October - Month of She

Breast Cancer Awareness Month → About 1 in 8 U.S. women (about 12.4%) will develop invasive breast cancer over the course of her lifetime. In 2018, an estimated 266,120 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 63,960 new cases of non-invasive (in situ) breast cancer. About 2,550 new cases of invasive breast cancer are expected to be diagnosed in men in 2018. A man’s lifetime risk of breast cancer is about 1 in 1,000. Breast cancer incidence rates in the U.S. began decreasing in the year 2000, after increasing for the previous two decades. They dropped by 7% from 2002 to 2003 alone. One theory is that this decrease was partially due to the reduced use of hormone replacement therapy (HRT) by women after the results of a large study called the Women’s Health Initiative were published in 2002. These results suggested a connection between HRT and increased breast cancer risk.

Over the years there has been general shift in the way women are treated and respected in society, however we still have quite a ways to go. The women before us have slowly been paving the road, brick by brick, in order to help show us the way. Sometimes in history we have been stuck in one area for a bit too long or maybe almost veered off the path, but we always return and keep moving forward. Together. One big area that is still lacking in proper education and availability to all sorts of women → proper health care + sex education. It is shocking the lack of education children receive in their elementary through high school days on this topic. Some women never getting the proper education they need in order to know how to take care of their bodies in the years to come.

This lack of education creates a downward spiral of poor health care and education amongst the population. One of the easiest ways to keep up with your healthcare is to get regular screenings with the proper specialists. When you are educated in these subjects you can also feel more in control of your health by learning self screening techniques at home. Early detection for any disease or condition is critical for proper care. Denial unfortunately gets us nowhere but in a worse state of health when we finally decide to seek help. Early detection usually means far less invasive procedures and/or full remission.

One self exam that every single woman (& man) should know → breast exam!

Laying Down

  • Place a pillow under your right shoulder and place your right arm behind your head.

  • Using the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Press firmly enough to know how your breast feels, using firmer pressure for tissue closest to the chest & ribs. A firm ridge in the lower curve of each breast is normal.

  • Press firmly on the breast in an up-and-down or “strip” pattern. You can also use a circular or wedge pattern, but be sure to use the same pattern each time.

    • Check entire breast area, from underarm to the sternum and from the collarbone to the ribs below the breast.

    • Remember how your breast feels month-to-month

  • Repeat on opposite side

  • If you find any masses, lumps, or skin changes, see you doctor right away

Standing Up

  • While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast.

    • Pressing down on hips contracts your chest wall muscles and enhances any breast changes

  • Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area.

    • Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

Cervical Cancer screenings by Pap smear has contributed to a significant decline in the incidence of and mortality from cervical cancer.  The goal of this screening is to sample the transformation zone is, where dysplasia and cancer arise. Two primary types of cervical cancer 80-90% are squamous cell carcinomas and 10-20% are adenocarcinomas in glandular cells.

Risk factors for cervical cancer are both viral and behavioral. Genital HPV infection is the most common STI in the United States. Approximately 15% of the population (20 million Americans) are infected. HPV infections are cleared by the immune system in 1-2 years. HPV infections with high-risk subtypes are found in virtually all cervical cancers. The most important risk factor is persistent infection with high-risk HPV subtypes (16 & 18).

Two notable risk factors for cervical cancer include failure to undergo screening, which accounts for roughly HALF of women diagnosed with cervical cancer, and multiple sexual partners. Other risk factors may include smoking, immunosuppression for any cause, long-term use of oral contraception, co-infection with chlamydia, fertility, and prior cervical cancer.

General Guidelines for Cervical Cancer Screening

  • First screen → Begin by age 21 or sexually active

  • Ages 21-29 → Screen every 3 years w/ cytology  (OBGYNs prefer previous normal screens)

  • Ages 30-65 → Screen every 3 years w/ cytology if three consecutive negative screenings

  • Ages > 65 → Discontinue screening if three or more negative cytology tests in a row & no abnormal test results in the past 20 years

The HPV Vaccine (Gardasil) recommended schedule came out in 2007 stating that kids should be vaccinated before their first sexual contact. Usually starting around 11 or 12, sometimes as early as 9. Now this does not mean that your child will be sexually active that young but it gives the body the best possible environment to create an immunity by allowing enough time in between the vaccine and first sexual contact which places them at risk for exposure to HPV.

  • Gardasil is a 3-dose series that targets HPV 16, 18, 6 & 11 and prevents most cases of cervical cancer.

  • Vaccine also reduces the risk of anogenital warts, invasie anogenital cancers, and vulvar & vaginal cancers.

Ovarian Cancer - Although it is relatively rare, it is the 5th leading cause of cancer-related death for women. 2/3rds of women affected are over age 55. Most are diagnosed when the cancer has already metastasized. In women over 50, three symptoms merit special attention: abdominal distention, abdominal bloating, and urinary frequency. Risk factors for ovarian cancer include: family history and presence of the BRCA1 or BRCA2 gene mutation. Risk is tripled if there is a first-degree relative with breast or ovarian cancer. Risk is decreased by use of oral contraceptives, pregnancy, and a history of breast-feeding.

Sexually Transmitted Infection - U.S. rates of STIs are the highest in the industrialized world. Chlamydia trachomatis is the most commonly reported STI in the United States and the most common STI in women, with highest prevalence in women ages 15-19. With other STIs, risk factors are: age less than 24 & sexually active, prior infection with Chlamydia or other STIs, new or multiple partners, and inconsistent condom use.

To improve detection & treatment, the CDC and the U.S. Preventive Services Task Force strongly recommend:

Annual screening for cervical Chlamydia & routine screenings for syphilis + gonorrhea in all sexually active and pregnant women age 26 & younger, and in older women at increased risk

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References: Bates Guide to Physical Examination and History Taking