Women diagnosed with breast cancer who carry particular BRCA1 and BRCA2 genetic variants are offered surgery to remove the ovaries and fallopian tubes as this dramatically reduces their risk of ovarian cancer. Now, Cambridge researchers have shown that this procedure – known as bilateral salpingo-oophorectomy (BSO) – is associated with a substantial reduction in the risk of early death among these women, without any serious side-effects.
Women with certain variants of the genes BRCA1 and BRCA2 have a high risk of developing ovarian and breast cancer. These women are recommended to have their ovaries and fallopian tubes removed at a relatively early age – between the ages 35 and 40 years for BRCA1 carriers, and between the ages 40 and 45 for BRCA2 carriers.
Previously, BSO has been shown to lead to an 80% reduction in the risk of developing ovarian cancer among these women, but there is concern that there may be unintended consequences as a result of the body’s main source of oestrogen being removed, which brings on early menopause. This can be especially challenging for BRCA1 and BRCA2 carriers with a history of breast cancer, as they may not typically receive hormone replacement therapy to manage symptoms. The overall impact of BSO in BRCA1 and BRCA2 carriers with a prior history of breast cancer remains uncertain.
Ordinarily, researchers would assess the benefits and risks associated with BSO through randomised controlled trials, the ‘gold standard’ for testing how well treatments work. However, to do so in women who carry the BRCA1 and BRCA2 variants would be unethical as it would put them at substantially greater risk of developing ovarian cancer.
To work around this problem, a team at the University of Cambridge, in collaboration with the National Disease Registration Service (NDRS) in NHS England, turned to electronic health records and data from NHS genetic testing laboratories collected and curated by NDRS to examine the long-term outcomes of BSO among BRCA1 and BRCA2 PV carriers diagnosed with breast cancer. The results of their study, the first large-scale study of its kind, are published today in The Lancet Oncology.
The team identified a total of 3400 women carrying one of the BRCA1 and BRCA2 cancer-causing variants (around 1700 women for each variant). Around 850 of the BRCA1 carriers and 1,000 of the BRCA2 carriers had undergone BSO surgery.
Women who underwent BSO were around half as likely to die from cancer or any other cause over the follow-up period (a median follow-up time of 5.5 years). This reduction was more pronounced in BRCA2 carriers compared to BRCA1 carriers (a 56% reduction compared to 38% respectively). These women were also at around a 40% lower risk of developing a second cancer.
Although the team say it is impossible to say with 100% certainty that BSO causes this reduction in risk, they argue that the evidence points strongly towards this conclusion.
Importantly, the researchers found no link between BSO and increased risk of other long-term outcomes such as heart disease and stroke, or with depression. This is in contrast to previous studies that found evidence in the general population of an association between BSO and increased risk of these conditions.
First author Hend Hassan, a PhD student at the Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, and Wolfson College, Cambridge, said: “We know that removing the ovaries and fallopian tubes dramatically reduces the risk of ovarian cancer, but there’s been a question mark over the potential unintended consequences that might arise from the sudden onset of menopause that this causes.
“Reassuringly, our research has shown that for women with a personal history of breast cancer, this procedure brings clear benefits in terms of survival and a lower risk of other cancers without the adverse side effects such as heart conditions or depression.”
Most women undergoing BSO were white. Black and Asian women were around half as likely to have BSO compared to white women. Women who lived in less deprived areas were more likely to have BSO compared to those in the most-deprived category.
Hassan added: “Given the clear benefits that this procedure provides for at-risk women, it’s concerning that some groups of women are less likely to undergo it. We need to understand why this is and encourage uptake among these women.”
Professor Antonis Antoniou, from the Department of Public Health and Primary Care, the study’s senior author, said: “Our findings will be crucial for counselling women with cancer linked to one of the BRCA1 and BRCA2 variants, allowing them to make informed decisions about whether or not to opt for this operation.”
Professor Antoniou, who is also Director of the Cancer Data-Driven Detection programme, added: “The study also highlights the power of exceptional NHS datasets in driving impactful, clinically relevant research.”
The research was funded by Cancer Research UK, with additional support from the National Institute for Health and Care Research (NIHR) Cambridge Biomedical Research Centre.
