Are You Confused About Mammogram Screening For Breast Cancer?
Breast cancer screening guidelines have become a bit confusing. There are quite a few organizations who have established guidelines but at present there are differing opinions.
The groups all agree that mammogram screening helps reduce deaths from breast cancer in women. However, the controversy involves the issue of when women should begin having screening mammogram and the frequency with which mammograms should be done. The experts from the various organizations have reviewed various published studies and have reached different conclusions.
Mammogram with small cancer
The fact is that screening mammograms can detect breast abnormalities. Clinical trials have demonstrated that for women in the 40s and 50s screening mammograms can reduce cancer deaths by as much as 15 to 29 percent. However, one study reported that despite early diagnosis resulting from screening mammograms, the number of women being diagnosed with advanced breast cancer hasn’t changed. One conclusion that this suggested was that some women will be diagnosed with early breast cancer that would never have affected their health or lifespan.
The problem arises from the the fact that doctors cannot distinguish “dangerous” breast cancers that will eventually progress to advanced disease from those that will not become life-threatening. Therefore, annual mammograms remain the best alternative for detecting early disease and reducing the risk of death.
There is a legitimate concern that mammogram screening can lead to false positive results. A false positive occurs when an abnormality is detected that eventually proves to be benign—not cancer. A woman receiving a false positive result on screening mammogram may be asked to obtain additional mammogram images and other testing like an ultrasound. The problem of false positives is particularly difficult for younger women who may be more likely to receive a false positive results.
Images of various findings on mammogram
Presently, the decision on timing (and frequency) of mammogram screening is best decided based on each individual’s risk in discussion with her health care provider.
Breast cancer screening guidelines
(Chart from www.FacingOurRisk.org “Mammogram Update by Lisa Schlager)
(To download a copy of this chart Comparison Breast Cancer Screening (1).)
- ACR, SBI, ACOG — annual mammogram starting at age 40, with no upper age limit
- ACS — start at age 45, annual 45-54, biennial starting at 55, continue if life expectancy >10 years
- Canada & most European countries start biennial screening at age 50 & stop at age 69
- USPSTF, CDC, AAFP –every 2 years from age 50-74
- USPSTF & ACS do not recommend Clinical Breast Exam (performed by healthcare provider)
For clarification, I will provide the names of the above mentioned organizations.
ACR American College of Radiology
SBI Society of Breast Imaging
ACOG American College of Obstetrics and Gynecology
USPSTF US Prevention Service Task Force
AAFP American Academy of Family Physicians
ACS American Cancer Society
CDC Center for Disease Control
The density of the breast tissue as described on the mammogram can shape the decision as to what sort of mammogram study is preferred. Dense breast tissue is more difficult to assess on mammogram and the 3D mammogram is better suited for women with dense breast tissue. The absolute guidelines have not been formulated for 3D mammograms. 3D mammograms are not offered everywhere and not all insurance companies cover the additional cost.
DNA Double Helix
If you have a strong family history of breast cancer please review this with your provider to determine if you may be a candidate for genetic screening.
Also keep in mind risk reduction starts with lifestyle including avoiding smoking cigarettes and drinking alcohol.
Remaining physically active and eating a diet high in fresh vegetables, fruits and whole foods does decrease risk of breast cancer and important for heart health as well.
NEWSLETTER Spring 2016
Asheville Gynecology & Wellness strives to transform women’s health care one patient at a time. We provide personalized, gynecological care to women at every stage of life, taking the time to listen and build partnerships in health. We are a gynecology practice that is reaching beyond convention to find innovative ways to improve women’s health and well-being.
(Space is available for Tomorrow’s KICKSTART, Tomorrow April 5th)
ACUPUNCTURE NOW AVAILABLE
Image from www.theage.com.au 10/2/11
Natasha Kubis is a Licensed Acupuncturist in North Carolina & New York. She is Board Certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). In 2009, she graduated from Eastern School of Acupuncture and Traditional Medicine in Montclair, NJ where she received a Masters Diploma and graduated with honors. The program was three years in length and involved 3,000 hours. Natasha practices a combination of traditional Chinese as well as Japanese styles of acupuncture in her treatments. She studied with world-renowned pioneer in Japanese acupuncture, Kiiko Matsumoto. She implements both theories in her diagnostic principles but utilizes Japanese needling techniques for a pain free acupuncture experience.
