Annual Mammograms Now Recommended For Women Beginning At Age 40

Dr. Enrique Jacome MD

Due to the high incidence of breast cancer in the US and the potential to reduce deaths from it when caught early, The American College of Obstetricians and Gynecologists (The College) recently issued new breast cancer screening guidelines that recommend mammography screening be offered annually to women beginning at age 40. Previous College guidelines recommended mammograms every one to two years starting at age 40 and annually beginning at age 50.


According to Jennifer Griffin, MD, MPH, who co-authored The College guidelines, the change in mammography screening for women beginning at age 40 is based on three factors: the incidence of breast cancer, the sojourn time for breast cancer growth, and the potential to reduce the number of deaths from it. The time period between when a breast cancer may be detected by a mammogram while it is very small and before it grows big enough to become symptomatic is known as the sojourn time. Although the sojourn time of individual cancers can vary, the greatest predictor is age. Women ages 40-49 have the shortest average sojourn time (2-2.4 years), while women ages 70-74 have the longest average sojourn time (4-4.1 years).


"Although women in their 40s have a lower overall incidence of breast cancer compared with older women, the window to detect tumors before they become symptomatic is shorter, on average," said Dr. Griffin. The five-year survival rate is 98% for women whose breast cancer tumors are discovered at their earliest stage, before they are palpable and when they are small and confined to the breast. "If women in their 40s have annual mammograms, there is a better chance of detecting and treating the cancer before it has time to spread than if they wait two years between mammograms."


The College continues to recommend annual clinical breast exams (CBE) for women ages 40 and older, and every one to three years for women ages 20-39. Additionally, The College encourages "breast self-awareness" for women ages 20 and older. Enhanced breast cancer screening, such as more frequent CBEs, annual MRI (magnetic resonance imaging), or mammograms before age 40, may be recommended for women at high risk of breast cancer. Breast MRI is not recommended for women at average risk of developing breast cancer.


Breast cancer is the second leading cause of all cancer-related deaths among American women. The incidence of breast cancer in the US declined 2% each year between 1999 and 2006, and deaths from breast cancer have also declined steadily over the past two decades. Evidence suggests the drop in breast cancer rates is most likely due to fewer women getting mammograms and therefore not being diagnosed, as well as a significant drop in women using hormone therapy for menopausal symptoms. "The good news is that fewer women are dying from breast cancer because of earlier detection and improved treatments," said Gerald F. Joseph, Jr, MD, Vice President for Practice Activities of The College.


The College's breast cancer screening guidelines also address clinical breast exams and breast self-awareness:


Clinical Breast Exam
Studies on CBEs suggest they can help detect breast cancer early, particularly when used along with mammograms. Thus, The College recommends that women ages 40 and older have an annual CBE performed by their physician. Although the benefit of CBEs isn't clear for those younger than age 40, The College continues to recommend that women ages 20-39 have a CBE every one to three years.


Breast Self-Awareness
The traditional breast self-exam (BSE) has shifted toward a newer concept called "breast self-awareness." BSE is performed in a systematic way on a regular basis, typically monthly. Breast self-awareness, on the other hand, is women understanding the normal appearance and feel of their breasts, but without a specific interval or systematic examination technique. The College endorses educating women ages 20 and older regarding breast self-awareness.


"The goal here is for women to be alert to any changes, no matter how small, in their breasts, and report them to their doctor," said Dr. Griffin. "Although we've moved away from routinely recommending BSEs, some women will want to continue doing them and that's OK."


According to The College, there is no consensus on the upper age limit for mammograms, although the benefits of screening declines with increasing age compared with the harms of overtreatment. Women ages 75 and older should discuss with their doctor whether to continue getting mammograms, said Dr. Griffin.

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HPV Infection Remains Common Among Women In The US, CDC Study Confirms

Dr. Enrique Jacome MD

Recently CDC researchers published two analyses looking at the prevalence of HPV among women in the United States.  The first, an updated estimate of the prevalence of HPV, found that during 2003-2006, 42.5 percent of women aged 14-59 years were infected with at least one of 37 types of genital HPV.  In a second analysis limited to the prevalence of the four types of HPV that are vaccine-preventable in the same time period, researchers found that prevalence was highest among young women aged 20-24 years.