The University of Cambridge is fundraising for a new hospital that will transform how we diagnose and treat cancer. Cambridge Cancer Research Hospital, a partnership with Cambridge University Hospitals NHS Foundation Trust, will treat patients across the East of England, but the research that takes place there promises to change the lives of cancer patients across the UK and beyond. Find out more here.
That’s the takeaway from new research from a team of scientists, including researchers from the University of Colorado Boulder. The findings suggests that long-term exposure to Martian dust could create a host of health problems for future astronauts – leading to chronic respiratory problems, thyroid disease and more.
The study, published in the journal GeoHealth, is the first to take a comprehensive look at the chemical ingredients that make up Martian dust, and their possible impacts on human health. It was undertaken by a team from the worlds of medicine, geology and aerospace engineering.
“This isn’t the most dangerous part about going to Mars,” said Justin Wang, lead author of the study and a student in the Keck School of Medicine at the University of Southern California in Los Angeles. “But dust is a solvable problem, and it’s worth putting in the effort to develop Mars-focused technologies for preventing these health problems in the first place.”
Wang, a CU Boulder alumnus, noted that Apollo era astronauts experienced runny eyes and irritated throats after inhaling dust from the moon. Apollo 17’s Harrison Schmitt likened the symptoms to hay fever.
But scientists know a lot less about the potential harms of Martian dust. To begin to answer that question, Wang and his colleagues drew on data from rovers on Mars and even Martian meteorites to better understand what makes up the planet’s dust. The group discovered a “laundry list” of chemical compounds that could be dangerous for people—at least when inhaled in large quantities and over long periods of time.
They include minerals rich in silicates and iron oxides, metals like beryllium and arsenic and a particularly nasty class of compounds called perchlorates.
In many cases, those ingredients are present in only trace amounts in Mars dust. But the first human explorers on Mars may spend around a year and a half on the surface, increasing their exposure, said study co-author Brian Hynek.
“You’re going to get dust on your spacesuits, and you’re going to have to deal with regular dust storms,” said Hynek, a geologist at the Laboratory for Atmospheric and Space Physics (LASP) at CU Boulder. “We really need to characterize this dust so that we know what the hazards are.”
Into the bloodstream
One thing is clear, he added: Mars is a dusty place.
Much of the planet is covered in a thick layer of dust rich in tiny particles of iron, which gives the planet its famous red colour. Swirling dust storms are common and, in some cases, can engulf the entire globe.
“We think there could be 10 metres of dust sitting on top of the bigger volcanoes,” said Hynek, a professor in the Department of Geological Sciences. “If you tried to land a spacecraft there, you’re going to just sink into the dust.”
Wang found his own way to Martian dust through a unique academic path. He started medical school after earning bachelor’s degrees from CU Boulder in astronomy and molecular, cellular and developmental biology, followed by a master’s degree in aerospace engineering sciences. He currently serves in the Navy through its Health Professions Scholarship Program.
He noted that the biggest problem with Martian dust comes down to its size. Estimates suggest that the average size of dust grains on Mars may be as little as 3 micrometers across, or roughly one-ten-thousandth of an inch.
“That’s smaller than what the mucus in our lungs can expel,” Wang said. “So after we inhale Martian dust, a lot of it could remain in our lungs and be absorbed into our blood stream.”
An ounce of prevention
In the current study, Wang and several of his fellow medical students at USC scoured research papers to unearth the potential toxicological effects of the ingredients in Martian dust.
Some of what they found resembled common health problems on Earth. Dust on Mars, for example, contains large amounts of the compound silica, which is abundant in minerals on our own planet. People who inhale a lot of silica, such as glass blowers, can develop a condition known as silicosis. Their lung tissue becomes scarred, making it hard to breath—symptoms similar to the “black lung” disease that coal miners often contract. Currently, there is no cure for silicosis.
In other cases, the potential health consequences are much less well-known.
Martian dust carries large quantities of highly oxidising compounds called perchlorates, which are made up of one chlorine and multiple oxygen atoms. Perchlorates are rare on Earth, but some evidence suggests that they can interfere with human thyroid function, leading to severe anaemia. Even inhaling a few milligrams of perchlorates in Martian dust could be dangerous for astronauts.
