Women’s Health Newsletter, Volume 4 Issue 4


Vol 4, Issue 4www.ElCaminoWomen.comOctober 19, 2019


October already! It’s so hard to believe we’re arranging our end of the year plans already!

We were hoping to be planning our move by now, but unfortunately, there’s been a delay to early 2020. Our new office has beautiful views and more space. We’ve designed it to allow for us to offer women’s health talks and classes. If there are any services you want us to add to our office, please let us know here.

October is Breast Cancer Awareness Month! We’ve reprinted a previous article by Dr. Singhal on what women can do to help prevent cancer. If you or someone you know has been affected by breast cancer (or any cancer) and the skin and hair changes that occur after treatment, check out Dr. Singhal’s Chemo Companions products. They make lovely, thoughtful gifts for women going through or recovering from some of the most challenging moments of their lives.

In November we’re also launching our brand new website, which is beautiful! Aside from a great design and hopefully more straightforward navigation, our office has started working with an anti-aging skincare company and another hair care company to also offer their products to patients looking to prevent or treat wrinkles or thinning hair. You’ll hear more about that by the end of the year.

As always, feedback is always welcome on our practice, customer service, and even this newsletter!

Sarah Azad, MD

In this issue:

Practice Updates

Going Green: The Menstrual Cup

Hair Loss in Women

AAP Announces New Recommendations for Children’s Media Use

A Primer on Sexual Devices

Here’s a Tip: No Q-Tips?

Cancer Prevention Recommendations

Breast Cancer Awareness Month

Highlights from our Women’s Health Blog


 With the upcoming Thanksgiving and Christmas Holidays, our staff and physicians will be taking off time as well, and there will be fewer openings for patient visits some days of the week. For urgent needs, we are always available. However, if you have any medical needs you want to be addressed before the end of the year, please book your appointments soon. During the two weeks of holidays at the end of the year, we will only be scheduling urgent visits and those related to pregnancy, allowing more of our staff time home with their families. Please also make sure you give us enough time for any refills on prescriptions you will need over the holidays.

 We’re super excited about our new space in the IMOB across the street. We’ve FINALLY had a tour. If you’re interested in seeing the progress, you can follow here. This is our third home since we opened in July of 2009, we’re looking forward to finally settling down in this new, larger suite. The move will hopefully be before the spring of 2020!

Don’t forget to follow us on social media to stay up to date on office information as well as women’s health topics. You can follow us on Facebook, Twitter, LinkedIn, or Instagram. Your feedback on our office practices and our physician and staff communication are always welcome. 



The average woman has approximately 450 periods in her life. Most women usually bleed for two to seven days, with the average being closer to four. Assuming women change their disposable period product every six hours for four days every period, that’s 7,200 tampons or pads in the trash for every woman! Not only is that costly, but that’s a whole lot of trash filling up landfills.  

A solution: the Menstrual Cup 

What is a menstrual cup? A menstrual cup is a rubber or silicone device that is roughly bell-shaped, which is inserted into the vaginal canal to collect the blood from a woman’s period. They are usually reusable and can be safely kept in for up to 12 hours. There are over 200 different brands of menstrual cups and are safe for anyone with a period to use. They can be used in people who have periods who are virginal, sexually active, but have not given birth or have had a vaginal or cesarean delivery. With many different styles, shapes, rigidities, and sizes, it may take some trial and error to find the one you are most comfortable with, but there’s likely one you’ll love. 

