Very bad!...Kogi State University is in the news for unpleasant reasons as lesbian s*x videos involving students of the university recently emerged on the campus.
Some of the students involved are those of Economics and English Education departments.
The two students in one of the videos monitored by Vanguard, revealed how deep the culture of lesbianism had infiltrated the female hostels in the school.
One of the students is considering leaving the school to avoid possible stigmatization as the videos
had gone viral.
A female student in the Department of Zoology who craved anonymity, told Vanguard that lesbianism was becoming a big issue in the university.
She said young, fresh undergraduates were lured into the immoral club as many of them do not know what was in it before joining the lesbian ring.
“Kogi State University is fast becoming the comfort zone for lesbians. Many Jambites are lured into the ring because they don’t even know what it is all about.
What they do now is to relocate off-campus in order to enjoy the privacy needed for their illicit and immoral act. Once in it, it is so difficult to renounce because lesbians share a lot of gifts to keep victims in it.
The authorities of this school may need to take drastic steps to restore the moral integrity and discipline for which we were known,” she said.
When Vanguard got in contact with one of the lesbians, she said she was lured into lesbianism in her first week on campus by a very wealthy 300 student.
She said she was not aware that their sex escapades were recorded, threatening to quit the university in order to save the integrity of her family.
“My attention was drawn to the video in circulation by one of my friends. When I watched it, I knew that was the end of my stay in this school.
Many of my course mates already have the video, so it will be difficult for me to continue my academic programme because of possible stigmatization. I have brought shame to myself and my family,” she lamented.
Although the school authorities are yet to release an official statement on the scandal, sources close to the authorities said investigations into the issue of lesbianism among the students had commenced.
A SUV travels on a glass bridge during a load testing at the Grand Canyon of Zhangjiajie, central China's Hunan Province, June 25, 2016. The bridge is 430 meters long, six meters wide and 300 meters above the valley.A SUV travels on a glass bridge during a load testing at the Grand Canyon of Zhangjiajie, central China's Hunan Province, June 25, 2016. The bridge is 430 meters long, six meters wide and 300 meters above the valley.
An angry mob tied two cable thieves to the fence of a transformer in a village at the Gwagwalada area council. The dramtatic incident occurred on Wednesday night after the two men were caught stealing cables from a tranformer which had just been installed on the outskirts of the village.
Unfortunately for the cable thieves, a security guard alerted passersby as a mob quickly gathered at the scene of the crime. The mob then decided to tie both men up at the scene of their crime before handing them to men of the Nigerian Security and Civil Defence Corps (NSCDC) at Gwagwalada
The Lagos State Government, LASG has harped on the need to make Yoruba Language a compulsory teaching subject in all schools in the state.
The state Governor, Akinwunmi Ambode, represented by his deputy Dr. Idiat Oluranti Adebule, made this known on Thursday at a stakeholders’ forum organised by the state House of Assembly at Academy hall, Agidingbi, Ikeja.
He said the state had concluded plans and that the subject will be taught in primary schools and junior secondary school, JSS 3 across the state.
The Governor, who expressed reservations that government’s previous efforts at making the teaching of the language compulsory in all schools in the state were being frustrated by proprietors of private schools, noted that it was important for children not only to learn the language of their environment, but also the culture and the people’s general way of life.
“It is very important for every Yoruba child to be able to speak the language very fluently, enriched with adequate cultural norms of the people so as to guarantee a responsible life in the future.
“the state government equally noted that the imposition of western culture and language on Nigerian children has done a lot of damage to the rich local cultural heritage of the Yoruba people,” he said.
Ambode expressed optimism that the State House of Assembly will do the needful to make the dream come to reality even as he commended the members for their efforts at ensuring that Yoruba language is not relegated to the background.
He noted that their effort would further help the state government in the implementation of its policy on the teaching of Yoruba language, adding that the House would help make the appropriate legislation that would back up government’s efforts at making Yoruba language a compulsory subject across all schools in the state.
The Federal Ministry of Education will convene a meeting with vice-chancellors, admission officers, and other stakeholders to discuss processes for the post-Unified Tertiary Matriculation Examination (UTME).
Dr Folashade Yemi-Esan, the Permanent Secretary, Federal Ministry of Education made this known while speaking with the News Agency of Nigeria (NAN) on Wednesday in Abuja. According to her, the meeting will hold next week.
The Minister of Education, Malam Adamu Adamu, had recently scrapped the post-UTME test “As far as I am concerned, if the nation has confidence in what JAMB is doing, the universities should not be holding another examination.
“If the universities have any complain against JAMB, let them bring it and then we address it.
“But if JAMB is qualified enough to conduct tests and they have conducted test, then there will be no need to conduct another test for students to gain admission,” Adamu had said.
According to Mrs Yemi-Esan, the minister had made a pronouncement which should be complied with.
“The responsibility is now on us to give them guidelines and modalities on how to go about what the honourable minister has said.
“There is no written directive but all the stakeholders were at that meeting where the minster said it openly.
“There is going to be a meeting of the all the vice-chancellors and admission officers sometime next week to work our modalities,” she said.
The National Drug Law Enforcement Agency (NDLEA), has arrested 156 drug traffickers in various communities raided by the agency in Anambra State.
The NDLEA Commander in the State Mr. Sule Momodu, who said this at a press conference, on Thursday said that the offenders were apprehended between January and May, 2016.
He noted that those arrested included 146 males and 10 females.
He said that within the period under review, the agency seized drugs weighing 923kg and three ehicles, noting that 65 out of the 156 suspects arrested were charged to court.
The NDLEA boss commended Governor Willie Obiano for being of tremendous help which, according to him, had propelled the agency to accomplish a number of feats, but regretted that the lack of operational vehicles had continued to limit their achievements.
Cameron who was a staunch supporter of the ‘Remain’ position will see the crucial vote to leave the EU as a sign of his increasing unpopularity. He has announced that ‘fresh leadership’ will be required’ and he disclosed that he will quit his position as Prime Minister in October.
His acceptance of the referendum was grudging as he said, “The British people have voted to leave the European Union and their will must be respected, The will of the British people is an instruction that must be delivered.”
With more than 30 million people voting, 51.9% decided in favor of leaving the EU, making Britain the first country to leave the organization since its formation.
Following a petition from a group called Adamawa Awareness for Change, The Economic and Financial Crimes Commission began an investigation into allegations of fraud in Adamawa state.
