SIMEDHealth

Breast Cancer with Dr. Jenny Chen

Family Medicine Physician, ​Dr. Jenny Chen discusses the risk factors, diagnosis, and treatment for breast cancer.

 

 

1.) What are the risk factors for developing breast cancer? Does age, gender, or race affect risks?

Globally, breast cancer is the most frequently diagnosed malignancy and the leading cause of cancer death in women, and in the US, it is the second leading cause of cancer death in women, trailing only lung cancer. While men can also get breast cancer, women are approximately 100 times more likely to get breast cancer than men. The highest breast cancer risk occurs among white women, although breast cancer remains the most common cancer among women of every major ethnicity and racial group. There are many other risk factors for breast cancer, including postmenopausal obesity, aging, family history, alcohol use, smoking, and menopausal hormone replacement therapy. In addition, earlier age at starting periods, and later age of menopause are also associated with an increased risk. Conversely, breastfeeding, increased physical activity and a diet rich in fruits, vegetables, fish and olive oil (Mediterranean diet) are associated with a decreased risk of breast cancer. Lastly, a meta-analysis showed dietary fiber intake was associated with a 12 percent relative risk reduction in breast cancer incidence.

 

2.) What are early signs of breast cancer?

A breast lump or mass is a common early sign of breast cancer. In countries with established breast cancer screening programs, most patients present due to an abnormal mammogram. However, up to 15 percent of women are diagnosed with breast cancer due to the presence of a breast mass that is not detected on mammogram. Other signs include breast skin changes such as dimpling and red discoloration, nipple retraction or inversion, localized pain or swelling, or enlarged axillary lymph nodes.

 

3.) Do self-breast exams make a difference in early diagnosis of breast cancer? What about breast exams by physicians?

Trials evaluating clinical breast examination (CBE) and breast self-examination (BSE), with or without mammography have not demonstrated efficacy in early cancer detection or improved outcomes. Therefore we no longer suggest using clinical breast examination (CBE) or breast self-examination (BSE) as part of screening of average-risk women. Screening CBE may be helpful, however, in resource-limited settings where there is limited mammogram imaging availability. Mammography is the recommended modality of breast cancer screening for the vast majority of women. The starting age and frequency of screening mammography depends on the individual’s risk, including genetic risk. No screening guideline recommends routine

screening for average-risk women (defined as less than 15 percent lifetime risk) who are under 40 years of age. Most United States expert groups encourage shared decision-making for women in their 40s for average-risk women, although European screening guidelines recommend starting screening at age 45. Regular mammograms are recommended for all women ages 50-75.

 

4.) 1 out of 8 women will develop breast cancer, and most of them survive the disease. What treatments are contributing to breast cancer survival?

Breast cancer mortality has dropped dramatically since the 1980s, and both earlier detection through screening and improvements in breast cancer treatment are responsible for this reduction in mortality. Medical treatment of breast cancer using endocrine therapy, and chemotherapy have increased the survival rates of breast cancer patients in the past few decades. For example, estrogen receptor-positive breast cancer patients benefit from the use of endocrine therapy with anti-estrogen drugs. More recently, advancement in genetic testing and immunotherapy are also transforming the way we treat breast cancer. Immunotherapy is a type of cancer treatment that helps our immune system fight cancer. These modern medical treatments, along with advances in surgical technique and radiation oncology equipment have helped more, and more women become breast cancer survivors.

Ovarian Cancer with Dr. Oscar Osorio

It's Ovarian Cancer Awareness Month and we heard from SIMEDHealth Gynecologist Dr. Oscar Osorio

 

 

 

 

 

 

 

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Osteoporosis with Dr. Miguel Rodriguez

We had questions about osteoporosis and SIMEDHealth Rheumatologist Dr. Miguel Rodriguez had answers!

 

Dr. Rodriguez sees patients at our Gainesville and Ocala locations; to schedule an appointment, visit https://bit.ly/3t2VJhd .