The Pros and Cons: 


  • It can be kept in for up to 12 hours. (For example, you can empty it first thing in the morning and not have to empty until you get home.)
  • Most are reusable.
  • Great for reducing your environmental impact.
  • It is priced most often around $24, with a range from $1 to $50.
  • Over 200 different brands sold in 100 countries.
  • Cleaning only requires mild soap and drinkable water.
  • It can be sterilized in the comfort of your own home with boiling water.
  • It can be quickly emptied, wiped out, and reinserted in public restrooms. (Damp toilet paper or wipes recommended when washing is not available, however not required)
  • They last for up to 10 years, depending on brand and care taken to keep clean.
  • Most come with a bag to store when not in use.
  • Travel easily all over the world with a menstrual cup without having to worry about finding or packing pads or tampons.
  • Amazing for places with less developed sanitation systems.
  • It is often made with medical-grade silicone or rubber that is resistant to bacterial growth.
  • Neutral effect on vaginal pH and healthy bacteria.
  • Less odor since the menstrual blood does not make contact with the air due to the seal.
  • Highly effective in all environments, including underwater.
  • Anyone can use one.
  • Same or lower risk of vaginal infection compared with other period products.


  • There’s a learning curve:
    • A backup method highly recommended when first trying.
    • May have to spend time and money discovering the right one.
  • It can leak when overfilled or not inserted correctly.
  • Removal can be a little messy or awkward at first.
  • They can cause vaginal irritation in some women
  • In some people, it can feel uncomfortable during a bowel movement or expelled during one.
  • Caution for IUD users: There are some reports of women accidentally pulling out their intrauterine devices (IUD) while trying to remove a menstrual cup. This is likely due to some combination of suction pressure and long IUD strings. We recommend visiting your OB/GYN to make sure the strings are cut short and to always release the seal of the menstrual cup before removing. Many people use menstrual cups with IUDs and have no issues.
  • For some people, their anatomy is not conducive for a menstrual cup to be effective or comfortable. Fortunately, there are many brands, sizes, shapes, and even types (like cervical menstrual cups) that make this a rare issue.

Only you can decide whether the menstrual cup is a good option for you. Worldwide, menstrual cups are one of the least talked about period products even though they are highly practical and cost-effective no matter where you live. There is now an abundance of videos, articles, and other instructional information that you can look at to help you make your decision. Talk to your OB/GYN if you have any specific questions about menstrual cups. Here at El Camino Women’s Medical Group, we do not have a particular brand we recommend since there is incredible variety in menstrual cups, and the one you feel is most comfortable is the best one for you. If you want to decrease your environmental impact and save on tampons, pads, and trips to the store for disposable products, a menstrual cup may be an excellent option for you.

Some Videos on menstrual cups:







Lillian Soohoo, MD
Board Certified Dermatologist

Thinning scalp hair is usually not related to serious health issues, but can be a huge source of stress and anxiety for women. In most cases, the reason for hair loss can be determined by consultation and careful examination by a board-certified dermatologist.

When the cause of hair loss (also known as alopecia) isn’t clear, a biopsy of scalp skin and/or blood tests may be helpful. A dermatologist has the training and expertise to manage all types of hair loss and will be able to guide you regarding the need for further testing and treatment options.

What are the most likely reasons for hair loss in women? First of all, you should know that it is normal to have some hair loss or shedding. Actually, the American Academy of Dermatology reports that people lose up to 150 scalp hairs each day. This is completely normal. Different types of hair loss can result in significant thinning over the entire scalp or the development of smaller bald patches. Dermatologists can treat most causes of hair loss.

Here are some common causes:

Female Pattern Hair Loss (Androgenetic Alopecia)
Similar to scalp hair loss in men, female pattern hair loss (known medically as androgenetic alopecia in both sexes), is a result of the effect of hormones called androgens on the scalp hair follicles. Androgens (mostly testosterone) cause actual miniaturization of hair follicles in genetically susceptible individuals. The result is that scalp hairs become tiny and almost too small to see. For women, this type of hair loss occurs on the crown or topmost part of the scalp and is commonly seen after menopause. In men, hair thinning usually starts from the frontal hairline and extends to the back of the head, beginning as early as the teen years. Androgenetic alopecia is a common cause of hair loss in women, affecting an estimated 30-50 million in the US. Fortunately, it is unlikely to progress to complete scalp baldness, although it can be a significant source of anxiety and stress.

