Index -- WPGYN Newsletter -- Volume 8, Issue 4, October 2011
Remodeling is complete,including a new entrance!
At your next office visit, you may notice a number of changes. The first is a new entrance. We are still Suite 221, but the door is now the first door on the right as you walk down the hall. It is recessed into the wall so it is easy to miss. It’s the same door that was previously used to enter the laboratory draw station.
When you enter, you will see a new reception area. Many patients have commented that they like the smaller, more intimate feel. Once inside the main suite, the exam rooms and consulting offices shine with a fresh coat of paint, new carpet and computer upgrades to accommodate our electronic medical records.
We look forward to seeing you for your next visit. We continue to evolve to offer you the best of medical care.
Watch Nurse Barb and Dr. Sutherland on CBS-5
Women Physician’s own nurse practitioner, Barbara Dehn, has partnered with El Camino Hospital and KPIX (CBS 5) to produce a five-minute health and wellness segment highlighting the most up to date medical news, technology, and innovation. Each month Nurse Barb will focus on a new topic of importance in health. The topic for November is pelvic health. Dr. Sutherland will be interviewed regarding common problems for women, including pelvic pain, abnormal bleeding, sexual dysfunction, and infertility. Be sure to tune in on November 16 at 7:20 pm.
Nurse Barb continues to provide women with smart straightforward advice, both in the office and on her popular nursing blog, Barb’s Daily Dose (http://barbsdailydose.com/ ).
Are You at High Risk for Breast Cancer?
All women worry about breast cancer. And they should. It’s the most common cancer in women, affecting 1 out of 8. And the majority of women to get breast cancer have no risk factors. I can testify to that fact since I was diagnosed with breast cancer at the age of 45 with no risk factors. As I like to say, “If you have breasts, you are at risk of breast cancer.”
On the other hand, some women are truly at an increased risk, and their screening and management should be different than what is normally done for low-risk women.
There are a number of known risk factors for breast cancer. These include:
· Age: especially over the age of 50
· Family History: one or more close relatives
· Menstrual History: early onset of menses or late cessation of menses
· Obesity: a BMI of > 30
· Alcohol Use: more than 1-2 servings of alcohol of any type per day
· Radiation: to the breast or chest wall
· Hormone Replacement Therapy: dependent on the greater the dose and the longer the duration
· Dense breasts: as described on a mammogram report
Low risk women may be fine to have a mammogram every 1 to 2 years in the 40s and every year in the 50s and older. I am glad I was having yearly mammograms in my 40s because my breast cancer was identified on a mammogram very early at the DCIS stage. High risk women may need more intensive screening, such as yearly MRIs, or high risk women with dense breasts may need yearly automated breast ultrasounds (more on that later). Some women with strong family histories may need testing for the BRCA gene, and if positive, even more aggressive screening and treatment should be considered for both breast and ovarian cancer.
So how do you know what risk category you are in?
There are a number of tools that have been developed to help determine what a woman’s 5 year risk and lifetime risk of breast cancer may be. Some of them even help calculate what the risk of having a BRCA gene may be. None of the tools are perfect, but they are often used by doctors and insurance companies (sigh) to decide if ordering an expensive test like a breast MRI is really justified. In general, if a life-time risk of breast cancer is greater than 20 to 25%, a yearly breast MRI should be performed. If you use the models below and find you are in a high risk category, print out your results and bring them in to your physician.
One of the oldest and simplest tools is often referred to as the Gail model. Because of its simplicity and limited family history information, it can miss many high risk women. You can find the Gail model at his website—http://www.cancer.gov/bcrisktool/ .
The Tyrer-Cuzick model is more detailed. Currently it is available on the internet “for research purposes only”. If you have an extensive family history, you may find it more accurate. Go to http://www.ems-trials.org/riskevaluator/ and select software. If you have Windows, select the IBIS Risk Evaluator.zip. Then download and open the IBIS Risk Evaluator. Select Evaluate and fill in the blanks. Print the results and bring in for a discussion with your physician.
Perhaps the best model currently available is not a “do-it-yourself” but rather is a very sophisticated program called the Hughes Risk App. El Camino Hospital has incorporated this software into their mammogram and breast screening program. If your mammograms are done at El Camino, starting within the next few months, you may be asked at your mammogram appointment to fill out pertinent information which will go to a secure server and be used to determine your five-year and lifetime risk of breast cancer, as well as your risk of having a BRCA gene. A nurse navigator will get back to you or your physician with the results and recommendations.
What if I am High Risk?
Talk to your physician if you are high risk. The good news is there are many things that can be done to allow early diagnosis and proper treatment and very possibly save your life. More breast screening may be required, such as breast MRIs or automated breast ultrasounds. You may be a candidate for genetic screening to test for the BRCA genes. You may be referred to the El Camino High Risk Breast Clinic which includes multi-disciplinary practitioners such as breast surgeons, radiation therapists, medical oncologists, gynecologic oncologists, genetic counselors, and plastic surgeons. Your doctors at Women Physicians can help guide you through your many choices.