It’s important to note that although the body naturally clears about 90 percent of infections within two years, some high-risk types persist and can cause cervical cancer in women.  There are two vaccines available to protect against the types of HPV that cause most cervical cancers.

Authors also underscore that HPV DNA prevalence estimates offer a snapshot of the number of women infected with HPV at a given point in time, but they do not reflect past infections or the risk for future infection.  Therefore, these estimates do not fully capture the magnitude of HPV infection in the United States.  Despite these limitations, the studies will offer a baseline for measuring the early impact of available vaccines and for monitoring changes in HPV prevalence.

The studies, published this week in the Journal of Infectious Diseases, are available online at:http://jid.oxfordjournals.org/content/current.

• Prevalence of Genital HPV among Females in the United States, the National Health and Nutrition Examination Survey, 2003-2006

Overall, HPV Infection Commonly Affects Young Women in the U.S.

An analysis led by CDC’s Dr. Susan Hariri analyzed overall HPV prevalence among women aged 14-59 years in the U.S. during 2003-2006, finding that nearly one-half of women (42.5 percent; or 39.5 million women) were infected with at least one of 37 types of genital HPV.  Prevalence of HPV infection was lowest among 14-19-year-old females (32.9 percent) and highest among 20-24-year-old females (53.8 percent).

The research shows that HPV prevalence is associated with poverty, number of sexual partners, age at sexual debut, and marital status. 

• Human Papillomavirus (HPV) 6, 11, 16 and 18 Prevalence among Females in the United States – National Health and Nutrition Examination Survey, 2003-2006: Opportunity to Measure HPV Vaccine Impact?

Young Women Have the Highest Prevalence of Vaccine-Preventable HPV

A separate analysis, led by CDC’s Dr. Eileen Dunne, examined the prevalence of vaccine-preventable high-risk HPV types 16 and 18, responsible for 70 percent of cervical cancers, and low-risk HPV types 6 and 11, responsible for nearly all genital warts, during 2003-2006.  Researchers found that 8.8 percent of women aged 14-59 years in the United States were infected with at least one of these types of HPV.  Further, by age, prevalence of infection with any of the four types was highest among women aged 20-24 years (18.5 percent). 

By types, prevalence of types 16 and 18 was highest among women aged 20-24 years (12.5 percent and 3.6 percent respectively).  Prevalence of types 6 and 11 was highest among women aged 14-19 years (5.4 percent and 1.0 percent respectively). 

How the New Data Update Previous NHANES Analyses of HPV Prevalence

The data published today are an update of a 2007 analysis published in the Journal of the American Medical Association examining HPV prevalence among women using only data from 2003-2004. 

Though findings from both the current and previous studies are based on data from CDC’s National Health and Nutrition Examination Survey (NHANES), a nationally-representative survey of the U.S. household population that assesses a broad range of health issues, the current study incorporates two additional years’ worth of data – 2005 and 2006. 

Authors believe this updated prevalence estimate is higher than the previous estimate because an improved HPV test -- which detects HPV at lower quantities – was used for this study.

For more information about HPV and the HPV vaccine, visit: http://www.cdc.gov/hpv/.

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Dr. Blessing's Book Reviews: “What I know about Success” by Ellen Spragins

Dr. Bev Blessing FNP, PHD

I recently read Ellen Spragins' latest book “What I know about Success ”.  You may have heard of the author before.  She is a well known speaker and author, and has made her name by writing about her discussions with successful women, asking them to imagine they could talk to their younger selves about lessons they have learned.  This is her third book in this format.  The book is divided into chapters which highlight well known women from various walks of life.  The author introduces the women being interviewed, gives a little about their background, and then shows the letter the women would have written to her younger self.  I thoroughly enjoyed reading about these women, many of whom I have seen on TV or read about in business journals.  

What was so refreshing was how honest they were in reminding their younger versions that some of the toughest challenges they would meet, would become some of the most valuable and influential times of their lives. We can read about the details of their fears, anxieties, or feelings of helplessness.  We see how they would encourage themselves to continue with the journey and stay focused on their passions. And because we know the outcome of their present life, we know that this is wisdom worth applying.  