Wang noted that the best time to prepare for the health risks of Martian dust is before humans ever make it to the planet. Iodine supplements, for example, would boost astronauts’ thyroid function, potentially counteracting the toll of perchlorates – although taking too much iodine can also, paradoxically, lead to thyroid disease. Filters specifically designed to screen out Martian dust could also help to keep the air in living spaces clean.
“Prevention is key. We tell everyone to go see their primary care provider to check your cholesterol before it gives you a heart attack,” Wang said. “The best thing we can do on Mars is make sure the astronauts aren’t exposed to dust in the first place.”
New research from the University of Sydney reveals that obesity, having a knee injury and occupational risks such as shift work and lifting heavy loads are primary causes of knee osteoarthritis.
The study also found that following a mediterranean diet, drinking green tea and eating dark bread could reduce the risk of developing knee osteoarthritis.
Using data from 131 studies conducted between 1988 to 2024, the researchers examined over 150 risk factors in participants ranging from 20 to 80 years old to determine which were associated with an increased risk of developing knee osteoarthritis.
“Our research found that while factors such as eating ultra-processed foods and being overweight increase the risk, addressing lifestyle factors – such as losing weight or adopting a better diet – could significantly improve people’s health,” Associate Professor Abdel Shaheed said.
Co-author Professor David Hunter, a researcher at the Kolling Institute and Professor of Medicine at the University of Sydney, said: “Women were twice as likely to develop the condition than men, and older age was only mildly associated with increased risk.”
Reducing the risk of knee osteoarthritis
Dr Duong, lead author and post-doctoral researcher at the Kolling Institute, said: “Eliminating obesity and knee injuries combined could potentially reduce the risk of developing knee osteoarthritis by 14 percent across the population.
“We urge governments and the healthcare sector to take this seriously and to implement policy reforms that address occupational risks, subsidise knee injury prevention programs, and promote healthy eating and physical activity to reduce obesity.”
Trade unions, medical associations and universities are raising the alarm that Gauteng budget cuts at the cost of doctors’ take-home pay will have dire consequences for public sector health. Meanwhile, the National Minister of Health has convened a committee to review the future of overtime for state doctors.
Dysfunction in the Gauteng Department of Health hit home hard for many public sector doctors on 29 April when their overtime payments due for the month went unpaid.
The non-payment came without notice and affected medical staff in facilities across the province, according to the South African Medical Association (SAMA). Only by 6 May did some doctors start to see payments reflect in their bank accounts. More payments are expected soon given that, according to the Basic Conditions of Employment Act, the employer has seven days to settle, said SAMA.
But tensions are rising as this payment blunder follows a protracted row over the department’s unilateral decision to cut and change the terms of commuted overtime in the province. Proposals to cut down on commuted overtime come in the light of a very tight provincial health budget. As with most other provincial health departments, Gauteng’s health budget has been shrinking in real terms for several years.
The delayed payments and the ongoing review of cuts and changes to commuted overtime pay has led to threats of protests and legal action. SAMA says they will make civil claims for salaries owed, including for interest and legal costs. Registrars and medical officers at Dr George Mukhari Academic Hospital in Ga-Rankuwa collectively wrote to the hospital giving notice of withdrawal of overtime services until the non-payment issue is completely resolved. By 7 May, the head of anaesthesiology at Sefako Makgatho Health Sciences University wrote to the CEO of George Mukhari Hospital informing him that no anaesthesia services would take place at the hospital starting 8 May, given the decision by registrars and medical officers to down tools outside of regular work hours.
Those from the medical fraternity that Spotlight spoke to have set out a series of concerns. These include resignations; an exodus of doctors, especially specialists from the public sector; plummeting staff morale; negative impacts on the training of doctors as fewer consultants and seniors are available to supervise – which then puts universities’ training accreditations at risk. Ultimately, several sources point out, it is the services offered to the public that suffer.
Committee appointed
By the beginning of April, there appeared to be some walking back by the Gauteng health department of its unilateral cutback proposals after meeting with the South African Medical Association Trade Union (SAMATU). In the same week, a circular was issued announcing that the national health department was conducting a review of its own, instructing provinces to hold off on their plans. Health Minister Dr Aaron Motsoaledi then set up a committee of experts to review certain human resource policies in the public healthcare sector. This includes a review of community service, commuted overtime, remunerative work outside the public service for health professionals, and rural and related allowances.
