Breast Cancer- What’s Your Risk?
In honor of the end of Breast Cancer Awareness Month let’s talk about risks and screenings. When should you get a screening mammogram? At what age should you start? How often should you get one? Do you need an ultrasound or an MRI for further evaluation and how often?
These questions have different answers depending on whose advice you are looking for. All the groups that make official recommendations have their own particular guidelines for routine screening mammograms. They all agree on the risk factors though.
- Family history/ genetics
- Age
- Younger age for first period
- Older age for first childbirth
- Older age for menopause
- Breast density
- Use of birth control and/or hormone replacement
- Obesity
- Lack of exercise
- Alcohol use
- Radiation exposure
The most aggressive guidelines for screening are from the National Comprehensive Cancer Network. They recommend annual mammograms starting at age 40, and clinical breast exams. The most relaxed guidelines are from the US Preventive Services Task Force which does not even give recommendations for women with higher risk but only recommends screening mammograms every 2 years, beginning at age 50, and recommends against breast self-exam. The American Cancer Society recommends screening mammograms annually at 45 and decreasing to every other year at 55. The American Congress of Obstetricians & Gynecologists recommends annual screening mammos at age 40. All but the USPSTF recommend being aware of the feeling of your own normal breast tissue and having an annual MRI if the lifetime risk of breast cancer is calculated to be more than 20% based on family history.
How do you determine a woman’s lifetime risk of getting breast cancer? There are computer programs available that allow us to calculate that based on family history and the personal risk factors listed above. At your next physical exam we can determine if we need to calculate this risk, and at a followup appointment we can take the time to enter your personal and family data into a program that will give us a percentage chance that you could have breast cancer in the next 10 years and also the chances of developing breast cancer in your lifetime. These are sobering statistics (I have entered my own data and even with no family history of breast cancer my lifetime chances of developing it are 12%!). If your lifetime risk is 20% or higher you are entitled to see a genetic counselor and your insurance is obligated to pay for it, as well as an MRI (thank you Affordable Care Act).
Come in and let’s talk about your personal and family risk factors for developing breast cancer and make sure you are getting the appropriate screening to ensure your longest healthiest life.
STD boom!
Congratulations Washington, DC- your rate of syphilis is #3 highest in the US. As STD rates have continued to rise over the past few years, our area has the unfortunate distinction of having high rates of sexually transmitted infections. The latest report released this week from the CDC includes data on chlamydia, gonorrhea, and syphilis. Infections caused by HIV, human papillomavirus, herpes simplex virus, and trichomonas are not tracked in this report and CDC reminds us that the total number of infections shared through sexual contact is in fact far beyond the rates shared in this report. What is shocking is that HALF of all infections occur in people ages 15-24.
So how bad is it? Well the CDC tracks a lot of diseases, but chlamydia has now broken the record of highest number of any disease EVER REPORTED. It is easily treated with antibiotics. But here’s the problem- since many men and women never have symptoms, they don’t know they have been infected. The disease damages the reproductive tract which means women are at greater risk for ectopic pregnancy (life threatening) and that’s if they can get pregnant at all. Gonorrhea is increasing as well and is becoming resistant to antibiotics. Gonorrhea transmitted during oral sex can cause a sore throat and it can cause infertility in both men and women. Both chlamydia and gonorrhea can be “silent” and cause no symptoms, but when there are symptoms they are usually discharge, burning or pain in genital area and/or with urination. While the symptoms come and go, the infection does not resolve unless treated with antibiotics.
Syphilis sounds old-fashioned but it is definitely back and on the rise. It is cured with penicillin, but is often missed in its early stage. The first symptom of syphilis is a sore. This sore can be small, and since it is painless and can be inside the vagina or rectum people may not notice it. Or perhaps they notice it but think it is an ingrown hair, or shaving nick. If it’s on the mouth or lip they may confuse it with a cold sore or canker sore. It is important to be treated at this early stage, because the next stages cause symptoms like rash, flu like illness, hair loss, among others. Eventually the bacteria enters the brain and causes serious symptoms like dementia, paralysis and even death.
All of these infections can be passed on to a fetus in utero, or a baby through birth, and cause serious health concerns, and the pregnancy may end in miscarriage or result in premature birth. If you are pregnant or may become pregnant make sure you’re screened ASAP.
20 MILLION infections each year cost $16 BILLION (yes that’s a “b” in billion) in health care costs.
And that’s not counting the effects and costs of infertility and ectopic pregnancies that are caused by sexually transmitted infections.
Protect your fertility by getting screened for STDs every 6-12 months if you are sexually active. Come talk to us and we will give you a personalized recommendation based on your life. We are easy to talk to- even about sex- and can help you stay healthy.
Is bright morning light better than Viagra?
What if bright light for 30 min each morning could increase a man’s sexual satisfaction and even boost his testosterone levels? How much less Viagra would be prescribed?
We know that light therapy (using a lamp that that has the right wavelengths and strength) is an effective treatment for SAD (seasonal effective disorder). We are still in the midst of learning about light therapy and all of its potential. But knowing that most babies are conceived in June, when we have the maximum hours of daylight, there is a basis for looking into the effect of light on reproduction. A group in Italy studied a group of 38 sexually unsatisfied men and shared their results with the European Congress of Neuropsychopharmacology in September. This group of men had a mean sexual satisfaction score of 2/10 at the beginning of the study. After just 2 weeks of treatment with 30 minutes of 10000 lux light each morning, the mean score had increased to 6/10. In the control group, who was treated with filtered light, the mean score was 2.7/10. In addition to the subjective satisfaction score, the mens’ testosterone levels almost doubled. The retinohypothalamic tract (sunlight to retina to hypothalamus) is well established as the circadian rhythm pathway. Treating our brains with bright light at various times of day has different effects. Bright morning light helps us wake up, energizes us, and according to this study may improve a man’s sexual satisfaction and testosterone levels. Conversely, bright light at night, or even that from our phones and computers, can cause insomnia, make it hard to get out of bed in the morning, and affect our mood in a negative way. We’ll have another post about that soon, along with information about the types of lights needed.
This is a fascinating area of study. Be prepared to see more chronotherapy (time and light therapies) as they are non-pharmacologic treatments. That means they cost less, and have fewer side effects or interactions with medications, and they are helpful for mental health issues at the very least, if not more. Further, here at any of our Kelly Goodman Group locations we are open to discussing any complementary, integrative, or functional medicine treatment you would like to try.