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"Hot Chocolate Goes With Everything"
DOCTOR'S CORNER
SOUTHWEST PROSTATE CANCER FOUNDATION’S RADIO SHOW
SPONSORED BY SOUTHWEST ONCOLOGY CENTERS
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*THURSDAY’S AT 10:00 TO 11:00 AM*
Erectile Dysfunction
What: Men’s Health Talk Program
Topics: “ERECTILE DYSFUNCTION”
Special guests
and presenters:
*Dr. Brandon Chastant NM.D; Dr. Phranq Tamburrie NM.D,
Dr.Tursha’ Hamilton N.D. & Fred Taylor EX. Director SWPCF.
When: Thursday, December 3, 2009.
Time: 10:00 AM to 11: 00 (NEW TIME FORMAT)
Where: Radio Station – KXXT 1010 AM, or,
Online–www.familyvaluesradio.net (click left side of menu), or,
Call-in Number: 602.296.3632
*Dr. Brandon Chastant is an expert on Erectile Dysfunction. He serves with the Summit Medical Center.
THE SHOW COVERS A VARIETY OF CANCERS INCLUDING PROSTATE CANCER, BREAST CANCER, AND COLON CANCER. A MAJOR COMPONENT OF THE SHOW WILL BE DISCUSSIONS BY HEALTH CARE PROFESSIONALS ON CANCER. HEALTHY LIVING FOR BOTH SEXES IS KEY.
SOUTHWEST PROSTATE CANCER FOUNDATION
FRED TAYLOR, EXECUTIVE DIRECTOR
P.0. BOX 12186
GLENDALE, AZ 85308
602-547-3806
E-MAIL swprostatecancer@aol.cpm
WEB SITE www.sw-prostatecancer.com
Health Advisory WHAT IS SWINE FLU?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.
Turn the volume down 50%! Happy listening now and Future!
American Speech-Language-Hearing Association, ASHA, program Listen to Your Buds. Parents those little wires leading to those ears may hurt!
ASHA recommends that we keep the volume at 50 percent and listen to no more than one hour at a time. Notes one expert!
NIH supports turning the sound down. Experts says Turn the volume down.
Buds send sound directly into the ears, parents may not be bothered by loudness: may not realize children listening to damaging levels.
Parents may be close to their kids, but music may be even closer – in their ear canals, blasting out of their ear buds.
Always consult your healthcare professional on all matters of health. Always avoid self diagnosis! Seek consultation always!!!
Since uncontrolled blood sugar levels can have both immediate and long-term serious adverse effects. Consult your Doctor for instructions!
Based on available data,FDA recommends patients should not stop taking their insulin therapy without consulting a physician.
The possible risk: Cancer in patients with diabetes. Three of the four studies suggest an increased risk for cancer associated w use Lantus.
FDA notified healthcare professionals and patients that it is aware of four observational studies: the use of Lantus (insulin glargine)
FDA approves ferumoxytol (Feraheme Injection, AMAG Phar. Inc) for treatment of iron deficiency anemia in adults with chronic kidney disease.
H1N1
What are the signs and symptoms of swine flu in people?
CDC Swine Influenza (Flu)
CLICK HERE
CENTER FOR DISEASE CONTROL SWINE FLU INFO
CDC LATEST INFO!
How many U.S. Cases?
Worldwide cases-How many?
WHO Case Count as of May 1, 2009
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Women's Health Week
May 12-18, 2009
Key Medical Issues All Women Should Know!
by Dr. Jack Poles
OSTEOPOROSIS
In this country 8 million women and 2 million men have osteoporosis, a condition in which the bone has decrease strength which in turn leads to a higher frequency of fractures. The diagnosis is considered in patients (especially older patients) who have non-traumatic or only minimal traumatic fractures and who have a positive X-ray called a bone densitometry or DEXA scan.
The density of the patient's bone is compared to that of a young person of the same sex and is measured by standard deviations (like a bell shaped curve has standard deviations). This is called a T-score. A score of-1 or less is normal, from -1.1 to -2.5 is called osteopenia, and greater than -2.5 is called osteoporosis. Each standard deviation below normal represents an approximately 10% lifetime chance of a fracture at that site. The sites measured are usually the lumbar spine, the hip, and sometimes the wrist. Based on the score and other factors the patient will be offered medicine to prevent worsening of the density (to be discussed in a subsequent report).
