Another reason to encourage weight control in adolescents

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Obesity is a known risk for high blood pressure, diabetes, heart disease and colon cancer. A recent study out of Israel found that obese or overweight 17- and 18-year-olds can have an increased risk of developing colon and rectal cancer, and the risk may be increased as high as 50%! We now have another reason to encourage good eating and exercise habits for our children. The earlier these healthy life style habits begin, the better.

-Dr. P

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Why Overweight Women May Have an Increased Chance of Cancer

Why Overweight Women May Have an Increased Chance of Cancer_81946825 [Converted]Most of us are aware that being overweight has been associated with an increased risk of developing heart disease and hypertension, but it can also increase a woman’s chance of breast and uterine cancer.  By using a person’s height and weight, a BMI (body mass index) can be determined.  A measurement of 25 to 29 is considered overweight and 30 or higher is considered obese.  According to a recent study, 40% of American women meet the clinical definition of obesity.

The exact relationship between obesity and certain female cancers is not perfectly understood, but there seems to be three factors that may play a role:

  • A body being in a state of chronic inflammation is pro-carcinogenic, and obesity is considered a chronic inflammatory state.
  • There are enzymes in fat cells which increase the production of estrogen, and an elevated level of estrogen has been associated with a higher risk of breast and endometrial (uterine) cancer.
  • Fat cells produce hormones that may stimulate tumor growth.

Please speak to your health care provider to determine your BMI, and start using the walking shoes your loved ones gave you for the recent holidays!

-Dr. P

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Ovarian Cancer Treatment – One Essential Step You Must Take

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Last week, I attended a daylong conference at the Memorial Sloan Kettering Cancer Center in New York City.  The event was the State of the Art Ovarian Cancer Conference.  It was wonderful to hear of all the advances in the treatment and care of the women who are fighting this terrible disease.

Being associated with a special gynecologic oncologist for many years, I saw firsthand the benefits of the initial surgery for ovarian cancer and the need for an extensive surgical procedure.  At the conference, this was especially emphasized and the long-term benefits were so significant.

It is important to remember that if a loved one or you find yourself in a battle with ovarian cancer, you must find a gynecologic oncologist for your initial surgery and get the best results possible.

-Dr. P

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What Are the New Breast Cancer Screening Guidelines for Average-Risk Women?

Nurse Assisting Patient Undergoing MammogramThe American Cancer Society (ACS) recently updated their breast cancer screening guidelines for women who are at an average risk of developing the disease.  It was published in the October 20, 2015 issue of JAMA (Journal of the American Medical Society).

Here are the recommendations:

  • Women with an average risk of breast cancer should undergo regular screening mammograms starting at age 45
  • Starting at 40, have annual screenings if the woman desires
  • For women aged 45 to 54, the screenings must be annual
  • For women over 55, mammograms every 2 years or annually if the women desires
  • Screen as long as the overall health of the women is good or if her life expectancy is 10 years or greater
  • For average-risk women at any age, ACS does not recommend clinical breast exams for breast cancer screening

These recommendations have refueled the debate over what are the best guidelines, and these differ from the other major health organizations.  It can be confusing, but I think it opens more discussions between women and their health care providers concerning the best way to screen for breast cancer for each individual.  Please continue to speak to your health care provider about your breast health and come up with a plan best suited for you.

-Dr. P

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New Hope for Women with Ovarian Cancer

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A recent medical article reviewed that the ten year survival rate of patients who were treated for ovarian cancer has been increasing and now may be approaching 30%.  This is an exciting report, and it suggests that the current medical and surgical treatments are starting to have a positive effect on survival rates.

Early diagnosis is still most important when dealing with any cancer and especially ovarian cancer.  Remember to visit your health care provider if you are experiencing increased gastrointestinal bloating or if your “stomach” is just not right.

-Dr. P

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Why Are Colonoscopies Crucial for You and When?

I would like to introduce you to my son, Dr. Michael Polcino III!  He is a board certified colorectal surgeon and surgical oncologist.  Today, he is discussing colorectal cancer and indications for a colonoscopy.  Colorectal cancer is the third most commonly diagnosed cancer for both men and women and is the second leading cause of cancer deaths in the U.S.  My son’s website is: colorectalsurgeryoflongisland.com  His blog: colorectalsurgeryoflongisland.com/blog

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When Should Young Women Start Getting Pap Smears?