Alopecia Areata
This type of hair loss is the result of an autoimmune condition and may appear suddenly. The characteristic findings are smooth, round, hairless patches on the scalp. The hair follicles are still intact, and the hair can regrow completely. Again, genetics and possibly environmental factors such as stress are thought to be the cause of this type of hair loss. Approximately 2% of the population may develop alopecia areata in their lifetime, and it often begins in childhood. Scalp injections by a dermatologist using a dilute concentration of cortisone are safe and very effective in directly treating scalp areas affected by this type of hair loss.

Diet, Stress, and Pregnancy
These factors commonly lead women to notice that their hair feels thinner than usual. This form of alopecia is called telogen effluvium, which literally means “a flood of hair loss.” and typically occurs rapidly over a period of weeks to months following a major stressful event. Telogen effluvium may also be triggered by crash dieting, surgery, extreme emotional stress (e.g., after the loss of a loved one), or an illness with fever. In all of these situations, the cause of the “flood” of hair loss is the effect of stressors on the hair follicle. This results in an abrupt shortening of the hair growth cycle from a normal 3-year growth period for each hair to only a few months’ growth before the hair is shed. With telogen effluvium, the patient’s hair loss can be dramatic with large clumps of hair falling out suddenly, leading to diffuse thinning or baldness around 3-4 months after the triggering event. Fortunately, this hair loss is completely reversible and affected individuals should be reassured that their hair will grow back normally within a year or so.

Medical conditions
Thyroid dysfunction (both over and under-active thyroid), iron deficiency anemia, connective tissue diseases (such as lupus), eating disorders, and nutritional deficiencies (protein, vitamins, minerals) can result in diffuse scalp hair loss. Treatment of these medical conditions and restoration of health through the combination of medications, proper diet and exercise can often (but not always) be helpful in reducing or stopping loss of hair due to these factors.

Treatment for Hair Loss in Women

5% Minoxidil (Rogaine)
This is a topical product that is available (without a prescription) in both foam and liquid preparations to apply directly on the scalp twice daily. One-third of patients who use minoxidil as directed will experience some hair regrowth, one third will maintain the hair they have, and one third will see no benefit. It is FDA-approved for female and male pattern baldness (androgenetic alopecia) and is safe and effective. Patients should use Minoxidil for a minimum of 6 months to assess results. Continued use is necessary to maintain hair growth. Side effects are uncommon and are limited to irritation, possible allergy, and unwanted excessive hair growth. Do not apply Minoxidil immediately before bedtime to avoid getting it on your pillow—this could result in inadvertent facial hair growth. Available a Costco and local pharmacies.

Platelet Rich Plasma (PRP)
This is an exciting new treatment for both female patient hair loss (androgenetic alopecia) and alopecia areata. The use of PRP has seen numerous innovations in the past decade for alopecIa, wound healing, leg ulcers, acne scarring, and skin rejuvenation. Platelets in human blood are a natural source of growth factors and a variety of biological molecules that serve to promote cell growth, proliferation, and regeneration.

The source of PRP is the patient’s own blood, which is drawn as usual in a lab and then spun in a centrifuge machine to separate out the platelets. These platelets (PRP) are then injected in small amounts throughout the affected scalp areas. The treatment itself takes only a few minutes and repeated once each month for a total of four to six treatments. This is followed by maintenance treatments every three months. The discomfort is minor and lessened by preparing the scalp with a cooling device or ice immediately prior to the injections.
Many scientific studies published in the medical literature show that the majority of patients treated with PRP experience successful hair growth in both androgenetic alopecia and alopecia areata. This a cosmetic treatment that is performed by a dermatologist and costs approximately $600-700 per treatment.