Some key differences between Japanese Style acupuncture and Traditional Chinese style acupuncture are the needle size, depths of insertion, insertion technique as well as needle stimulation. Natasha uses Japanese style needling techniques which involve smaller needles, more shallow needling, the use of a guide tube which allows for quick and precise insertion, and less manipulation of the needle after it has been inserted. Patients find this technique to be painless compared to Traditional Chinese style.
Japanese Acupuncture involves a great deal of palpation of the acupuncture point before insertion of the needle. In Japan, acupuncture was traditionally an occupation for the blind. Acupuncture has been practiced in China for over 2,500 years. It involves the insertion of small, thin, sterile needles into the skin at acupuncture points to treat a wide range of disorders, most commonly chronic pain.
Today, stainless steel is used to make needles and needles are discarded after a single use. As a natural form of healing, acupuncture has the following benefits:
- It provides drug-free pain relief.
- It effectively treats a wide range of acute and chronic ailments.
- It treats the underlying cause of disease and illness as well as the symptoms.
- It provides a holistic approach to the treatment of disease and illness, linking body, mind and emotions.
- It assists in the prevention against disease and illness as well as the maintenance of general well-being.
Acupuncture is based on the Meridian Theory. A meridian is an ‘energy highway’ in the human body that connects different areas. Energy (Chi) flows through 12 main channels and 8 extra secondary channels. There are over 2,000 points on the body. Stimulating the points along the meridian system allows different parts of the body to communicate. This is important to move blockages when there are traffic jams along the meridian pathways. Blockages can lead to acute or chronic illness whether it is physical or emotional. Stimulating acupuncture points triggers the release of opioid peptides, naturally occurring chemicals that have an analgesic effect, enhance our sense of well-being, and possibly improve immune function..
Natasha believes in educating her patients and creating an environment in which they feel involved and connected to their own particular curative process. She creates cooperative partnerships with her patients in their process of self-healing. She is a general practitioner with special interests in pain management, emotional well-being, immune system support and reproductive health.
FOOD FOR LIFE
Food For Life: Kickstart
(Nutrition Education and cooking demo)
Begins: April 5th at 5:30 PM to 7:30 PM
Instructor: Terri Edwards
Registration at http://tiny.cc/9a7z9x
The Food for Life: Kickstart Your Health classes opportunities to discover which foods are optimal for weight management, learn about various health topics including blood pressure and digestion, and get empowered with the practical cooking skills needed to help you on your journey to better health.In the classes, attendees do all of this while enjoying a cooking demonstration of healthful dishes in a supportive setting.
Food for Life: Diabetes Initiative NOW Enrolling for MAY 17th This class offers many of the same principles of plant-based eating with a special focus on diabetes, pre-diabetes. Adult onset diabetes (Type 2) has become an enormous public health burden that is directly related to the foods we eat. http://www.eatplant-based.com/food-for-life-classes.html
REFER A FRIEND Asheville Gynecology & Wellness is grateful when our patients refer friends or family members. When you refer someone, we know that you are giving us a vote of confidence. It is always helpful when a new patient lets us know that they were referred by one of our patients.
Our Booth was a big success. We had more than 1,000 visitors and our staff was available to answer questions, pass out gifts, and serve smoothie samples.
Congratulations to Kathryn Bailey.
Kathryn won the Raffle for the gift basket from Gerber Village valued at nearly $500
LIKE US ON FACEBOOK & TWITTER
Dr. Vicky Scott @DrVickyScott AshevilleGynecologyWellness
DID YOU KNOW?
- Heart disease is the leading cause of death for women in the United States.
