By Stephanie Frye – Family Nurse Practitioner

May 9 starts National Women’s Health Week and with that in mind, let’s talk about the health of our breasts. 

Breast Cancer: Rates and Risk Factors

First the numbers: in 2017 among the top 10 cancers for females, breast cancer leads in the list of the new cancer cases and is the second on the list by rates of cancer deaths. In the U.S., about one in eight women will develop invasive breast cancer over the course of her lifetime, with an estimated 281,550 new cases of invasive breast cancer and 49,290 new cases of non-invasive (in situ) breast cancer expected to be diagnosed in women in 2021.

You can divide the risk factors for breast cancer into groups: those you can control and those you can’t. The first group includes smoking, drinking alcohol, being obese and being physical inactive. Also, if you’ve had radiation therapy to your chest or breasts, have taken the drug diethylstilbestrol (DES) or used specific forms of hormone replacement therapy during menopause, or certain types of oral contraceptives, your risk also increases. 

As for factors outside your control, these include being 50 years old or older, having dense breast tissue, your reproductive history (when you started and stopped having periods), a family history of breast or ovarian cancer and genetic mutations such as BRCA1 and BRCA2. Certain races and ethnicities also face an increased risk. This could be due to various lifestyle patterns, reduced access to mammography or lower quality medical care.

Tip: Want to know more about what you can do? Download the Think Pink, Live Green: A Step-by-Step Guide to Reducing Your Risk of Breast Cancer for 31 risk-reducing steps you can take today.

 

Breast Cancer Screening: Breast Self Exams (BSEs) and Mammograms 

Now that you know your risk, what else can you do besides making changes to reduce your controllable factors? Follow these two steps: know what’s normal for your breasts and undergo mammograms according to the schedule advised by your health care practitioner. 

What are some breast changes that you should bring to your doctor’s attention? Komen.org lists the following:

• A lump, hard knot or thickening inside the breast or underarm area
• A swelling, warmth, redness or darkening of the breast or a new pain in one area
• A change in the size or shape of the breast
• Dimpling or puckering of the skin
• Itchy, scaly sore or rash on the nipple or sudden nipple discharge 
• Pulling in or dimpling of the skin of your nipple or other parts of the breast

A breast self-exam (BSE) involves both looking at your breasts in a mirror and using your fingers to touch all the areas of both breasts while lying down and sitting. If you’re still having periods, do the physical exam a few days after your period starts, since your breasts are less lumpy and painful. (Follow the detailed instructions here.)

While a BSE shouldn’t replace mammograms, it could increase the odds of early detection as well as help you learn what’s normal for your breasts.

When you have an annual healthcare visit, you can ask for a clinical breast exam. It’s performed by a healthcare professional who is trained to know the various breast abnormalities and warning signs that could indicate a need for a more thorough screening. 

Next on the list is a mammogram. This is a low-dose x-ray exam that gives doctors a closer look at your breast tissue to identify changes that can’t be felt during a breast exam. It can take about 20 minutes from start to finish, since each breast is done separately, with two pictures taken of each: one from the side and one from above. While it’s true that having your breast compressed between the machine’s two plates can be uncomfortable, remember it only lasts a few seconds. 

There are two kinds of mammograms: screening and diagnostic. Screening mammograms are for those women with no symptoms of breast cancer, while diagnostic mammograms are used when a lump or other symptom or sign of breast cancer has been found. (Women with dense breast may benefit from having a digital screening mammogram rather than a film one since it may provide a better image.)

A three-dimensional (3-D) mammogram, also called breast tomosynthesis and digital breast tomosynthesis (DBT), takes multiple images of the breast from different angles, then reconstructs the images to give a three-dimensional image set. Studies have shown that this form of screening provides improved breast cancer detection rates and fewer “call-backs” for additional testing because of a potentially abnormal finding. It can also be more gentle on the breast than the conventional mammogram. 

