Thursday, June 8, 2017

Breast cancer survivors have little fear- pregnancy does not mean recurrence is near!

Image result for breast cancer prevention infographicBreast cancer is something that every woman at one point in her life is worried about. Even though women try to follow precautionary screening steps such as getting mammograms or doing self-exams feeling for lumps, concern seems to be inevitable. 
Studies by the National Cancer Institute speculate that breast cancer will increase by 50% by 2030. According to a senior cancer epidemiology expert, Philip Rosenberg, one in eight women will develop breast cancer in her lifetime. Moreover, the average age at which women have children has been rising in the US and more women are being diagnosed with breast cancer during these years. Of the several kinds of breast cancer that occur, the good news is that ER-negative tumors, or those that do not respond to estrogen and thus are more difficult to treat, seem to be on the decline.
These  important observations reflect the immense money, time, and research that go into combating this disease.

Cancer survivors are some of the most resilient, inspiring, powerful women. That being said, life following cancer remission does not necessarily need to be devoid of the ability to start a family. A recent research study conducted in Chicago followed 1,200 breast cancer survivors of whom many had estrogen fueled tumors. Of these women, 333 became pregnant a couple of years after their diagnosis and were compared with their non-pregnant counterparts. The study found that 12 years after conception, breast cancer recurrence rates were similar. Moreover, information regarding breastfeeding from 64 of the mothers indicated that many were able to successfully breastfeed post surgery. Additional studies are being conducted regarding pregnancy while taking hormone blocking drugs like tamoxifen.

Studies like the one from Chicago offer a big sigh of relief to many soon-to-be moms! Give a shoutout to your superwoman, survivor, mother!

Wednesday, May 31, 2017

Aspirin the unsung cure-all?

We have all taken an aspirin for a headache, body pain or fever and found a sense of immediate relief. To many of us this magical pill may be how we get through our more hectic days. In hindsight, not much thought goes into the 500 mg pill other than pain reliever. However, what if I told you that recent studies have revealed breast cancer preventative properties of aspirin. Now before we all go reaching for our closest aspirin, some pros and cons need to be considered.
Aspirin (in low doses), has been shown to prevent cardiovascular diseases such as heart attacks, strokes, etc. for individuals with a 10% or higher risk. The caveat is that results have not been seen until 5-10 years of regular aspirin use. The recommended aspirin dose by the US Preventative Services Task Force is 75-100 mg because of aspirin's blood thinning abilities. Beyond that, the recent study by City of Hope showed that low dose aspirin (81 mg) can reduce the risk of HER2 negative breast cancer in women up to 16% if taken three times a week.
Only low dose aspirin was effective compared to the regular strength taken for headaches or pain. Interestingly, the way that low dose aspirin works is through its aromatase inhibitor properties (by blocking the enzyme that makes estrogen in post-menopausal women). This reduction in estrogen may reduce the likelihood of breast cancer developing. Moreover, aspirin reduces inflammation which can also decrease the risk of breast cancer developing or recurring. Aspirin, however, is not a treatment for breast cancer; rather it is a preventative measure against developing breast cancer in the first place or helping maintain remission.
Although there appear to be many hidden benefits to taking low dose aspirin, there are also health risks associated with it especially for individuals who are over 60 years old. This is because extensive aspirin use can cause gastrointestinal bleeding. Exercise, diet and lifestyle choices are always the best preventative measures but if you fit within the non-health risk category, aspirin may be the choice for you! 