Botanical Supplements: Saw Palmetto
There are several oral supplements available online, in retail stores, and in doctors’ offices and sold without the need for a prescription. Many purport to grow hair in women. One of the most popular of these is currently marketed as Nutrofol vitamins, which contain the active ingredient, saw palmetto. This active ingredient is extracted from a small palm endemic to the Southeastern US called Serenoa repens. It functions to block the androgen effect on hair follicles by inhibiting the enzyme 5-alpha reductase. This end result causes lengthening the duration of the growth phase in the hair follicle. Saw palmetto also activates estrogen receptors and may be harmful in women with a history of estrogen-receptor-positive breast cancer. For this reason, non-prescription supplements such as Nutrofol vitamins should be cleared by your physician prior to use.

If you are a woman experiencing hair loss, see a dermatologist to determine the cause and the best ways to treat thinning hair for you.

Lillian Soohoo, MD
Board Certified Dermatologist
The Menkes Clinic
2490 Hospital Drive Suite 201, MV



By Molly Rad, MD
Board Certified Pediatrician

Shared from the American Academy of Pediatrics

  The AAP recommends parents prioritize creative, unplugged playtime for infants and toddlers. Some media can have educational value for children starting at around 18 months of age, but it’s critically important that this be high-quality programmings, such as the content offered by Sesame Workshop and PBS. Parents of young children should watch media with their child, to help children understand what they are seeing.

For school-aged children and adolescents, the idea is to balance media use with other healthy behaviors.

“Parents play an important role in helping children and teens navigate media, which can have both positive and negative effects,” said Megan Moreno, MD, MSEd, MPH, FAAP, lead author of the policy statement on media use in school-aged children and teens. “Parents can set expectations and boundaries to make sure their children’s media experience is a positive one. The key is mindful use of media within a family.”

Problems begin when media use displaces physical activity, hands-on exploration, and face-to-face social interaction in the real world, which is critical to learning. Too much screen time can also harm the amount and quality of sleep. Organizations like Common Sense Media can help parents evaluate media content and make decisions about what is appropriate for their family.

Among the AAP recommendations:

  • For children younger than 18 months, avoid the use of screen media other than video-chatting. Parents of children 18 to 24 months of age who want to introduce digital media should choose high-quality programming, and watch it with their children to help them understand what they’re seeing.
  • For children ages 2 to 5 years, limit screen use to 1 hour per day of high-quality programs. Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
  • For children ages six and older, place consistent limits on the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity and other behaviors essential to health.
  • Designate media-free times together, such as dinner or driving, as well as media-free locations at home, such as bedrooms.
  • Have ongoing communication about online citizenship and safety, including treating others with respect online and offline.

The Family Media Use Plan tool will be launched on HealthyChildren.org on Friday, Oct. 21. A preview version is available for journalists to review at HealthyChildren.org/MediaUsePlan. This link should not be made public until 12:01 a.m. ET Friday, Oct. 21.



Once a taboo subject, sexual devices are now quite mainstream. There’s even a beginner’s guide in Good Housekeeping! More than half of all women in the US have used a vibrator, and more than a third have used a dildo. What’s the difference, you ask? That’s what this article is for, to explain it all.

Sexual devices are designed to aid in sexual activity. They are most commonly associated with use for pleasure, whether alone or with a partner. Sexual devices are also used to assist women with a wide variety of conditions. Given that over 40% of women report some type of sexual dysfunction, the use of sexual devices is only going to become more prevalent. They can help with decreased libido, anorgasmia (inability to have an orgasm), conditions that prevent vaginal penetration (or result in very painful penetration), disorders of the pelvic floor, the genitourinary syndrome of menopause and women with other chronic illnesses.

