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What you should know about breast cancer and tips for reading online information

Since October is Breast Cancer Awareness Month, I’ve been paying more attention to online blogs about breast cancer and realize there is a lot of information and misinformation out there. How can you know what’s correct, what’s marketing, and what is just plain wrong? Here are some tips:

  1. Be an aware and questioning reader: Ask yourself some of the following questions. What is the source of the information? Does the author have anything to gain financially from the information? Are there studies that provide data supporting the recommendations? Who funded the studies and were there any potential conflicts of interest?
  2. Investigate more than one source: Healthcare has become very politicized and complicated but you can find reliable sources. But realize even with trusted sources the information provided may be conflicting. Some reliable sources include: Swedish Cancer Institute, Breast Cancer Action, National Cancer Institute, and American Cancer Society.

  3. Don’t be taken in by conspiracy theorists: I have practiced surgery for 30 years in a variety of situations and healthcare institutions and NEVER have I experienced a desire to withhold effective tests and treatments from patients. Physicians and hospital systems are not suppressing tests, treatments, and /or cures in order to stay in business. I don’t know a breast surgeon who wouldn’t be thrilled to have to practice another specialty if there was a way to prevent breast cancer.

Here are some things that I think it is important to know about breast cancer:

Do self breast exams matter?

Self breast exams: to do or not to do?

Remember when there were monthly emails you could sign up for to remind you and your friends to do your self breast exams at home? Remember seeing the news anchors talking about their monthly self breast exams in an attempt to remind you to do your breast “due diligence?” What happened to self breast exams and are they still important?

Initially, self breast exams were recommended as a screening tool to help early detection of breast cancer. Unfortunately long-term studies have not confirmed that they actually live up to their hype. Two large studies looking at over 200,000 women in both Russia and China didn’t show any difference in breast cancer mortality after 15 years between the women who were performing routine self exams and those who were not. In fact, the women that were practicing self exams found more lumps and underwent more biopsies for benign reasons. Reviews of several other studies failed to show a benefit of regular breast self-examinations including no benefit of early diagnosis, or reductions in deaths or stage at diagnosis. Hence in 2009, the US Preventative Services Task Force advised that clinicians no longer recommend routine self breast examination as a screening tool for breast cancer detection.

Even though you don’t need to be doing a monthly self exam, you should...

What test is best for breast screening?

I often get asked why can’t a woman just get a breast MRI rather than a mammogram. The imaging tests that we do for breast cancer screening and evaluation of abnormalities have different strengths and weaknesses.

Mammograms are very useful as a screening tool. They can be done quickly and read efficiently by the breast radiologist. They have minimal radiation exposure. They can be done by a mobile coach in locations that are more convenient to patients. They are excellent for identifying abnormal calcium deposits within the breast tissue and for seeing disrupted tissue and masses. They may be less effective in women who have dense breast tissue but the digital techniques have helped some with that. 

Ultrasound is a great tool for evaluating a mass or tissue asymmetry found on mammograms. It can distinguish between a benign appearing solid mass, a fluid filled cyst, a mass that is suspicious for cancer, or normal appearing breast tissue. There is no radiation exposure. It is less reliable as a screening tool because it can be dependent on the skill of the physician or technologist doing the procedure. It is possible to miss abnormalities or to mis-interpret normal findings as abnormal. There are studies underway evaluating using an automated version of ultrasound as a screening test but the results are not conclusive and this is not considered ready for standard practice.

Breast MRI is a highly sensitive test that is very dependent on...

Celebrate the 20th Annual World Breastfeeding Week at Swedish/Issaquah

World Breastfeeding Week is an annual celebration held around the world to generate public awareness and support for breastfeeding families. And, in honor of this special week, Swedish/Issaquah Pediatrics and OB are hosting a community celebration – and you’re invited.

Join us on Wednesday, Aug. 1 from 11 a.m.-3 p.m. for a fun-filled day of activities. Raising a healthy, happy baby is one of the most rewarding things you’ll do. And, it doesn’t have to feel overwhelming.

We’re bringing together an impressive group of individuals and vendors to provide you and your family with information about health and education services. Our event will also feature:

  • Door Prizes
  • Story Telling
  • Teddy Bear Clinic
  • Massages
  • The Leche Lounge
  • Live Music
  • Yoga
  • “Ask-the-Doc” Booth

Event Location:
Swedish/Issaquah
751 N.E. Blakely Drive
Issaquah, WA 98029
2nd Floor Conference Center

Getting a mammogram

Frequently women will ask me: Where should I get my mammograms? There are several things to think about.

First, you want to go to a Center that is accredited by the American College of Radiology. This means that they have high quality images and well-trained radiologists. It is preferable to have a digital mammogram but if that technology is not available, then film mammograms are better than not having one done. While it is not clear that digital mammograms improve survival, they do allow the radiologist to examine the images more clearly and to use computer assisted diagnostic tools.

The radiologists’ experience is also important. Dedicated breast centers usually have radiologists who are specialized in breast imaging. These sub-specialized radiologists are very experienced in using mammograms, ultrasound, and breast MRI to diagnose breast disorders and are less likely to miss abnormalities.

Convenience is also a consideration. You want to make it easy to get your mammograms. Some Breast Centers will have mobile mammography programs that will bring mammogram screening to your place of work, local community or senior center, or even your church or synagogue. If possible, it is a good idea to get your mammograms at the same Center or within the same hospital system every year. That way the radiologists have easy access to your prior studies and can compare them to the current ones.

Here are some other things to know about getting mammograms:

One size does NOT fit all: features to consider when choosing your birth control

We are lucky to have so many birth control options available to us. Not all methods will be ideal for all couples, so how do you figure out how to pick a method? Here are some features to consider – but keep in mind that not all features will be important to you in your personal circumstances.

Effectiveness: How well will a particular approach work to prevent pregnancy?

There are some times in life where avoiding pregnancy is more important than other times, so most effective forms should be selected when it is critical to prevent pregnancy.

There are two scales of effectiveness, typical user effectiveness and perfect use rates. Some birth control depends a lot on...

Hormone therapy

Symptoms associated with menopause have been treated with estrogen and progesterone for many years. When I went into private practice in 1986, we had been taught that hormones given to postmenopausal women were protective. We prescribed them widely, like they were vitamins. If menses stopped, the next thing to do was to take hormone replacement therapy. We asked patients to let us know when their menses stopped so that we could administer hormone therapy promptly.

Today we have concerns about hormone therapy. The Women’s Health Initiative was a large study that collected data on the incidence of heart disease, stroke, cancer and bone fracture in women taking hormones as compared with women who did not take hormones in menopause. In 2002, a large portion of the study was discontinued because it appeared that women taking estrogen and progesterone were at increased risk for heart disease, stroke and breast cancer.

In 2002 many women went off of hormone therapy and many physicians stopped prescribing it. In the months that followed, many women found that they had symptoms of menopause that interfered with their lives. The consumer media began reporting on natural and bio-identical hormones. Claims surfaced of superior safety.

What are natural hormones?

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