Major contributing factors are some medicines (such as cortisone), lack of physical activity, smoking, alcohol, and some chronic conditions such as rheumatoid arthritis. Diseases that increase fall risk such as Parkinson's disease, strokes, or multiple sclerosis also increase fracture risk. All women should be screened no later than age 65 and probably shortly after menopause. The subsequent frequency thereafter is every one or two years, although women with perfectly normal bone densities and no other medical issues could probably go every 2-3 years. Aside from the medications to be discussed in another article, physical activity is vitally important to try and promote bone stimulation and improved bone density. In this situation, the more exercise done, the better the results.
The general recommendation is 30 minutes of walking or equivalent 5 or 6 days a week. Unfortunately although swimming is a great exercise it doe not give the gravity-dependent bone stimulation of vertical exercises. Even in impaired patients, any exercise such as chair exercise or tai chi is helpful. Hip and knee protectors may help prevent fractures. Avoidance of tobacco and alcohol should be attempted for multiple reasons. Hip fractures usually require surgery with the insertion of a plate and screw into the injured area for stability, and sometimes a total hip replacement..
Spine fractures (compression fractures) are often asymptomatic, but if there is severe pain from a new fracture then a procedure called a kyphoplasty can be performed. This involves putting a balloon (similar to a balloon for coronary artery angioplasty and stenting but at much higher pressure) into the affected vertebrae and then inflating it to decompress the fracture. A cement is then inserted to keep the vertebra from compressing again. Multiple consecutive compression fractures can lead to problems involving the spinal cord, and that requires a different type of surgery, which is beyond the scope of this article.
Return to top
Women's Health Week
May 12-18, 2009
Key Medical Issues All Women Should Know!
by Dr. Jack Poles
OSTEOPOROSIS
In this country 8 million women and 2 million men have osteoporosis, a condition in which the bone has decrease strength which in turn leads to a higher frequency of fractures. The diagnosis is considered in patients (especially older patients) who have non-traumatic or only minimal traumatic fractures and who have a positive X-ray called a bone densitometry or DEXA scan.
The density of the patient's bone is compared to that of a young person of the same sex and is measured by standard deviations (like a bell shaped curve has standard deviations). This is called a T-score. A score of-1 or less is normal, from -1.1 to -2.5 is called osteopenia, and greater than -2.5 is called osteoporosis. Each standard deviation below normal represents an approximately 10% lifetime chance of a fracture at that site. The sites measured are usually the lumbar spine, the hip, and sometimes the wrist. Based on the score and other factors the patient will be offered medicine to prevent worsening of the density (to be discussed in a subsequent report).
Major contributing factors are some medicines (such as cortisone), lack of physical activity, smoking, alcohol, and some chronic conditions such as rheumatoid arthritis. Diseases that increase fall risk such as Parkinson's disease, strokes, or multiple sclerosis also increase fracture risk. All women should be screened no later than age 65 and probably shortly after menopause. The subsequent frequency thereafter is every one or two years, although women with perfectly normal bone densities and no other medical issues could probably go every 2-3 years. Aside from the medications to be discussed in another article, physical activity is vitally important to try and promote bone stimulation and improved bone density. In this situation, the more exercise done, the better the results.
The general recommendation is 30 minutes of walking or equivalent 5 or 6 days a week. Unfortunately although swimming is a great exercise it doe not give the gravity-dependent bone stimulation of vertical exercises. Even in impaired patients, any exercise such as chair exercise or tai chi is helpful. Hip and knee protectors may help prevent fractures. Avoidance of tobacco and alcohol should be attempted for multiple reasons. Hip fractures usually require surgery with the insertion of a plate and screw into the injured area for stability, and sometimes a total hip replacement..
Spine fractures (compression fractures) are often asymptomatic, but if there is severe pain from a new fracture then a procedure called a kyphoplasty can be performed. This involves putting a balloon (similar to a balloon for coronary artery angioplasty and stenting but at much higher pressure) into the affected vertebrae and then inflating it to decompress the fracture. A cement is then inserted to keep the vertebra from compressing again. Multiple consecutive compression fractures can lead to problems involving the spinal cord, and that requires a different type of surgery, which is beyond the scope of this article.