Some basic vocabulary:
Sexual Device: any object designed to physically aid in sexual arousal, activity, or stimulation.
Sex toy: a common colloquial term for sexual devices. Often refers to devices when used for purely recreational sexual enhancement.
Dilators: smooth plastic, rubber, or silicone cylinder-shaped objects that come in a variety of graduated sizes or electronically increase in size.
Vibrator: a device using an electric motor to create vibration for external or internal genital stimulation.
Dildo: a phallus-shaped device designed for vaginal or rectal penetration or stimulation. Can be combined with a harness. Dildos with two insertive ends for partner use are called “double-sided dildos.”Strap-on: a harness and dildo used in combination to facilitate hands-free sexual activity.
Anal plug: a wedge-shaped device with a wide protective flange designed to be placed in the rectum and remain there for the duration of sexual activity.
Air pulsation device: a device using mild air pulsations directly to the clitoris.
Collision dyspareunia aid: a protective donut-shaped bumper that rests around the base of the penis or dildo to prevent deep penetration

Basics of the most common devices:


Coming in a variety of shapes, sizes, and designs, these devices are designed to provide vibratory stimulation to the genitalia or anus. They may be battery-powered, rechargeable, or be plugged into an outlet. Common shapes include:

Wand: vibrators with a soft, tennis-ball size head that vibrates and contains a handle for the motor.
Bullet: thumb-sized, battery-powered vibrators intended for external use only.
Dual-stimulation: vibrators designed to simultaneously stimulate the internal and external genitalia
Wearable: vibrators designed to maintain external stimulation during sexual activity, including vaginal penetration, either using leg straps or an internal portion using pelvic floor muscles.

Penetrative devices (Dildos)

These devices are designed for penetration for the purpose of masturbation or partnered sexual activity. These can be found in all types of sizes and designs, but in general, are the size of the average penis. They can be used both vaginally and anally, but to be safe for anal penetration, the device must have a flared base to prevent it from entirely slipping into the rectum (and leading to an awkward ER visit to get it out!). They are sometimes indistinguishable from dilators and can sometimes be used interchangeably, depending on the patient’s goals. Dildos are sometimes double-sided, allowing for both partners to experience penetration and sometimes they have the ability to vibrate.

Harnesses of different varieties are used to create a “strap-on” dildo. This allows for vaginal or anal penetration in many different positions and can be an asset for patients with limited mobility.

Anal-specific Devices

Vibrators and dildos can be used for anal stimulation and penetration, but there are some safety issues in their use. If they do not have a flared base, they can be drawn into the rectum and become difficult to remove (see above about ER visits!). Lubrication is important to avoid traumatic injury to the anal lining. And the material of the device should be designed to prevent the spread of rectal bacteria. Glass devices should never be used anally.

Staying safe

With proper use and cleaning, sex devices rarely cause problems. Less than 2% of women using vibrators have ever had an injury. When women do report issues related to sex devices, they are nearly always self-limiting or easily treated. However, “proper” use and cleaning are worth learning.

Preventing trauma:
The most common issue is losing a device in the rectum. This will often require a trip to the ER to get it out, and sometimes from the ER to the OR (operating room!). It’s vital than any devices being used anally have a flared base to prevent this issue. Lubrication is also essential to avoid trauma to the surrounding vaginal or anal tissue. Lube can be oil, water, or silicone-based, but it’s important to know what is recommended for the device you’re using. For example, a silicone-covered dildo can’t be used with a silicone-based lubricant, you best use water-based ones.

Preventing infections:
Bacterial, viral, and parasitic sexually transmitted devices can all be passed through the shared use of sexual devices. This includes gonorrhea, chlamydia, herpes, HPV, HIV, syphilis, and trichomonas. It’s essential that devices are cleaned between uses and disinfected between use with different partners. It’s best to not share devices with non-monogamous partners or to use a condom or other barrier when sharing. Even with condom use, devices should be cleaned and disinfected regularly.
Bacterial vaginosis and other vaginal infections and irritation can also be caused by the use of a personal device that’s not shared with others. Regular cleaning and disinfecting of devices is important. If a woman does develop BV, it’s important to stop the use of the device until completion of treatment and to thoroughly disinfect the device before using it again. Recurrent BV is often caused by the use of sexual devices, and since so many physicians don’t screen for sexual device use, it’s often not picked up as the nidus of the infection.