If your screening mammogram shows test result that suggest an abnormality, the next step may be any or all of the following: 

• An ultrasound—an imaging test that uses sound waves to create a picture of your breast
• A magnetic resonance imaging (MRI)—an imaging test that uses a powerful magnet linked to a computer to provide an image
• A biopsy—a test that removes fluid or tissue from your breast to examine for cancer cells

The schedule for screening mammograms can vary. According to the United States Preventive Services Task Force (USPSTF), women ages 50 to 74 years should get a mammogram every two years. The American Cancer Society says women age 40 to 44 should have the choice to start annual breast cancer screening with mammograms, while those age 45 to 54 should get mammograms every year, and after that switching either to mammograms every two years, or continuing with yearly screening. In general, it’s a good idea to discuss the best frequency and your risk factors with their health care providers.

For more about mammograms, download this fact sheet from the Office on Women’s Health. You can also watch this video from Cedars-Sinai on the breast cancer screening process. 

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Patoka Family Health Care in November, 2021 – Call ahead to schedule your preventative screening.

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By Stephanie Frye – Family Nurse Practitioner

There are more than 150 different types of HPV. They can range in appearance from small, painless, rough-surfaced warts to larger, more painful and flatter plantar warts. According to the CDC, 85% of people will get HPV infections in their lifetime

And while being called a “wart” doesn’t sound all that serious, it can be if your body doesn’t clear out the virus on its own. HPV causes about 44,000 cancers in men and women each year in the US, from cervical cancer (the leading cause) to cancers of the vagina, vulva, penis, anus, and mouth, according to Harvard Health. According to the CDC, more women (about 25,400) than men (about 19,900) develop HPV-associated cancers in the United States each year. 

Here’s what else you should know about HPV

HPV is the most common sexually transmitted infection. While using condoms consistently and correctly can lower the chances of acquiring and transmitting HPV and developing HPV-related diseases, it’s not a fool-proof strategy, according to the CDC, because the virus can also infect areas that aren’t covered. Limiting the number of sex partners can reduce the risk, although even if you have only one lifetime sex partner, you can still get HPV. The only reliable method for preventing genital HPV infection is abstaining from sexual activity. 

The FDA has only approved tests to find HPV in individuals with a cervix. Positive results can be then managed with extra testing and prompt treatment if the infection causes abnormal cell growth. (Note: There is no approved HPV test to find HPV in the mouth or throat.)

The HPV vaccine has a 15-year track record of success. Since the HPV vaccination was first recommended in 2006, there has been a significant reduction in HPV infections, with fewer teens and young adults getting genital warts. The HPV vaccine has the potential to prevent more than 90% of HPV-attributable cancers and has also reduced the number of cases of precancers of the cervix in young women. The HPV vaccine offers long-lasting protection against HPV infection and HPV disease—even against new HPV infections. This makes the vaccine a valuable weapon against causal HPV infection for cancers since it can take decades after the infection for the cancer to be diagnosed.

HPV is thought to cause 70% of oropharyngeal cancers in the United States – cancer in the back of the throat, tongue or tonsils. The vaccine protects against the types of HPV that can cause this cancer and can prevent this cancer from developing. 

The HPV vaccine is safe and effective for children ages 9-12. Why start that early? According to Claire McCarthy, MD, Senior Faculty Editor at Harvard Health Publishing, the HPV vaccine is most effective if it’s done before your teen becomes sexually active. Those who haven’t been vaccinated at an early age can have a catch-up vaccination—recommended for females and certain special populations through age 26, and for males through age 21, according to the CDC. The Cervarix and Gardasil vaccines protect against most cases of cervical cancer; Gardasil also protects against most genital warts. Both vaccines are recommended for girls and women, while only the Gardasil is recommended for boys and men. Recently the HPV vaccine eligible age has been increased to 45. People aged 27 to 45 should discuss HPV vaccination with their doctor and their decisions on an individual basis.

The more you know about HPV, the better you can protect yourself and your children. While the Healthy People 2020 goal was to reach 80% in terms of HPV vaccination coverage, a study in JAMA Pediatrics showed that the U.S. was far below that number. Part of the reason may be that most adults, men and women, weren’t well informed about HPV, HPV vaccination, and the relationship between HPV and cancer. For example, more than 70% of adults didn’t realize that HPV causes oral, anal, and penile cancers. Since parents make HPV vaccination decisions for their children, it’s important to discuss the need for this vaccine with your doctor or your child’s pediatrician. 

by Missy Ray, MSN Family Nurse Practitioner

 

What is endometriosis?

