Study Assesses Risks of Cervical Cancer Outcomes for Women Exiting Screening at Age 65

Cervical cancer screening guidelines in the U.S. recommend that most women can discontinue routine screening at age 65 after receiving two consecutive negative cotests, which involve concurrent human papillomavirus (HPV) and Papanicolaou (Pap) tests. However, empirical data on cancer and mortality risks for this demographic group remain sparse. A decision analytical comparative modeling study was conducted to estimate risks of cervical cancer and associated mortality for women who meet the exit criteria. Recent study utilized four distinct models from the Cancer Intervention and Surveillance Modeling Network (CISNET) and validated them against published data on cervical intraepithelial neoplasia grade 3 (CIN3) risks from a Kaiser Permanente Northern California (KPNC) cohort.

Model Outcomes and Analysis

With attention to both age-conditional and cumulative risks of cervical cancer and cancer death, the models generated outcomes for women aged 65, 70, 75, 80, and 85 years. Following the harmonized guidelines established in 2012, which reaffirmed the exit criteria based on adequate screening, the analysis sought to delineate cancer risks for those who had shown consistent negative results.

Microsimulations and Findings

The models involved microsimulations calibrated using U.S. epidemiologic data and facilitated comparisons of cancer risk under various screening histories. The findings highlighted that the 3-year risk for CIN3 for two consecutive negative results ranged from approximately 0.035% to 0.038%, marginally exceeding published bounds from the KPNC cohort, while the 5-year risks aligned within the accepted confidence interval, reflecting an estimated incidence of 0.075% to 0.083%.

Age-Conditional Risks Evaluation

In evaluating age-conditional risks, results indicated that, while the risks were generally low across both groups, lower age-conditional risks of cervical cancer and mortality were projected for those with comprehensive screening histories compared to those with only the two negative results when exiting screening. However, one of the models (Policy1-Cervix) produced a discrepancy, predicting higher risks in certain age brackets, suggesting variability among models stemming from different assumptions about cancer progression pathways.

Cumulative Risk Projections

Cumulatively, risks of cervical cancer by age 85 were projected to be between 0.026% and 0.081%, with mortality risks also being low (ranging from 0.005% to 0.038%). Interestingly, scenarios applying lower sensitivity for cytology tests and increased HPV incidence showed a slight escalation in these risks, underscoring the complexity of HPV theory in relation to cervical cancer risk. The present findings represent the first comprehensive estimates pertaining to this specific subset of older women and reaffirm the consequential role of rigorous screening in risk management. Despite the study’s insights, limitations were noted, including potential demographic disparities in the KPNC population and constraints surrounding various screening cessation criteria. Future guidelines should consider a broader spectrum of screening cessation strategies given the persistent uncertainties surrounding HPV incidence among aging cohorts. The analysis advocates for an intricate balance between minimizing cancer risks and evaluating screening-related harms and benefits, especially in the context of competing health concerns that accompany aging women. Continued surveillance of HPV prevalence should be prioritized to inform evolving cervical screening recommendations.

Key Points

– Cervical cancer screening in the U.S. allows most women to stop routine screening at age 65 after two consecutive negative HPV and Pap tests, but data on cancer and mortality risks for this age group is limited. A comparative modeling study aimed to fill this knowledge gap.

– The study employed four models from the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate cancer and mortality risks in women aged 65 to 85, using data from a Kaiser Permanente Northern California cohort for validation.

– Microsimulations demonstrated that the 3-year risk for cervical intraepithelial neoplasia grade 3 (CIN3) after two negative tests was between 0.035% and 0.038%, with 5-year risks falling within acceptable confidence intervals, estimated at 0.075% to 0.083%.

– Age-conditional risks revealed that women with comprehensive screening histories exhibited lower cervical cancer and mortality risks compared to those who had only the necessary two negative results. However, one of the models predicted higher risks for certain age groups, indicating variability in model outcomes based on different cancer progression assumptions.

– Cumulative risk projections indicated a cervical cancer risk by age 85 of 0.026% to 0.081%, with associated mortality risks ranging from 0.005% to 0.038%. Increased HPV incidence and lower sensitivity in cytology tests were associated with slight increases in these risks.

– The study acknowledged demographic disparities in the data and the need for future guidelines to account for varied screening cessation strategies, emphasizing the importance of balancing cancer risk reduction with the assessment of screening-related benefits and harms in aging populations. Ongoing monitoring of HPV prevalence is crucial for adapting cervical screening recommendations.