Though hardly complete, this is meant to cover the most common devices out there, and what they can or can’t do for women looking to enhance their sexual activity, or work on issues related to sexual dysfunction or pain. You should always feel comfortable bringing up questions with your gynecologist. If your OBGYN doesn’t seem particularly comfortable with the topic, there are often other physicians or other types of providers in your area that may be more versed in sexual dysfunction. The directory on the website of the International Society for the Study of Women’s Sexual Health is an excellent place to start.

Sexual health is an important part of women’s health, and for most women plays a major part in their overall well being, self-esteem, and quality of life.



By Katrina Chaung, M.D.
Board Certified ENT

Here’s a tip: No Q-tips!

Earwax is actually a good thing. Earwax, or cerumen, is made from the secretions of glands in the skin of the outer ear canal as it mixes with dead skin and other debris. Earwax has antibacterial and antifungal properties that can help protect the ear and prevent infection. In fact, an ear canal completely devoid of any earwax can cause many problems, including pain, itching, and infection.

As your jaw moves when chewing or talking and as the skin of the ear canal turns over, earwax is propelled outward through the canal. For some people, however, earwax tends to build up. This can be due to the consistency of the earwax (dry versus sticky), the shape of the outer ear canal (straight versus curved), and other conditions such as eczema. The consistency of cerumen, as well as other factors, can also change as you age, making you more prone to earwax buildup, even if you never had issues in the past. An excess of earwax can cause discomfort, pain, hearing loss, and even infection.

So how do I clean my ears?

For those who do have a buildup of cerumen, the last thing you want to do is stick a Q-tip (or hairpin or toothpick or any other object!) in your ear. While you may feel like it is cleaning your ears, you can actually push and pack the earwax deeper into the canal. This can make it much more difficult and even painful to remove. You can also create small scratches in the ear canal that can lead to infection or cause serious injuries like an eardrum perforation or permanent hearing loss! As long as you do not have a perforation, or hole, in your eardrum, you may try to put a few drops of mineral oil or an over-the-counter “earwax removal drop” such as Debrox in the ears. This helps soften the earwax buildup and allows it to be expelled more easily. You can also use a bulb syringe with warm (NOT hot) water to gently try to irrigate out cerumen. Be very gentle with this as forceful irrigation can also cause pain and injury. If you know or think that you have a perforation of your eardrum, do not apply any eardrops or perform any irrigation without first discussing it with your physician.

What about “ear candling”?

Just say NO! Ear candling refers to placing a lighted candle into the ear canal to theoretically create a vacuum to “suck” out the earwax. Research has proven that this technique does not work and, in fact, deposits even more debris into the ear canal. Additionally, we see many injuries from attempts at ear candling such as burns, eardrum perforations, hearing loss, and permanent scarring, sometimes requiring surgery to correct.

The safest way to remove an earwax blockage is to visit your Ear, Nose, and Throat doctor who will have special equipment to ensure that no structures are injured and that there is not another underlying issue.

If you are having ear symptoms, you may benefit from an Ear, Nose and Throat evaluation.

Katrina Chaung, M.D.
Board-certified, Otolaryngology-Head and Neck Surgery (Ear, Nose, & Throat)
2204 Grant Road, Suite 102
Mountain View, CA 94040
(650) 988-4161



Shyamali Singhal MD
Surgical Oncology

Cancer is Preventable!

In this month, where all of us have breast cancer on our minds, it seems that all of us know someone with cancer. It seems so much more common than ever before. As a surgical oncologist, every day I wish we did not have so many patients with cancer. If there was something we could do to decrease risk, we all should do it.

In the US in 2018, there an estimated 1.73 million new cases of cancer diagnosed, and 600,000 of those will die of the disease. The most common cancers in descending order of frequency breast, lung, prostate, colon and rectum, melanoma, bladder, Non-Hodgkin’s lymphoma, kidney cancer, endometrial cancer, leukemia, pancreatic cancer, thyroid cancer, and liver cancer.

