SEATTLE, Feb. 12, 2003 - Joy Zia, M.D., who is a physician with Swedish OB/GYN Ballard, took part in a discussion today on KUOW Radio (94.9 FM; NPR) about the pros and cons of at-home and hospital births.
I am an OB/GYN who has been in practice now for 20 years in Seattle. My early training had a strong emphasis on vaginal reconstructive surgery, but I was always frustrated with our poor success rate in repair of pelvic prolapsed and urinary incontinence. As my practice has evolved I have continued to focus on urinary incontinence and new techniques for treating pelvic prolapse. In the recent years there have been some very exciting new changes.
Urinary incontinence in women
Many women are bothered by urinary incontinence. Recent studies have shown that this is worse if you have had a vaginal delivery, but some of women have either wide pelvic openings or poor tissue elasticity that can lead to this without ever having had a vaginal delivery. This is an embarrassing problem and can be very inconvenient, with many women carrying a change of clothes or wearing daily pads. In the elderly this can lead to slips or falls and even broken hips. For women who have had children, this may keep them from exercising or playing with their children for fear of leakage. Many women suffer in silence because this is too embarrassing to share even with their doctors.
Today we have several ways ....
ISSAQUAH, WASH., Feb. 1, 2013 – Childbirth is often painful and always unpredictable, but postpartum recovery doesn’t have to be. New mothers can now leave the hospital even happier with Postnatal Body Therapy™ by Bavia™. This postnatal massage service is now available at Swedish/Issaquah.
A recent article in the Seattle Times references the 2012 Dartmouth Atlas Report: Improving Patient Decision-Making in Health Care. Unfortunately their take home line, "A new report that found wide geographical variation in the use of elective surgical procedures in Pacific states reflects the preferences of physicians – not what patients want or need, the authors say,” oversimplifies a complicated situation.
On my reading of the report, it stresses the values that an individual woman brings to the decision:
“Different women will prefer one option or the other, depending upon how much they value preserving their breast, their willingness to undergo radiation or more invasive surgery, and the level of uncertainty they are willing to live with in terms of their cancer recurring.”
As a breast surgeon who has practiced in Seattle for almost 40 years, I don’t believe that “the preferences of physicians” are the driving factor. I have a few observations to make.
It is clear that wide variations in treatment of early stage breast cancer can be seen across the USA, as the Dartmouth-Atlas data confirms. Some factors that influence this are physician related – for example, what % of their surgical practice involves treating women with breast cancer. Specialists in breast cancer or general surgeons who treat large numbers of women with breast cancer are motivated to be current in their practice patterns and to make sure that their patients are making considered decisions. The utilization of breast MRI has been shown to influence the mastectomy rates and there is regional variation in the use of that study. Distance to a radiation oncology treatment center is a factor for some women as are potential differences in out of pocket costs between mastectomy and breast conservation.
All of the local breast surgeons that I know strongly value shared decision making with their patients. We all work hard to present treatment options fairly and as neutrally as possible. If we have a patient that we think is choosing mastectomy over breast conservation out of fear – for example, fear of radiation therapy – we will encourage her to consult with a radiation oncology specialist prior to making a final decision. We believe that one of our roles is to help our patients make informed decisions. If there are clear medical reasons why one treatment is preferred, we will state that but otherwise encourage the patient to make the best decision for herself.
In the haze of joy and sleeplessness during the months after childbirth, thoughts about breast cancer are the last thing on a new mother’s mind. Her body is undergoing so many changes that, of course, she and her doctors would naturally assume any breast changes are related to breastfeeding.
Probably, they are. However, there is a small but real incidence of women who develop breast cancer during and following pregnancy. Often, they end up having delays in seeking evaluation and getting a diagnosis, because they or their doctors may not appreciate that risk!
So, what things should prompt an evaluation?
- Lumps most often will be changes in the breast tissue as it revs up milk production. A distinct lump or “dominant mass” could be a clogged duct, galactocele, cyst or a common benign tumor called a fibroadenoma, but if it doesn’t resolve within a few weeks with treatment, it needs imaging.
- Redness most often will represent infections like mastitis or an abscess, but if it doesn’t resolve within a few weeks with treatment, it will also need imaging and possibly a biopsy. At the very least, that could determine if the right antibiotics are being used. An uncommon form of breast cancer called inflammatory breast cancer can present this way.
- Bloody milk or baby refusing one breast most often will be due to nipple trauma, latch issues, or positioning; if so, seeing a board-certified lactation consultant is appropriate. But rarely, this can represent a form of breast cancer within the milk ducts.
- “Something’s not right”. You are the most knowledgeable person about your own breasts. Even if it doesn’t neatly fit one of the categories above, if something really seems wrong to you, your doctors should take that seriously.
What evaluation should be done?
Just as all breast cancers are not alike, the impact of breast cancer is not the same for all women. African American women are less likely to get breast cancer than Caucasian women, but they are about 40% more likely to die of it when they do get it. African American women are also more likely to be diagnosed with breast cancer at a younger age than Caucasian women and to have more advanced cancers at diagnosis.
There appear to be multiple reasons for these disparities - including cultural beliefs / misperceptions about screening and cancer; lack of access to screening; inequities in healthcare delivery and treatment; concerns about being exposed to racism by healthcare institutions; and biological differences in the cancers themselves.
Let’s look at some of these more closely.
- Cultural beliefs / misperceptions about ....
ISSAQUAH, WASH., Oct. 23, 2012 – The public is invited to ‘A Night Out at Swedish: Fall Arts Showcase’ on Thursday, Nov. 1 from 6-8 p.m. This free evening event, which will take place in the first-floor lobby of Swedish/Issaquah (751 N.E. Blakely Dr.), will feature a community concert by the Sammamish Symphony String Quartet.