Reference –

Shalini L Kulasingam et al. (2025). Estimated Cancer Risk In Females Who Meet The Criteria To Exit Cervical Cancer Screening. *JAMA Network Open*, 8. https://doi.org/10.1001/jamanetworkopen.2025.0479.

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Glucocorticoid-Induced Adrenal Insufficiency rare after Prednisolone Cessation in polymyalgia rheumatica and giant cell arteritis: JAMA

Researchers have discovered in a new study that glucocorticoid-induced adrenal insufficiency (GIAI) was rare (1.9%) in patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) two or more weeks after stopping prednisolone, based on the 250 μg short corticotropin test . However, one-third of patients had symptoms of adrenal insufficiency despite normal SST results and showed lower basal cortisol levels. These findings highlight the need for better diagnostic and therapeutic tools, as well as future randomized clinical trials incorporating both physician- and patient-reported outcomes. The study was conducted by Simon B. and fellow researchers.

This cross-sectional multicenter study was performed at three hospitals in Denmark as part of an ongoing randomized clinical trial. Data on clinical, demographic, and treatment characteristics were obtained at baseline between March 2021 and March 2024. All 267 participants had a diagnosis of PMR and/or GCA and had their axes evaluated a median of 39 days after pre-planned withdrawal of prednisolone. Participants were taking prednisolone at baseline for a median duration of 13 months.

The primary outcome was the prevalence of GIAI, evaluated using a short corticotropin stimulation test (SST) (0.25 mg). Although there is no established threshold for adrenal insufficiency in this situation, participants with a baseline cortisol level <420 nmol/L at 30 minutes after the SST were defined to have adrenal insufficiency. The second outcome was to evaluate if participants had GIAI and were symptomatic using a questionnaire assessing quality of life in addisonian patients (AddiQol-30). Finally, both body composition and muscle function were evaluated, as these factors may be more direct measures of health than biochemistry findings.

Key Findings

  • Prevalence of GIAI: Only 5 of the 267 patients met criteria for GIAI (1.9%; 95% CI, 0.8%-4.3%), suggesting GIAI is rare after steroid withdrawal.

  • Prevalence of symptoms: Despite low prevalence of GIAI, there were 75 patients (34%; 95% CI, 28%-41%) that were symptomatic, identified via an AddiQol-30 score <85 (in this cohort, the AddiQoL-30 score is a measure of symptomology and health status).

  • Cortisol levels: Symptomatic participants had significantly lower baseline cortisol levels compared with asymptomatic participants (263 nmol/L; 95% CI, 242-283 nmol/L vs 309 nmol/L; 95% CI, 295-324 nmol/L, p<0 .001).

  • Associated factors: Symptoms of adrenal insufficiency were more prevalent in women (PR, 1.68; 95% CI, 1.13-2.51) and were associated with increased body fat percentage (PR, 2.33; 95% CI, 1.21-4.50), reduced hand grip strength (PR, 2.71; 95% CI, 1.44-5.10), and a low Short Physical Performance Battery score (PR, 2.78; 95% CI, 1.42-5.42).

The current study suggests that GIAI is uncommon among patients who have PMR or GCA after stopping prednisolone and lends credence to a selective strategy of evaluating persons with symptoms rather than universal testing. However, the high frequency of symptoms consistent with adrenal insufficiency does present clinical difficulties regarding steroid cessation and emphasizes the necessity of research to enhance patient management in the future.

Reference:

Hansen SB, Dreyer AF, Jørgensen NT, et al. Changes in Adrenal Function and Insufficiency Symptoms After Cessation of Prednisolone. JAMA Netw Open. 2025;8(3):e251029. doi:10.1001/jamanetworkopen.2025.1029

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Individuals with COPD and frailty have increased risk of dyspnea and exacerbations: Study

A new study published in the journal of BMC Pulmonary Medicine showed that dyspnea (mMRC score 1.67), symptom load (CAT score 10.24), and exacerbations were considerably greater in frail patients with chronic obstructive pulmonary disease (COPD).

Frailty is a multifaceted condition marked by a build-up of physiological deficiencies that lead to a loss of functional, cognitive, and physical reserves. A person is more susceptible to health stresses, including falls, hospital stays, and acute flare-ups of chronic illnesses, when frailty is present and worsens. 