Commuted overtime is a pre-determined amount of overtime that doctors employed by provincial health departments are allowed to work. The amount is historically decided by hospital management and is based on an employee’s role, seniority, the department they work in and the amount of overtime they are allowed to safely work. It’s a fixed rate of 1.3 times the applicable hourly tariff for a specific work grade.
There are five contract options. A is no overtime worked; B is overtime of between four and eight hours a week; C is overtime between 9 and 12 hours a week; D is overtime between 13 and 20 hours per week; and an option E is where, on approval, a doctor can be authorised to work more than 20 hours of overtime a week.
As a fixed amount, commuted overtime is predictable supplemental income and for many doctors, it amounts to about a third of their take-home pay.
The long rumblings to cut their overtime pay has seen doctors being required to motivate why they should remain on contracts that pay for more overtime hours and junior doctors say they are being pressured to sign option C contracts, which will pay for fewer overtime hours. There are also proposals to change some of the terms relating to overtime, including scrapping overtime payments for doctors who are on call but not physically present at a facility.
Many doctors already exceed the maximum hours of their contracts because of the emergency nature of their work, gross understaffing and backlogs at their hospitals.
Costly, but essential?
The commuted overtime pay model has been contentious for years because it adds up to a sizeable chunk of the healthcare budget. According to a spending review conducted in 2022 on behalf of National Treasury, the country’s health departments spent R6.9 billion on commuted overtime in 2021. This made up about 70% of the total R9.9 billion spent on all types of overtime.
In an editorial published in the South African Medical Journal in April 2025, health sciences academics, associations, and unions slammed the Gauteng health department’s handling of pay issues. They argue that the basic salaries of medical professionals in the public health sector are already much lower than what would be considered fair pay.
“COT [commuted overtime] has long served as a critical mechanism to ensure that doctors are available beyond the standard workday, safeguarding round-the-clock care in the public health system…The abrupt curtailment of this framework risks hollowing out the after-hours safety net, leaving emergency rooms, wards and clinics dangerously under-resourced,” they wrote.
A co-author of the editorial, SAMA CEO Dr Mzulungile Nodikida, told Spotlight: “Medical doctors in South Africa’s public sector are severely underpaid. A study by SAMA has shown that even the annual cost of living adjustments that have been made on the salaries have not matched inflation in the last 5 years. Commuted overtime has had the effect of masking a deficient salary.”
He said the Gauteng health department has shown itself to be an “unreliable employer”, adding that its relationship with doctors remains fractured as a loss of confidence in the department deepens.
“This breach of the most basic employment obligation: timely remuneration, has cascading effects. It jeopardises morale, compromises service delivery, and calls into question the department’s commitment to its workforce. Doctors now operate under a cloud of uncertainty, unsure whether they will receive their salaries at month-end. This anxiety permeates every aspect of the employment relationship, from retention efforts to the willingness to engage in additional responsibilities,” said Nodikida.
View from the wards
Two doctors who spoke to Spotlight independently, and from two different Gauteng hospitals, say the commuted overtime pay disaster is yet another symptom of weak human resources and poor management from the department of health. For them, proposals to cut commuted overtime is the department shirking from addressing the staffing crisis; the need to improve human resources systems; and rooting out corruption, maladministration and wasteful expenditure. Both doctors asked not to be named for fear of reprisals.
Dr A, who is based at Charlotte Maxeke Johannesburg Academic Hospital, said: “Instead of having a system in place to record how many hours each doctor is actually working and what overtime that person should be paid, the department pays everyone this commuted overtime fixed sum….[Y]ou could be a dermatologist or a psychologist and have very few overtime hours or be a surgeon who is doing a lot of overtime but you all get paid the same if you’re on the same contract option,” she said. “But right now, in my career I’m working way more overtime hours than my contract and I’m not being reimbursed for any of it.”
Dr A said the overtime pay cuts and proposed changes will impact her decision to stay in the public sector.
“It used to be the case that you were happy, once specialised, to stay because the overall lump sum of money from your salary and commuted overtime made up a decent pay – not comparable to what you could earn in private – but decent enough to stay,” she said.
