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Index   --   WPGYN Newsletter  --  Volume 9, Issue 4,  October 2012

Dr. Litwin Announces Her Retirement at the End of 2012

Do You Have Dense Breasts?

Dr. Litwin Announces Her Retirement at the End of 2012

Step with care and great tact and remember that

Life's a great balancing Act. -- Dr. Suess

Who, among us, hasn’t enjoyed reading Dr. Seuss to our children and grand children?  Or maybe you’re young enough to have had them read to you.  His stories and rhymes appeal to the child in all of us.  Yet his quotes are more, sometimes even profound wisdom.

“Don't cry because it's over, smile because it happened.”

I love this quote and have made it my mantra over the past few months as I’ve come to accept what I must do. After 30 years of practicing medicine at El Camino Hospital, 29 of them with Dr. Sutherland, I will be retiring, due to disability, in early 2013. 
I have had many emotions as I’ve come to this decision.  Sadness, guilt, regret, anger, melancholy and fear had been dominant until I came across this quote.  Now I’m smiling at my long successful career.  (I wish I could say that I have been able to completely over-come all the negative emotion, but alas I cannot.)  With the exception of my first year in private practice, I’ve essentially had one job for 30 years—how many people today can say that

“Today was good. Today was fun. Tomorrow is another one.”
And oh what an experience I’ve had!  What fun I’ve had.  What a rush it’s been. What friendships I’ve made.  How many people’s lives have I touched?  I can’t even begin to estimate a number.  More than 35 years, including residency, of helping people and being with them to enjoy and celebrate the good times and maybe more importantly, helping them through the bad.

“You’re in pretty good shape for the shape you are in.” 
I’ve been plagued by arthritis for a long time—too severe and too early I’m told.  Blame it on genetics.  My hands and right shoulder are the most affected joints and are the cause of my decision.  I had shoulder surgery in 2010 and the doctor said that he’d never seen a shoulder as bad as mine except in a man who had performed heavy manual labor all of his life.  I guess delivering babies is heavy labor not only for the mother-to-be but for the doctor as well!  I stopped doing obstetric and surgery in July of 2010.  I did this because I thought it best for my patients.  It was an ethical issue for me—my hand strength and diminished dexterity made surgery difficult.  Now unfortunately, working is aggravating my pain and so I feel it is time to stop.

“I meant what I said and I said what I said,
an elephant’s faithful one hundred percent.”

As difficult as it is to leave my patients, leaving Dr. Sutherland may be even harder.  I met Dr. Sutherland when we both just started working at El Camino Hospital after residency.  We were in different groups our first year but gravitated towards each other, as we were the only young women in the ob department.  In fact, there were only 6 women on the entire staff at El Camino, when we started in 1982.  Hard to believe now when the staff is about half female.
We both had young daughters (almost 2 and 1) and supportive husbands who enjoyed being together.  We have not just had a business relationship but a personal one as well. We’ve been together through good and bad times—the birth of Dr. Sutherland’s second daughter (now 27), our children’s graduations from college,  Dr. Sutherland’s breast cancer and my husband’s diagnosis of cancer to name a few. A more wonderful or supportive relationship I can’t imagine.  I am extremely grateful for our friendship

“Will you succeed? Yes you will indeed! 
Ninety-eight and three-quarters percent guaranteed.”
While I watched the Olympics this year, the announcer commented that a particular gymnast had done over 17,000 repetitions of his routine.  It made me think about how many deliveries, pelvic and breast exams, hysterectomies and D&Cs I’ve done in my career.  At an average of 10 pelvic exams/day (an underestimate), 4 days/week for 30 years (an overestimate since it doesn’t take into account vacations)---that’s 62,400 exams in one career!  I beat the gymnast hands (or speculum) down.  Gross estimates for deliveries--3,500, and for major and minor surgical procedures-- in excess of 1,000.  That’s quite a career—and something to smile about.

“You have brains in your head. You have feet in your shoes.
You can steer yourself any direction you choose.
                  You're on your own. And you know what you know.
       And YOU are the one who'll decide where to go.”
What’s next, who knows?  But I do know there are a lot of options including just relaxing for a while.  Do I know how to do that?
I hope to be able to see many of you before I leave.  Please call to schedule your appointments.  Dr. Sutherland or Nurse Barb will be happy to continue your care and I know that I leave you in good hands. 
I will miss you all and enjoy all the great memories.  Anyone who wants to contact me can do so via email at drchrislitwin@gmail.com.

“How did it get so late so soon? 
It’s night before it’s afternoon.
December is here before its June.
My goodness how the time has flewn.
How did it get so late so soon?”

 (All quotes attributed to Dr. Seuss)


Do You Have Dense Breasts?