Despite the underlying causes of frailty are many, they share characteristics with those of COPD, including endocrine dysregulation, decreased muscle mass and function, and chronic systemic inflammation. To learn more about the relationship between frailty and clinical outcomes for individuals with COPD, Mathew Cherian and team conducted a systematic review and meta-analysis of the literature.

This study reviewed MEDLINE, Cochrane Central, EMBASE, CINAHL, and Web of Science for observational studies assessing the relationship between frailty and clinical outcomes in people with COPD. The included studies evaluated dyspnea, symptom load, health-related quality of life, exacerbations, hospitalization, or death between frail and non-frail patients, diagnosed COPD by spirometry, and employed a validated frailty assessment instrument. 

7 of the 16 studies which represented a total of 5903 individuals were included in the meta-analyses out of the 1,385 identified studies. 50% of the included studies employed the Fried Frailty Phenotype assessment. Pooled estimates showed that frail individuals with COPD experienced increased dyspnea ratings, a greater burden of symptoms, and more COPD exacerbations during the previous year when compared to non-frail individuals. Frail vs. non-frail COPD patients had a higher mortality risk, according to the biggest research with the longest follow-up duration.

Overall, the patients who are frail have higher rates of hospitalizations, exacerbations, symptom load, and dyspnea when compared to COPD patients who are not weak. Frailty should be seen as a therapeutic feature because it is a strong predictor of outcomes for individuals with COPD.

Reference:

Cherian, M., Masoudian, P., Thavorn, K., Sandoz, J., Shorr, R., & Mulpuru, S. (2025). The impact of frailty on clinical outcomes among individuals with COPD: a systematic review and meta-analysis. BMC Pulmonary Medicine, 25(1), 146. https://doi.org/10.1186/s12890-025-03595-z

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Poor oral health linked with body pain and migraines in women in new study

New research from the University of Sydney has revealed poor oral health is significantly associated with higher instances of migraines, abdominal and body pain in women.

Published in Frontiers in Pain Research, the world-first study identified specific oral microbes correlated with certain pain conditions, suggesting a potential relationship between the oral microbiome and the nervous system.

The findings highlight the importance of good oral health to potentially mitigate pain and improve overall wellbeing, prompting further exploration into the role of oral microbiota in chronic unexplained pain conditions. This includes fibromyalgia, a condition experienced by 67 percent of the study participants.

“This is the first study to investigate oral health, oral microbiota and pain commonly experienced in women with fibromyalgia, with our study showing a clear and significant association between poor oral health and pain,” said lead investigator Associate Professor Joanna Harnett from the Faculty of Medicine and Health.

“Our findings are particularly important to fibromyalgia which, despite being a common rheumatological condition, is often underrecognised,” said first author and PhD candidate in the Faculty of Medicine and HealthSharon Erdrich.

“Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, and headaches including headaches, as well as fatigue, sleep disturbances, and cognitive problems.”

How the research worked

The research examined associations between self-reported oral health, the oral microbiome, and various pain presentations in a group of New Zealand women with and without fibromyalgia.

Oral health was assessed using the WHO oral health questionnaire and evaluated against body pain, headaches, migraines, and abdominal pain using validated instruments, including the Short-form 36 (which measures quality of life), the International Headache Society headache survey and the functional bowel disorder severity index. Strong associations were evident between oral health scores and pain and each of these were associated with specific microbes found in the mouth, which were assessed using advanced genomic technology.

Participants with the poorest oral health were more likely to suffer from higher pain scores: 60 percent were more likely to experience moderate to severe body pain, and 49 percent were more likely to experience migraine headaches. Lower oral health was a statistically significant predictor of frequent and chronic migraine.

Four oral microbial species from the Dialister, Fusobacterium, Parvimonas and Solobacterium genera were significantly associated with pain after age, BMI and added dietary sugars were considered.

A weak but significant inverse correlation with diet quality and oral health was also found, though the researchers note this has yet to be investigated in detail.

The Australian Dental Association recommends regular oral hygiene appointments and dental health checks, in addition to twice daily teeth brushing and flossing. 