She said she feels like doctors are now being under-valued and coming under attack by their own employer. “The message we are getting is that ‘if you’re not happy, there’s the door’ – but what the department doesn’t understand is that you can’t just replace someone with 10 years’ experience or someone who has 30 years’ experience, it has a huge impact,” she said.
“Our patients are suffering; and every day it’s like a game of Survivor. We run multiple clinics in one clinic space at Charlotte Maxeke, but you can’t offer a functioning service like that. It’s noisy, the computers don’t work, and the intercom is going off the whole time.
“The other day, I had a 90-year-old patient have a panic attack in the waiting room. He had been waiting for a while and left his wife, who is blind, in the car. He had to park far from the hospital building because the parking lot from the hospital fire [in April 2021] is still not properly repaired and he was overcome with worry,” she said.
Dr B works at Chris Hani Baragwanath Hospital and he said the debacle over doctors’ overtime pay has pushed him to the edge. He said doctors are already overworked and disheartened from working within a failing system. He sent photos to Spotlight of theatres and wards in darkness as power went off at the Soweto hospital for days at the end of April.
Chris Hani Baragwanath Hospital plunged in darkness after days-long power outage in late April. (Supplied)
He said staff bring in their own toilet paper because they’re told there’s none. Most alarming, he said “doctors are not getting the training and supervision they need” and regularly perform surgeries and procedures without adequate experience and with no supervision.
“They are overwhelmed, overworked and doing way too many overtime hours that they’re not being paid for. Then they go home overtired, eat a pizza and crash, sleep a few hours then do it all over again the next day, and the next day,” he said.
“We, doctors, are literally the ones putting patients’ lives at risk,” he said, adding that he is “surviving on anti-depressants” and has sometimes shut himself away in hospital storerooms crying tears of sheer frustration, exhaustion and exasperation.
Dr B does still count the wins though. It’s days when he clears an impossibly long patient list of children who need procedures done. It’s when he and his colleagues decide to push through to make sure no child’s procedure gets cancelled.
“Those are the good days – they’re just few and far between. And now the department is coming for us by cutting our overtime pay and forcing us to sign contracts to downgrade our overtime pay,” he said.
Resignations and impact on training
Professor Shabir Madhi is dean of the faculty of Health Sciences at the University of Witwatersrand. He said the proposed cuts and freezing of posts and changes to commuted overtime pay has already resulted in resignations of some senior staff at state hospitals.
“If we don’t have the proper consultant staff complement in these hospitals who can provide supervision throughout the day, it compromises our training of specialists as well as of undergraduate students.
“If the Health Professions Council of South Africa were to do an audit and find that there isn’t adequate consultant cover and supervision, they could remove the accreditation of the training programmes offered by the universities.
“The medical schools are completely dependent on the Gauteng Department of Health to retain consultants and other categories of staff, and to ensure that staff are allocated time for supervision and training of future medical doctors, including specialist, as well as other academic activities.
“It means decision-making around cuts to overtime pay need to be cognisant of the overall impact that it would have, and not only in how it would assess budget constraints. This situation needs meaningful and informed decision-making,” he said.
Dr Phuti Ratshabedi, Gauteng chairperson of SAMATU, said the non-payment of commuted overtime pay in April was a slap in the face from the provincial health department as the union had a meeting with the department that month and left with the department agreeing to uphold their contractual agreements to leave contracts terms for commuted overtime pay unchanged at least till the end of March 2026 – the end of the financial year.
“What we saw is that the department will promise one thing and do another. But we will be holding them to what they stated in their own circular or we will look to legal action.
“What we want to see in this review period is that they go after departments [where overtime is not being performed, but being paid for] but leave other departments alone – they cannot put everyone under the same blanket.
“If the government is able to bail out over and over things like Eskom and Transnet, how can they not prioritise healthcare – this sets our country way back and we doctors will no longer be silent about this,” said Ratshabedi.
Spotlight sent questions to the Gauteng health department, including on how the payment delay happened; the number of people affected; how the department is addressing the wide-spread knock-on effects of their proposed commuted overtime cuts; and what amendments they hope will come out of the national review. Despite several reminders, the department did not respond to our questions.