- Exercise spread out during the week in smaller chunks of time during the day provides many of the same benefits as continuous exercise. Adults are encouraged to exercise for 2 hours and 30 minutes (or 150 minutes total) each week.
- Vitamin D has important roles in heart health, immune and nervous system function, and of course bone health. Vitamin K, found in green leafy vegetables, has also been shown to reduce the risk of bone fractures.
- The new U.S. Dietary Guidelines, which are updated every 5 years, may not go far enough according to some experts. The recommendations for reducing refined sugar to 10% of a daily 2000-calorie diet and the unclear recommendation to reduce red meat and processed meats for men and boys fails to address the proven role of these foods in heart disease, inflammation, and cancer. For more information go to https://www.drmcdougall.com/misc/2010other/guidelines.htm
- What influences our chances of living to be 100 years old? You may be interested in watching a very intriguing TED Talk by Dan Buettner, who teamed up with National Geographic, to investigate 4 “Blue Zones” across the world with a higher proportion of the population who live to 100. Watch the TED Talk at https://www.ted.com/talks/dan_buettner_how_to_live_to_be_100
Asheville Gynecology & Wellness
11 Crispin Ct, E-106
Asheville, NC 28803
PH (828) 585-6655 FAX (828) 585-6656
DO I NEED STD/STI TESTING?
- If you have had unprotected sex
- If you have a new partner (or more than one partner)
Then the answer is YES! The recent move to rename Sexually Transmitted Disease (STD) with the term Sexually Transmitted Infections (STI)is intended to broaden the concept to include curable diseases that often show few symptoms.
RECOMMENDATIONS FOR STD/STI AND HIV SCREENING (CDC)
- All adults and adolescents from ages 13 to 64 should be tested once for HIV
- Annual chlamydia screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
- Annual gonorrhea screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
- Screening at least once a year for syphilis, chlamydia and gonorrhea for all sexually active gay, bisexual, and other men who have sex with men (MSM) MSM who have multiple or anonymous partners should be screened more frequently for STDs/STI’s (3-6 months intervals)
- Anyone who has unsafe sex or who shares injection drug equipment should be tested for HIV at least once a year
- Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women and gonorrhea screening for at-risk pregnant women starting in early pregnancy and repeat testing as needed
- Hepatitis C testing for Women born 1945-1965 and women with other risk factors like IV drug use
- Herpes type specific testing should be considered for women presenting for STD/STI screening
- Trichomonas should be considered for women with multiple sexual partners
SYMPTOMS OF STD/STI
Most of the time there are either minimal symptoms and signs or no symptoms and signs at all of the STD (sexually transmitted disease). This is why the name is being replaced by STI (sexually transmitted infection) to encompass the idea that some STIs will not present with signs and symptoms of a disease. If you have had unprotected sex, you have a new partner, you have more than one partner, or if for any reason are worried you have been exposed to an STD/STI talk to your healthcare provider about getting tested.
HOW DO STI TESTS WORK?
Getting tested can be quick and easy. Depending on what test is being performed your provider may take a blood sample, a swab, or ask for you a urine sample. Below is a list describing how what is done to test for each STI.
Swab or urine sample
More info @ http://www.cdc.gov/std/chlamydia/chlamydia-factsheet-june-2014.pdf
Swab or urine sample
More info @ http://www.cdc.gov/std/gonorrhea/gon-factsheet-july-2014.pdf
More info @ http://www.cdc.gov/std/hiv/hiv-std-factsheet-dec-2014.pdf
HERPES WITHOUT SYMPTOMS
Blood sample for type IgG test
More info @ http://www.cdc.gov/std/herpes/herpes-factsheet-july-2014.pdf
HERPES WITH SYMPTOMS
Blood sample or swab from a sore
More info at http://www.cdc.gov/std/syphilis/syphilis-factsheet-july-2014.pdf
More info @ http://www.cdc.gov/std/trichomonas/trich-fact-sheet-aug-2012.pdf
HPV GENITAL WARTS
Visual inspection and at times biopsy
Testing can be done during routine Pap
More info @ http://www.cdc.gov/std/general/other.htm
From the Centers for Disease Control Website @
One of the most important aspects of prevention of STIs is the use of safe sex practices. Women under 26 are encouraged to be vaccinated against HPV types 16 and 18 which are often seen in cervical cancers
The Centers for Disease Control and Prevention (CDC) are notified of positive test results for HIV, Syphilis, Gonorrhea, and Chlamydia tests. These are public health concerns and it is the function of the CDC to maintain accurate records that permit effective disease surveillance and the CDC is also responsible for helping develop policy and guidelines for managing communicable diseases.