The subjects of the investigation were Ja’afaru Maliki, an aide to former governor of Adamawa State, Murtala Nyako, along with Vwapamkai Bafyau, director of Rural Access Mobility Project/World Bank; Farouk Abdullahi Tarja, director, Civil Works; James Zarma and Suleiman Mohammed, both deputy permanent secretaries, and Mamman Malgwi, a permanent secretary.
Following investigation, the EFCC arraigned them before Justice Balkisu Aliyu of a Federal High Court, Yola, Adamawa State on June 22, 2016.
The defendants are facing nine-count charges bordering on procurement fraud and diversion of funds to the tune of N700 million. The funds were meant for the development of the Yola bye-pass Phase 1 road project awarded to Nasser & Associate Global International Limited.
Nigeria’s FIFA under 17 world cup winner Kelechi Nwakali has signed for Arsenal football club on a 5 year deal.
Kelechi who captained the Golden Eaglets to victory at the tournament announced on Facebook yesterday that he had agreed a move to the Emirates.
Nwakali’s transfer has been in the works since January, when he visited current Gunner’s boss Arsene Wenger at the Emirates Stadium while Vardy Turns Down Arsenal Offer
He had been ineligible for a transfer due to FIFA regulations on signing youth players from other countries.
The impending transfer was recently concluded because he turned 18 this month and the midfielder posted a picture of himself holding an Arsenal shirt with his name on the back
In his keynote address at the “First National Judicial Round table on The Intersection between Law and Religion” at the National Judicial Institute, Abuja on Monday, Osinbajo averred that the protection of freedom of worship and the practice of one’s beliefs was crucial especially in a democratic society.
“Those laws according to the Nigerian Constitution where they restrict freedom of worship, must be reasonably justifiable in a democratic society in the interest of defence, public safety, public order, public morality or public health.
“Or for the purpose of protecting the rights and freedom or other persons. “It is this test that restrictive laws should satisfy every law that seeks to restrict religious freedom, that is, is this legislation reasonably justifiable in a democratic society for the protection of one of the listed public goods?
“The crucial question with respect to such laws is whether they should be allowed to exercise prior-restraint?
“For example should there be licensing of places of worship or the dissemination of religious information? Or should the laws punish offending conduct when it occurs, such as the dissemination of hate speech?
“Is it reasonably justifiable in a democratic society to make laws that restrict freedom of speech by the fact that it says you must seek permission before you can make certain types of public utterances?”
Osinbajo noted that prior-restraint “is open to abuse, will unduly restrict freedom of worship and is probably unconstitutional”.
He acknowledged that freedom of speech is not only a fundamental right (in its own right) but it is also the vehicle for the realisation of other rights.
However, Osinbajo said that the laws must be enforced to punish offensive conduct such as the dissemination of hate speech or the perpetration of unlawful acts under the guise of religious beliefs. The vice president emphasized that courts must be more careful to maintain their neutrality in the trial of such matters
The naira appreciated by 31 per cent to 288.85 against the United States dollar on Monday at the close of trading at the newly established interbank market.
The local currency also depreciated at the parallel market where it closed at 346 to the greenback, down from around 330 and 335 on Friday.
The Central Bank of Nigeria had last week introduced new guidelines for the nation’s foreign exchange market with the adoption of a single structure through the interbank/autonomous window.
The naira, which was pegged at 197-199 per dollar before the emergence of the new forex policy, closed at 288.85 to the dollar on Monday, with the forces of demand and supply coming to play to determine the value of the nation’s currency after the CBN allowed it to float freely.
The CBN said it cleared a total foreign exchange demand backlog of $4bn with a dollar exchanging for N280 at the foreign exchange market.
The apex bank, in a statement issued on Monday by the Acting Director, Corporate Communications Department, Mr. Isaac Okoroafor, expressed satisfaction with the performance of the market on its first day.
The statement reads in part, “Nigeria’s new foreign exchange market made a robust take-off on Monday, June 20, 2016, clearing all the backlog of $4bn pent-up demand for foreign exchange, with the naira exchanging at 280 to the United States dollar.
“The objectives of the CBN to clear the forex demand backlog, perform its role as strictly a market intervention participant, and re-launch a functioning and efficient interbank market were met.
“The CBN, in line with its desire to promote a transparent, liquid and efficient market, and in order to engender market confidence and ensure credible price formation, intervened in the market through a special secondary market intervention sales addressing the issue of the FX demand backlog by clearing $4.02bn through spot and forward sales.
“This served in no small way to stimulate price discovery, with the determination of a marginal rate of $/280.00 through the special SMIS process. So, we can state to you categorically that the FX demand backlog has now been cleared and behind us for good.”
Okoroafor assured market participants and the general public that the bank was committed to making the FX market globally competitive, credible, transparent, liquid and efficient.
Our correspondents gathered that the naira was trading around 270 to a dollar in the early hours of trading on Monday with no deals consummated by the banks as dealers were only interested in buying.
A currency analyst at Ecobank, Mr. Kunle Ezun, said when the market opened in the morning, the naira went up to 285 to the dollar and later came down to 255 to 260 before the CBN intervened in the market by selling over $500m at the rate of N280 per dollar.
He said, “We didn’t have any firm deals; no deal was consummated until when the CBN intervened and gave the rate at 280 and that became the rallying point for the market. We saw price discovery; different banks were quoting on two-way quote for the naira and dollar.
“We saw a lot of quotes today; banks were willing to quote but everybody was willing to buy, not to sell until the CBN came to the bank later in the day to sell. When the CBN sells to you, you are expected to sell in the market. So that created activity in the market.
“What we had today is more like a market depreciation of the naira to 280. Tomorrow , you may see appreciation of the naira or further depreciation. It depends on how much the CBN is willing to supply to the market. If they are able to supply what they supplied today in two or three times consecutively, the market will be calmed and the naira will appreciate in the next few days.”
The Head, Research and Investment Advisory, Sterling Capital, Mr. Sewa Wusu, said the naira closed at 288.85 after a little bit of oscillation, adding, “The interplay of demand and supply has started. I think the proper value of the naira will be determined as time goes on and more dollars will also come.”
He, however, said foreign portfolio investors might still be on the sidelines to watch developments to see how the current mechanism would play out before they would begin to have some level of comfort on the level of dollar liquidity.
The President, Association of Bureau De Change Operators of Nigeria, Alhaji Aminu Gwadabe, said the naira fell to 346 against the dollar at the parallel market, because “the interbank market has not effectively taken off.”