5461276006_df3a5a44b8_zCervical cancer was once the number one cancer killer, but with the introduction of the Pap smear almost 60 years ago, this cancer has become increasingly rare.  The guidelines for cervical cancer screening are always evolving, and the American Society for Colposcopy and Cervical Pathology (ASCCP) has been at the forefront of these changes.

The relationship between high-risk HPV (human papillomavirus) and the development of pre-cervical and cervical cancer has been well established.  Thankfully, most HPV infections are short-lived and not detected within 1-2 years.  Only a small percentage of infected women will go on to develop a high-grade cervical abnormality or cervical cancer.

More than 80% of all women will develop a genital HPV infection by the time they reach the age of 50.  HPV infections are the most common in young women, and again, these infections are cleared by most young women in less than two years.

We now have a good understanding of the natural history of HPV infections and the development of cervical cancer and the pre-cancers.  ASCCP’s guidelines advise that cervical cancer screening should begin at age 21 regardless of the age of sexual initiation.  Since most of the infections in the young will regress, starting a screening program at an earlier age may result in many unnecessary treatment interventions.

Remember to always discuss your particular concerns and develop your individual screening program with your healthcare professional.

-Dr. P

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A Tool to Measure Your Risk of Developing Breast Cancer

A Tool to Measure Your Risk of Developing Breast CancerMany women who are at an increased risk of developing breast cancer are not aware of their risk.  If you are at an increased risk, a pharmacologic preventive therapy (chemoprevention) is a consideration you should discuss with your health care provider.  It has been reported that the agents used can reduce the risk by 50%.

The Gail Breast Cancer Risk Assessment Tool is one of the models that has been developed to quantify a woman’s risk of developing breast cancer.  By answering a series of questions about lifestyle, obstetric and gynecological history, and family history, a 5 year and lifetime risk can be calculated.  If there is a moderate to high risk, lifestyle and pharmacologic interventions should be considered.

Tamoxifen (Nolvadex) and Raloxifene (Evista) are two agents that may be discussed to help in the reduction in breast cancer.  There are risks and benefits to both medications, which need to be considered.

-Dr. P

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Don’t Only Be Aware in October

As October quickly comes to a close, the breast cancer awareness campaign will also come to an end.  It is imperative that our fight against breast cancer should not be at the forefront of our minds only in October but be there day by day, all year long.  All of us have someone close who has suffered with this cancer, so all of us must encourage the women in our lives to pursue proper breast health.  Don’t hold back today; speak to someone dear to you about breast cancer and you may save a loved one’s life!Mother and Daughter Face To Face

-Dr. P

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The Vegetable from the Fountain of Youth

“If you’re looking for the Fountain of Youth, kale may just be it!” Tom Gatto, a registered dietician, updates us on the nutritional powerhouse called kale. His discussion includes nutrient density, how to prepare it, and which vitamins, minerals, and antioxidants it contains and how they enhance our health.

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What Makes You at Risk for Hepatitis C?

…..Recently, the newspapers have been full of articles concerning the hepatitis C virus (HCV) and a new medication that reportedly cures people with the chronic type of the disease.  It is a very expensive drug, but the results have been wonderful; so I think it is time to give a little review of this disease.Hepatitis C Risk Factors 2

…..Hepatitis C is a contagious disease that is usually transmitted through blood contact with an infected person.  When first getting the disease (acute HCV), there may be no symptoms or only mild flu-like symptoms.  Most people do not even know that they have the disease, and most will go on to develop the chronic HCV, which is a long-term illness.

…..Of those with the chronic illness, about 25% will develop a severe liver disease such as cirrhosis or cancer.  At this time, baby boomers seem to be at the highest risk for the chronic version of this disease.  This will include the population born between 1945 and 1965.