Reference:

Sharon Erdrich, An association between poor oral health, oral microbiota, and pain identified in New Zealand women with central sensitisation disorders: a prospective clinical study, Frontiers in Pain Research, https://doi.org/10.3389/fpain.2025.1577193

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Resistance exercise may be best type for tackling insomnia in older age: Study

Resistance or muscle strengthening exercise, using weights or the body itself, may be the best type of exercise for tackling insomnia in older age, suggests a pooled data analysis of the available research, published in the open access journal Family Medicine and Community Health.

Aerobic exercise or a mix of strength, aerobic, balance, and flexibility exercises also seem to be effective, the analysis indicates.

Sleep quality tends to decline with age. And up to 1 in five older adults has insomnia, say the researchers. Poor quality sleep is not only linked to a range of serious health problems and cognitive impairment, but it also increases the likelihood of workplace underperformance and absenteeism, they add.

Previously published research suggests that exercise helps to alleviate the symptoms of insomnia, but it’s not clear which type of exercise might be most helpful.

In a bid to find out, the researchers scoured research databases for relevant clinical trials, published up to October 2022 that compared physical exercise with routine activities, usual care, other non-physical activity, or health education in people formally diagnosed with insomnia, using The Global Pittsburgh Sleep Quality Index (GPSQI).

The types of exercise covered by the studies included: aerobic, such as cycling, dancing, swimming, brisk walking, and gardening; resistance, such as using weights, push-ups, and planks; balance, such as step-ups, heel to toe walking; flexibility, such as gymnastics, yoga, and Pilates; and combination exercise encompassing a mix.

Twenty four studies, involving 2045 adults aged at least 60 (average 70), were included in the pooled data analysis. Most were carried out in Asia (56%), North America (16%), South America (16%), and Europe (12%). One in five were carried out in nursing homes.

Over half of the reported exercise intensity was mild to moderate and moderate, with average length of a session just over 50 minutes, and frequency around 2 to 3 times a week. On average, the exercise programmes lasted 14 weeks.

The pooled data analysis included only studies looking at combination exercise and aerobic exercise, because there weren’t enough studies covering the other exercise types.

This analysis showed that combined exercise significantly improved the GPSQI by 2.35 points while aerobic activity improved it by 4.35 points.

When the data were pooled using a network meta analysis–a statistical method that looks at several different ‘treatments’ and combines both direct and indirect effects-strength/resistance exercise was the most effective, improving the GPSQI by 5.75 points.

Aerobic exercise improved the GPQSI by 3.76 points, while combination exercise improved it by 2.54.

Of the comparators, sleep education was the most effective, although what this entailed wasn’t clearly defined in the included studies, and it still wasn’t as good as muscle strengthening/resistance exercise, the analysis showed.

The researchers caution that the design and methodology of the included studies varied considerably, and only a few looked at particular types of exercise. Several didn’t include any information on exercise intensity either.

Some exercises may prove challenging for older people because of restricted physical capabilities, suggest the researchers. But they nevertheless conclude that: “Exercise, particularly strengthening exercise and aerobic exercise, is beneficial for enhancing subjective sleep quality at a clinically significant level compared with normal activities.”

Reference:

Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomised controlled trials Doi: 10.1136/fmch-2024-003056.

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Batch of Telma AM earlier classified as NSQ now flagged as Spurious

New Delhi: Through a recent revised Drug Alert for January 2025, the Central Drugs Standard Control Organisation (CDSCO) has classified a batch of TELMA AM as Spurious. The batch was earlier classified as Not of Standard Quality (NSQ).

Medical Dialogues team had reported that 93 drug formulations were declared as Not of Standard Quality (NSQ) in January 2025, based on testing conducted by various State Drug Control Authorities. Among these was a batch of TELMA AM (Batch No. 5240367), listed under Glenmark Pharmaceuticals Ltd., Solan (H.P.), which was flagged by the State Drugs Testing Laboratory, Kolkata for “not conforming to I.P. standards.”

Also Read: 93 Formulations Declared Not of Standard Quality as per Data Provided by States: CDSCO Drug Alert

However, the same batch has now also been classified as “purportedly spurious” in CDSCO’s revised alert, with Glenmark informing that it did not manufacture this batch.

The batch in question — Batch No. 5240367, with a manufacturing date of March 2024 and expiry of February 2027 — carries Glenmark’s name on the label. However, the company has officially clarified that it did not manufacture this particular batch.

“The actual manufacturer (as per label claim) has informed that the impugned batch of the product has not been manufactured by them and that it is a spurious drug,” the CDSCO stated in its revised alert.