He said, “There is no way demand can reduce at the parallel market now because the 41 imported items are still banned from accessing official forex market,” he said, adding that the backlog of dollar demand was far higher than $4bn.
“Up untill now, many correspondent banks have yet to send their unmet obligations to the Central Bank of Nigeria. And for the foreign inflow that we are expecting, there is still lack of confidence by the investors as to how liquidity is going to be sustainable so that when they want to move out, they won’t have the problem of dollar scarcity. So, they are watching to see how liquid the market will be, and that will take a couple of weeks before this can be unravelled,” Gwadabe explained.
There may be “higher volatility until the market becomes more functional,” Bloomberg quoted the Head of Africa Strategy at Standard Chartered Bank Limited in London, Samir Gadio, as saying in an e-mailed response to questions.
1.His full name was Stephen Okechukwu Chinedu Keshi.
2.He was born on January 23, 1962.
3.He hails from Oshimili North Local Government Area of Delta State.
4.He played as a defender for Super Eagles of Nigerian and several football clubs.
5.Apart from the Nigerian national team, Keshi coached the Togolese and Malian national teams.
6.He is the only coach to have taken the Togolese team to the World cup championship till date.
7.The first football club he ever played for in Nigeria was ACB Football Club, before joining New Nigeria Bank, Stade d’Abidjan, Africa Sports, Lokeren, Anderlecht, RC Strasbourg among other clubs.
8.From 1981 to 1995 when he stopped playing international football for Nigeria, Keshi appeared 64 times in the Eagles colour and scored a total of nine goals.
9.He served as head coach for the Junior Eagles at the 2001 African Youth Championship.
10.He spoke French and English fluently.
11.Keshi was one of the only two soccer stars, along with Egypt’s Mahmoud El-Gohary, to have won the Africa Cup of Nations both as a player and a coach.
12.He won the African Nations Cup in 1994 as a captain and as a coach in 2013.
13.His wife of 33 years, Kate died on December 9, 2015 after losing a long battle with cancer.
14.Keshi is survived by four children and his mother.
Over the past 15 years, tremendous strides have been made in providing
computing equipment and Internet access to schools around the world.
Despite this, however, many teachers and students – especially those in
rural communities in middle and low-income countries (and occasionally
in OECD countries as well) remain largely un-connected.
In response, and as a (presumably, or at least hopefully) temporary
stop-gap measure, scores of countries have piloted and championed the
use of ‘mobile internet computing facilities’ of various sorts as a way
to provide access for learners in remote communities to digital teaching
and learning resources through the use of things like ‘internet buses’.
For some students, ‘mobile learning’ takes place not with the aid of a
smart phone, but rather through monthly visits of Internet-connected
buses filled with computers. From Big Blue in Zimbabwe to the Google Internet Bus in India to similar sorts of efforts in countries as diverse as Tunisia, Pakistan, Rwanda, Mauritius, the Philippines, Malaysia, the United States, Canada, Mexico and China, technology-rich portable classrooms on wheels of various sorts are in use – and many more are being considered and planned.
Most efforts of these sorts seem to have been conceptualized and
implemented in a vacuum, not informed by related experiences in other
places. Even where such efforts help meet objectives that are (if we are
honest) more related to politics and public relations than they are to learning, what guidance should the people in charge of such efforts consider in order to get the most out of related investments?
And: Might there be some related lessons and insights drawn from
experience in operating mobile computing learning classrooms that can
inform ongoing investments in other areas (school transportation,
distance learning, school computer labs, rural Internet access)?
Historically, some of these efforts have grown out of the 'telecentre' movement, with a few notable examples across South Asia (Daknet in India, the 'etuktuk' in Sri Lanka, Telecentre on Wheels in West Bengal) and elsewhere (like the Vasconcelos program in Mexico).
In addition, long-standing initiatives to support bookmobiles (small libraries that
travel around in the back of buses or vans) and portable science
laboratories are beginning to be adapted to include the use of
information and communication technologies in many ways. The Internet Archive Bookmobile is a rather famous reimagining of what a 'bookmobile in the Internet age' might look like, the Nepal Book Bus is another example. In some rural communities around the world, inventive folks have deployed a variety of animals, from camels to donkeys, to transport 'mobile libraries; one effort in Zimbabwe has sought to repurpose this mode of transport in the digital age.
Recognizing that many rural students spend long hours on buses to and
from school each day and use this time to do their homework, a number of
schools districts across the United States and Canada have been
equipping these buses with wi-fi. The rural Coachella school district in California supports perhaps the most well-known effort of this sort; other examples can be found in Minnesota, Arizona and Alberta. In Rwanda,
over 400 buses have been connected to 4G Internet, offering passengers
(including many schoolchildren) free wireless Internet while taking
public transport.
It is perhaps ironic that, when people usually talk about 'mobile
education' they are referring to the use of small devices (like phones)
that can be carried easily from place to place, but that these devices
are in actual practice largely utilized when the user is stationary
(sitting, standing, or even lying down). With some high profile analysts
have noted that, if we are interested in learning about what's
happening at the 'frontier of mobile', we should not be looking to the
handset (where innovation, some claim, is slowing, and where a
saturation point lies not far off in the horizon) but rather to the
automobile. Some activities are taking place at the intersection of
these two 'mobile' worlds in education, from transforming a bus into a
permanent Internet-connected classroom in the UK to driving and parking a bus that broadcasts a wi-fi signal to houses in a low income communities so that kids can have Internet access at home. Under the Samsung Solar Powered Internet School (SPIS) project, school children in Kenya and South Africa have
classes in 40 foot shipping containers that are deposited next to their
schools and which feature a number of laptops and Internet
connectivity, powered by the sun -- an example of 'mobile Internet
classroom' that really only moves once.
Despite the high profile of many such efforts (which can make for
irresistible public relations opportunities for politicians and cute
stories in the media), however, little is known about them.
Where are these sorts of initiatives occurring?
What common circumstances and challenges typically instigate such efforts?
What are the common deployment models?
What user groups are being targeted?
What do such learning environments actually look like?
Who owns and operates such facilities?
What does a typical usage schedule (daily, weekly, monthly) for such facilities look like?
What are typical usage scenarios?
What technology set-ups are common?
What are some related emerging good (and bad) practices?
What do we know about related costs – and benefits?
