Contemporary OB/GYN week in review: anal cancer risk, endocrinologist referral, and more

This week at Contemporary OB/GYN®, we covered topics ranging from when to referral a patient to an endocrinologist to nontraditional causes of heart attacks. Click the links below to read anything you might have missed from Monday, September 15, to September 19, 2025.

Haluk Damgacioglu, PhD, discusses cervical cancer's link to anal cancer risk

In a recent interview with Contemporary OB/GYN, Haluk Damgacioglu, PhD, assistant professor at the Medical University of South Carolina, discussed his findings about the link between cervical cancer and future anal cancer risk.

Damgacioglu and his colleagues conducted one of the first large-scale epidemiologic studies to specifically assess the link between cervical cancer history and anal cancer risk. Their findings indicate that women with prior cervical cancer diagnoses, particularly those diagnosed 10 to 15 years earlier and currently aged 65 to 74 years, have a significantly greater risk of developing anal cancer.

The study reported incidence rates exceeding 17 cases per 100,000 person-years, a threshold used by international societies to justify screening. These results suggest that women with cervical cancer history meet criteria that warrant further investigation into targeted screening strategies.

When to refer to a reproductive endocrinologist and how to ensure a seamless handoff

While most women will have an established and likely longstanding relationship with an ob-gyn who will provide routine gynecologic and obstetric care, they likely won’t ever see a reproductive endocrinologist and infertility specialist (REI) unless there’s a problem.

Knowing when to refer starts with asking patients key questions that might go beyond the scope of routine well-woman exams. Are you considering building a family? What might that look like for you? How long have you been trying to get pregnant or build your family? How long have you been unsuccessful?

Given that female fertility starts to drop off significantly with age, patients younger than 35 who haven’t gotten pregnant after 12 months of unprotected intercourse, or patients over 35 who haven’t gotten pregnant after 6 months of unprotected intercourse, should be referred to an REI immediately.

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Oral HRT linked to increased heart risks in T2D patients

Data presented at the Annual Meeting of The European Association for the Study of Diabetes between September 15 and September 19, 2025, has indicated increased cardiovascular risk in patients taking oral hormone replacement therapy (HRT).

Prior data has indicated no significant impact of HRT on blood clot or stroke risk in women with type 2 diabetes (T2D). However, this research has unveiled a 2-fold increase in pulmonary embolism risk among T2D patients taking oral HRT vs transdermal HRT, alongside a 21% increased risk of heart disease.

“Our study suggests that up to 5 years of regulator-approved doses of transdermal HRT appears safe in a large cohort of women in midlife with T2D and that the use of HRT skin patches is not associated with an excess increased risk of cardiovascular complications,” said Matthew Anson, BSc, researcher at the University of Liverpool.

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Nontraditional causes linked to many heart attacks in younger women

Researchers from Mayo Clinic have identified factors other than clogged arteries leading to heart attacks in women aged under 65 years, publishing their findings in the Journal of the American College of Cardiology.

Nontraditional factors were linked to over 50% of heart attacks in this population, including embolism, spontaneous coronary artery dissection (SCAD), and other conditions. While women presented with fewer heart attacks than men, these patients were more likely to have their primary causes of heart attack misdiagnosed.

"This research shines a spotlight on heart attack causes that have historically been under-recognized, particularly in women," said Claire Raphael, MBBS, PhD, study author and interventional cardiologist at Mayo Clinic. “When the root cause of a heart attack is misunderstood, it can lead to treatments that are less effective—or even harmful."

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Romosozumab outperforms teriparatide and denosumab in bone strength

A recent clinical study presented by Koji Ishikawa, MD, PhD, orthopedic spine surgeon at Duke University, and Tony M. Keaveny, PhD, Founder and Chief Science Officer of O.N. Diagnostics, compared the effects of romosozumab, teriparatide, and denosumab on bone strength in patients with osteoporosis.

The analysis focused on the hip and spine, where fracture risk is particularly great. Results showed that romosozumab provided substantially greater improvements in bone strength after 1 year of treatment compared to the other 2 drugs. At the spine, for example, romosozumab increased bone density by approximately 25% but boosted bone strength by about 40%, highlighting that strength gains are not fully reflected by bone density measurements from standard DXA scans.

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