The matter is now under active investigation. While the product is currently listed as “purportedly spurious,” the final classification will depend on the outcome of the ongoing inquiry.

Drug Alert for the Month of January–2025 (Revised)

List of Drugs, Medical Devices, Vaccine and Cosmetics declared as Not of Standard Quality/Spurious/Adulterated/Misbranded for the Month of January– 2025 (Revised)

S.

No

Name of

Drugs/medical device/cosmetics

Batch No.

Date of Manufacture

Date of Expiry

Manufactured by

Reason for failure

Drawn By

Firm’s reply

Remarks

79.

TELMA AM

5240367

Mar-24

Feb-27

Under

Investigation

Does not confirm to I.P.

–

The actual manufacturer (as per label claim) has informed that the impugned batch of the product has not been manufactured by them and that it is a spurious drug.

The product is

purported to be spurious,

however, the

same is subject to outcome of

investigation

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Is increased sleepiness in 80s tied to higher dementia risk?

A study in Neurology, led by Yue Leng, PhD, and Sasha Milton, followed the sleep patterns of 733 older female participants to see if specific patterns of change were associated with a higher risk of dementia. The participants, whose average age was 83, were monitored by wrist devices that track movement and time spent asleep. They had normal cognition at the start of the study.

At the end of the study, five years later, 13% had developed dementia. This included 25 participants (8%) with stable sleep patterns, 39 (15%) with declining nighttime sleep patterns and 29 (19%) with increasing sleepiness. After adjusting for factors like age, education, diabetes and hypertension, those with increasing sleepiness had double the risk of the stable sleepers.

This study is one of the first to look at how sleep patterns change over time and relate to dementia risk. It adds to a body of recent UCSF-led research that shows poor sleep quality in midlife, delayed dream phase and extended napping are linked to a higher risk of dementia.

It is unknown if worsening sleep increases the risk of dementia or if dementia leads to worsening sleep. Some scientists believe both theories may be correct. 

Reference:

Sasha Milton, Clémence Cavaillès Five-Year Changes in 24-Hour Sleep-Wake Activity and Dementia Risk in Oldest Old Women, https://doi.org/10.1212/WNL.0000000000213403

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Sex Hormones Increase Endometrial Cancer Risk in Postmenopausal Women: Study

Researchers have identified in a new study that high levels of circulating sex hormones have a greater risk of endometrial cancer (EC) in postmenopausal women but a lower risk with high levels of sex hormone-binding globulin (SHBG). The study was conducted by Pengfei Z. and fellow researchers published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

Endometrial cancer, a prevalent gynecologic malignancy, is recognized as hormonally sensitive. Although endogenous sex hormones like estrogens and androgens have long been suspected to play a role in EC risk, results from different studies have been inconsistent. This new meta-analysis sought to combine the evidence regarding the association between several circulating sex hormones such as estrogens, androgens, and SHBG and EC risk, with specific emphasis on postmenopausal women where the hormonal alterations are more significant and the risk for EC is elevated.

The authors performed systematic searches in the PubMed, Web of Science, and Scopus databases to find relevant observational studies. Sixteen included studies were identified as eligible in the final analysis, and they had data that were pooled through a random effects model. The strength of association between hormone level and risk for EC was analyzed using odds ratios (ORs) and 95% confidence intervals (CIs). There was also an analysis of the non-linear dose–response association and the test of the effects of possible modifiers including age, menopausal status, type of cancer, study design, geographic location, and levels of covariate adjustments.

Key Findings

Strong and statistically significant associations between increased levels of certain endogenous hormones and increased EC risk were identified by the meta-analysis:

  • Total testosterone: OR 1.70 (95% CI not reported)

  • Free testosterone: OR 1.75

  • Dehydroepiandrosterone sulfate (DHEAS): OR 1.39

  • Androstenedione: OR 1.58

Estrogens also showed strong associations with increased EC risk:

  • Estrone: OR 1.55

  • Unconjugated estrone: OR 1.86

  • Estradiol: OR 1.38

  • Unconjugated estradiol: OR 2.14

  • Estriol: OR 1.75

  • Unconjugated estriol: OR 1.99

  • Conjugated estrogens had no marked association with EC risk, implying that the type of estrogen can be very important.

