Newsletter Supplementary Articles

Review of USPSTF 2009 Study

Supplement to Ask Dr. Julie, Spring 2010

In November 2009, the U.S. Preventative Services Task Force (USPSTF) released new recommendations regarding mammogram screening. Their recommendation changed from starting routine mammograms when a woman turns 40 to when she turns 50, and then to screen only every two years instead of annually. For my response to women who are confused about what to do, see the newsletter of the Humboldt Community Breast Health Project, Spring 2010. There is no simple answer that fits everyone. This is my summary of the USPSTF report to supplement that newsletter article.

Read the full summary (PDF, 98 KB)

Tables to accompany the summary of the USPSTF report. (PDF, 807 KB)

Medical Imaging

Supplement to Ask Dr. Julie, Fall 2009

For more information about the risks associated with medical imaging, go to www.xrayrisk.com The following charts, available at that website, were published by the National Academy of Sciences, Washington, DC, 2005 in their report, Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2.

Graph 1: Lifetime Attributable Risk of Cancer from Exposure to Radiation

Click on image for larger view

Table 2: Average Effective Doses from Common Imaging Studies

Click on image for larger view

Osteoporosis and Bone Health Links

Supplement to April 2009, Call of the Amazons

National Osteoporosis Foundation

National Osteoporosis Foundation FAQ
National Osteoporosis Foundation FAQ in Spanish
25 Ways to Improve Your Bone Health (PDF)
Bone Mineral Testing
Fall Prevention
Guidelines for Safe Movement (PDF)
Secondary Causes of Osteoporosis
Paying for Osteoporosis Medication (PDF)
Calcium

FRAX® WHO Fracture Risk Assessment Tool

FRAX® web site

Harvard School of Public Health

General Nutrition
Vitamin D
Vitamin D and Chronic Disease
Calcium

American Institute for Cancer Research

Nutritional Information

Menus and Recipes

Menus and recipes from Diana Dyer MS, RD, who in between cancer diagnoses had a 20+ year career as a clinical dietitian

Strength Training Resources

STRONG Strength Training Resources for Osteoporosis - Northcoast Group Project STRONG offers a variety of free or low-cost exercise classes in many communities.

Gynecologic Cancer Chart

Supplement to September 2008, Call of the Amazons

Cervical Cancer

Symptoms	Abnormal vaginal bleeding; Bleeding after sex; Vaginal discharge (Note: early stages often asymptomatic)
Causes	Human Papilloma viruses (HVP)
Risk Factors	Early sexual activity; Multiple partners; High-risk sexual partner; HPV or sexually transmitted disease (e.g., Chlamydia, herpes simplex virus); Smoking; HIV; Bearing many children; Prolonged use of oral contraceptives; Poverty; History of vulvar or vaginal cancer
Detection / Prevention	Regular Pap test; HPV testing - - - Treat abnormal pre-cancer findings; Limit sexual partners; Condoms; No smoking; Partner is circumcised; HPV vaccine
Incidence	11,150 new cases / year 3670 deaths annually 50% higher in African American women, 66% higher in Hispanic women

Ovarian Cancer

Symptoms	Daily occurrences for several weeks of: Bloating; Increased abdominal size; Urinary urgency or frequency; Difficulty eating or feeling full; Abdominal or pelvic pain
Causes	Unknown
Risk Factors	BRCA genes; Relative with ovarian cancer; Not bearing children; Age; Endometriosis; Prolonged usage of HRT (<> 10 years); Risk lowered with pregnancy; use of oral contraceptives; tubal ligation or hysterectomy with ovaries preserved; breast-feeding
Detection / Prevention	Role of symptom recognition: New Ovasure screening test for high risk (91% early detection rate and 99% rate of ruling out ovarian cancer) - - - Vitamin D3; Prophylactic oophorectomy (ovaries removed)
Incidence	20,180 new cases / year 15,310 deaths annually Most cases diagnosed at a late stage

Uterine / Uterine Sarcomas Cancer

Symptoms	Abnormal uterine bleeding - even one drop in post-menopausal women; Endometrial cells on a Pap test; Thickening of uterine lining on ultrasound; Sarcomas: Abnormal bleeding Pelvic pressure/pain; Enlarged uterus; Rapidly growing fibroids
Causes	Prolonged unopposed estrogen exposure (e.g., late menopause, or not using progestin with HRT
Risk Factors	Estrogen replacement therapy at higher doses and prolonged usage; Tamoxifen; Chronic anovulatory cycles (polycystic ovary syndrome); Estrogen secreting tumors; Diabetes; Obesity; Alcohol; Age; Hypertension; Hereditary non-polyposis colorectal cancer; Breast cancer; BRCA1; Not bearing children; Early menarche, or late menopause; Long-term soy supplementation; Vitamin D deficiency
Detection / Prevention	Trans-vaginal ultrasound and/or endometrial biopsy: 2-4% of uterine cancers are uterine sarcomas requiring histological exam of the entire uterus (endometrial sampling alone can be negative) - - - Protective factors: ideal weight maintenance; oral contraceptives; combined hormone replacement therapy; smoking; vitamin D3
Incidence	39,000 new cases / year 7,400 deaths annually Uterine sarcomas represent 2-4% of uterine cancers. Exclusion of a uterine sarcoma requires histological exam of the entire uterus - endometrial sampling alone can be negative.

Vulvar / Vaginal Cancer

Symptoms	Broad, raised unifocal or multifocal vulvar skin growth; Ulcer, or lump (fleshy, nodular, or warty) most commonly on the labia majora; Itching or burning; Skin growth with bleeding or discharge (Note: Many growths are without symptoms)
Causes	HPV; In-utero DES exposure for vaginal cancer; Extension of other genital cancers
Risk Factors	HPV infection; Cigarette smoking; Lichen sclerosis; Vulvar in-situ cancer; Other genital cancers; HIV; Prior history of cervical cancer; Northern European ancestry
Detection / Prevention	Vulvar self exam; Annual clinical exam - - - Possibly HPV vaccine; Postponing the beginning of sexual activity; Limiting the number of sexual partners
Incidence	3,490 new cases / year 880 deaths annually Vulvar in-situ cancers have more than doubled in women < 45

Second Opinions

Supplement to September 2008, Call of the Amazons

Though it may feel awkward between the patient and medical provider, you should feel a right to seek another perspective on your situation, disease, pathology or treatment. It has been shown that when medical providers get ill, they often seek second, third, and fourth opinions. What is best for medical providers should absolutely be your right as well.

Sometimes you'll get the same recommendations in a second opinion, and you may be in a different space to hear and understand them. Sometimes you will be heard in a different way. Cancerguide.org provides the why, when, and who of second opinions: (summarized)

WHY:

To get a different perspective--some doctors are conservative and others more aggressive
Because no doctor can know everything all the time
To get a general quality check

WHEN: