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 Welcome to Women’s Health Imaging QuarterlyWomen today have more access to information about personal health than ever before. Yet, much of that information lacks the authenticity of a genuine conversation between a physician and her patient. The topics you’ll find in Women’s Health Imaging Quarterly are derived from actual questions my own patients ask most frequently. My motivation to create Women’s Health Imagine Quarterly is to inform, reassure, and educate as many women as possible. I truly hope you find this new women’s health care resource helpful and informative. And if you have questions you’d like me to answer in Women’s Health Imaging Quarterly, send me an email at lweinstock@womensdigital.com Lisa Weinstock, MD Genetic Testing: When to go... What to know Every year, nearly 192,000 women worldwide are diagnosed with breast or ovarian cancer. Over 10 percent of these women carry an inherited mutation of the BRCA1 and BRCA2 genes, which are responsible for controlling cell growth. Women who carry the BRCA mutation are 3 to 7 times more likely to develop breast or ovarian cancer before menopause. Thanks to widely accessible genetic testing, it’s relatively easy to find out if you carry the mutated BRCA1 and BRCA2 genes. There are a number of misunderstandings about genetic testing, mainly the assumption that positive results mean that one already has, or is guaranteed to get, cancer. Neither is true. Genetic testing determines what is your level of risk for developing cancer. There’s even more confusion about who should take the test. With so much “genetic testing hype” in the media, many of my patients, who have no personal or family history of premenopausal breast or ovarian cancer, are convinced they need testing. This is absolutely not the case! The odds of inheriting a mutation are low where there is no personal or family history. Results aren’t always straightforward; while a positive result is conclusive, a negative can go both ways. That’s why in families with a history of cancer, the first person who should be tested for BRCA mutations is the “affected” family memberâÄ”the one with cancer. Her results can determine whether or not the entire family should be tested. I’ll explain: If the “affected” family member tests positive, you and your relatives should consider testing. If you, too, test positive, then you have a greater-than-average risk for developing cancer, and must speak with your doctor (or a doctor who specializes in high risk patients) about high-risk surveillance including mammography, MRI and breast ultrasound, even medication and the advantages and disadvantages to prophylactic mastectomy and oopherectomy (removal of the ovaries). If the “affected” relative tests positive and you test negative, even though the genes are present in your family, your level of risk for developing cancer is no greater than average. What about when the “affected” relative tests negative? First, you and your relatives most likely do not need testing. The rest depends on your family history. Without a family history of premenopausal breast or ovarian cancer, a negative result means a cancer risk no greater than average. Please note: it doesn’t mean you’re “immune.” You still need regularly scheduled mammography, sonogram, and clinical- and self-examinations. What if there is a family history? The negative result rules out BRCA1 and BRCA2 mutations, so there’s no need for testing. But – it doesn’t rule out the possibility that the source of cancer in your family is a yet-to-be-discovered gene mutation. Because this is a genuine concern, you must consider yourself at high risk and take proactive measures to prevent and detect cancer early. Often, those who need genetic testing the most refuse to go because they’re concerned about job security, or losing medical coverage. Until recently, these fears were not unfounded. Despite sweeping legislation in 1996 and 2000 to limit unauthorized access to private medical files, lawmakers did little to prevent discrimination based on a genetic predisposition to disease or illness. In May 2008, however, the House and Senate voted to enact laws that specifically prevent employers or insurance companies from using genetic test results to reject job applications, deny health coverage, or set insurance premiums. It’s worth talking to your healthcare provider about BRCA hereditary testing. Knowing the negative and positive of testing may save your life, and the lives of members of your family. |
Vitamin-D for Deficiency? When you were a student, getting a “D” was bad news. But as an adult, getting a “D” – Vitamin-D – is a great way to keep your teeth and bones healthy, and to keep your immune and hormonal systems strong and in balance. Yet, recent studies indicate that many Americans are dangerously deficient in Vitamin-D. Being Vitamin-D deficient is a serious hazard to your health and mental well-being. A lack of sufficient levels of Vitamin-D actually reverses its benefits and leads to heart disease, diabetes, digestive and kidney disorders, and depression. It gets worse. A recent study released by the American Society of Clinical Oncology reveals that breast cancer patients with low levels of Vitamin-D are not only less likely to recover from cancer, their cancer is more likely to spread compared to patients deemed to have sufficient levels of Vitamin-D. There’s a simple blood test that will determine if you’re getting enough Vitamin-D. or not. But you already know, because telltale signs of Vitamin-D deficiency includes muscle pain, increased bone fractures, sluggishness, difficulty sleeping, severe PMS, mood swings, and depression. Luckily, there are numerous sources for Vitamin-D. These include complex carbohydrates, eggs, dairy products, and nutrient-rich fatty fish provide Vitamin-D. But there’s an even easier way to load up on Vitamin-D, and it’s right above your head: sunlight. For several months a year, millions of Americans don’t have access to the most potent source of Vitamin-D. Just 20 minutes of exposure to sunlight a day is enough to keep our bodies sufficiently stocked with Vitamin-D. That seems easy enough. So why are so many women Vitamin-D deficient? One key culprit is lifestyle. Once upon a time, we spent nearly every daylight hour outside. In 2008, however, we spend our lives inside cars, behind the tinted glass windows of our offices, and inside air-conditioned malls and homes. And when we do go outside, we’re either fully clothed, or slathered with sunblock. No wonder we aren’t getting enough sun. It’s even worse if you live on the East Coast. During the winter and early spring, the sun’s intensity isn’t strong enough to trigger our ability to fully absorb its Vitamin-D. In other words, for several months of every year, millions of Americans simply have no access to the most potent and abundant source of Vitamin-D. Vitamin-D supplements are a partial solution. That’s because our bodies synthesize different sources of Vitamin D in different ways. For example, 20 minutes of direct sunlight provides 20,000 IU of Vitamin-D. That same 20,000 IU in the form of oral supplements can be toxic. Summer is upon us, and now is the chance to load up on Vitamin-D. But don’t overdo it. Depending on your skin tone – light to dark – 15 to 40 minutes of sunlight is sufficient. You should still use sunblock whenever else you’re in the sun for prolonged periods; the safest time for your daily dose is in the early morning or late afternoon. Healthy Hint If you check your bone density in your twenties or thirties, you’ll have a chance to build bone mass if results indicate that you have not reached “peak bone mass.” At the very least, go for a bone density test in your forties. This way you can establish a baseline of your bone mass BEFORE you reach menopause. Research Study Concludes: A long-awaited study was released in May by the Journal of the American Medical Association confirming that ultrasound combined with mammography is more effective at detecting breast cancer than mammography or ultrasound alone. The combination method is especially effective in women with a high risk for cancer, or dense breast tissue. In the study, the ultrasound/mammography combination detected 91 percent of tumors, compared to mammography or ultrasound alone, which detected 78 percent and 80 percent, respectively. Per 1000 women, mammography alone detected 7.6 cancers, while the ultrasound/mammography combination detected 11.8.
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| Women’s Health Quartely is published four times a year by Women’s Digital Imaging of Ridgewood, New Jersey, a private practice led by Dr. Lisa Weinstock, specializing in detecting and diagnosing conditions such as breast cancer, gynecological diseases and osteoporosis. WDI offers a comfortable, private environment, the accuracyof the most advanced diagnostic instruments, and exceptional care from compassionate, highly qualified female doctors. |  |