More fundamentally:
Do such efforts offer viable, cost-effective approaches to help teachers
and students in remote communities take advantage of some of the
benefits of educational computing, and/or provide access to specialized
equipment related to STEM education?
Or rather:
Are they in the end just high profile, expensive band-aids that, on a
practical level, do little to help reduce the ‘digital divide’?
As a result of the increased attention that the education of transient
refugee children is currently receiving, a number of organizations are
exploring the use of 'non-traditional' mobile classroom environments,
many of which envision the use of information and communication
technologies in fundamental ways. As far as I know, no one has (yet)
done a rigorous global survey of the use of mobile Internet computer
facilities to support teachers and learners in remote communities in an
attempt to document and bring together practical information and
insights from various efforts that have occured around the world in the
past decade or so. Before a number of groups decide to invest lots of
money to try to do things like this at a large scale: Maybe someone should?
This is the sweetest, most romantic story I have read this year. Look at
the lady's beautiful smile...they are well and truly in love.
The world's shortest couple - who both measure less then three feet tall
- have proved that size doesn't matter when it comes to love.
Paulo Gabriel da Silva Barros and Katyucia Hoshino, from Brazil, both
have forms of dwarfism and stand at 34.8in and 35.2in respectively.
The pair, who hope to enter the Guinness Book of World Records, said
they met on a social media website ten years ago and started chatting on
MSN Messenger.
Paulo, 30, who has a rare genetic condition called diastrophic dysplasia dwarfism, said it was love at first sight for him.
Ever heard of ‘scratch and sniff?’This is exactly the reason why I am
always careful whose hands I shake because you can never know where
those hands have been.
Germany’s manager Joachim Low must have been very distracted, as he was
captured on camera carrying out not one, but two scratch and sniffs
during Germany’s European Championship game against Ukraine on Sunday.
After having a good scratch, he sat down and took deep lungfuls of pubic
perfume.
DIETS RICH IN SUGAR INCREASES RISK OF BREAST CANCER TUMORS AND METASTASIS
Cancer Research, demonstrated dietary sugar’s effect on an enzymatic signaling pathway known as 12-LOX (12-lipoxygenase).
“We found that sucrose intake in mice comparable to levels of Western
diets led to increased tumor growth and metastasis, when compared to a
non-sugar starch diet,” said Peiying Yang, Ph.D., assistant professor of
Palliative, Rehabilitation, and Integrative Medicine. “This was due, in
part, to increased expression of 12-LOX and a related fatty acid called
12-HETE.”
Previous epidemiological studies have shown that dietary sugar intake
has an impact on breast cancer development, with inflammation thought to
play a role.
“The current study investigated the impact of dietary sugar on mammary
gland tumor development in multiple mouse models, along with mechanisms
that may be involved,” said co-author Lorenzo Cohen, Ph.D., professor of
Palliative, Rehabilitation, and Integrative Medicine. “We determined
that it was specifically fructose, in table sugar and high-fructose corn
syrup, ubiquitous within our food system, which was responsible for
facilitating lung metastasis and 12-HETE production in breast tumors.”
Cohen added that the data suggested that dietary sugar induces 12-LOX
signaling to increase risks for breast cancer development and
metastasis.
Identifying risk factors for breast cancer is a public health priority,
say the authors. The researchers state that moderate sugar consumption
is critical, given that the per capita consumption of sugar in the U.S.
has surged to over 100 lbs. per year and an increase in consumption of
sugar-sweetened beverages has been identified as a significant
contributor to an epidemic of obesity, heart disease and cancer
worldwide.
“Prior research has examined the role of sugar, especially glucose, and
energy-based metabolic pathways in cancer development,” said Yang.
“However, the inflammatory cascade may be an alternative route of
studying sugar-driven carcinogenesis that warrants further study.”
No previous studies have investigated the direct effect of sugar
consumption on the development of breast cancer using breast cancer
animal models or examined specific mechanisms, she added.
The MD Anderson team conducted four different studies in which mice were
randomized to different diet groups and fed one of four diets. At six
months of age, 30 percent of mice on a starch-control diet had
measurable tumors, whereas 50 to 58 percent of the mice on
sucrose-enriched diets had developed mammary tumors. The study also
showed that numbers of lung metastases were significantly higher in mice
on a sucrose- or a fructose-enriched diet, versus mice on a
starch-control diet.
“This study suggests that dietary sucrose or fructose induced 12-LOX and
12-HETE production in breast tumor cells in vivo,” said Cohen. “This
indicates a possible signaling pathway responsible for sugar-promoted
tumor growth in mice. How dietary sucrose and fructose induces 12-HETE
and whether it has a direct or indirect effect remains in question.”
The study team believes that the mechanism by which dietary sucrose or
fructose affects breast tumor growth and metastasis, especially through
the 12-LOX pathways, warrants further investigation.
MD Anderson research team members included Yan Jiang, Yong Pan, Patrea
Rhea, and Lin Tan, all of Palliative, Rehabilitation and Integrative
Medicine; Mihai Gagea, D.V.M., Ph.D., Veterinary Medicine & Surgery;
and Susan Fischer, Epigenetics & Molecular Carcinogenesis.
The study was funded by the National Institutes of Health
(P30CA0166672), Mr. and Mrs. H. Leighton Steward and EOG Resources, Inc.
Fibroids are non-cancerous (benign) tumors that grow from the muscle layers of the uterus (womb).
They are also known as uterine fibroids, myomas, or fibromyomas. The
singular of uterine fibroids is Uterine Fibroma. Fibroids are growths of
smooth muscle and fibrous tissue. Fibroids can vary in size, from that
of a bean to as large as a melon.
Fibroids affect at least 20% of all women at sometime during their life.
Women aged between 30 and 50 are the most likely to develop fibroids.
Overweight and obese women are at significantly higher risk of
developing fibroids, compared to women of normal weight.
Malignant (cancerous) growths on the smooth muscles inside the womb can
develop, called leiomyosarcoma of the womb. However, this is extremely
rare.
Four types of fibroids
There are four types of fibroids and these are:
A diagram of the female reproductive system.
Intramural
These are located in the wall of the uterus. These are the most common types of fibroids.
Subserosal fibroids
These are located outside the wall of the uterus. They can develop into
pedunculated fibroids (stalks). Subserosal fibroids can become quite
large.
Submucosal fibroids
These are located in the muscle beneath the lining of the uterus wall.