We talk about the genetic origins of cancer, which really only accounts for about 10% of patients and cannot be modified. What is less well known is that 30-50% of new cancer diagnoses are preventable with minimal changes to your lifestyle. The two obvious lifestyle ones are 1) quit smoking, and 2) stay out of the sun. The less obvious, diet and exercise have a tremendous impact on the risk of developing cancer.

We recommend a diet rich in fruits and vegetables, exercise to exceed 150 minutes a week, and maintaining BMI less than 25.

Cancer Prevention Recommendations

These ten cancer prevention recommendations are drawn from the AICR/WCRF Third Expert Report.

Be a healthy weight
Keep your weight within the healthy range and avoid weight gain in adult life

Next to not smoking, maintaining a healthy weight is the most important thing you can do to reduce your risk of cancer. Aim to be at the lower end of the healthy Body Mass Index (BMI) range.

Body fat doesn’t just sit there on our waists – it acts like a ‘hormone pump’ releasing insulin, estrogen, and other hormones into the bloodstream, which can spur cancer growth. See Recommendations 2 and 3 for strategies for weight management.

Be physically active
Be physically active as part of everyday life— walk more and sit less

Physical activity in any form helps to lower cancer risk. Aim to build more activity, like brisk walking, into your daily routine.

As well as helping us avoid weight gain, the activity itself can help to prevent cancer. Studies show that regular activity can help to keep hormone levels in check, which is important because having high levels of some hormones can increase your cancer risk.

For maximum health benefits, scientists recommend that we aim for 150 minutes of moderate, or 75 minutes of vigorous, physical activity a week.

Emerging research is showing that extended periods of inactivity – sitting at a computer, watching tv, etc. – increase many indicators for cancer risk. Break up your day by getting up and walking around a few minutes every hour.

Eat a diet rich in whole grains, vegetables, fruits and beans
Make whole grains, vegetables, fruits and pulses (legumes) such as beans and lentils a major part of your usual daily diet

Basing our diets around plant foods (like vegetables, fruits, whole grains, and beans), which contain fiber and other nutrients, can reduce our risk of cancer.

For good health, we recommend that we base all of our meals on plant foods. When preparing a meal, aim to fill at least two-thirds of your plate with vegetables, fruits, whole grains, and beans.

As well as containing vitamins and minerals, plant foods are good sources of substances called phytochemicals. These are biologically active compounds, which can help to protect cells in the body from damage that can lead to cancer.

Plant foods can also help us to maintain a healthy weight because many of them are lower in energy density (calories).

Limit consumption of “fast foods” and other processed foods high in fat, starches or sugars
Limiting these foods helps control calorie intake and maintain a healthy weight

There is strong evidence that consuming “fast-foods” and a “Western-type” diet are causes of weight gain, overweight, and obesity, which are linked to 12 cancers. Glycemic load also increases the risk of endometrial cancer.

Limit consumption of red and processed meat
Eat no more than moderate amounts of red meat, such as beef, pork, and lamb. Eat little, if any, processed meat.

The evidence that red meat (beef, pork, and lamb) is a cause of colorectal cancer is convincing. Studies show, however, that we can consume modest amounts — 12 to 18 ounces (cooked) per week — without a measurable increase in colorectal cancer risk.

But when it comes to processed meat (ham, bacon, salami, hot dogs, sausages), the evidence is just as convincing, and cancer risk begins to increase with even very low consumption. This is why the expert panel advises limiting red meat and avoiding processed meat.

Limit consumption of sugar-sweetened drinks
Drink mostly water and unsweetened drinks

There is strong evidence that consuming sugar-sweetened beverages causes weight gain, overweight, and obesity, linked to 12 cancers

. Sugar-sweetened beverages provide energy, but may not influence appetite in the same way as food does and can promote overconsumption of calories.

Limit alcohol consumption
For cancer prevention, it’s best not to drink alcohol

Previous research has shown that modest amounts of alcohol may have a protective effect against coronary heart disease.

