Prof. Antonio Cano: the challenges of the treatment of menopause

Editor’s note

Providing an evidence-based approach to the universal experience of menopause, the book “Menopause” edited by Prof. Antonio Cano and written by respected experts in the field, clearly separates the biological basis form the clinical impact and quality of life, while also examining menopause within the context of healthy ageing in females. To benefit the physicians and patients in China and to further the communication in the field, we tried to approach Prof. Antonio Cano to conduct an interview. In this interview, Prof. Antonio Cano has shared with us his experience and research in the field of gynecological endocrinology, and stories of this excellent book.

Expert’s introduction

Prof. Antonio Cano (Figure 1) is a physician specialist in Obstetrics and Gynecology. Full Professor of Obstetrics and Gynecology and Head of the Department of Obstetrics Gynecology at Hospital Clínico Universitario, Valencia. Training as a scholar at the University of Bologna in 1979, and postdoctoral fellow in the Imperial Cancer Research Fund in London, UK (grants British Council-Spanish Ministry of Education [1984–1985]. Main interest is gynecological endocrinology, with specific attention to menopause and the impact on susceptibility to osteoporosis, metabolic syndrome, and cardiovascular disease. He is acquainted with basic research, including genomics (single-nucleotide polymorphisms and microRNAs).

Figure 1 Prof. Antonio Cano.

Leadership in clinical trials involving menopausal hormone therapy as well as the modulatory role of selective estrogen receptors modulators, like raloxifene.

Prof. Cano has published over 200 papers in journals including for the JCR Science Edition. He has also published some 150 additional papers or chapters in books and has edited 12 books.

Interview questions

A close look at gynecological endocrinology

GPM: You are a board-certified gynecological endocrinologist. Can you please briefly introduce gynecological endocrinology? What made you decide to contribute to gynecological endocrinology?

Prof. Cano: Gynaecological endocrinology deals with all aspects related with the action of hormones in the field of Gynecology. This focuses mainly in reproduction, which is not only fertility, but also contraception, menopause, chronic diseases with a hormonal background after menopause (osteoporosis for example) and the world of pregnancy, including placental endocrinology, etc.

GPM: What is the most interesting part in your work as a Full Professor of Obstetrics and Gynecology at the University of Valencia?

Prof. Cano: I am involved in research, obviously, but also in the clinical tasks related with a Department in a University hospital. Furthermore, I have some teaching duties to both pre- and post-graduates.

GPM: What is the training pathway of a gynecological endocrinologist in Spain? And what are the challenges to be a gynecological endocrinologist?

Prof. Cano: Doctors need to complete their training as residents, which involves 4 years and covers the full background of the speciality. Those interested in Gyn Endocrinol may focus in that specifically, but only later, once they attach themselves to a third level hospital. There is not the Gyn Endocrinology as a sub-speciality. Sub-specialities do not exist in most of Europe for Obstet & Gynecol.

GPM: What are the hot topics in gynecological endocrinology?

Prof. Cano: Menopause, obviously, and the relation of that with women’s health in general. Innovative áreas in relation with fertility (stem cells for example), catch much interest as well.

GPM: In one of your recent articles “Real-world Adherence and Persistence with Bisphosphonate Therapy in Postmenopausal Women: A Systematic Review”, you concluded that suboptimal adherence to and persistence with bisphosphonate therapy in postmenopausal women are common and increase the risk of fracture. What is the role of bisphosphonate therapy in the treatment of postmenopausal women? And what is your expectation for the future treatment of postmenopausal women?

Prof. Cano: Bisphosphonates are already a classical group of drugs in the management of osteoporosis. They seem, therefore, to be less innovative than the biological options, like antibodies, etc. But the good thing with bisphosphonates is that they are very consolidated and give much return in terms of fracture protection. They are also very cost-effective, a reason of being a first option in therapy.

In the cases of women, they are the first option after the initial postmenopausal years, in which hormone therapy or SERMs occupy the first therapeutic choice.

GPM: Could you introduce us some significant research projects/trails you were involved in? What is your future research direction?

Prof. Cano: I have been involved in trials related with the role of hormones in postmenopausal osteoporosis, mainly SERMs. For the moment, no projects are alive in my group concerning osteoporosis.

About the book of Menopause

GPM: Can you please briefly introduce status of menopause? What are the challenges of the treatment of menopause?

Prof. Cano: Two main challenges in the management of menopause are the implementation of lifestyle, particularly now that women are reluctant to take hormones, and of course, the correct implementation of menopausal hormone therapy. Hormones are very efficacious and protective, although obviously not for all women. Some selections need to be done.

GPM: What sparked your interest in editing the book Menopause? Or what is your writing intention?

Prof. Cano: As I say above, menopause is an area that extends more and more because the population of menopausal women grows as a result of the increase in life expectancy. The topic has been removed from many tertiary centres and, therefore, residents do not get enough training in the field. Moreover, there are very innovative areas, like the impact of new technologies, that required attention.

GPM: When did you start writing this book? Did you meet any challenges during the writing process?

Prof. Cano: I started soon after the ISGE Congress in Florence, in 2016. But one difficulty was to get the commitment of co-authors. Some of them have taken more time to complete their duties, as always in this sort of enterprises, and that makes that the whole thing takes time.

GPM: What are the key features of this book?

Prof. Cano: I have given a face of menopause that integrates the very specific areas related with the biology of the process, clinical symptoms, risk of disease, etc., all of them quite classical, with some innovation, for example the use of new ICT technologies to help women to cope with the process. I have also made an effort to integrate the whole index into what responds to the concept of women’s health.

GPM: What are the targeted readers?

Prof. Cano: Doctors and nurses, and also the academic world, students and scholars. Perhaps some lay public may get some profit from some chapters, but the book has been written with a focus on technically competent readers.

GPM: Do you have a plan for a new edition on Menopause?

Prof. Cano: Not for the moment.

Acknowledgments

We would like to express our sincerest gratitude to Prof. Antonio Cano for sharing his stories, insights and opinions with us.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Gynecology and Pelvic Medicine. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://gpm.amegroups.org/article/view/10.21037/gpm.2019.07.05/coif). SZ reports that she is a full-time employee of AME Publishing Company (publisher of the journal). The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

(Science Editor: Silvia Zhou, GPM, gpm@amegroups.com)