Cervical fibroids
These are located in the neck of the womb (the cervix).
Causes of fibroids
Experts cannot come to a common consensus about why fibroids occur.
During a woman's reproductive years her estrogen and progesterone
levels are high. When estrogen levels are high, especially during
pregnancy, fibroids tend to swell. When estrogen levels are low fibroids
may shrink, e.g. during a woman's menopause.
Heredity may also be a factor. Women whose mothers and/or sisters have/had fibroids have a higher risk of developing them too.
Symptoms of uterine fibroids
Most women have no symptoms. That is why most patients with fibroids do
not know they have them. When symptoms do develop, they may include:
Discomfort in the lower abdomen (especially if fibroids are large)
Frequent urination
Heavy painful periods
Pain in the legs
Painful sex
Swelling in the lower abdomen (especially if fibroids are large)
Other possible symptoms of uterine fibroids include:
Labor problems
Pregnancy problems
Fertility problems
Repeated miscarriages
Diagnosis of fibroids
In most cases, the symptoms of fibroids are rarely felt and the patient
does not know she has them. They are usually discovered during a vaginal
examination.
An ultrasound scan can often be used to diagnose fibroids.
Ultrasound
If the doctor thinks fibroids may be present he/she may use an
ultrasound scan to find out. Ultrasound can also eliminate other
possible conditions which may have similar symptoms. Ultrasound scans
are often used when the patient has heavy periods and blood tests have
revealed nothing conclusive.
Trans-vaginal scan
A small scanner is inserted into the patient's vagina so that the uterus can be viewed close up.
Hysteroscopy
This is a small telescope that examines the inside of the uterus. During
this procedure, if necessary, a biopsy can be taken of the lining of
the uterus (womb).
Laparoscopy
A laparoscope is a small device that looks at the outside of the uterus -
where the doctor examines its size and shape. A laparoscope is a small
flexible tube. During this procedure, if necessary, a biopsy can be
taken of the outer layer of the uterus.
Biopsy
A small sample of the lining of the uterus is taken and then examined under a microscope.
Cervical cancer, or cancer of the cervix, is cancer of the entrance to the uterus (womb). The
cervix is the narrow part of the lower uterus, often referred to as the
neck of the womb. Cervical cancer occurs most commonly in women over the
age of 30.
The American Cancer Society estimates that 12,900 diagnoses of cervical
cancer will be made by the end of 2015 in the USA. Over 4,000 women in
the USA die from cervical cancer each year.
The National Health Service (NHS), UK, says that over 3,000 women are
diagnosed with cervical cancer each year in the UK. According to the
World Health Organization (WHO) at least 200,000 women worldwide die of
cervical cancer each year. WHO adds that if the HPV vaccine is administered globally, hundreds of thousands of lives each year could eventually be saved.
Cancer research UK reported that the rate of women diagnosed with the cervical cancer in the UK has halved from 16 per 100,000 in 1988 to 8 per 100,000 - the NHS (National Health Service) Cervical Screening Programme began in 1988.
Fast facts on cervical cancer
Here are some key points about cervical cancer. More detail and supporting information is in the main article.
There are two main types of cervical cancer: squamous cell cervical cancer and adenocarcinoma of the cervix.
Cervical cells are most likely to become cancerous in the transformation zone, found at the opening of the cervix.
Women can be asymptomatic during the early stages of cervical cancer.
Cervical cancer risk factors include smoking, giving birth at a young age and having a weakened immune system.
It is estimated that the majority of cervical cancer deaths would be prevented if all women underwent cervical cancer screening.
Cervical cancer screening should begin from the age of 21, or within three years of the first sexual encounter.
Like all cancers, there are various stages of severity to cervical cancer, numbered from 0-4.
Treatment for cancer that is confined to the cervix has a high rate of success - around 80%-95%.
Cervical cancer risk can be reduced through various measures,
including the human papillomavirus vaccine and practicing safe sex.
What is the cervix?
The cervix is part of the female reproductive system and is often referred to as the neck of the womb.
The cervix, or the neck of the womb, and the womb are both parts of a
female reproductive system. The female reproductive system consists of:
Vagina
Womb (uterus), which includes the cervix
Ovaries.
Women have two ovaries, one on either side of the lower abdomen
(pelvis). Each month one of the ovaries produces an egg. Each ovary is
connected to the uterus by a tube called the Fallopian tube.
In between each menstrual period an egg travels down one of the
fallopian tubes and into the uterus. They alternate - one month may be
the left side, and the next month the right side. When the egg enters
the womb its lining thickens in preparation; in case the egg is
fertilized by a man's sperm. If fertilization does not occur the
thickened lining of the uterus is shed - a period (menses) occurs.
The cervix is the opening from the uterus to the vagina. It is a tight
muscle that is normally firmly shut, with a small opening to allow the
sperm through and the flow from a menstrual period. During labor
(childbirth) the cervix opens.
Types of cervical cancer
Ectocervix - flat cells - squamous cell cervical cancer
The ectocervix is the portion of the cervix that projects into the
vagina, also known and the portio vaginalis. It is about 3 cm long and
2.5 cm wide. There are flat cells on the outer surface of the
ectocervix. These fish scale-like cells can become cancerous, leading to
squamous cell cervical cancer.
Squamous cells - flat cells that look like fish scales. The word comes
from Latin "squama" meaning "the scale of a fish or serpent". Our
outer-layer skin cells are squamous cells, as well as the passages of
the respiratory and digestive tracts, and the linings of hollow internal
organs.
Endocervix - glandular cells - adenocarcinoma of the cervix
The endocervix is the inside of the cervix. There are glandular cells
lining the endocervix; these cells produce mucus. These glandular cells
can become cancerous, leading to adenocarcinoma of the cervix.
Adenocarcinoma - any cancer that develops in the lining or inner surface of an organ.
Transformation zone
This is where cervical cells are most likely to become cancerous. The
transformation zone is located around the opening of the cervix, leading
on to the endocervical canal (narrow passageway running up the cervix
into the uterus). During cervical screening doctors and nurses will
focus on this area.
Causes of cervical cancer
Cancer is the result of the uncontrolled division of abnormal cells.
Most of the cells in our body have a set lifespan; when they die new
cells are produced to replace them. Abnormal cells can have two
problems:
They do not die
They continue dividing.
This results in an excessive accumulation of cells which eventually form a lump - a tumor.
Scientists are not completely sure why cells become cancerous.