This comprehensive meta-analysis results in the determination that higher endogenous sex hormone levels both androgens and estrogens are predictive of a markedly elevated risk for endometrial cancer in postmenopausal women. Higher levels of SHBG, conversely, would decrease the risk for EC. These results point toward hormone profiling as a worthwhile adjunct to risk assessment for EC and highlight an increased need for monitoring in women postmenopausal with a heightened level of hormones.

Reference:

Zhu, P., Ren, J., Sun, J., Geng, J., Wang, H., & Ma, M. (2025). The association of endogenous sex hormones with endometrial cancer risk: A systematic review and meta-analysis. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 113997, 113997. https://doi.org/10.1016/j.ejogrb.2025.113997

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Which are Effective options for Prevention of postoperative nausea and vomiting in Thyroidectomy Patients?

Postoperative nausea and vomiting (PONV) represent a major concern in surgical patient care, with incidence rates as high as 30% for the general population and reaching 80% in high-risk groups. Despite existing effective protocols for the management of PONV in the operating room and post-anesthesia care units (PACUs), gaps usually arise when patients transition to wards or intensive care units (ICUs), leading to prolonged recovery periods, increased healthcare costs, and diminished patient satisfaction. To tackle these issues, a novel continuum-based PONV prophylaxis protocol (CBPPP) has been developed, accompanied by a checklist for practical application in clinical settings. The formulation of the CBPPP began with a systematic review of existing guidelines, systematic reviews, meta-analyses, and primary research on PONV prevention. Recent review leveraged extensive databases including PubMed, Cochrane Library, Scopus, and Embase, emphasizing studies from the last decade to ensure contemporary relevance. Contributions from the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting greatly aided the understanding of effective antiemetic pharmacotherapy and perioperative interventions.

Data Synthesis and Collaboration

Data synthesis was meticulously undertaken to map PONV risk factors, evaluate antiemetic strategies, and explore adjunct measures for both intraoperative and postoperative care. This process enabled the development of tailored stratified approaches specific to varying risk profiles among surgical patients. The protocol emerged from collaboration with a multidisciplinary team consisting of anaesthesiologists, surgeons, and clinical pharmacologists. The feedback gathered from this team emphasized critical aspects such as practicality, feasibility, and potential implementation barriers, which were addressed in the final protocol draft.

Structure of CBPPP

CBPPP is structured in four pivotal phases: preoperative, intraoperative, PACU, and postoperative. During the preoperative phase, a thorough risk assessment is conducted, utilizing established criteria such as the Apfel score, which encompasses risk factors like gender, smoking status, history of PONV or motion sickness, and opioid use. Adequate prophylaxis planning is critical, paving the way for a structured approach to managing potential PONV occurrences.

PACU Phase Recommendations

In the PACU phase, the protocol encourages immediate reassessment of the patient’s response to antiemetics upon arrival. A key recommendation includes monitoring for nausea and vomiting within the first 24 hours post-surgery and adjusting prophylactic measures accordingly. This immediate feedback loop is vital for optimizing patient care and minimizing the risk of PONV.

Need for Validation

The development of this protocol does not negate the need for further validation; prospective studies and randomized controlled trials are necessary to adequately evaluate the efficacy and feasibility of the CBPPP in real-world settings. The introduction of a supporting checklist is intended to facilitate the practical application of the protocol within clinical workflows, promoting a standardized approach to PONV prophylaxis.

Goals of CBPPP

Ultimately, the continuum-based PONV prophylaxis protocol aims to enhance patient outcomes significantly, improve recovery times, and increase overall patient satisfaction. This structured and evidence-based approach underscores the commitment to addressing the challenges of PONV management throughout the perioperative continuum, signaling a step towards improved surgical patient care.

Reference –

Singh MP, Gupta A, Bhardwaj S. Continuum based postoperative nausea and vomiting prophylaxis protocol: Development and real world implementation checklist. Indian J Anaesth 2025;69:402-5

Y. Cho et al. (2021). Pharmacologic Interventions For Postoperative Nausea And Vomiting After Thyroidectomy: A Systematic Review And Network Meta-Analysis. *PLoS ONE*, 16. https://doi.org/10.1371/journal.pone.0243865

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Vitamin D Key Player in Colorectal Cancer Prevention Through Immune Regulation and Inflammation Control, Review Reveals

Hungary: A recent review published in Nutrients suggests that higher vitamin D levels may significantly reduce the risk of colorectal cancer (CRC), with some studies showing up to a 58% reduction in risk. By analyzing 50 previous studies, the review emphasizes vitamin D’s role in preventing CRC by reducing inflammation and promoting cancer cell death. These effects are crucial for both CRC prevention and management.