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*
DRUG THERAPY IN PRE-MENOPAUSAL WOMEN
CONTRACEPTION
There are lots of options here. The most common is cyclical 28 day regimens of low dose estrogen and progesterone for 21 days and then an inert pill for the last 7 days to allow a normal menstsrual period. Over the years the doses of both hormones have been decreased to minimize the side effects (such as nausea, bloating, edema, or breast tenderness) although some women have breakthroght (mid-cycle) spotting or bleeding. There is also a 3 month combination (Seasonalle and others) which contains 84 active and 7 inert pills allowing only 4 periods yearly.
In addition there is a continuous contraceptive (Lybrel) that prevents any periods from occurring. Some physicians will let the woman take the conventional monthly birth control pill (BCP) continuously and skipping the 7 day inert pill regimen to effectively eliminate periods also. There is also a weekly patch (Ortho-Evra) which has less breakthrough bleeding but has the disadvantage that the patch sometimes falls out, a monthly shot (Lunelle), progesterone only pills, and an implantable 3 year rod called Implanon.
The progesterone only pill is only 93 % effective versus 98-99% for the others and the return to normal periods can take 12-18 months as opposed to 3-6 months when coming off another BCP. Oral contraceptives are contraindicated in women with breast cancer, previous blood clots, or liver disease. They are relatively contraindicated in women over 35 who smoke, uncontrolled hypertension, diabetes with kidney involvement, or a history of migraine headaches or other neurological conditions. Oral contraceptives decrease the risk BCP's seem to decrease the risk of cancer of the ovary and uterus at a later age.
Non- medicinal contraceptives include barrier methods (condoms, diaphragms, or cervical caps) spermicidal gels (that are not very effective without condom use), and intra-uterine devices (lUD's). The latter are highly effective but can cause bleeding, pain, and rarely perforation of the uterus. With the use of BCP'S a missed day of taking "the pill" can result in pregnancy, so condoms should be used until tshe next month. Unprotected sex carries an 8% risk of pregnancy, and use of multiple combinations of 2-4 BCP pills or "Plan B" (the morning after pill) will prevent implantation. Also recently approved is RU 486 (Miferex) which will prevent implantation.
SEXUALLY TRANSMITTED DISEASES (STD'S)
None of the contraceptives mentioned above (with the exception of condoms) do one very important thing—prevent sexually transmitted diseases. Most of these diseases (such as herpes, gonorrhea, syphilis, Chlamydia, HPV, and other more unusual diseases) have treatments, but they can cause pain, fever, bleeding, and ultimately infertility if left untreated.
The one STD that is most feared is HIV/AIDS, for which there is treatment but also the possibility of dire complications including death. The treatments for AIDS (unlike the other disease mentioned above) may be for a lifetime. The lesson is clear—unless you know your partner for a long time (and have been tested regularly) condoms are the only way of preventing these disease even if you are on contraceptives. Talk to your doctor in detail about your options.
Return to top
DRUG THERAPY IN PRE-MENOPAUSAL WOMEN
CONTRACEPTION
There are lots of options here. The most common is cyclical 28 day regimens of low dose estrogen and progesterone for 21 days and then an inert pill for the last 7 days to allow a normal menstsrual period. Over the years the doses of both hormones have been decreased to minimize the side effects (such as nausea, bloating, edema, or breast tenderness) although some women have breakthroght (mid-cycle) spotting or bleeding. There is also a 3 month combination (Seasonalle and others) which contains 84 active and 7 inert pills allowing only 4 periods yearly.
In addition there is a continuous contraceptive (Lybrel) that prevents any periods from occurring. Some physicians will let the woman take the conventional monthly birth control pill (BCP) continuously and skipping the 7 day inert pill regimen to effectively eliminate periods also. There is also a weekly patch (Ortho-Evra) which has less breakthrough bleeding but has the disadvantage that the patch sometimes falls out, a monthly shot (Lunelle), progesterone only pills, and an implantable 3 year rod called Implanon.
The progesterone only pill is only 93 % effective versus 98-99% for the others and the return to normal periods can take 12-18 months as opposed to 3-6 months when coming off another BCP. Oral contraceptives are contraindicated in women with breast cancer, previous blood clots, or liver disease. They are relatively contraindicated in women over 35 who smoke, uncontrolled hypertension, diabetes with kidney involvement, or a history of migraine headaches or other neurological conditions. Oral contraceptives decrease the risk BCP's seem to decrease the risk of cancer of the ovary and uterus at a later age.