However, there are some risk factors which are known to increase the
risk of developing cervical cancer. These risk factors include:
HPV (human papilloma virus)
Around 70% of cervical cancer cases are estimated to be caused by HPV.
Human papilloma virus infection is a sexually transmitted virus. There
are over 100 different types of HPVs - 15 types can cause cervical
cancer; probably 99% of them. In addition there are a number of types
which can cause genital warts.
It is estimated that HPV types 16 and 18 cause about 70% of cases
cervical cancer while HPV types 6 and 11 cause 90% of genital warts.
Other HPV types can cause cervical intra-epithelial neoplasia (CIN) - the growth of abnormal cells on the surface of the cervix.
Many sexual partners, becoming sexually active early
Cervical cancer-causing HPV types are nearly always transmitted as a
result of sexual contact with an infected individual. Women who have had
many sexual partners generally have a higher risk of becoming infected
with HPV, which raises their risk of developing cervical cancer. There
is also a link between becoming sexually active at a young age and a
higher risk of cervical cancer.
If a woman develops cervical cancer it does not mean she had several
sexual partners, or became sexually active earlier than most other
females. It is just a risk factor. Women who only ever had one sexual
partner can develop cervical cancer.
Smoking
Smoking increases the risk of developing many cancers, including cervical cancer.
Weakened immune system
People with weakened immune systems, such as those with HIV/AIDS, or transplant recipients taking immunosuppressive medications have a higher risk of developing cervical cancer.
Certain genetic factors
Scientists at Albert Einstein College of Medicine of Yeshiva University found that women with certain gene variations appear to be protected against cervical cancer.
Women who gave birth before the age of 17 are significantly more likely
to develop cervical cancer compared to women who had their first baby
when they were aged 25 or over.
Several pregnancies
Women who have had at least three children in separate pregnancies are
more likely to develop cervical cancer compared to women who never had
children.
Contraceptive pill
Long-term use of some common contraceptive pills slightly raises a woman's risk.
Studies in several countries have revealed that women in deprived areas
have significantly higher rates of cervical cancer, compared to women
who live in other areas. Studies have also found higher rates in women
of working age in manual jobs, compared to women in non-manual jobs. The
most likely reason is a difference in the proportion of women who have
regular screening. Scientists at King's College London found that some areas in South East England had rates that were three times higher than neighboring areas.
Recent developments on cervical cancer causes from MNT news Oral HPV 'can be transmitted by oral-to-oral, oral-to-genital routes'
A new study claims to provide further evidence that oral human
papillomavirus infections can be transmitted via oral-to-oral and
oral-to-genital routes. Two thirds of healthy American adults 'infected with HPV,' study suggests
In what has been deemed the "largest and most detailed genetic
analysis of its kind," researchers have discovered that two thirds of
healthy American adults may be infected with one or more of 109 strains
of human papillomavirus.
Symptoms of cervical cancer
Often during the early stages people may experience no symptoms at all.
That is why women should have regular cervical smear tests.
Cervical cancer screening should occur no more than once every three to five years,
the American College of Obstetricians and Gynecologists announced on
23rd October, 2012. They added that the PAP test should be carried out
at the same time as the HPV test - testing for both is better than just
the PAP test alone. The College emphasized that this recommendation is
just for women aged 30 years or more. Their guidelines were published in
Obstetrics & Gynecology.
Cervical screening - LBC or Pap smear test
In the USA over 11,000 women are diagnosed with invasive cervical cancer
each year and about 4,000 die of it. The majority of these deaths could
be prevented if all women had undergone cervical screening. US
authorities say a female should start screening at the age of 21, or
within three years of her first sexual encounter - whichever occurs
first.
The test looks for abnormal changes in the cells of the cervix. If left
untreated some abnormal cells can eventually develop into cancer.
Cervical screening does not detect cancer.
Experts
believe that the majority of deaths from cervical cancer would be
prevented if all women underwent cervical screening as recommended.
Cervical screening used to be the old pap smear test - which is still
used in many parts of the world. More recently, testing using LBC
(liquid based cytology) has become more commonplace. A sample of cells
is taken from the cervix. The doctor or nurse inserts a speculum - an
instrument used to widen the opening of the vagina so that the cervix is
more easily visible - and uses a spatula which is brushed around the
cervix. The procedure is just mildly uncomfortable for the majority of
women. If abnormal cells are there, there is a good chance they will be
detected, but not not always.
What is LBC (liquid based cytology)?
Cytology is the medical and scientific study of cells - diagnosing
diseases and conditions by examining tissue samples (cell samples) from
the body. With liquid based cytology the sample is collected in much the
same way as a conventional smear. However, instead of smearing the
sample onto a microscope slide, the head of the brush where the sample
cells are caught is broken off and placed in a small glass vial which
contains preservative fluid - sometimes it can be rinsed directly into
the preservative fluid. In the laboratory it is spun and treated to
remove mucus, pus
and other materials. A random sample of the remaining cells is taken. A
thin layer of the cells is placed on a microscope slide and examined.
The test is not designed for diagnosing cancer. It is designed to check
the health of the cervix and to detect early changes in the cells, which
could develop into cancer in the future.
The best time to have the test is in the middle of the menstrual cycle - between periods.
If the test results show abnormal cells in the cervix the doctor will refer the patient to a gynecologist. In the UK the patient may also be referred to a nurse colposcopist.
HPV DNA test
Also known as just "HPV test". This test determines whether the patient
is infected with any of the HPV types that are most likely to cause
cervical cancer. This involves collecting cells from the cervix for lab
testing. The test can detect high risk HPV strains in cell DNA before
any cervix cell abnormalities appear. A British study found that the combination of HPV testing with regular liquid-based cytology (LBC) screening
does not improve the detection of cervical cancer compared with LBC
screening alone. An eight-year trial involving more than 130,000 women
published in The New England Journal of Medicine found that that in low-resource settings a single round of HPV testing significantly reduces the numbers of advanced cervical cancers and deaths, compared with Pap (cytology) testing.
If the patient experiences signs and symptoms of cervical cancer, or if
the Pap test revealed abnormal cells, the patient may undergo additional
tests:
Biopsy
A small piece of tissue will be taken. The patient will be anesthetized for this.
Colposcopy
This is performed in the doctor's office. A speculum is placed to hold
the vagina open and the gynecologist looks at the cervix through a
colposcope - a lighted magnifying instrument specifically designed for
examining the tissues of the vagina and the cervix. If the doctor is
still unable to see the abnormal area clearly a cone biopsy or LETTZ may
be done.