Healthy hearts are adaptable, and heartbeats exhibit complex variation as they adjust to tiny changes in the body and environment. Mass General Brigham researchers have applied a new way to measure the complexity of pulse rates, using data collected through wearable pulse oximetry devices. The new method, published in the Journal of the American Heart Association, provides a more detailed peek into heart health than traditional measures, uncovering a link between reduced complexity and future cognitive decline.
“Heart rate complexity is a hallmark of healthy physiology,” said senior author Peng Li, PhD, of the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital (MGH) and the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital (BWH). “Our hearts must balance between spontaneity and adaptability, incorporating internal needs and external stressors.”
The study used data from 503 participants (average age 82, 76% women) in the Rush Memory and Aging Project. The researchers analysed overnight pulse rate measurements – collected by a fingertip pulse oximetry device known as the Itamar WatchPAT 300 device – and comprehensive measures of cognitive functions, collected around the same time as the pulse rate measurement and at least one annual follow-up visit up to 4.5 years later.
The team found that people with greater complexity in their heartbeats at baseline tend to experience slower cognitive decline over time. They determined that the conventional measures of heart rate variability did not predict this effect, indicating their measure was more sensitive in capturing heart functions predictive of cognitive decline.
The researchers plan to investigate whether pulse rate complexity can predict development of dementia, which would make it useful for identifying people at an early stage who might benefit from therapeutic interventions.
“The findings underscore the usefulness of our approach as a noninvasive measure for how flexible the heart is in responding to nervous system cues,” said lead author Chenlu Gao, PhD, also in the Department of Anesthesia, Critical Care and Pain Medicine at MGH. “It is suitable for future studies aimed at understanding the interplay between heart health and cognitive aging.”
Having a larger waistline, high blood pressure and other risk factors that make up metabolic syndrome is associated with an increased risk of young-onset dementia, according to a study published on April 23, 2025, online in Neurology®, the medical journal of the American Academy of Neurology. Young-onset dementia is diagnosed before the age of 65. The study does not prove that metabolic syndrome causes young-onset dementia, it only shows an association.
Metabolic syndrome is defined as having excess belly fat plus two or more of the following risk factors: high blood pressure, high blood sugar, higher than normal triglycerides, which are a type of fat found in the blood, and low high-density lipoprotein (HDL) cholesterol, or “good” cholesterol.
“While most dementia is diagnosed in older age, young-onset dementia occurs while a person is still working and perhaps raising a family,” said study author Minwoo Lee, MD, PhD, of Hallym University Sacred Heart Hospital in Anyang, South Korea. “Our study found having metabolic syndrome in middle age is a risk factor for young-onset dementia.”
For the study, researchers reviewed national health insurance data in South Korea to identify nearly two million people between the ages of 40 and 60 who had a health check-up. The check-up included measurements of waist circumference, blood pressure, blood sugar, triglyceride and cholesterol levels. Of all participants, 25% had metabolic syndrome.
Over an average follow-up period of eight years, 8921 people, or 0.45% of all participants, developed dementia. For those with metabolic syndrome, the incidence rate was 0.86 cases per 1000 person-years, compared to 0.49 cases for those without metabolic syndrome. Person-years represent both the number of people in the study and the amount of time each person spends in the study.
After adjusting for age, education and health factors such as level of physical activity, depression and stroke, researchers found metabolic syndrome was associated with a 24% higher risk of dementia. When looking at specific types of dementia, it was associated with a 12% increased risk of Alzheimer’s disease and a 21% increased risk of vascular dementia.
Researchers found female participants with metabolic syndrome had a 34% increased risk of dementia compared to male participants who had a 15% increased risk. People in their 40s had a greater risk than people in their 50s.
Researchers found each component of metabolic syndrome was associated with an increased risk of dementia, which was cumulative. People with all five components had a 70% increased risk of dementia.
“Our findings suggest that lifestyle changes to reduce the risk of metabolic syndrome, such as eating a healthy diet, exercising regularly, maintaining a healthy weight, quitting smoking and reducing stress, may help reduce the risk of young-onset dementia,” said Lee. “Future research that follows people over longer periods of time and uses brain scans to look for biomarkers of dementia is needed to confirm and expand upon our findings.”
A limitation of the study was that researchers did not review genetic risk factors for Alzheimer’s disease.
The study was supported by the Korean National Research Foundation.