Non- medicinal contraceptives include barrier methods (condoms, diaphragms, or cervical caps) spermicidal gels (that are not very effective without condom use), and intra-uterine devices (lUD's). The latter are highly effective but can cause bleeding, pain, and rarely perforation of the uterus. With the use of BCP'S a missed day of taking "the pill" can result in pregnancy, so condoms should be used until tshe next month. Unprotected sex carries an 8% risk of pregnancy, and use of multiple combinations of 2-4 BCP pills or "Plan B" (the morning after pill) will prevent implantation. Also recently approved is RU 486 (Miferex) which will prevent implantation.
SEXUALLY TRANSMITTED DISEASES (STD'S)
None of the contraceptives mentioned above (with the exception of condoms) do one very important thing—prevent sexually transmitted diseases. Most of these diseases (such as herpes, gonorrhea, syphilis, Chlamydia, HPV, and other more unusual diseases) have treatments, but they can cause pain, fever, bleeding, and ultimately infertility if left untreated.
The one STD that is most feared is HIV/AIDS, for which there is treatment but also the possibility of dire complications including death. The treatments for AIDS (unlike the other disease mentioned above) may be for a lifetime. The lesson is clear—unless you know your partner for a long time (and have been tested regularly) condoms are the only way of preventing these disease even if you are on contraceptives. Talk to your doctor in detail about your options.
Return to top
*
POST-MENOPAUSAL DRUG THERAPY
HORMONE REPLACEMENT THERAPY (HRT)
The debate about postsmenopausal estrogen/ progesterone is everchanging and controversial. The benefits of estrogen therapy for the usual post-menopausal syndrome (hot flashes, moods swings, insomnia) etc. are not debatable. None of the other products (listed below) are equivalent in efficacy. These other drugs include prescription drugs (the anti-hypertensive drug clonidine, antidepressants, and testosterone for low libido) and over-the-counter products such as phytoestrogens (soy estrogens),, black cohash, and others.
The Women's Health Initiative (WHI) in 2000 raised the issue of benefits and risk to postmenopausal women in using hormone therapy, specifically an increase in breast cancer in women using the combination drug Prempro, although estrogen by itself seemed to be relatively safer. Women who still have their uterus need to take a combination hormone to prevent later endometrial cancer. The bottom line after multiple subsequent years of debate is that the drugs are safest if taken at the lowest dose for the shortest period of time (less than 5 years), after which the risk returns to baseline if they are discontinued.
In addition postmenopausal estrogen has the same potential risk as the birth control pill in premenopausal women—hypertension, blood clots, edema, but also the risk of heart attacks and strokes. They do prevent osteoporosis and colon cancer to some extent, but the consensus is that the risks outweigh the benefits. Unfortunately, for the many millions of women who are sufferers, the risks are worth it, at least temporarily.
There are questions as to whether other preparations including transdermal estrogen with or without progesterone would be safer, but no definitive answer is currently available. Vaginal dryness, another post-menopausal symptom can be treated with estrogen cream, or even safer, with moisturizing lubricants. The estrogen vaginal cream is helpful in preventing recurrent urine infections, a common problem in this population.
OSTEOPOROSIS
The diagnosis of this disorder was discussed previously, as were the consequences if left untreated. The usual classes of drugs useful for this are estrogen, biphosphanates (such as Fosamax), Evista (an estrogen-like compound), Calcitonin (a hormone produced in the thyroid gland that is given intra-nasally) and in refractory cases a parathyroid hormone (Forteo) that is given by daily injections. Estrogen was discussed above.
The biphosphanates are generally effective but can cause GI distress and shoul not be given to people with hiatal hernia and reflux symptoms, both because they can be worsened but because of recent reports of an increased risk of esophageal cancer in those particular individuals. There is a once yearly intravenous product (Reclast) or quarterly (Boniva) that avoids the GI issues and may be slightly more effective. Reports of the drugs causing bone death in the jaw (osteonecrosis) occur rarely and are much more common in patients with underlying malignancies, who get these types of drugs for bone metastases.
They can all cause transient bone or muscle pain. Evista is also effective and has no GI toxicity but has many of the same side effects as estrogen but protects the breast and uterus from cancer 30-40%. It can cause the return of hot flashes. Calcitonin is not as effective but has none of the side effects of the others and it's only real side effect is nasal irritation or nosebleeds. As mentioned above, Forteo is the drug used when the others fail, but it must be given daily for two years, and then the patient can resume one of the other products.
