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'Women's Health' posts

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...

Eating for Two? Nutrition in Pregnancy

You may have many questions when you find out that you are pregnant, but some of the most common concerns revolve around nutrition and food safety. These are some basic guidelines from the American College of Obstetricians and Gynecologists to get you started. As always, your situation may be different and so always discuss specifics with your provider.

How much weight should I gain?

This depends on your pre-pregnancy BMI (body mass index - a calculation from your height and weight). In general, however, if your pre-pregnancy weight is normal you should gain between 25 to 35 pounds. Most women stay within this goal with an increase of only 300 extra calories a day (equal to about 2 tablespoons of peanut butter and one slice of whole wheat bread). If you are underweight, however, you may need to gain more weight, and if you are overweight, less. Your doctor can help you to come up with a specific weight goal.

What foods can't I eat?

Alcohol, of course, is not recommended in pregnancy, but there are other restrictions. Other foods can put you at risk for listeriosis, a bacterial infection that causes miscarriage and stillbirth. Unpasteurized milk and cheese can put you at risk, as can raw or undercooked shellfish, meat, or poultry. Deli meats and hotdogs are okay if they are heated until they are steaming hot.

What about fish?

That depends on the fish! Certain large fish may contain too much mercury to be safely eaten in pregnancy. High levels of mercury exposure in pregnancy may lead to nervous system damage in the unborn child. If you are pregnant you should avoid eating Shark, Tilefish, Swordfish, and King Mackerel and limit your intake of albacore tuna to 6 ounces a week.

You may eat fish and shellfish that are lower in mercury, but no more than 12 ounces a week. If you want to eat fish caught by family or friends from local waterways check for local advisories first, and do not eat more than 6 ounces.

Do I need to take extra vitamins or supplements?

It is important to take ...

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:

Swedish Set to Open Comprehensive True Family Women’s Cancer Center

SEATTLE – May 29, 2012 – Swedish Cancer Institute (SCI) is set to open its new True Family Women’s Cancer Center to patients on Tuesday, June 5. Carefully designed with the female cancer patient in mind, the new 23,600-square-foot women’s cancer center gives Swedish Cancer Institute the ability to consolidate most of its services for treating women’s cancers into one facility. The new center acts as a treatment hub where women are guided through personalized and coordinated multidisciplinary treatment of their cancer, including disease-specific education and holistic support activities.

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?

Are You Up to Date on Your Pap Smear?

Recent changes to Pap guidelines may have you wondering when exactly you need to have a pap smear and in turn, how often you really need an annual exam with your gynecologist. Here I’m going to review the new pap guidelines so you can determine if you are up to date! Of course, every patient should check with their physician about what they recommend regarding the timing of cervical cancer screening because some specific populations may have different recommendations. These are just the general guidelines.

Pap smears are a screening test for cervical cancer. They have helped decrease the incidence of cervical cancer by more than 50% in the last 30 years. Over the last decade we’ve also begun testing for HPV (or Human Papillomavirus) which is by far the most common cause of abnormal pap smears and cervical cancer. It is an incredibly common sexually transmitted virus that can be spread by genital to genital contact but also oral to genital and manual to genital contact. It has been estimated that 75 to 80 percent of sexually active adults will acquire a genital tract HPV infection before the age of 50. Luckily, most HPV-infected women, especially younger women, will mount an effective immune response to the virus and will never develop dysplasia or cancer.

HPV is not like herpes —YOU CAN GET RID OF IT! The amount of time it takes to get rid of the virus varies but most experts think it takes an average of 8-24 months. Women with persistent HPV infections are more likely to get dysplasia and if it goes undetected or untreated, over time it can develop into cancer. HPV infections of the cervix do not cause symptoms and can only be detected by pap screening. Unfortunately we don’t have a cure for HPV, but vaccinations are available and FDA approved for girls and now boys ages 9-26. More on HPV is sure to show up in future blog posts, so stay tuned!

The American College of Obstetrics and Gynecology (ACOG) recommends starting pap screening ....

Mammography-Detected Breast Cancer in 40-49 Year-olds Has Better Prognosis

SEATTLE, Feb. 23, 2012 – Based on a study of nearly 2,000 breast-cancer patients, researchers at the Swedish Cancer Institute say that, in women between the ages of 40 and 49, breast cancers detected by mammography have a better prognosis. The study appears in the March issue of Radiology.

“In our study, women aged 40 to 49 whose breast cancer was detected by mammography were easier to treat and had less recurring disease and mortality, because their cancer was found at an earlier stage,” Henry Kaplan, M.D., medical oncologist with Swedish Cancer Institute (SCI).  

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