Cone biopsy
A small cone-shaped section of the abnormal tissue is taken from the
cervix for examination under a microscope. The patient is usually under
local anesthetic; sometimes general anesthetic is used. The biopsy may
indicate whether the abnormal cells are CIN 1, 2 or 3, or whether deeper
levels of the cervix are affected.
LLETZ
A diathermy (wire loop with an electric current) is used to remove
abnormal tissue. The tissue is sent to the lab to be checked. This is a
common treatment for CIN.
Blood tests
A blood test will reveal the number of blood cells, as well as identifying any liver or kidney problems.
Chest X-ray
This is to determine the health of the patient's lungs and heart.
Examination under anesthetic (EUA)
This allows the doctor to examine the vagina and cervix more thoroughly.
The patient is under a general anesthetic. The doctor may also check
the bladder with a cystoscope, or/and the colon and rectum with a
procto-sigmoidoscope to determine whether the cancer has spread. During
this whole procedure the doctor may take a biopsy of the bladder,
colon/rectum and the lining of the uterus.
CT (computerized tomography) scan
A CT scanner emits a series of narrow beams through the human body as
it moves through an arc, unlike an X-ray machine which sends just one
radiation beam. The final picture is far more detailed than an X-ray
one. Inside the CT scanner there is an X-ray detector which can see
hundreds of different levels of density. It can see tissues inside a
solid organ. This data is transmitted to a computer, which builds up a
3-D cross-sectional picture of the part of the body and displays it on
the screen. The doctor will have a much better idea of the size and
position of the cancer.
The patient will have to have a barium drink beforehand. The barium
appears white on the scan. Just before the scan a tampon may be placed
into the vagina, and a barium liquid may be placed into the rectum. The
whole scan takes from 10 to 30 minutes.
MRI (magnetic resonance imaging scan)
An MRI
does not use X-rays; it uses magnets and radio waves to build up
cross-sectional images of the targeted part of the body. The patient
lies very still on a couch inside a long tube which enters a
doughnut-like machine. As the machine can become noise patients will
usually be given earphones so that they can listen to music - some may
even let you bring your own tunes. All metal items should be removed
beforehand because the MRI machine is a powerful magnet. If you have any
metal in your body, such as a pacemaker or surgical clips you cannot
have an MRI scan. By using high-MRI with a special vaginal coil,
a technique to measure the movement of water within tissue, researchers
may be able to identify cervical cancer in its early stages,
researchers at Cancer Research UK Clinical Magnetic Resonance Research
Group reported.
Pelvic ultrasound
This is a device that uses high frequency sound waves which create an
image on a monitor of the target area. The patient will be asked to
drink plenty of fluids beforehand so that the bladder is full and a
clear picture can be viewed. A transvaginal ultrasound device may be inserted into the vagina, or an external device may be placed next to the stomach.
After carrying out the various tests the doctor will determine the stage
of the cancer. The stage of a cancer refers to how far it has spread.
Determining the stage of the cancer is important because it is the main
factor in deciding on treatment options. Cancers have various staging
systems. In cervical cancer, stages are numbered from 0 to 4. If you
have CIN it means you have abnormal cells, it is not the same as
cervical cancer and the stages below do not apply, except for perhaps
stage 0.
Stage 0 - Carcinoma in situ (stage 0)
Even though there are only abnormal cells on the surface layer of the
cervix and this is not considered to be part of the cervical cancer
staging system, many doctors will call this Stage 0. It is not an
invasive cancer; the cells have not left the area where they started to
grow. This is the same as CIN 3.
Stage 1 cervical cancer
The cancer is only in the cervix (the neck of the uterus, womb). This stage is divided into:
Stage 1A - cancer is microscopic; it can only be viewed through a microscope. This stage is divided into two:
1A1 - cancer has grown into less than 3 mm of the cervical tissue, and is less than 7mm wide
1A2 - cancer has grown 3-5mm into cervical tissue, and is less than 7mm wide.
Stage 1B - cancer is larger and is usually visible with the naked
eye, but is confined to the cervical tissue and has not spread. This
stage is divided into two:
1B1 - cancer is no larger than 4cm
1B2 - cancer is larger than 4cm.
This stage of cervical cancer is generally treated with surgery or radiotherapy. For patients at Stage 1B2 a combination of chemotherapy and radiotherapy may be recommended sometimes.
Stage 2 cervical cancer
The cancer includes the cervix and uterus, but has not yet spread into
the pelvic wall or lower portions of the vagina. It is divided into two
stages:
Stage 2A - the cancer has reached the top of the vagina
Stage 2B - the cancer has reached tissue around the cervix.
Treatment for Stage 2A usually consists of surgery or radiotherapy, and
sometimes both. Treatment for Stage 2B invariably consists of a
combination of radiotherapy and chemotherapy.
Stage 3 cervical cancer
The cancer has spread beyond the cervix and uterus and has reached the
surrounding structures of the pelvic area, the lower portion of the
vagina, and the pelvic wall (muscles and ligaments that line the
pelvis). The cancer growth may have blocked the ureter (the tube that
carries urine from the kidneys to the bladder). It is divided into two
stages:
Stage 3A - the cancer has reached the lower third of the vagina, but not the pelvic wall
Stage 3B - the cancer has grown through the pelvic wall, or is blocking one ureter or both of them.
The most common treatment option for this stage is a combination of chemotherapy and radiotherapy.
Stage 4 cervical cancer
Advanced cancer; the cancer has spread to nearby organs, such as the
bladder or rectum, or it has spread further into other parts of the
body, such as the liver, lungs or bones. This is divided into two
stages:
Stage 4A - the cancer has reached the bladder or rectum (nearby organs)
Stage 4B - the cancer has spread further, possibly including the lungs, liver or bones.
Treatments for cervical cancer
It is important to ask questions about any aspects of your treatment that you are not sure about, or anything that worries you.
Talking about the benefits and disadvantages of various options with an
expert, such as a gynecologist, gynecological nurse or your GP (general
practitioner, primary care physician) will help you understand the
process. Some people find it useful to write down a list of questions,
while others appreciate the company and support of a relative or close
friend when they go to the doctor.