…..The risk factors include:

  • Having a blood transfusion before 1992
  • Being on kidney dialysis
  • Sexual contact with an infected partner
  • Obtaining a tattoo or body piercing with an unclean instrument
  • Being exposed as a health care worker
  • Injecting drugs

…..Since baby boomers are many times more likely to have chronic HCV than other age populations, a screening blood test should be considered for this age group.  Feeling tired seems to be the most common symptom of the disease, so talk to your health care professional to see if a test should be considered for you!

-Dr. P

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Osteoporosis – Are You at Risk and How Do You Treat It?

…..Many menopausal women suffer from osteoporosis.  Osteoporosis is the thinning of bones which causes them to become weak, brittle, and more susceptible to fractures.  Women have an increased risk of osteoporosis throughout their lifetime.  Risk factors include:

  • Low body weight
  • Smoking history
  • Fair skin
  • Menopausal state

…..There are various methods of prevention and treatment for osteoporosis.  There are medications such as the bisphosphonates (Fosamax) and selective estrogen receptor modulators (Evista).  Supplements such as calcium and Vitamin D are important additives.  Helpful lifestyle Osteoporosis Treatment Preventionchanges include the cessation of smoking, decreased alcohol use, and weight-bearing exercises.

…..Evista is a medication used to treat osteoporosis in the selective estrogen receptor modulator class.  It mimics the beneficial effects of estrogen by increasing bone density.  Many studies have also shown that Evista decreases the risk of certain types of breast cancer.  The side effects of Evista are hot flushes, leg cramps, and infrequent blood clots or strokes.

…..Speak to your health care provider to see if Evista can be of benefit for you to treat osteoporosis and prevent breast cancer.

-Dr. P

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Why Finding Out if You Have Cancer Genes Is Imperative

…..Breast cancer and Lynch syndrome genes are carried by over one million people in the United States, and these two conditions are associated with the most common hereditary gynecological cancers.  At present, only a very small percentage of the women who carry these genes have been identified.  Therefore, the protocols that can be used to decrease the risk of dying from the cancers that these genes can cause are not being instituted.

…..GenesOur family history will be the first indication that these genes may be a part of our genetic pool, and this can lead to testing for our carrier status.  If identified, the cancer screening tests start earlier for the individual carrier and for their relatives in future generations.

…..We must remember that, based on family history, about ten percent of women are at an increased risk for a gynecological cancer.  Due to the increased risk of breast, ovarian, colorectal, and prostate cancer, which is determined from the family history, a more intense and earlier testing program may be needed.

…..A woman with a first degree relative with breast cancer has an increased risk for developing that cancer, and it is greater if that cancer was found in that relative before the age of 50.  A first degree relative is a parent, brother, sister, or child.

-Dr. P

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An Important Action to Take to Prepare for Future Medical Conditions

…..Every day there is another story on the daily news about a genetic breakthrough concerning a medical condition.  Be it about an increased risk for developing a cancer or an inherited condition affected by a specific lifestyle, genetic technologies are advancing rapidly.  This will lead to a more personalized medical care based on an individual’s personal risk.Family Portrait

…..Before stepping into this new world of high-tech genetics, we must not forget about the low-tech importance of obtaining our family’s medical history.  Most of us feel that our family history is important but some studies have shown that only about 30% of us will actively collect information about family health conditions.  It is important to be armed with this information so when you visit your health professional, the best care can be obtained.

…..Therefore, at your next family party when you are having coffee with your great Aunt Mary, get her to tell some good family stories, and begin the collection process for your family’s medical history.

-Dr. P

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Cervical Cancer Update – Including When and How Often You Should Screen

…..CCervical Cancer Updateervical cancer in the United States has been dramatically reduced over the past 30 years due to the widespread testing of cervical cells with the use of the Pap smear.  The cervical screening program is constantly evolving as more studies mature the guidelines.  The American College of Obstetrics and Gynecology (ACOG) in November of 2012 issued a new Practice Bulletin, which gives new guidelines to improve cervical cancer screening, based on the latest studies.  This will be a short summary of these guidelines:

  • The cervical cancer screening program begins at age 21 regardless of the onset of sexual activity.
  • With women 30 to 65 years of age, cervical cancer screenings should not be performed as often as annually.  Annual well woman exams are still recommended and extremely important!
  • For women ages 21 to 29, Pap smears should be done every 3 years.
  • For women ages 30 to 65, Pap smears should also be done every 3 years.
  • Co-testing (Pap smears and HPV testing) should not be performed with women 21 to 29 years of age.
  • Co-testing should occur every 5 years with women 30 to 65 years of age.
  • With adequate screening history, cervical screening can be stopped after age 65.
  • After a hysterectomy in which the cervix has been removed, screening can be stopped.
  • Any woman who has received the HPV vaccine should be screened by the same guidelines.