Good news for us ladies in California.
For the 40% of us women who have dense breasts, this information will no longer be a secret, and we thankfully have some FDA-approved options as to what we can do about it. 

Breast Notification Bill signed into law. 
Governor Jerry Brown has signed a bill to improve breast cancer detection in women with dense breast tissue. The law will take effect April 1, 2013. Senate Bill 1538, authored by State Senator Joe Simitian (D-Palo Alto), will require that following a mammogram, women with dense breast tissue be informed of the following:

• They have dense breast tissue;
• that dense breast tissue can make it harder to evaluate the results of a mammogram;
• that it is associated with an increased risk of breast cancer;
• that information about breast density is given to discuss with their doctor; and
• that a range of screening options are available.

California joins 4 other states with similar laws on notification of breast density—New York, Virginia, Texas and Connecticut. Similar bills are pending in 12 states.  Connecticut, the first state to pass a notification bill, has shown a 100 percent increase in breast cancer detection rates in women with dense breast tissue who had supplementary screenings.  Connecticut also requires insurers to pay for ultrasounds for women with dense breasts. The additional screening for the 8,652 women found to have lesions on supplementary ultrasound cost $2.15 million, or $110,000 for each additional cancer found.  Most authorities feel that finding cancers early saves many times that amount compared with the cost of late-stage cancer treatment.

What does it mean to have dense breasts?

Women's breasts are a mixture of dense tissue and fatty tissue (which is less dense), and generally become more fatty with age. Density can't be determined in a physical exam, only by imaging. An estimated 66% of premenopausal women, and 25% of postmenopausal women, have breasts that are dense enough to interfere with mammogram accuracy, according to a landmark 1996 study.

Roughly 40 percent of the women who have mammograms have dense breast tissue.  Breast cancers are not detected by mammography in one-third of women with dense breasts, because cancer appears as a white mass against white breast tissue (in women with fatty breasts, 95 percent of cancers are detected).   A January 2011 study by the Mayo Clinic found that in women with extremely dense breast tissue, 75 percent of cancer is missed by mammography alone.

The National Cancer Institute estimates that one in eight women will develop breast cancer. The risk for women with extremely dense breast tissue is four to five times greater than the risk for women with low breast density. You can understand why it is important to know your breast density and know your risk.

What should I do if I have dense breasts?

The US Food and Drug Administration (FDA) approved the first ultrasound device for use in combination with mammography in women with dense breast tissue on September 18, 2012.  With ultrasound, most cancers are black or dark gray against the white background, making them easier to detect—which is especially important for women with dense breasts.  The device, known as the somo-v Automated Breast Ultrasound System (ABUS; U-Systems Inc, Sunnyvale, California), provides an additional resource in screening women with dense breasts. The indication is limited to use in women who have a negative mammogram and no symptoms of breast cancer.

Ultrasound imaging has been proven capable of detecting small masses in dense breasts.  A clinical study has shown a statistically significant increase in breast cancer detection when ABUS images were reviewed in conjunction with mammograms compared with mammograms alone.   As part of the approval, the FDA requires that the manufacturer train physicians and technologists using the ABUS device, and that the manufacturer provide each facility with a manual clearly defining system tests required for initial, periodic, and yearly quality control measures.

The ultrasound works via a transducer that directs high-frequency sound waves at the breast. The specially shaped transducer of the somo-v ABUS can automatically scan the entire breast in about 1 minute to produce several images for review.  It is more accurate and faster than the using a hand-held transducer which can be very user dependent and is cumbersome and ineffective for screening asymptomatic women.

Where can I get an automated breast ultrasound? 
El Camino Hospital has recently purchased the ABUS system.  Their radiologists and staff are being trained in early October in accordance with the FDA guidelines.  By November, they plan to notify all women undergoing mammograms of their breast density and, with their doctor’s order, they will reflexively perform the automated breast ultrasound on all women with dense breasts. 

Dr. Litwin and Dr. Sutherland feel use of the automated breast ultrasound in women with dense breasts can be a boon to their health and will be ordering this test when indicated. 

Some insurances cover this testing and some do not.  It is anticipated that more insurances will cover it since it is now FDA approved.  El Camino Hospital has agreed to try to keep the price affordable for those patients who have no insurance coverage.  Please discuss pricing and insurance coverage with them directly.  

El Camino Women's Medical Group provides comprehensive Obstetric & Gynecologic care for patients throughout the Bay Area. Minimally invasive surgery, infertility, women's mental health, and the MonaLisa Touch are just a few of the specialized services we offer.
The MonaLisa Touch treatment is available at El Camino Women's Medical Group. Call the office (650-396-8110) or email Shar (Shar@ElCaminoWomen.com) for more information.
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