What’s New in Breast Cancer Screening?
We all know people whose breast cancer was missed on a mammogram. It can happen as much as 15% of the time. And the time it is most likely to happen is if the breasts are very dense, as they are in almost half of women under 50. Soon all women in California will receive notification of their mammographic breast density in accordance with Ca state legislation (SB173)
For many years, we have used a breast ultrasound to help evaluate a palpable lump or a nodularity seen on a mammogram. In the past, however, trying to do a complete breast ultrasound in a high risk patient or one with dense breasts has been frought with many technical difficulties leading to high false positive rates and poor accuracy rates.
Now automated 3D breast ultrasound is available. The technology has improved to make this appropriate in certain high risk women. It is meant to be used in combination with a mammogram. El Camino Hospital will be getting this technology in November. Your radiologist and ordering physician will help decide if you are a candidate.
Fortunately, we now have an on-site expert to help with genetic questions. Lillian K. Servais, MS, CGC, is working with the Genomics Medical Institute (GMI) of El Camino Hospital to help you decide if and what genetic testing you should do and how to interpret the results. She will be working closely with the High Risk Breast Clinic to provide genetic counseling regarding BRCA testing as well as counseling for other high risk cancer genes. She will also be involved in the interpretation of red flags identified on family history pedigrees, as discussed on the next page of this newsletter. She is well trained in the complete spectrum of the field of genetics.
You can make an appointment for a consultation on referral from your physician or as a self-referral. She is located in the Genomics Cafe by the entrance of Melchor Pavilion. The phone number is 650-962-4577 and the fax number is 650-962-4509.
One of the most significant factors for age of menopause is the age at which your mother or sisters went through it. The average age of menopause is 51, but you are about 6 times more likely to have an early menopause at age 45 if your mother or sisters did, and about 6 times as likely to have a late menopause at 54 if your mother did and twice as likely if your sister did. Likewise, if your mother and sisters were at an average age, it is likely you will be as well.
Environment and lifestyle can have effects as well. For example, women who smoke tend to go through menopause 1 to 2 years before nonsmokers. Women who have never had children also tend to go through menopause earlier.
Late menopause is associated with an increased risk of breast and endometrial cancers, but a decreased risk of cardiovascular disease. Since fertility wanes about 10 years before menopause, women in families with early menopause may be at risk of losing their fertility at earlier ages.
What? The Family History Health tool is a way to collect medical information on yourself and your relatives in a pedigree format. This can be easily done using the Family History Health Tool found at http://www.elcaminohospital.org/Genomic_Medicine_Institute/For_Patients_and_Families/Introduction_to_the_Family_Medical_History_Tool, or using the surgeon’s general tool at https://familyhistory.hhs.gov/fhh-web/familyHistory/start.action Once collected, it can be stored, shared, and updated. Saving FH at the General Surgeon’s site requires signing on to an account at the Microsoft HealthVault. On the El Camino website, the development and storing is password protected on a DNA Direct website. The General Surgeon’s site has the advantage of including the age of onset for diseases. The El Camino site has the advantage of being able to track disease patterns with color-coding.
Why? We’ve always known that family history is important for health care, but with the explosion of new information in genomics, it is more important than ever. A detailed family history can help us identify red flags that may suggest more detailed genetic testing would be useful. We can now make very specific recommendation regarding your health care based on your family history or genetic testing. For example, we might recommend more intensive screening of the breast or ovaries for someone with a breast cancer gene, or a preventative medicine like an anticoagulant for someone who carries a gene for clotting, or prenatal screening if there is a risk of a recessive gene like cystic fibrosis, Tay-Sachs, or spinal muscular atrophy (SMA). Some medicines are effective for you if you have one gene, and dangerous for you if you have another.
You have no doubt been asked by every doctor you’ve ever seen for a family history. On your first visit at Women Physicians, we included family history on your initial intake form. Now we often find this information is incomplete or confusing. It’s uncertain if the niece with cancer was the daughter of your sister or your brother, etc. Furthermore, the family history may not have been kept current as new developments have occurred.
When? The best time to complete a detailed family history is NOW. The sooner you start to develop your pedigree, the faster it will grow. You will find you may get stumped on what kind of cancer Aunt Lucy had, so some research may be necessary. Each year since 2004, the Surgeon General has declared that Thanksgiving is National Family History Day. Over the holiday or at other times when families gather, the Surgeon General encourages Americans to talk about, and to write down, the health problems that seem to run in their family. Gather more information at your next family reunion. Sadly, sometimes relatives have died before they could pass on details of their own medical history or that of their ancestors. Don’t let that happen.
Who? Everyone. It is best to go back at least 3 generations, but the more information, the better. Try to include every blood relative.
What’s Next? Collect all possible data, print it and bring it in with your next appt. Please add the date of diagnosis of any diseases. We will review it with you, look for red flags, and refer you to a genetic counselor when appropriate.
Information on this website is for educational and reference purposes only and should not be interpreted as specific medical advice.
Copyright © 2010
Women Physicians Gyn Medical Group