…..As always, all of this information should be discussed with your health care provider who will establish an individual plan for you.  Remember all recommendations may be modified based on the individual’s personal history.

-Dr. P

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Are You at a High Risk for Lung Cancer?

Last week, I spent the day attending a conference at the Icahn School of Medicine at Mount Sinai in New York City.  It was called Lung Cancer Screening: A Paradigm Shift in Primary Care.  The main focus was on the changing thoughts and new protocols for screening for lung cancer in high risk patients.  Of course I looked at the course through my OB/GYN glasses, and here are some of the points I took home:lungs brown and pink

  • Lung cancer is the #1 cancer killer in the United States, and it is now found as often in women as it is in men.
  • Therefore, for women in the United States, lung cancer is the #1 cancer killer, and its numbers are greater than breast, ovarian, and uterine cancer combined.
  • Smoking and exposure to passive smoke are the main causes of lung cancer.
  • Finding lung cancer at an early stage and having it removed can give an overall cure rate of 80% at the Stage 1 level.
  • Low-dose lung screening CAT scans can pick up these early cancers, and the radiation exposure can be low, thus decreasing the radiation exposure risks.
  • With the new thoracic laparoscopic surgical techniques, post-op pain and recovery time have been greatly reduced.

The questions that need to be resolved are many.  When do you start the screening process?  In the high risk patient, do you screen yearly?  How do you define who is the high risk patient?  How are the scans paid for?

I left the conference more determined than ever to try to help my patients stop smoking and to help the younger ones not to start.  If you do smoke and have been smoking for a while, please speak to your health care providers to see if these new developments may be of help for you.  The lung cancer screening protocols are evolving so keep your eyes and ears open!

-Dr. P

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Another Way to Reduce Your Risk of Developing Breast Cancer

Pink Breast Cancer RibbonSome women at a high risk for breast cancer may reduce their chance of developing invasive breast cancer with the use of the medication called tamoxifen.  Chemoprevention is the use of a medication to reduce cancer, and it may be considered in a patient who is at high risk of developing breast cancer.

In a high risk population, the risk reduction with the use of tamoxifen has been reported to be 49%, and this has resulted in the FDA approving tamoxifen as the first drug for breast cancer prevention.  In addition, studies have also found that another medication, called raloxifene, to be of benefit in menopausal women.  Of course there can be serious side effects with these medications, so their use may be limited.

If you are at a high risk of developing breast cancer, start a discussion with your medical team about the possible use of chemoprophylaxis!

-Dr. P

Read more about tamoxifen in my post: How Does Tamoxifen Treat Breast Cancer?

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What Other Issues Can HPV Cause?

It was not until the early 1980s that the association HPV Researchbetween the human papillomavirus (HPV) and genital tract infections became apparent.  A German research physician had isolated the HPV 16 and implicated its role in the development of cervical cancer, so a new scientific journey had begun.

We now know that the persistence of an HPV infection is necessary for the development of cervical cancers, and it is implicated in the majority of other genital tract infections in both men and women.  It is time to start our journey to a better understanding of a virus that affects so many of us!

Click here to continue to: Some Points You May Not Know About HPV

-Dr. P

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How Does Tamoxifen Treat Breast Cancer?

…..Science HealthTamoxifen is a common endocrine treatment for both early and advanced breast cancer in pre- and post-menopausal women.  Some breast cancer cells are stimulated to grow in the presence of the estrogen hormone.  The estrogens bind to special areas in the cancer cells called estrogen receptors, and once the estrogens are attached, the cancer cells’ growth is enhanced.  These breast cancers are called estrogen receptor positive.