Since reading this book, I have had the opportunity to talk to some very successful women here in our own valley, about what they would write.  An interesting conversation always follows.  When they stop to think about an answer, I find frequently that a reassuring calmness emerges, a smile, and then the details on some amazing lesson that they learned.  Even in my own life I would have to say that I have learned something from asking this question.  When I was a young officer in the military, I worked with some of the brightest individuals in health care.  One year, I worked on a project that would put me in the rooms with some of the world’s greatest experts in health demands and future projections.  We were tasked by Congress to gather them together, and forecast health care demand for 2010 and 2025.  We were all taken to a secluded location to work on a report that would later influence decisions about health care for years to come. 


That was twenty years ago.  That report is still used today as our politicians, insurance companies, universities, research labs, and medical schools all grapple with some of the issues of health care planning. At the time, I can remember being busy, and stressed, and worried about various aspects of the process. For me it felt like an intrusive task, that I didn’t have time for.  I just wanted this task to go away!  If I had the opportunity to write a letter, I would have told me to enjoy the moment, sit at the feet of scholars and learn what I could, and really be a part of this historic event.  As I fast forward back to my current life, I think maybe the advice is still the same… Enjoy the moment, learn what you can from within the challenges, and really be a part of life.


I hope you take the opportunity to read this book.  If not, take a few moments to have coffee with friends and really talk about how you would answer the question and what you would write.  Listen to what your friends would write.  It will likely be an amazing discussion. 


You may purchase Ellen's book Here.


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Dr. Jacome's Healthy Eating Tips: The Sweet Potato Is Sweet On Nutrition

Dr. Enrique Jacome MD

According to nutritionists at the Center for Science in the Public Interest (CSPI), the single most important dietary change for most people, including children, would be to replace fatty foods with foods rich in complex carbohydrates, such as sweet potatoes.
CSPI ranked the sweet potato number one in nutrition of all vegetables. With a score of 184, the sweet potato outscored the next highest vegetable by more than 100 points. Points were given for content of dietary fiber, naturally occurring sugars and complex carbohydrates, protein, vitamins A and C, iron and calcium. 

CSPI Rankings: Sweet potato baked 184 Potato, baked 83 Spinach 76 Kale 55 Mixed Vegetables 52 Broccoli 52 Winter Squash, Baked 44 Brussels Sprouts 37 Cabbage, Raw 34 Green Peas 33 Carrot 30 Okra 30 Corn on the Cob 27 Tomato 27 Green Pepper 26 Cauliflower 25 Artichoke 24 Romaine Lettuce 24 The Center for Science in the Public Interest, Washington D.C. copyright 1992

The reasons the sweet potato took first place? Dietary fiber, naturally occurring sugars, complex carbohydrates, protein, vitamins A and C, iron and calcium. The sweet potato received a score of 184; the vegetable ranked in second place was more than 100 points behind with a score of 83.

Sweet potatoes are high in the following: beta-carotene, vitamin A, vitamin B6 and vitamin C; fiber, thiamine, niacin, potassium and copper. They are also a good source of protein, calcium, vitamin E.

The numbers for the nutritional sweet potato speak for themselves: almost twice the recommended daily allowance of vitamin A, 42 percent of the recommendation for vitamin C, four times the RDA for beta carotene, and, when eaten with the skin, sweet potatoes have more fiber than oatmeal. All these benefits with only about 130 to 160 calories!

Sweet Potato Nutrition Facts  (for one medium size sweet potato)

Calories 130 Fat 0.39 g Protein 2.15 g Net Carbs 31.56 g Dietary Fiber 3.9 g Calcium 28.6 mg Sodium 16.9 mg Potassium 265.2 mg Folate 18.2 mcg Vitamin C 29.51 mg Vitamin A 26081.9 IU Source: US Department of Agriculture

Among root vegetables, sweet potatoes offer the lowest glycemic index rating. That’s because the sweet potato digests slowly, causing a gradual rise in blood sugar so you feel satisfied longer. It’s time to move sweet potatoes to the "good" carb list. 


Here is a fantastic sweet potato recipe: http://bit.ly/oEvaQh

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Breaking News: Say Goodbye To Co-Pays For Contraception!

