al., 2003)
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. The WHI was designed as a primary pre vention study that was, by many, anticipated to demonstrate the preventive effects of hormone therapy for postmenopausal women against CVD.
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Although the primary reason for hormone therapy in menopausal women is to treat for vasomotor symptoms (such as night sweats and hot flashes) , the WHI focused on primary prevention of coronary heart disease, cancer, and fractures, and relief of menopausal symptoms was not included as a major end point (Prentice and Anderson, 2008)
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, the decline in hormone therapy use was associated with exposure to newspaper coverage of the risks posed by hormone therapy. Taken together, those studies indicate that media coverage of the WHI affected women's decisions regarding continuing that therapy.
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About 3 years after women stopped taking combination hormone therapy, many of the health effects of hormones, such as increased risk of heart disease, were found to be diminished, but the risk of cancer remained elevated (Heiss et al., 2008)
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. An expert panel representing a dozen national organizations updated the 1999 guidelines in 2004 and 2007, providing clinical recommendations based on a review and evaluation of gender-specific results of clinical trials (Mosca et al., 2004a, 2007)
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. The major clinical trials that would have provided an evidentiary basis of safety, efficacy, benefit, and timing vs risk and outcomes had to yet be developed, but major organizations became engaged in the issues.
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Compared with news coverage in the 1960s, news stories increased especially in the category of "screening and diagnosis." Corbett and Mori (1999) found a lagged relationship of about 2 years between media coverage and increased breast-cancer incidence, which suggested an effect on screening behavior.
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. Following the voluntary program, state and federal legislation required facilities to meet quality standards, with all facilities requiring accreditation under the MQSA by October 1, 1994 (Destouet et al., 2005)
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. The investigators had re-examined the clinical trials that formed the basis of mammography guidelines, which were conducted in the 1980s and 1990s (Smith et al., 2004)
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. It concluded that women under 50 years old who had no familial or personal history of breast cancer should not be screened routinely, but that "the decision to start regular, biennial screen ing mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms" (US Preventive Services Task Force, 2009)
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Improved strategies for communicating research results to the public are needed. RECOMMENDATIONS • Research should be conducted on the best ways to translate research findings on women's health into clinical practice and public-health policies rapidly.
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2004. The impact of the Women's Health Initiative on discontinuation of postmenopausal hormone therapy: The Minnesota Heart Survey (2000–2002)
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2003. The hormone therapy dilemma: Women respond.
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2006. Hormone therapy after the Women's Health Initiative: A qualitative study.
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2007. Average household exposure to newspaper coverage about the harmful effects of hormone therapy and population-based declines in hormone therapy use.
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2007. Declines in invasive breast cancer and use of postmenopausal hormone therapy in a screening mammogra phy population.
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2004. Hormone therapy use after the Women's Health Initiative.
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2005. Effects of media coverage of women's health initiative study on attitudes and behavior of women receiving hormone replacement therapy.
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2008. Factors associated with obstetrician-gynecologists' response to the Women's Health Initiative Trial of combined hormone therapy.
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2005. After the Women's Health Initiative: Decision making and trust of women taking hormone therapy.
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2006. Menopausal hormone therapy in a health main tenance organization before and after Women's Health Initiative hormone trials termination.
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