All patients should be on calcium, at least 1200 mg daily and vitamin D 800-1000 units daily, although some experts recommend up to 2000 units daily, especially for those individuals who do not get sun exposure, a known producer of vitamin D. A vitamin D level is sometimes performed, and if low, the patient can be put on high dose prescription vitamin D 25000-50000 units once or twice weekly. There are a number of foods that are high in calcium and vitamin D, especially dairy products. Exercise, as mentioned in a previous article is of extreme importance in this condition. Bone density tests will determine the need for adjusting medicines.
Return to top
POST-MENOPAUSAL DRUG THERAPY
HORMONE REPLACEMENT THERAPY (HRT)
The debate about postsmenopausal estrogen/ progesterone is everchanging and controversial. The benefits of estrogen therapy for the usual post-menopausal syndrome (hot flashes, moods swings, insomnia) etc. are not debatable. None of the other products (listed below) are equivalent in efficacy. These other drugs include prescription drugs (the anti-hypertensive drug clonidine, antidepressants, and testosterone for low libido) and over-the-counter products such as phytoestrogens (soy estrogens),, black cohash, and others.
The Women's Health Initiative (WHI) in 2000 raised the issue of benefits and risk to postmenopausal women in using hormone therapy, specifically an increase in breast cancer in women using the combination drug Prempro, although estrogen by itself seemed to be relatively safer. Women who still have their uterus need to take a combination hormone to prevent later endometrial cancer. The bottom line after multiple subsequent years of debate is that the drugs are safest if taken at the lowest dose for the shortest period of time (less than 5 years), after which the risk returns to baseline if they are discontinued.
In addition postmenopausal estrogen has the same potential risk as the birth control pill in premenopausal women—hypertension, blood clots, edema, but also the risk of heart attacks and strokes. They do prevent osteoporosis and colon cancer to some extent, but the consensus is that the risks outweigh the benefits. Unfortunately, for the many millions of women who are sufferers, the risks are worth it, at least temporarily.
There are questions as to whether other preparations including transdermal estrogen with or without progesterone would be safer, but no definitive answer is currently available. Vaginal dryness, another post-menopausal symptom can be treated with estrogen cream, or even safer, with moisturizing lubricants. The estrogen vaginal cream is helpful in preventing recurrent urine infections, a common problem in this population.
OSTEOPOROSIS
The diagnosis of this disorder was discussed previously, as were the consequences if left untreated. The usual classes of drugs useful for this are estrogen, biphosphanates (such as Fosamax), Evista (an estrogen-like compound), Calcitonin (a hormone produced in the thyroid gland that is given intra-nasally) and in refractory cases a parathyroid hormone (Forteo) that is given by daily injections. Estrogen was discussed above.
The biphosphanates are generally effective but can cause GI distress and shoul not be given to people with hiatal hernia and reflux symptoms, both because they can be worsened but because of recent reports of an increased risk of esophageal cancer in those particular individuals. There is a once yearly intravenous product (Reclast) or quarterly (Boniva) that avoids the GI issues and may be slightly more effective. Reports of the drugs causing bone death in the jaw (osteonecrosis) occur rarely and are much more common in patients with underlying malignancies, who get these types of drugs for bone metastases.
They can all cause transient bone or muscle pain. Evista is also effective and has no GI toxicity but has many of the same side effects as estrogen but protects the breast and uterus from cancer 30-40%. It can cause the return of hot flashes. Calcitonin is not as effective but has none of the side effects of the others and it's only real side effect is nasal irritation or nosebleeds. As mentioned above, Forteo is the drug used when the others fail, but it must be given daily for two years, and then the patient can resume one of the other products.
All patients should be on calcium, at least 1200 mg daily and vitamin D 800-1000 units daily, although some experts recommend up to 2000 units daily, especially for those individuals who do not get sun exposure, a known producer of vitamin D. A vitamin D level is sometimes performed, and if low, the patient can be put on high dose prescription vitamin D 25000-50000 units once or twice weekly. There are a number of foods that are high in calcium and vitamin D, especially dairy products. Exercise, as mentioned in a previous article is of extreme importance in this condition. Bone density tests will determine the need for adjusting medicines.
Return to top
*
GYNECOLOGICAL CANCER
There are three types of pelvic female cancers-ovarian, endometrial, and cervical. The first two are usually in older women whereas cervical cancer can occur in younger women.
CERVICAL CANCER. This is more common in women who have a virus called the Human Papilloma Virus (HPV) which can causes changes in the entrance to the uterus, the cervix. It is also more common in women who have sex at an earlier age, or have multiple sexual partners.