ALL images were retrieved from the CDC website. http://www.cdc.gov/
Hysterectomy—Ovarian Cancer & the Fallopian Tubes
“There has been a major breakthrough in our understanding of the origin of ovarian cancer with the identification of the fallopian tubes as the major source of ovarian cancer.” (Dr. Daly, 4/15/15)
If you or someone you know is planning to have a hysterectomy for a benign condition such as fibroids, recent research that implicates the fallopian tubes in the development of ovarian cancer may be important to discuss with the doctor.
Breakthroughs in Ovarian Cancer
Ovarian cancer is relatively rare in the United States yet it represents the leading cause of gynecological cancers. The cure rates are high when the diagnosis is made in early-stage disease, but most women are diagnosed with late-stage disease. The screening options are limited.
Many of the theories about the causes of ovarian cancer came about from looking at things that reduce the incidence of this disease. For example, a history of taking oral contraceptives, pregnancy, tubal ligation, and hysterectomy in which the ovary is retained all have been associated with a reduced risk of ovarian cancer. A small portion of ovarian cancers occurs in women with inherited gene mutations linked to an increased risk of ovarian cancer. Genetic testing can detect gene mutations associated with inherited syndromes (including BRCA 1 & 2), but it is not useful for screening the general population.
Mary Daly, MD, head of the Genetics Risk Assessment Division of Fox Chase Cancer Center in Philadelphia commented for an article on MedScape, Ap 15, 2015, “There has been a major breakthrough in our understanding of the origin of ovarian cancer with the identification of the fallopian tubes as the major source of ovarian cancer.” High-grade serous cancer of the ovary is the most lethal form of ovarian cancer and appears to arise from the fallopian tube rather than the ovaries.
Implications for the Future
These breakthrough findings raises the question of risk-reducing surgeries that might be undertaken prior to menopause for those women identified to have the inherited genetic mutations that increase risk. It turns out that high grade serous cancer of the ovary is the most common form of ovarian cancer among women with high genetic risk.
Many women undergo hysterectomy for more benign conditions such as fibroids. A strong case can now be made for bilateral salpingectomy (removal of both fallopian tubes) with ovarian retention since this may reduce the risk of ovarian cancer among women undergoing a hysterectomy. Approximately 15% who have had a hysterectomy for benign conditions go on to develop ovarian cancer and performing removing the tubes while leaving the ovaries can be expected to reduce their risk. Undoubtedly, more research will be done to better understand the impact of removing the fallopian tubes on ovarian function and the risks involved in the surgical procedure itself. Before this approach of bilateral salpingectomy with ovarian retention becomes the standard of care, the safety and effectiveness of this approach needs to be established.
Talk to Your Doctor
Women who are anticipating having a hysterectomy may want to discuss these recent findings with their gynecologist prior to surgery.
3 Simple Keys to Better Health in the New Year
When it comes to diet, there are 3 simple keys to better health that consistently prove effective at promoting health and reversing chronic diseases. The 3 key principles are:
- Whole Food
- Plant Based
- Food As Grown
Register for the upcoming Food for Life program soon.
Industrial food production replaced traditional farming practices during the last century. One consequence of that sea change was that our nation went from having pockets of malnutrition to suffering widespread obesity, diabetes, chronic heart disease, and other infirmities directly attributable to changes to our diet. Well-meaning efforts to enrich food and extend the shelf life of food combined with an idea that products containing the same ingredients contained in original whole foods are equivalent took hold of industrialized nations.