But for cancer prevention, the evidence is clear and convincing: alcohol in any form is a potent carcinogen. It’s linked to 6 different cancers. The best advice for those concerned about cancer is not to drink.

If you do choose to drink alcohol, however, limit your consumption to one drink for women and two for men per day.

Do not use supplements for cancer prevention
Aim to meet nutritional needs through diet alone

For most people, it is possible to obtain adequate nutrition from a healthy diet that includes the right foods and drinks.

The panel doesn’t discourage the use of multivitamins or specific supplements for those sub-sections of the population who stand to benefit from them, such as women of childbearing age and the elderly. They simply caution against expecting any dietary supplement to lower cancer risk as well as a healthy diet can.

High-dose beta-carotene supplements have been linked to an increased risk for lung cancer in current and former smokers. It’s always best to discuss any dietary supplement with your doctor or a registered dietitian.

For mothers: breastfeed your baby, if you can
Breastfeeding is good for both mother and baby

According to the expert report, breastfeeding benefits both mother and child.

There is strong evidence that breastfeeding helps protect against breast cancer in the mother. There are likely two reasons for this. First, breastfeeding lowers the levels of some cancer-related hormones in the mother’s body. Second, at the end of breastfeeding, the body gets rid of any cells in the breast that may have DNA damage.

In addition, babies who are breastfed are less likely to become overweight and obese. Overweight and obese children tend to remain overweight in adult life.

If you’re planning to breastfeed your baby, your doctor or certified lactation consultant will be able to provide more information and support.

After a cancer diagnosis: follow our recommendations, if you can
Check with your health professional about what is right for you.

Shyamali Singhal MD
650 641 7861



October is Breast Cancer Awareness Month! This is a great month to learn about the latest guidelines for breast cancer screening.

The first step is for all women to see their gynecologist once a year for an annual well-woman exam. These visits should be focused on a woman’s overall health and a complete exam. If one has other issues that need to be addressed (heavy periods, painful sex, etc.), it is best to schedule an appointment for those first and have the well-woman exam separately. It’s during these exams that physicians are able to update a woman’s personal and family history, assess risk factors for different common diseases, and help educate women on relevant lifestyle modifications, updated screening guidelines, and new technology available for testing.

For women with a family history of breast cancer, it is important to have details on who has had breast cancer and their age of diagnosis. Certain family histories will trigger an offer for genetic counseling and/or genetic testing for hereditary cancer genes like BRCA 1/2. Models like the Gail Model and the Tyrer-Cuzick Model are able to calculate a lifetime risk of developing breast cancer. This type of information helps stratify women into low and high-risk categories.

  • For women with certain patterns of breast or ovarian cancer in their family histories, genetic testing is important to plan for how best to screen for breast cancer properly
  • For women at a higher risk of breast cancer (greater than a 20% lifetime risk), current recommendations include a clinical breast exam in the doctor’s office every six months, an annual mammogram, and potentially an annual breast MRI. The best age to start mammograms and MRIs will depend on specific family history information
  • Some women at higher risk of breast cancer are candidates for “chemoprevention” by taking medications that will help prevent the disease from developing.
  • For women at a lower risk of breast cancer, an individualized plan should be made between her and her physician to decide when to start and how often to perform screening tests

It is important to know that 85% of women with a diagnosis of breast cancer have no family history of the disease.

El Camino Hospital has events this month to further educate women about breast cancer, updates in screening, and treatment. The National Comprehensive Cancer Network also has helpful information about breast cancer and screening in low and high-risk patients.

If it’s not time for your annual exam, but you are concerned about your personal risk of breast cancer or have new family history information that you find concerning, you can always schedule a consultation with your gynecologist to discuss this important health issue.



Our Women’s Health Blog is a way for us to put out up to date information on various topics. Our most popular article this last quarter was from a year ago: Seeking Help for Vaginal Dryness. An August article on the risks associated with “Advanced Paternal Age” was a close second. Our 4th article in the series, on Intermittent Fasting, was the next most popular.

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