That is why the new HPV vaccine is being promoted in females aged 9-26 (and possibly later) to prevent cervical cancer from occurring in the most common strains of the virus that cause cancer. It is given in 3 separate injections. Pap smears are up to 95% effective in diagnosing precancerous or early cancerous disease but less helpful in later stages of the cancer.
Precancerous lesions can be followed with periodic repeat Pap smears which may show either a disappearance of the precancerous tissue or worsening, in which case other tests such as colposcopy ( a scope put into the cervical canal) or a cone biopsy, where a cone-shaped piece of the cervix is removed. In the case of early stage cancer this may be alhhat is necessary but in later stages a complete hysterectomy (removal of the uterus, ovaries, and fallopian tubes) is preferred.
ENDOMETRIAL CANCER
This is the most common of the three pelvic cancers and the eighth most common female cause of death. Obesity, infertility, early sart of menstrual cycles or late onset of menopause are all contributing factors as well as unopposed estrogen postmenopausally .Anti-estrogens such as tamoxifen, which is used of breast cancer, can also increase the risk .The disease can prevent as bleeding or discharge. Biopsies of the endometrium (the lining cells of the uterus) or scraping out tissue (called a D&C, dilatation and curettage) are the diagnostic procedures to make a diagnosis. A thickened uterine lining on ultrsasound suggests the diagnosis but is not definitive. Complete hysterectomy is the treatment of choice.
OVARIAN CANCER
Tragically this is the hardest to diagnose early and therefore has the highest mortality rate of the three. An early diagnosis can be made by feeling a mass on pelvic examination or finding it incidentally when doing abdominal ultrasounds or CT scans for another reason. Women with the BRCA gene (a known cause of breast cancer also) and a certain form of genetic colon cancer have a high incidence of this cancer.
Other risk factors are infertility, no pregnancies, or frequent miscarriages increase the risk later on in life, whereas multiple pregnancies, breast feeding, tubal ligation (tying off the fallopian tubes to prevent further pregnancies) and oral conctraceptives decrease the risk. Postmenopausal hormone replacement therapy probably does not affect risk, although this is somewhat controversial. High risk patients (genetic subtypes noted above or with breast cancer) should get increased surveillance with ultrasounds or a tumor marker called CA-125, which is uses after surgery to see if the cancer has come back also. There is no evidence that these additional tests are warranted in the general population.
PAP SMEARS
Needless to say, every women who has not had a complete hysterectomy (for whom Pap smears are not needed in the absence of previous cancer) should have periodic pelvic exams and Pap smears starting at age 21 or earlier if they are sexually active. The presence of the HPV can be detected with these smears so that the indivcidually can then be followed more closely if needed.
The tests should be continued until age 70 after which time a woman with negative smears for 10 years has the option to not get them repeated thereafter, but this needs to be discussed with her physician. Likewise a woman in a monogamous relation and three consecutive negative tests may have testing after age 30 every 2 or 3 years.
Unfortunately women who are poor or do not have access to medial care have a higher incidence of all of these cancers due to lack of screening.
Return to top
GYNECOLOGICAL CANCER
There are three types of pelvic female cancers-ovarian, endometrial, and cervical. The first two are usually in older women whereas cervical cancer can occur in younger women.
CERVICAL CANCER. This is more common in women who have a virus called the Human Papilloma Virus (HPV) which can causes changes in the entrance to the uterus, the cervix. It is also more common in women who have sex at an earlier age, or have multiple sexual partners.
That is why the new HPV vaccine is being promoted in females aged 9-26 (and possibly later) to prevent cervical cancer from occurring in the most common strains of the virus that cause cancer. It is given in 3 separate injections. Pap smears are up to 95% effective in diagnosing precancerous or early cancerous disease but less helpful in later stages of the cancer.
Precancerous lesions can be followed with periodic repeat Pap smears which may show either a disappearance of the precancerous tissue or worsening, in which case other tests such as colposcopy ( a scope put into the cervical canal) or a cone biopsy, where a cone-shaped piece of the cervix is removed. In the case of early stage cancer this may be alhhat is necessary but in later stages a complete hysterectomy (removal of the uterus, ovaries, and fallopian tubes) is preferred.
ENDOMETRIAL CANCER
This is the most common of the three pelvic cancers and the eighth most common female cause of death. Obesity, infertility, early sart of menstrual cycles or late onset of menopause are all contributing factors as well as unopposed estrogen postmenopausally .Anti-estrogens such as tamoxifen, which is used of breast cancer, can also increase the risk .The disease can prevent as bleeding or discharge. Biopsies of the endometrium (the lining cells of the uterus) or scraping out tissue (called a D&C, dilatation and curettage) are the diagnostic procedures to make a diagnosis. A thickened uterine lining on ultrsasound suggests the diagnosis but is not definitive. Complete hysterectomy is the treatment of choice.
OVARIAN CANCER
Tragically this is the hardest to diagnose early and therefore has the highest mortality rate of the three. An early diagnosis can be made by feeling a mass on pelvic examination or finding it incidentally when doing abdominal ultrasounds or CT scans for another reason. Women with the BRCA gene (a known cause of breast cancer also) and a certain form of genetic colon cancer have a high incidence of this cancer.
Other risk factors are infertility, no pregnancies, or frequent miscarriages increase the risk later on in life, whereas multiple pregnancies, breast feeding, tubal ligation (tying off the fallopian tubes to prevent further pregnancies) and oral conctraceptives decrease the risk. Postmenopausal hormone replacement therapy probably does not affect risk, although this is somewhat controversial. High risk patients (genetic subtypes noted above or with breast cancer) should get increased surveillance with ultrasounds or a tumor marker called CA-125, which is uses after surgery to see if the cancer has come back also. There is no evidence that these additional tests are warranted in the general population.
PAP SMEARS
Needless to say, every women who has not had a complete hysterectomy (for whom Pap smears are not needed in the absence of previous cancer) should have periodic pelvic exams and Pap smears starting at age 21 or earlier if they are sexually active. The presence of the HPV can be detected with these smears so that the indivcidually can then be followed more closely if needed.
The tests should be continued until age 70 after which time a woman with negative smears for 10 years has the option to not get them repeated thereafter, but this needs to be discussed with her physician. Likewise a woman in a monogamous relation and three consecutive negative tests may have testing after age 30 every 2 or 3 years.
Unfortunately women who are poor or do not have access to medial care have a higher incidence of all of these cancers due to lack of screening.
Return to top
*
MAMMOGRAMS/BREAST CANCER
The incidence of breast cancer in this country is one in eight women, and is higher in African- American and Caucasian females than other ethnic groups, with the highest mortality in blacks. The incidence of breast cancer has decrease by 8.6% with the diminished use of postmenopausal hormone repkcement therapy (HRT) although the survival rates are unchanged. Most of the increase of breast cancer has occurred in women using the combination of estrogen and progesterone, and the form used in the landmark study called Women's Health Initiative in 2000 used a brand called Prempro, which some argue is somewhat different than other combinations. Additionally women are at higher risk if they have had no pregnancies, family members with breast cancer (especially if they have the BRCA 1 or 2 genes), previous breast cancer,, multiple breast biopsies, or dense breasts.
The standard technique for diagnosing breast cancer is the conventional mammogram, but there are other techniques that are more sensitive but also have more false positives (i.e., cause more biopsies to be performed which are benign). Conventionally, an abnormal mammogram leads to coned-down views of the abnormal breast with an ultrasound if there is a mass noted. Some women present with an abnormal pattern of calcifications that can also lead to further studies, often a biopsy. Other more sophisticated techniques include digital (filmless) mammograms and MRI's, although the latter is not recommended ordinarily but is used in high risk groups.
All post-menopausal women with a palpable or radiographic mass need further evaluation, often resulting in a computer-assisted (stereotaxic) biopsy, unless the mass is determined to be a simple cyst, in which case it might be watched or aspirated. In pre-menopausal women, the mass is often a simple cyst which will disappear over time, especially if it is felt or X-rayed close to the menstrual period, when the breast are more swollen. If the mass goes away within a month either by palpation or by follow-up short term mammography (in 3-6 months) then nothing else needs to be done. In either event if the biopsy shows malignancy then the patient needs to see a surgeon to discuss various options, which usually are either lumpectomy (taking out the affected portion of the breast) with lymph node biopsy to determine staging (i.e., whether there are positive nodes that require consideration of chemotherapy).
