BREAST CANCER: 2015

In case you missed it, October was National Breast Cancer Awareness month, and there were at least two important events:

The first was a wonderful WHEP seminar by “Living Beyond Breast Cancer” including a very impactful panel discussion with four survivors,

and the second was a change in the American Cancer Society (ACS) guidelines for mammography screening (published October 20, 2015 in the Journal of the American Medical Association).

A little history...

In 2003, the ACS recommended annual mammograms for all women starting at age 40 and continuing as long as a woman remained in good health, and clinical breast examination periodically for women in their 20s and 30s and annually for women 40 years and older.

Contrast that with the new recommendations:

Women with an “average risk” of breast cancer – (i.e. most women) – should begin yearly mammograms at age 45.  However, the ACS also states that women should be able to start the screening as early as age 40, if they want to.  We know that about 12% of women in the general population will develop breast cancer sometime during their lives.  For women in their 40s and 50s, randomized trials have shown that screening mammography modestly decreases breast cancer mortality by approximately 15%.

• At age 55, women should have mammograms every other year – though, again, women who prefer to continue yearly mammograms may do so.
• Regular mammograms should continue for as long as a woman is in good health.
• Breast exams, either from a medical provider or self-exams, are no longer recommended.  Still, the ACS says all women should be familiar with how their breasts normally look and feel and report any changes to their health care provider right away.

These guidelines do not pertain to women at “high risk” due to family history, a breast condition, or other reason.  Clearly, women who are BRCA 1 or 2 positive are at high risk for breast cancer as are those with a strong family history (multiple relatives with breast cancer).  But how should we think about risk when breast cancer has occurred in a single first degree relative knowing that women with a "family history" of breast cancer make up only 5 to 7 percent of all women with breast cancer?

Bottom line: the ACS guidelines recommend that screening decisions be individualized to reflect a woman’s values and preferences, as well as her underlying risk of breast cancer.  Is this a “hedge” or a move toward more personalized medicine?

                                                                                                                         Judith Wolf, MD   Associate Director, WHEP

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Taking a Sexual History

The 5 P's of Sexual History Taking:

For additional resources that were not covered in class, please refer to the following on effective Sexual History Taking:

http://www.cdc.gov/std/treatment/sexualhistory.pdf

https://www.cdph.ca.gov/pubsforms/Guidelines/Documents/CA-STD-Clinician-Guide-Sexual-History-Taking.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114389/

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Should I be juicing?

 

One of the new and interesting things I have been getting a lot of questions about recently are juice cleanses. These juice cleanses are 1-4 week journeys where people seek to drink nothing but fruits and vegetables in juice form or even only water with different additions like cayenne pepper and honey. As a long time food lover this seemed almost tortuous to me and I wanted to figure out what was behind peoples motivation to try these things. It seemed that in a desperation before the summer to obtain that perfect “beach bod” people were turning to anything they could find including these cleanses. Some people justified it by saying that they felt overloaded with toxins after overeating all winter and others simply saw this as a quick and efficient way to lose some weight. Wondering about some of the pros and cons into juicing and whether or not this could be hurting us I did a little bit of research.

 

   In general when we do not put food into our body our body senses distress and goes into starvation mode. First it begins breaking down any sugar that we had stored in our body as glycogen—we only have about 24 hours of stored glycogen so after that we start breaking down the fats. After the fats start breaking down that’s when we start to get into a bit of trouble and break down our muscles (don’t forget the heart is a muscle too) and this can end up doing significant damage. The other thing is that our livers and kidneys are REMARKABLE organs and in our everyday life are capable of filtering out toxins meaning that as long as we are not poisoning our bodies our livers and kidneys can keep up and do a good job.

 

Usually when a person starts a juice cleanse they might notice a sudden drop in weight which is mostly all water weight, but as the body goes more and more into starvation mode and will eventually store almost anything you feed the body when the diet is over. This means that whatever water weight you lose at the beginning you can end up rebounding and gaining it all back and more when you stop. Another problem is that when you juice the fruits and vegetables you lose a lot of the nutrients that you would normally get just by eating an apple or cucumber.

 

One final thing that I thought about when looking through all these products that they try to sell you to get you to buy into the whole juice cleanse thing is WOW are these products expensive! Is it worth it to get all of these powders or supplements just to lose a few pounds and gain it back? Really we are better off at picking a few things that we can change in our lives—they don’t have to be big changes but they can make a difference. Pack an apple in your lunch instead of potato chips, or even just try cutting out all other drinks besides water—you would be surprised at not only how much weight you might lose but how much better you feel!

 

So skip the juice diets and the water cleanses because you could be permanently lowering your metabolism and setting yourself up for failure in the future once you re-enter the real world of food. Try small things every day—you don’t have to change your entire diet in one day—and make that a permanent change in your life because it will be way more worthwhile and effective in the long term.

-Sarah Hall, MS4

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