 …..Tamoxifen breaks down in the body into a compound that also binds to the estrogen receptor in the cancer cell, but it does not stimulate the cancer cell to grow.  Since the binding site is filled, any available estrogen cannot attach to the cancer cell and stimulate its growth.

…..After the diagnosis and treatment of a breast cancer that was estrogen receptor positive, many patients would be placed on 5 years of tamoxifen treatment, and this would reduce the recurrence of the disease.  New studies may cause oncologists to change the protocol to 10 years of tamoxifen treatment due to the findings of better long-term outcomes.  There are currently ongoing studies which should shed more light on the possibility of modifying the protocols.

…..I would like to touch upon two other points.  As with all medications, tamoxifen can have side effects.  Endometrial cancer is increased with the use of tamoxifen, and so oncologists follow patients closely for this potential problem.  Lastly, another group of medications, called aromatase inhibitors, is now being used more frequently with these patients, but worldwide tamoxifen remains widely used.

-Dr. P

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Hysterectomies in This Day and Age

.Surgery….A hysterectomy is the surgical removal of the uterus.  There are many reasons to have this surgical procedure, and the decision to undergo a hysterectomy must never be made lightly.  Today, the decisions are becoming more complicated as the surgical techniques change and more options are available.

…..The first laparoscopic hysterectomy was performed about 25 years ago, and this changed gynecological surgery forever.  The instruments used were very basic, the technique was new, and acceptance was gradual.

…..In 2008, only about 20% of hysterectomies performed in the USA were being performed with a laparoscopic technique, but by 2012 the number had risen to about 40%.  This minimally invasive route includes the robotic and the conventional laparoscopic procedures.  The refinement of instruments and robotic technology continues the march to an even larger percentage of hysterectomies being performed by the minimally invasive approaches.

…..Remember, before undergoing any surgery, do your research into the indication for the surgery and the type of procedure.  Check into the surgeon’s experience and background, and always ask many questions before any decisions are made!

-Dr. P

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Is Egg Freezing for You?

…..There is a recent report from the American Society of Reproductive Medicine which states that oocyte cryopreservation is now an officially sanctioned option for young women with special fertility needs.  Sperm and embryo freezing have been available and used successfully by infertility specialists for many years, but the techniques for egg freezing/warming is now a viable option in special conditions.  The latest studies reveal an equal IVF (in vitro fertilization) successful pregnancy rate with the use of fresh eggs or frozen eggs.

…..Egg freezing can be considered to help women with the following conditions, which may endanger their fertility:

  • A young woman about to undergo chemotherapy for a cancer; the medications can be toxic to her eggs
  • A young woman with any condition that points towards early ovarian failure
  • An IVF cycle where eggs are available but sufficient sperm is not available
  • Some couples involved with IVF treatment do not want to freeze extra embryos

…..There is a new controversy arising from this available technique.  As we are all aware, childbearing in our society is being delayed to later in a woman’s life for many individual reasons.  Should egg freezing be considered to help ensure fertility success for some time later in a woman’s life?

-Dr. P

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Breast Cancer – Early Detection Can Save Your Life

…..October is Breast Cancer Awareness Month, and hopefully we are all aware of the high risk of breast cancer that surrounds us.  We know that 1 in 8 women will develop breast cancer in their lifetime, and all of us have someone close who has suffered with this cancer.  In my own family, we lost Mary Ann’s mom, who was my wife’s mother, to this terrible disease.

…..Early detection saves lives, and it is all of our responsibility to encourage the special women whom we love to practice good breast health, which should include:

  • Monthly self breast examsBreast Cancer Pink Ribbon Patch
  • At a minimum of once a year, breast exams from your health care provider
  • Yearly mammograms starting at age 40
  • Special follow-up programs if there is a strong family history of breast cancer

…..As a gynecologist, breast health has been a daily and major part of my professional life.  I encourage all of my patients to be their own best advocates when it comes to breast health.  Do your self-exams.  Do the recommended breast studies.  Once the studies are done, get the results and understand what the results are.  Do the follow-up studies and follow-up consults that are advised.  If there is a problem, see the breast specialists.  Get second opinions if there is ever a doubt.  Let us all work together to defeat this foe!

-Dr. P

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