A lot of surgeons are now doing sentinel node biopsies, which involves removal of just one lymph node closest to the malignant area rather than the more disfiguring multiple node biopsies, which in the past had more complications such as swelling in the arm. When just a portion of the breast is removed then follow-up radiation is required. Some women will opt for a mastectomy, where the entire breast is removed. This avoids radiation but leaves the women without any breast on the affected side. What many surgeons advocate (especially in younger women) is to have a breast implant put in at the time of the surgery (usually a temporary one) followed by a more definitive saline or silicone implant later on. This is a decision that only the woman and her physician(s) can make before surgery, and there is really no right or wrong answer as the results of lumpectomy/radiation or mastectomy are the same as long as the cancer is small (less than 2 cm.) Large breast masses will probably require mastectomy. There are also drugs post-operatively that are anti-estrogens that can reduce the risk of recurrence.
All women should start having mammograms at age 35 (unless a direct blood relative had breast cancer at a very early age in which case the first mammogram should be one decade prior to that age. In a low risk population follow-up mammogram should be repeated at age 40 and every one to two years thereafter, although mammograms are less sensitive in premenopausal women due to their breast density. After age 50 a mammogram should be performed yearly at least until age 70 and individualized to one or two years after that. Women in their 80's or who have other severe medical problems may not need mammograms, but this needs to be discussed with the physician.
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MAMMOGRAMS/BREAST CANCER
The incidence of breast cancer in this country is one in eight women, and is higher in African- American and Caucasian females than other ethnic groups, with the highest mortality in blacks. The incidence of breast cancer has decrease by 8.6% with the diminished use of postmenopausal hormone repkcement therapy (HRT) although the survival rates are unchanged. Most of the increase of breast cancer has occurred in women using the combination of estrogen and progesterone, and the form used in the landmark study called Women's Health Initiative in 2000 used a brand called Prempro, which some argue is somewhat different than other combinations. Additionally women are at higher risk if they have had no pregnancies, family members with breast cancer (especially if they have the BRCA 1 or 2 genes), previous breast cancer,, multiple breast biopsies, or dense breasts.
The standard technique for diagnosing breast cancer is the conventional mammogram, but there are other techniques that are more sensitive but also have more false positives (i.e., cause more biopsies to be performed which are benign). Conventionally, an abnormal mammogram leads to coned-down views of the abnormal breast with an ultrasound if there is a mass noted. Some women present with an abnormal pattern of calcifications that can also lead to further studies, often a biopsy. Other more sophisticated techniques include digital (filmless) mammograms and MRI's, although the latter is not recommended ordinarily but is used in high risk groups.
All post-menopausal women with a palpable or radiographic mass need further evaluation, often resulting in a computer-assisted (stereotaxic) biopsy, unless the mass is determined to be a simple cyst, in which case it might be watched or aspirated. In pre-menopausal women, the mass is often a simple cyst which will disappear over time, especially if it is felt or X-rayed close to the menstrual period, when the breast are more swollen. If the mass goes away within a month either by palpation or by follow-up short term mammography (in 3-6 months) then nothing else needs to be done. In either event if the biopsy shows malignancy then the patient needs to see a surgeon to discuss various options, which usually are either lumpectomy (taking out the affected portion of the breast) with lymph node biopsy to determine staging (i.e., whether there are positive nodes that require consideration of chemotherapy).
A lot of surgeons are now doing sentinel node biopsies, which involves removal of just one lymph node closest to the malignant area rather than the more disfiguring multiple node biopsies, which in the past had more complications such as swelling in the arm. When just a portion of the breast is removed then follow-up radiation is required. Some women will opt for a mastectomy, where the entire breast is removed. This avoids radiation but leaves the women without any breast on the affected side. What many surgeons advocate (especially in younger women) is to have a breast implant put in at the time of the surgery (usually a temporary one) followed by a more definitive saline or silicone implant later on. This is a decision that only the woman and her physician(s) can make before surgery, and there is really no right or wrong answer as the results of lumpectomy/radiation or mastectomy are the same as long as the cancer is small (less than 2 cm.) Large breast masses will probably require mastectomy. There are also drugs post-operatively that are anti-estrogens that can reduce the risk of recurrence.
All women should start having mammograms at age 35 (unless a direct blood relative had breast cancer at a very early age in which case the first mammogram should be one decade prior to that age. In a low risk population follow-up mammogram should be repeated at age 40 and every one to two years thereafter, although mammograms are less sensitive in premenopausal women due to their breast density. After age 50 a mammogram should be performed yearly at least until age 70 and individualized to one or two years after that. Women in their 80's or who have other severe medical problems may not need mammograms, but this needs to be discussed with the physician.
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