Category Archives: Women’s Health

Women’s Health Topics

Stroke Prevention Works!

General Medicine,Prevention,Women's Health, , , , ,

The July issue of the Journal of the American Medical Association has just published new data showing that the rate of stroke, the 4th leading cause of death in the US, has dropped steadily over the last 20 years. A fantastic result validating 2 decades of advancing medical practice!

What reduced the risk of stroke and death from stroke?
Researchers attribute the dramatic results to successful treatment of risk factors such as high cholesterol and hypertension, and a reduction in the number of people who smoke tobacco. The magnitude of benefit was greatest in adults over age 65, where the use of cholesterol lowering medication and blood pressure medication has increased the most. Effects were more modest for middle aged adults, and researchers point out that rising rates of obesity and diabetes in the middle aged population might reverse this trend as we see more obesity in elderly adults.

How big was the effect?
The rate of death from stroke dropped 25% and the number of strokes fell by 20%.

What is my risk of stroke?
A variety of tools have been published allowing patients and physicians to estimate an individual person’s risk of stroke and heart attack. Most of them predict 10 year risk, so the calculators apply best to patients over age 50 where the risk of stroke and heart attack is easier to measure and benefits are more obvious. Click here for one example of a Risk Estimation Calculator.

Putting a variety of hypothetical numbers into the calculator can be a very informative demonstration of the power of controlling blood pressure, treating high cholesterol, or quitting smoking.

Does treating my risk factors before age 50 make a difference?
Even though the risk calculators won’t show such impressive changes when applied to younger patients, we know that early and aggressive treatment of smoking, obesity, hypertension and high cholesterol have a huge impact on health later in life.

The MyLifeCheck campaign from the American Heart and American Stroke association presents what we know about heart attack and stroke risk reduction in younger patients very clearly. Visit their excellent website to learn more.

What can I do now?
The answer is obvious but not necessarily easy: eat well, exercise, and don’t smoke. If you have questions about healthy lifestyle choices, if you need help quitting smoking, or if you are interested in finding out more about your blood pressure and cholesterol numbers, check in with your physician. We would be glad to help!

 

Can exercise prevent cancer?

Cancer Screening,General Medicine,Women's Health

Medical research is well known to have proven that exercise can improve health by reducing  our risk of premature death and death from heart disease.  Exercise decreases  rates of hypertension, diabetes, osteoporosis and arthritis and can improve our sense of psychological well being . What is less widely appreciated is the compelling evidence that exercise can PREVENT some kinds of cancer.

Is this really a big deal?
The most compelling evidence relates to the reduced risk of developing colon cancer. More than 50 different studies have consistently demonstrated that adults who increase  the intensity, frequency or duration of exercise can reduce their risk of developing colon cancer by 30-40% relative to those who are sedentary.  According to the American Cancer Society, the lifetime risk of developing colon cancer is about 1 in 20. A 35% reduction in that risk would change the numbers to only 1 in 30. Studies in breast cancer risk reduction (more than 60 so far) are more variable but show 20-80% risk reductions.  Current US estimates place a woman’s lifetime risk of developing  breast cancer at 1 in 8.  If we assume a conservative 30% benefit, this would change the odds to 1 in 18!   There are fewer studies but positive results for lung cancer, endometrial cancer, and prostate cancer as well.

How does it work?
Researchers don’t think that people who exercise are just more heath conscious. It seems that exercise changes the way our bodies work and the way our genetic material is expressed or emphasized. Exercise induces changes in hormone metabolism, insulin regulation, and changes the genetic expression of growth factors and immune modulators.  The impact of these specific changes on cancer is the subject of ongoing research.

How much exercise is enough?
The studies differ widely in the subject’s frequency, duration and intensity of exercise, so making comparisons is difficult. In some studies more vigorous activity seemed most  helpful, and in breast cancer research activity in adolescence seemed particularly helpful, but changes in exercise even after menopause still produced benefits. Exercise helped across all ages, and across all body types as measured by body mass index.  It is generally accepted that  30- 60 minutes of moderate to high intensity of physical activity is sufficient to achieve cancer risk reduction.  Examples of moderate and vigorous exercise can be found here. If you have questions about your own risk of cancer, cancer screening, or would like to discuss exercise capacity and goals we would be glad to help!

Should You Get Genetic Testing For Breast Cancer?

Cancer Screening,Women's Health

The Fraser Medical Clinic is committed to providing the best possible preventative care for our patients.  This requires careful attention to evolving guidelines regarding best practices.

I would like to take a moment to explore the recently published United States Preventative Services Task Force or USPSTF recommendations regarding genetic testing for breast cancer risk.

Medical testing is now available for the BRCA 1 and BRCA2 genes.  If one or both of these genes is defective a woman’s estimated lifetime risk of breast cancer increases from an average of 12.5% in the unaffected population to a range of 45-65%.  With defective BRCA genetics ovarian cancer risk increases from a lifetime average of 1.4% to 10-35%.  Women who are identified as high risk can benefit from options such as more frequent or technologically advanced cancer screening, risk reducing medications, and risk reducing surgery.

The newly published guidelines states that women who have family members with cancer of the breast, ovaries, fallopian tubes, lining of the pelvis or abdomen, or any BRCA-genetic related cancer should use a risk assessment questionnaire, and women with positive screening risk questionnaires should be offered genetic counseling. The USPSTF does not recommend genetic testing for women with average breast cancer risk.

There are 5 acceptable versions of a risk assessment interview. These are the Ontario Family History Assessment Tool, the Manchester Scoring System, the Referral Screening Tool, the Pedigree Assessment Tool (PAT) and the FHS-7 Tool. Of these, the FHS-7 is the easiest to use, as a single yes answer to any of these questions is an indication for genetic testing.

The FHS-7 Breast Cancer Screening Tool

Did any of your first-degree relatives have breast or ovarian cancer?

Did any of your relatives have bilateral breast cancer?

Did any man in your family have breast cancer?

Did any woman in your family have breast and ovarian cancer?

Did any woman in your family have breast cancer before age 50 y?

Do you have 2 or more relatives with breast and/orovarian cancer?

Do you have 2 or more relatives with breast and/or bowel cancer?

You can review all of the tools mentioned above on the USPSTF website here: http://www.uspreventiveservicestaskforce.org/uspstf12/brcatest/brcatestfinalrstab.htm#tab5

Testing for the BRCA 1 and BRCA 2 is approximately $3500 and is only sometimes covered by medical insurance.

We would be happy to review this with you at an appointment, and can coordinate genetic testing and genetic counseling for you.