Dr Enrique Jacome MD

Recently, Health and Human Services Secretary Kathleen Sebelius announced news she called "historic": Beginning August 12, 2012, new guidelines under the Affordable Care Act requires new health insurance plans to cover women’s preventive services such as well-woman visits, breastfeeding support, domestic violence screening, and contraception without charging a co-payment or a deductible.


The complete list of benefits now covered as a part of these new guidelines include: well-woman visits; screening for gestational diabetes; human papillomavirus (HPV) DNA testing for women 30 years and older; sexually-transmitted infection counseling (STI screening for high-risk populations are already covered under the Act); human immunodeficiency virus (HIV) screening and counseling; FDA-approved contraception methods (yes, condoms are included, but your doc would have to give you a "prescription" for them!) and contraceptive counseling; breastfeeding support, supplies, and counseling; and domestic violence screening and counseling.

This is big news for women's health, and Secretary Sebelius emphasized that the new guidelines were a major step forward for health care equality, saying that the news means that "no woman in America has to choose between a grocery bill and [contraception]." 

Experts estimate that eliminating co-pays for preventive health care will help reduce unintended pregnancies in the United States. According to Planned Parenthood, the unintended pregnancy rate in the United States ranks among the highest in the developed world. In the U.S., nearly half of all pregnancies are unintended. This is mind-boggling, to me. And, currently, the average woman in the U.S. pays somewhere between $15-$50/month for birth control co-pays.

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Menopause: Fitness Counts

Dr. Enrique Jacome MD

Menopause is an important milestone in a woman's life. Use it as a reminder to take good care of yourself. Regular physical activity is crucial for women facing menopause. Consider what physical activity can do for you — and how to apply fitness tips for menopause to your daily routine.


Why bother with fitness during menopause?

Whether you've exercised faithfully for years or you haven't been physically active, physical activity during and after menopause offers many benefits. For example, regular physical activity can:

• Prevent weight gain. Women tend to lose muscle mass and gain abdominal fat during and after menopause. Even slight increases in physical activity can help prevent weight gain.
• Reduce the risk of breast cancer. Physical activity during and after menopause can help you lose excess weight or maintain a healthy weight, which may offer protection from breast cancer.
• Strengthen your bones. Physical activity can slow bone loss after menopause, which lowers the risk of fractures and osteoporosis.
• Reduce the risk of other diseases. During and after menopause, the risk of various chronic conditions — including cardiovascular disease and type 2 diabetes — increases. Regular physical activity can counter these risks.
• Boost your mood. Physical activity can improve your psychological health at any stage of life.

How does physical activity affect menopause signs and symptoms?

Physical activity isn't a proven way to reduce menopausal symptoms, such as hot flashes and sleep disturbances. For some women, however, regular physical activity during and after menopause seems to relieve stress and improve quality of life.

What are reasonable goals for physical activity during menopause?

For most healthy women, the Department of Health and Human Services recommends:

• At least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week — preferably spread throughout the week
• Strength training exercises at least twice a week

For motivation, set realistic, achievable goals. Rather than vowing to exercise more, for example, commit to a daily 30-minute walk after dinner. Frequently update your goals. Teaming up with someone — such as a partner, friend or neighbor — can make a difference, too.

What are the best physical activities to try?

When you're ready to get started, you have many choices. Consider:

• Aerobic activity. Aerobic activity is the cornerstone of most fitness programs. Try walking, jogging, biking, swimming or water aerobics. Any physical activity that uses large muscle groups and increases your heart rate counts. If you're a beginner, start with 10 minutes of light activity and gradually increase the intensity of your activity.
• Strength training. Regular strength training can help you reduce body fat, strengthen your muscles and more efficiently burn calories. Try weight machines, hand-held weights or resistance tubing. Choose a weight or resistance level heavy enough to tire your muscles after about 12 repetitions. Gradually increase the resistance level as you get stronger.
• Stretching. Stretching increases flexibility, improves range of motion and promotes better circulation. Set aside time to stretch after each workout, when your muscles are warm and receptive to stretching. Activities such as yoga promote flexibility, too.
• Stability and balance. Balance exercises improve stability and can help prevent falls. Try simple exercises, such as standing on one leg. Activities such as tai chi also can be helpful.

Remember, you don't have to go to the gym to exercise. Activities such as dancing, gardening and other yardwork also can improve your health. Whatever physical activities you choose, take time to warm up and cool down safely.

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