NEWS 9
to improve glycaemic control * for T2D patients requiring triple oral therapy 1 †
ausdoc . com . au 8 NOVEMBER 2024
NEWS 9
‘ IUD benefits outweigh cancer risk ’
Mohana Basu LEVONORGESTREL-releasing |
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80,000 patients aged 15-49 who had started an LNG-IUS and found 40 % increased odds of breast cancer with an LNG-IUS after adjusting for age , hormonal contraceptive history and more when compared with age-matched controls .
Patients who had used hormonal contraception within five years of starting an LNG-IUS were excluded from the study .
The excess risk was not linked to duration of use , the Danish researchers added .
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Dr Sara Whitburn , chair of the RACGP Specific Interests Sexual Health Medicine group , said other studies had suggested possible but small increases in breast cancer risk with progesterone-only contraception .
But she stressed that many factors contributed to breast cancer risk .
“ Breast cancer is a complex disease , and several modifiable factors contribute to the risk .
“ As a result , any risks associated with the use of hormonal
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contraception methods should be carefully discussed and weighed against their significant benefits .
“ These researchers did not allow for other risk factors for breast cancer , including obesity , alcohol intake , nulliparity and increasing age ,” she said .
LNG-IUSs could decrease the risk of endometrial cancer and possibly cervical and ovarian cancers , she added .
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IUDs may be associated with an increased risk of breast cancer , research suggests , but a GP says the devices have significant benefits compared with their risks .
In a letter published in JAMA , researchers said levonorgestrel-releasing intrauterine systems ( LNG- IUSs ) were linked to an excess breast cancer risk of 14 cases per 10,000 women .
Their registry study looked at
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JAMA 2024 ; 16 Oct . |
Dr Sara Whitburn . |
Doctors threaten resignation
Carmel Sparke HOSPITAL psychiatrists in NSW are threatening mass resignation unless their salaries are lifted to address a pay gap they say is behind “ disastrous ” staffing shortages .
With the pay of public sector psychiatrists some 30 % below their interstate peers , 140 of the 493 psychiatry positions in the NSW state system are now vacant .
Unless low pay is fixed , psychiatrists employed by NSW Health say they will hand in their resignation on 11 November .
A letter with space for doctors ’ names — titled “ notice of resignation ” — has been sent to members of the Australian Salaried Medical Officers ’ Federation ( ASMOF ) of NSW .
“ I have decided to resign from my employment because of NSW Health ’ s failure to resource and fund its public hospitals adequately ,” the letter reads .
“ I am making this difficult decision because I believe the current conditions are severely impacting the ability to provide high-quality mental health services to the NSW public .”
Currently , psychiatrists employed by NSW Health are on the level-one pay scale , which means they are paid between $ 262,000 and $ 354,000 a year based on their seniority .
ASMOF wants psychiatrists put on the level-four scale , increasing the pay range to between $ 273,000 and $ 369,000 a year .
It is expected to have at least one more negotiation meeting with NSW Health before the 11 November deadline .
A NSW Health spokesperson said it valued the role of psychiatrists in the mental health system and had been engaged in extensive discussions with doctor groups over pay and conditions .
FORXIGA ® / DPP4i
( dapagliflozin )
Working together
to improve glycaemic control * for T2D patients requiring triple oral therapy 1 †
* SIDAPVIA ® ( 10mg / 100mg ) combines FORXIGA ® ( SGLT2i ) and sitagliptin ( DPP4i ) with distinct and complementary MOA to improve glycaemic control ( HbA1c ); 1 † SIDAPVIA ® is indicated as an adjunct to diet and exercise to improve glycaemic control in adults with T2D when treatment with both FORXIGA ® and sitagliptin is appropriate . 1 SIDAPVIA ® should be used in combination with metformin unless contraindicated or not tolerated . 1
Selected Safety Information : KETOACIDOSIS – There have been reports of ketoacidosis , including DKA , a serious life-threatening condition requiring urgent hospitalisation in patients taking dapagliflozin and other SGLT2is . Fatal cases of ketoacidosis have been reported in patients taking dapagliflozin . Appropriate precautions for DKA for patients need to be taken during treatment with SGLT2i . 1 VOLUME DEPLETION AND / OR HYPOTENSION – Dapagliflozin induces osmotic diuresis which may lead to a modest decrease in blood pressure . Caution should be exercised in patients for whom a dapagliflozin-induced drop in blood pressure could pose a risk . 1 RENAL IMPAIRMENT – SIDAPVIA ® should not be used for the treatment of diabetes in patients with eGFR persistently below 45 mL / min / 1.73 m 2 . Renal function should be evaluated prior to initiation of SIDAPVIA and periodically thereafter . 1 PANCREATITIS - There have been reports of acute pancreatitis with sitagliptin . If pancreatitis is suspected , SIDAPVIA ® should be discontinued . 1 USE WITH MEDICATIONS KNOWN TO CAUSE HYPOGLYCAEMIA - Hypoglycaemia has been observed when dapagliflozin or sitagliptin was used in combination with insulin or an insulin secretagogue . Therefore , a lower dose of insulin or the insulin secretagogue may be required when used in combination with SIDAPVIA . ® 1 The adverse events with SIDAPVIA ® are consistent with the adverse events for each component . 1
PBS Information : SIDAPVIA ® & FORXIGA ® : Authority Required ( STREAMLINED ). Type 2 Diabetes . Refer to PBS Schedule for full Authority Required Information .
NOW PBS LISTED
PLEASE REVIEW FULL PRODUCT INFORMATION BEFORE PRESCRIBING SIDAPVIA ® OR FORXIGA . ® PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ASTRAZENECA ON 1800 805 342 OR BY SCANNING THIS QR CODE .
Bioequivalence has been confirmed between the SIDAPVIA ® 10 mg / 100 mg tablet and the individual dapagliflozin 10 mg and sitagliptin 100 mg tablets after single dose administration in the fasted state in healthy subjects . 1 BP , blood pressure ; DKA , diabetic ketoacidosis ; DPP4i , dipeptidyl peptidase 4 inhibitors ; eGFR , estimated glomerular filtration rate ; HbA1c , glycated hemoglobin ; MOA , mechanism of action ; SGLT2i , sodium-glucose cotransporter 2 inhibitors ; T2D , type 2 diabetes . Reference : 1 . SIDAPVIA ® Approved Product Information . SIDAPVIA ® and FORXIGA ® are registered trademarks of the AstraZeneca group of companies . Registered user AstraZeneca Pty . Ltd . ABN 54 009 682 311 . 66 Talavera Road , Macquarie Park , NSW 2113 . www . astrazeneca . com . au . For Medical Information enquiries or to report an adverse event or product quality complaint : Telephone 1800 805 342 or via https :// contactazmedical . astrazeneca . com . AU-20534 . 2565 . September 2024 .