 

1. What is osteoporosis?

Osteoporosis is a common bone disease that leads to an increased risk of fracture. Throughout our lives, our bones are constantly being broken down and built up again. Osteoporosis occurs when too much bone is lost and/or too little is made. This causes bones to become brittle and easier to break. In more severe osteoporosis, a minor trip, bump or even a sneeze may be all it takes to break a bone.

2. What are the symptoms of osteoporosis?

Most people with osteoporosis do not know they have the disease until they break a bone which is why osteoporosis is often called a “silent” disease. Once a bone fractures, it can be very painful and may take a very long time to heal. Some symptoms can become more noticeable with worsening disease and may include:

  • A gradual loss in height because of compressed vertebrae
  • Stooped posture or “Dowager’s hump”
  • Persistent back pain from collapsed or fractured vertebrae or other bone pain
  • More frequent fractures

3. What are the risk factors for osteoporosis?

Your risk of osteoporosis depends on:

  • Your age – bone density declines at a faster rate after the age of 50
  • Your diet – a regular intake of calcium and other minerals helps maintain bone health
  • How much you exercise and what type of exercise you do - weight-bearing exercises increase bone density
  • Sex hormone levels – women after menopause and men with low testosterone are at higher risk
  • Sun exposure – sun is needed in small amounts for our skin to make vitamin D
  • What other medical conditions you have – people with celiac disease, Crohn’s disease, or rheumatoid arthritis have a higher risk of osteoporosis
  • What medicines you take – corticosteroids, antiandrogens, and aromatase inhibitors increase risk
  • If you are deficient in any vitamins and minerals such as vitamin D or calcium
  • How much you smoke or drink – smoking or a high alcohol intake increases risk
  • How much you weigh – people who are underweight generally have lower bone densities
  • If you have had any previous fractures

4. How is osteoporosis diagnosed? 

Doctors usually diagnose osteoporosis during routine screening for the disease. The U.S. Preventive Services Task Force recommends screening for:

  • Women over age 65
  • Women of any age who have factors that increase the chance of developing osteoporosis

Your doctor may order a test that measures your bone mineral density (BMD) in a specific area of your bone. The most common test for measuring bone mineral density is dual-energy x-ray absorptiometry (DXA). It is a quick, painless, and noninvasive test. DXA uses low levels of x-rays as it passes a scanner over your body while you lie on a cushioned table. The test measures the BMD of your skeleton and at various sites that are prone to fracture, such as the hip and spine. Bone density measurement by DXA at the hip and spine is generally considered the most reliable way to diagnose osteoporosis and predict fracture risk.

A person can also be diagnosed with osteoporosis if they have a fragility fracture. Fragility fractures occur as a result of “low energy trauma”, often from a fall from standing height or less.

5. What medications are available to treat osteoporosis?

There are a number of different medicines used to treat osteoporosis. Some work by decreasing how fast bone is broken down, others increase the rate at which bone is built back up. Some can only be used in postmenopausal women.

Common medicines prescribed for osteoporosis include:

  • Bisphosphonates such as Actonel, Atelvia, Boniva, Binosto, Fosamax, Reclast, and Zometa
  • Hormone therapies, that replace missing hormones or mimic the actions of hormones, such as Calcitonin, Duavee, Evista, Femhrt, Forteo, Premarin, or Tymlos
  • Prolia – directly targets cells breaking down bone

6. Can osteoporosis be reversed?

Yes! Several treatments have been shown to improve bone density which slows or reverses the progression of osteoporosis, reducing the risk of fracture. However, osteoporosis cannot be cured indefinitely.  It requires ongoing actions to maintain your bone density. It’s never too late to treat your osteoporosis.  Don’t wait for a fracture to take action.

 

Pain Awareness Month with Dr. William Palmer

September is Pain Awareness Month, and we sat down with Rehabilitation Medicine physician Dr. William Palmer to discuss how long-term chronic pain affects people's health and what options doctors have to treat pain. 

 

 

 

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