Manufactured foods and whole foods are not identical. Manufactured foods typically contain more salt, added sugars, preservatives, and food coloring. When nature adds color to a whole food it often has antioxidant properties and may be a vital nutrients. There are ingredients that occur in nature but not in the quantities found in manufactured foods. Xanthum gum is a good example. After discovering that it was a natural biopolymer that increased the viscosity (stickiness) of foods, it went into industrial production in the 1960s. While it is a naturally occurring polymer (a molecule comprised of repeated subunits), it is NOT part of the normal diet. Xanthum gum keeps oil from separating in salad dressings and can change the consistency of food to which it is added.
Researchers at Cornell University, Oxford University, and the Chinese government embarked on a 20-year observational study of diets, lifestyle, and disease characteristics of 6,500 people in 65 rural Chinese counties. This famous study became known as The China Study and it found that people who eat a whole-food, plant-based diet and avoid eating processed foods and refined sugars can reduce or reverse the development of many different diseases. Dr. T. Colin Campbell published the results of this comprehensive study in a book titled The China Study.
It should come as no surprise that nature is the best manufacturing facility for foods. The natural processes that create food-as-grown have developed over millions of years. Even for those who eat meat, should keep in mind that there is a vast difference between meat from animals raised through industrial farm practices and meat from animals that have been grass fed. The ratios of fatty acids differ widely and grass-fed animals may be expected to be less harmful to our health.
Practices that increased food production during the last century produced undesirable consequences. Widespread use of fertilizers depleted the soil and discouraged sustainable practices like crop rotation, letting land lay fallow, and the intentional cultivation of weeds. Widespread use of pesticides caused harmful effect on the environment and some have proposed that pesticides may be contributing to Colony Collapse Disorder among honeybees.
Our ancestors possessed wisdom about many of the practices that organic farmers are reintroducing these days. For example, in ancient Israel it was customary to honor the Shemitah, also known as the sabbatical year. Modern Isreal has taken steps to encourage farmers to reintroduce this ancient Biblical practice described in Exodus.
Exodus 23:11 ”but on the seventh year you shall let it [land] rest and lie fallow, so that the needy of your people may eat; and whatever they leave the beast of the field may eat.
During the sabbatical year, the beasts of the field would also add vital nutrients to the soil.
Food-as-grown is a term that means everything from consuming food before it is processed to efforts to consume foods that are grown locally. Locally grown food is one way to reduce the environmental and economic impact of transporting foods to our table. Eating whole grains, fruits, vegetables, and legumes (beans, peas, lentils) with as little processing as possible consistently proves to be good for our health.
Medicine in the 21st Century
The 20th century witnessed medical advances in public health, antibiotic development, immunization, and effective interventions for people with advanced disease. The 21st century was ushered in with a great promise of personalized medicine resulting from the human genome project and genetic analysis of cancer. However, the greatest improvements in health during the 21st century may ultimately be achieved when we recover the basic principles of nutrition that were once commonplace.
Food For Life Program Starting Soon!
Asheville Gynecology & Wellness is a traditional gynecology practice, that has incorporated a teaching kitchen right into the practice. This is proving to be a great way of introducing the importance of dietary and lifestyles changes and how these can help reduce the burden of various chronic diseases.
I am excited to announce that beginning in February we will be offering a new, 5-week program, Food for Life in the evenings. This program is a practical, hand-on introduction to shifting toward the 3 keys to better health—a whole food, plant-based, fod-as-grown diet that is sponsored by the Physicians Committee for Responsible Medicine. I am also delighted to welcome Ms. Terri Edwards to the Asheville Gynecology & Wellness team. Terri will be leading the Food For Life classes and she has her own personal success story about the benefits she achieved through adopting a whole foods, plant-based diet.
To Register for the upcoming Food for Life program please go to the EventBrite site to sign up (http://tiny.cc/b37r7x) or call call Asheville Gynecology & Wellness at (828) 585-6655.