Cancer treatments can sometimes be complex and bewildering and not that
straightforward for lay people to figure out. Doctors and health care
professionals are used to people asking questions, and they should also
be used to and should not mind explaining things again and again. Even
if you worry that the hospital staff may be too busy to answer your
questions, they should be eager to answer your them thoroughly so that
you know how the therapies may possibly affect you.
Cervical cancer treatment options include surgery, radiotherapy,
chemotherapy, or combinations. Deciding on the kind of treatment depends
on several factors, such as the stage of the cancer, as well as the
patient's age and general state of health.
Treatment for early stage cervical cancer - cancer that is confined to
the cervix - has a success rate of 85% to 90%. The further the cancer
has spread out of the area it originated from, the lower the success
rate tends to be.
Early stage cancer treatment options
Surgery is commonly used when the cancer is confined to the cervix.
Radiotherapy may be used after surgery if the doctor believes there may
still be cancer cells inside the body. Radiotherapy may also be used to
reduce the risk of recurrence (cancer coming back). If the surgeon wants
to shrink the tumor in order to make it easier to operate, the patient
may receive chemotherapy - however, this is not so common.
The options for surgery in the early stages may include:
Cone biopsy (conization) - this procedure may also be used to remove
any abnormality. The surgeon uses a scalpel to remove a cone-shaped
piece of cervical tissue
Laser surgery - a narrow beam of intense light destroys cancerous and precancerous cells
LEEP (loop electrosurgical excision procedure) - a wire loop which
has an electric current cuts through tissue removing cells from the
mouth of the cervix
Cryosurgery - cancerous and precancerous cells are destroyed by freezing them
Hysterectomy - the cancerous and precancerous areas, as well as the
cervix and the uterus are surgically removed. This is not common and is
only done in certain cases of noninvasive cervical cancer.
Advanced cancer
When the cancer has spread beyond the cervix surgery is not usually an
option. Advanced cancer is also referred to as invasive cancer because
it has invaded other areas, not just where it started off. This type of
cancer requires more extensive treatment. The patient will typically be
treated with either radiotherapy or a combination of radiotherapy and
chemotherapy. In the later stages of cancer palliative therapy is
administered to relieve symptoms and improve quality of life.
Radiotherapy
Radiotherapy
is commonly used to treat advanced forms of cervical cancer. Around 40%
of all cancer patients undergo some form of radiotherapy.
Radiotherapy is also known as radiation therapy, radiation oncology and
XRT. It is used for treating cancer, thyroid disorders and some blood
disorders. Approximately 40% of cancer patients undergo some kind of
radiotherapy. It involves the use of beams of high-energy X-rays or
particles (radiation) to destroy cancer cells. Radiotherapy works by
damaging the DNA inside the tumor cells, destroying their ability to
reproduce.
This may be delivered externally or internally (brachytherapy) by
placing radioactive material near the cervix. For patients with advanced
cervical cancer radiation combined cisplatin-based chemotherapy is the
most effective treatment, according to gynecologic oncologists.
Radiation that is aimed in the pelvic area may cause the following side
effects; some of them may not emerge until well after the treatment is
over:
Chemotherapy is the use of chemicals (medication) to treat any disease -
more specifically in this text, it refers to the destruction of cancer
cells. Cytotoxic medication prevents cancer cells from dividing and
growing. When health care professionals talk about chemotherapy today,
they tend to refer more to cytotoxic medication than others.
Chemotherapy for cervical cancer, as well as most other cancers, is used
to target cancer cells that surgery cannot or did not remove, or to
help the symptoms of patients with advanced cancer.
Cisplatin, a chemotherapy drug, is frequently used in combination with radiotherapy.
Side effects of chemotherapy may vary, and depend a lot on the specific
drug being used. Below is a list of the more common side effects:
For some patients, participating in a clinical trial may be their best
treatment option. Many current treatments are the results of clinical
trials. Clinical trials are an integral part of the cancer research
process. A clinical trial is carried out to determine how safe and
effective new treatments are, and whether they are better than existing
ones.
A participant in a clinical trial may either receive the standard
treatment, or the new treatment. A clinical trial compares a number of
patients on the new treatment to a group of patients on an existing
treatment. Sometimes a clinical trial may also have a group of patients
taking a placebo (dummy drug).
Clinical trial participants contribute to cancer research and innovation.
Recent developments on cervical cancer treatment from MNT news Targeted drug 'prolongs survival for cervical cancer patients'
The American Cancer Society estimate that there will be 12,360 new
cases of invasive cervical cancer diagnosed this year, with 4,020 deaths
from the disease. Now, a phase II trial has found that a targeted
antitumor drug could prolong the survival of women with cervical cancer. Avastin Can Lengthen The Lives Of Advanced Cervical Cancer Patients
The addition of targeted therapy Avastin (bevacizumab) with
chemotherapy can significantly lengthen the lives of women with advanced
cervical cancer by close to 30%, according to research presented at the
2013 American Society of Clinical Oncology Congress. Just one HPV vaccine dose 'could be enough' to prevent cervical cancer
The need for numerous doses of the HPV vaccine has been called into
question by researchers who say that a one-dose schedule could be
sufficient and should be investigated for the protection of most women
against cervical cancer.
The suggestion comes from the authors of a new analysis to combine data
from two large phase 3 trials that has been published in The Lancet Oncology.
Prevention of cervical cancer
There are a number of measures that can be taken to reduce the chances of developing cervical cancer.
HPV (human papilloma virus) vaccine
The link between the development of cervical cancer and some types of
HPV is clear. At least 70% of all cases of cervical cancer occur because
of 2 types of HPVs for which there is a vaccine. If every female
adheres to current HPV vaccination programs the total number of female
deaths from cervical cancer globally will drop by hundreds of thousands
each year.
Public health authorities in most countries now offer the HPV vaccine as
part of their childhood immunization program. UK authorities say girls
should be given the vaccine when they are 12 to 13 years of age - in
three doses over a six month period.
Safe sex
The HPV vaccine only protects against two HPV strains. There are others
which can cause cervical cancer. Using a condom during sex helps protect
from HPV infection. HPV is a sexually transmitted infection.
Cervical screening
Regular cervical screening will make it much more likely that signs are
picked up early on and dealt with before cancer develops at all or too
far.
Have few sexual partners
The more sexual partners a woman has the higher is her risk of developing cervical cancer.
Delay first sexual intercourse
The younger a female is when she has her first sexual intercourse the
higher is her risk of developing cervical cancer. The longer she delays
it, the lower her risk.