However, the researchers stress the need for large-scale trials to determine optimal vitamin D dosages and to better understand the underlying mechanisms. Given the widespread vitamin D deficiency, particularly in areas with limited sunlight, increasing intake through vitamin D-rich foods or supplements could be a beneficial strategy to reduce CRC risk.

Vitamin D, synthesized in the skin through UV-B exposure, plays a vital role in calcium and phosphorus homeostasis. Beyond this, it modulates the immune system, reduces inflammation, induces apoptosis, and supports anti-angiogenesis. Available in two forms—D3 (from animal sources) and D2 (from plants)—D3 is more potent. The active form, 1,25-dihydroxyvitamin D, regulates key physiological processes and has anti-inflammatory and anti-carcinogenic effects, making it essential in preventing diseases like colorectal cancer.

Mónika Fekete and colleagues from the Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary, explored the physiological functions and anti-cancer properties of vitamin D, particularly in CRC. Their review also addresses the global prevalence of vitamin D deficiency and evaluates clinical trials assessing the impact of vitamin D supplementation on CRC outcomes.

In the review, researchers sifted through over 10,000 studies on colorectal cancer and vitamin D, narrowing it down to 50 after filtering out duplicates and irrelevant studies. The selected studies involved adult human participants with colorectal cancer, its precursors, or vitamin D deficiency, and those who received vitamin D supplementation.

Key Highlights:

  • Vitamin D supports various bodily functions, including nerve cell communication, blood pressure regulation, and prevention of respiratory infections.
  • It is important in maintaining gut health, thyroid hormone levels, blood sugar regulation, and mitigating aging effects.
  • Vitamin D acts as an antioxidant, reducing inflammation, suppressing autoimmune responses, and supporting immune cell function.
  • Previous research highlighted vitamin D’s ability to inhibit uncontrolled cell growth, angiogenesis (new blood vessel formation), and promote apoptosis in abnormal cells.
  • Vitamin D deficiency is strongly linked to an increased risk of colorectal cancer, as it exacerbates intestinal inflammation, promoting cancer progression.
  • A meta-analysis of 31 studies found that those with the highest vitamin D intake (80 ng/mL) had a 25% reduced risk of colorectal cancer compared to those with the lowest intake (10 ng/mL).
  • The Nurses’ Health Study showed that women with the highest vitamin D intake had a 58% reduced risk of colorectal cancer compared to those with the lowest intake.
  • The Iowa Women’s Health Study found that high calcium and vitamin D intake reduced colorectal cancer risk by about 50%.
  • The Spanish PREDIMED study and studies using vitamin D supplementation showed similar protective effects.
  • Vitamin D supplementation reduced the likelihood of polyp development by 33% and the risk of high-risk adenomatous polyps by 43%, according to a Canadian study.
  • Vitamin D is crucial in preventing and treating colorectal cancer by reducing inflammation, regulating immune responses, promoting cancer cell death, and inhibiting tumor growth.
  • For individuals with colorectal cancer, vitamin D may improve survival rates and reduce mortality.

Overall, the findings emphasize vitamin D’s vital role in preventing and treating colorectal cancer by influencing cancer cell proliferation, inflammation, and apoptosis, as well as the activity of the Sirtuin protein family.

“While recent studies highlight the importance of maintaining optimal vitamin D levels to reduce CRC risk and improve treatment outcomes, they also reveal limitations, such as the inability to define the exact mechanisms of vitamin D’s protective effects,” the authors stated. They concluded, “This emphasizes the need for more large-scale randomized clinical trials to determine optimal dosages and formulations for therapeutic use.”

Reference:

Fekete, M., Lehoczki, A., Szappanos, Á., Zábó, V., Kaposvári, C., Horváth, A., Farkas, Á., Major, D., Lipécz, Á., Csípő, T., & Varga, J. T. (2024). Vitamin D and Colorectal Cancer Prevention: Immunological Mechanisms, Inflammatory Pathways, and Nutritional Implications. Nutrients, 17(8), 1351. https://doi.org/10.3390/nu17081351

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