Endometriosis, also called “endo,” occurs when tissue similar to the lining of the uterus (called the endometrium) is found in other areas in the body. These areas or patches of endometriosis can also be called implants, nodules or lesions.

Most often, endometriosis occurs in the peritoneum, the ovaries, the fallopian tubes, on the outer surfaces of the uterus, bladder, ureters, intestines, and rectum or in the space behind the uterus called the “cul-de-sac.” In rare instances, endometriosis may grow on the lungs or in other parts of the body. Endometriosis causes a chronic inflammatory reaction that may result in scar tissue.

What causes endometriosis? 

While no one knows for sure what causes this disease, researchers are looking at several possibilities. These include problems with menstrual period flow, immune system problems, hormones or errors made during other surgery when endometrial tissue is moved by mistake. 

You also may be more likely to develop endometriosis if you never had children, had menstrual periods lasting longer then seven days, had shorter menstrual cycles, or have a health problem that interferes with the normal flow of menstrual blood. If a family member had endometriosis, you are most likely at greater risk since there is a genetic component.

While you can’t prevent endometriosis, you can reduce the risk by lowering your estrogen levels, since that hormone is responsible for helping to thicken your uterine lining during your menstrual cycle.

What are the symptoms? 

Common symptoms of endometriosis include very heavy periods and chronic pain in the abdomen, lower back, or pelvic areas, especially before and during menstruation or during sexual intercourse. Researchers have discovered that the severity or the location of the pain is not related to the size and location of the lesions, nor is it associated with a woman’s ability to get pregnant. 

However, some women with endometriosis may have no symptoms at all, with the condition identified only when they have difficulty conceiving. 

How is it diagnosed? 

There is no simple test that can be used to diagnose endometriosis. If your SICHC family provider suspects you may have endometriosis, then the first step is usually a physical exam, including a pelvic exam, where your doctor will feel for large cysts or scars behind your uterus.

You may undergo an imaging test—either an ultrasound or a magnetic resonance imaging (MRI)—that will provide pictures of your reproductive organs. However, undergoing a surgical procedure called a laparoscopy is the only way to definitively identify that you have endometriosis. During the procedure, a small amount of tissue may be removed (biopsied) to be tested (diagnostic evaluation).

Download the First Consultation pdf from Endometriosis.org to help you prepare for your visit.

What are the treatment options? 

While there is currently no cure for endometriosis, there are treatment options to help deal with the pain and any infertility issues it may have caused. Treatment choices will be based on the severity of your symptoms and the disease itself, your age and your desire to have children. 

Treatment options for endometriosis-associated pain include hormone therapy, over-the-counter or prescription pain relievers, and surgical procedures (laparoscopy or laparotomy) to identify and possibly remove endometriosis patches. Hormone therapy may also keep new lesions from forming but generally don’t get rid of any endometriosis tissue already present. 

However, not all treatments work well, and the symptoms may occur after medication is stopped or when a period of time has passed after surgery. 

Does endometriosis cause infertility? 

According to the American College of Obstetricians and Gynecologists, it’s estimated that close to four in 10 women with infertility have endometriosis, either due to inflammation from endometriosis inhibiting the movement of the sperm or egg through the fallopian tubes and uterus or because that inflammation has damaged the sperm or egg.

If the endometriosis is severe, it may have resulted in scar tissue or adhesions blocking the fallopian tubes. Removing endometriosis tissue through surgery may improve fertility.

 

For more information, visit these websites: Endometriosis Association, Endometriosis Foundation of America and Endometriosis Research Center, download this fact sheet from Office on Women’s Health, or schedule an appointment with SICHC’s Woman’s Health team, or if you prefer, we can recommend you to an OBGYN specialist.

 

Resources

American College of Obstetricians and Gynecologists

CDC-Women’s Reproductive Health 

Endometriosis.org

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Office on Women’s Health

World Endometriosis Society