Monday, May 15, 2017

A Day by Women, for Women

Image result for ann reeves jarvisYesterday was Mother’s Day, and while reading through the Sunday Philadelphia Inquirer I discovered something that as a daughter, mother and physician I never knew before:  rather than being a “Hallmark holiday”, Mother’s Day actually has its roots in a social reform and political action movement.  I learned that in 1858 social activist Ann Reeves Jarvis organized “Mother’s Day Work Clubs” in response to high maternal and infant mortality rates in the US.  The coalition raised money to buy medicines and hire mothers’ helpers for those suffering from tuberculosis,  inspect food and milk for contamination, and visit homes to teach mothers how to improve sanitary conditions.  
The Maternalist campaign (as it was subsequently dubbed) grew to over 10 million American women and became a formidable Washington lobby.  The funding secured for state-level programs on maternal and infant hygiene, prenatal health clinics, and visiting nurses for pregnant and new mothers contributed to a 10% decline in the overall infant mortality rate.  
Ann’s daughter Anna subsequently started a campaign to create a day commemorating the efforts and service of mothers like her own.  In 1908, the first official Mother’s Day was celebrated by 15,000 people in Grafton and Philadelphia.  A few years later in 1914, President Woodrow Wilson signed a resolution designating the second Sunday of May as Mother’s Day.  In light of all of the sociopolitical controversy and challenges facing us today, it’s heartening to know that women are ready to protect and defend the work of the Maternalists that started more than a century ago – and not only on Mother’s Day, but every day.   


       Judith Wolf, MD                                       Associate Director, WHEP

Friday, May 12, 2017

Is Gluten Allergy Even Real?!

Have you ever seen labels at grocery stores claiming to be gluten free on items ranging from certain crackers to ketchup and wondered what gluten really is-- a made up word from marketing experts to start yet another diet fad or a legitimate condition?

Truth is, gluten is a protein found within wheat, barley, and rye (grains that are surprisingly found a wide variety of foods). Many of us do not have the enzymes to completely break down this protein, which often remains undigested in our gut. For those of us who are gluten tolerant, these peptides or pieces of proteins are eliminated. However, for those who are gluten intolerant, the peptides are dangerous to the body, because they may cross our intestinal barrier and cause the immune system to attack the villi of the intestine that are important for absorbing nutrients. Hence, this autoimmune disease may eventually lead to malabsorption which can be very serious.

The truest label of gluten intolerance is known as celiac disease, which affects 1 in 133 individuals though up to 85% have yet to be diagnosed.  Both genetic (1 in 10 people with affected close relatives are at risk) and environmental circumstances can play a role. The symptoms of celiac disease range from bloating, gas, diarrhea, weight loss, depression, abdominal pain, anemia, and with children, distended abdomen, dental defects, and failure to thrive. Sometimes, this disease may also cause dermatitis herpetiformis (DH) that can cause itchy blisters. The only known treatment is to have a gluten-free diet; taking probiotics is also encouraged. However, not all individuals who believe they are allergic to gluten may have celiac but are in fact allergic to other foods that may be associated with wheat or are victims of a "created disease" without an underlying biological condition. 

The problem today is that there is a significant rise in celiac disease. In the 1950s prevalence of the disease was approximately 0.2%. Today, however, this number has grown to 1% which may not seem large but statistically is 3 million people out of 300 million individuals. According to Dr. Guandalini in an interview with University of Chicago, this rise may be attributed to the extreme cleanliness many children born in the United States are accustomed to. This hygiene hypothesis suggests that babies are not exposed to the same level of antigens and bacteria as in the past. Consequently, our gut immune system  responds in a autoimmune or allergic fashion.
What is your opinion concerning combating this disease in our every day life?

Meghana Pisupati
IMS 2017

Thursday, May 4, 2017

Research Looks Into Where Healthcare Dollars Are Being Spent

Ever wonder what your healthcare dollars go toward?  New data reveal that spending from 1996 to 2013 had gone far beyond individual treatment and helping alleviate co-pays for doctors' visits. The research breaks it down by 155 conditions, 6 types of health care, and 38 age and sex categories. Despite the growth in healthcare spending very little is known about how spending on each condition varies, especially by age. Healthcare spending in the United States is greater than in any other country in the world, so it’s very important to understand why. This study looked at government budgets, insurance claims, facility surveys, household surveys, and official US records from 1996-2013.

According to this study, the three most expensive conditions in 2013 were:
1)   Diabetes - $101 billion
2)   Ischemic heart disease - $88 billion
3)   Low back & neck pain - $88 billion
Another finding from this study showed that 38% of personal health spending in 2013 was for people over age 65.  Treatment of two conditions, hypertension and hyperlipidemia, were among the top 20 incurring spending. These results are not surprising, but it’s good to have factual evidence for it.

What makes this study different from its predecessors is that it “contains information and methodological improvements that were lacking in existing studies.” This will help “researchers and policy makers to focus more precisely on which conditions had increased spending, as well as on the ages and types of care where growth in health care spending is most accurate.” Hopefully this information will help to control US healthcare spending and at the very least provide a framework for future investigations into health care spending. Thoughts?

 Rachel Miller 
DUCOM 2017

Thursday, April 20, 2017

Pregnancy and Pertussis Prevention

Pregnancy is often considered one of the most beautiful yet complicated experiences in a woman's life. Woman are justifiably concerned about ensuring that they give their children the best start in life that they possibly can. Because of this love for their unborn child, women often modify their diets, stop drinking coffee and alcohol, and take the necessary vitamins and vaccines.  One of these important vaccines, Tdap (tetanus, diphtheria, acellular pertussis), can protect infants for the first 2 months from pertussis, better known as whooping cough. Infants younger than 2 months of age are not eligible to receive the vaccine, but their mothers are. When pregnant women are vaccinated, they develop protective antibodies that cross the placenta into the infant's bloodstream.  The ideal time for pregnant women to receive this vaccine is between 27 and 36 weeks of gestation.  And any adult planning to be in close contact with the newborn should also be vaccinated.
Currently, there are an estimated 16 million cases of whooping cough around the world and 195,000 deaths annually. This staggering number represents individuals of varying ages.  For most adolescents and adults, pertussis presents most often as a lingering, troublesome cough.  However, for infants under a year of age, pertussis can be particularly severe and potentially fatal. This is because the coughing spasms associated with pertussis may interfere with the ability of infants to breathe.                                   
As seen in a study conducted by Kaiser Permanente*, vaccination during pregnancy resulted in up to 91.4% protective efficacy during the first 2 months of the child's life - a very vulnerable period.  The CDC's vaccine schedule for children recommends a series of shots between 2 months-6 years with a closely related vaccine known as DTaP . This vaccine has shown 85% protection after the second shot at 4 months.

So remember ladies, stay healthy, fit, and get your vaccines!

* Baxter R, Bartlett J, Fireman B, et al.  Effectiveness of vaccination during pregnancy to prevent infant pertussis. [published online April 3, 2017]. Pediatrics. doi: 10.1542/peds.2016-4091

Wednesday, March 29, 2017

Pushing Away the Pelvic Exam

Going to the gynecologist can sometimes be a scary thing, especially when many women don't know what to expect. However, the major reason is because of the infamous pelvic exam that many of us dread. Pelvic exams are a way for physicians to look for illness in organs of the body such as the vulva, uterus, cervix, etc. This exam has traditionally been conducted annually (though this may be changing), when a woman is pregnant, or if she has an infection. Generally, this test should not be conducted during one's menstrual period, or post douche, use of birth control cream, or sex. Further, this examination can often be uncomfortable because of its invasive nature and use of hands. Often times, cultural or social barriers may be the root cause of a patient's hesitation to get this examination.

Pelvic exams can detect diseases ranging from ovarian cancer to STIs like bacterial vaginosis, genital herpes, trichomoniasis.  In fact, the United States has been shown to conduct twice as many cystectomies and hysterectomies compared to European countries because of findings on bimanual examinations.

However, often times, these exams may reveal benign conditions that can cause anxiety due to the need for further testing. Moreover, these tests are not the most effective screening tool to detect cancer, and additional measures are needed.

Therefore, considering these pros and cons, patients should have a say in and understand why their pelvic exam is being conducted.  Their awareness and understanding about its utility will help make them more comfortable with the exam. To ensure this sense of partnership between patients and physicians, medical evidence and personal support must be given to women to assure them that they are empowered in their decision making.

Meghana Pisupati

IMS 2017