Lives can be saved with appropriate genetic testing and follow-up.
There has been a wave of media attention around the breast cancer one and breast cancer two gene (commonly called BRCA 1 and BRCA 2) since Angelina Jolie shared her story of risk reducing breast surgery.
All men and women have the BRCA 1 and 2 genes. We inherit a copy of each gene from our parents. These genes are referred to as tumor suppressor genes. Their job is to help repair our DNA and prevent cancer cells from developing. If we inherit an altered/mutated copy of the gene, we can have a significantly elevated lifetime risk for cancer. Families who carry an altered BRCA 1 or BRCA 2 gene have a syndrome called Hereditary Breast and Ovarian Cancer syndrome (HBOC). Men and Women with HBOC are at increased risk for breast cancer, ovarian cancer, pancreatic cancer, prostate cancer and melanoma. Each person who carries the broken gene has a 50 percent chance they will pass this syndrome on to their children.
Genetic counseling for these gene alterations should be considered for families with a history of:
- male breast cancer
- breast cancer under the age of 50
- a person with two primary breast cancers
- ovarian cancer
- three or more HBOC cancers at any age
- pancreatic cancer
- aggressive prostate cancer
- Jewish ancestry with a history of a HBOC cancer
It is important to note that persons of Jewish ancestry have a much higher risk for the BRCA 1 and BRCA 2 gene mutations than those of non-Jewish ancestry.
If your family was identified at risk and you have had BRCA 1 and BRCA 2 gene testing prior to 2012 you may not have had complete BRCA testing. Approximately 13 percent of cancer related mutations are found by large rearrangement testing (called BART testing) on the BRCA 1 and BRCA 2 genes. Most insurance companies did not cover the BART portion of the BRCA 1 and BRCA 2 testing, prior to 2012.
If you have had BRCA 1 and BRCA 2 testing, please verify that you had complete testing, including BART. If you have not had BART testing, you may be at risk for a cancer related mutation. BART testing is now recommended for all persons who had prior BRCA 1 and BRCA 2 testing.
In addition, other cancer related gene mutations have been identified. We now have the ability to test for 25 cancer related genes. If you have a strong family history of breast, ovarian, aggressive prostate, colorectal, uterine or pancreatic cancers you may be eligible for expanded gene panel testing.
Genetic counseling, testing and appropriate follow up can save lives. Please contact our Cancer Genetics and High Risk Program for an updated genetics consultation.
Our program is comprehensive and will provide you with the most current information on cancer genetics, cancer surveillance, and cancer risk reduction strategies.
We look forward to caring for the health and wellness of your family.
Conni Murphy, ARNP
Angel Bosch, Program Coordinator
Cancer Genetics and High Risk Program
Menopause can leave you feeling less like Princess Fiona and more like Shrek. Hot flashes, mood changes, sleep disturbances, and weight gain would give anyone ogre-like tendencies. For almost 75 years, hormones were the mainstay for quelling these symptoms. However, over ten years ago, science questioned the safety of their use and left many women suffering. Fortunately, the Fairy Godmother waved her wand and granted the wishes of millions of women. The safety and effectiveness of three drugs was examined in recent clinical trials, and in the past year they have been prescribed to patients to help rewrite a happier ending.
The first of these is Brisdelle, an FDA-approved, non-hormonal therapy for moderate to severe hot flashes. It is a low-dose SSRI (Selective Serotonin Reuptake Inhibitor). These drugs were originally indicated for depression but were found to have an added benefit of decreasing hot flashes.
Duavee is another medication indicated to relieve hot flashes. It combines an estrogen with a SERM (Selective Estrogen Receptor Modulator–think Tamoxifen and Evista). By pairing an estrogen with a SERM, women can avoid taking progesterone and still protect against overgrowth of the uterine lining caused by estrogen alone. Additionally, Duavee helps to prevent postmenopausal bone loss–a win-win for postmenopausal women who have a uterus.
Osphena has been advertised heavily in the last few months. It also is a SERM. Osphena, however, is only indicated for painful intercourse as a symptom of vaginal dryness. Instead of vaginal estrogens, patients can take one daily dose of Osphena orally. Patients may experience hot flashes–just another day in Florida!
Not all of these medications are appropriate for all patients. As with any new drug, it is important to ask your physician about any contraindications. You can see some of the common side effects of these medications by clicking on the links above. Some of the drugs have side effects such as muscle spasms, nausea, diarrhea, excessive sweating, headaches, etc.
Fortunately, relief from menopause is no longer in the Kingdom of Far, Far Away!
– Susan Poncy, MD, Medical Director, Women’s Health Program
The author of this post reports no conflicts of interest.
Great advice from one of Jupiter Medical Center’s great nurses in the Pavilion. It’s very important caregivers take care of their health & wellness!
Ann-Marie’s tips in this video are particularly important for women. According to a recent report from the Alzheimer’s Association, women are 2.5 times more likely than men to be providing 24-hour care to a loved one with Alzheimer’s.
As we sprang ahead last weekend, it made for a difficult start Monday morning. Why do we even observe Daylight Saving Time? The premise is to save energy costs during nighttime hours at home. The Uniform Time Act of 1966 provided the framework for alternating between daylight saving and standard time with multiple updates from Congress, the latest in 2007. The energy saving studies were done in the 1970s, but more current evidence is questioning how much savings is really occurring.
This sounds a lot like medicine. We used to think that certain supplements, screening tests and medicines were good. Now we are learning that some of them are not only costly, they may provide minimal to no benefit. Remember prior to this century, hormone replacement therapy was a right of passage into menopause. The 2002 release of the Women’s Health Initiative linked hormone use to increased breast cancer risk and not only changed how we manage menopause but how we prescribe medications.
How do we make the right decisions about our health?
Let’s focus on another recent publication addressing breast cancer — the Canadian National Breast Screening Study. The study involved almost 90,000 women, aged 40-59, followed for 25 years and randomly assigned to screening mammography or not. The outcome measured was deaths from breast cancer. The conclusion was that mammography did not save lives. What…did not save lives? More evidence, however, contradicts this finding showing benefit to mammography. Because of these findings, the United States Preventative Services Task Force (USPSTF) recommends screening mammography for women over 50. However, the American Cancer Society and American College of Obstetrics and Gynecology still recommend beginning mammography at age 40. Which guidelines do we follow? What time is it? Interestingly enough, this study also showed a benefit to physical breast exam which had not been recommended by USPSTF. Annual physical breast exams were equal in measured outcome to mammography. However, mammography still detected more cancers and at an earlier stage.
If you are as confused as you were when you woke up on Monday morning, just remember to review your health history and family story with your physician. He/she can help guide your screening choices. Have an annual physical breast exam and make lifestyle changes such as increasing exercise, limiting alcohol and maintaining a healthy weight to reduce your cancer risks.
Ah, February, the time of Punxsutawney Phil, the Olympics and all things red and pink. The American Heart Association has cleverly designated February National Heart Month because of the barrage of heart shaped reminders we receive all month long. In the United States, 1 in 31 women die of breast cancer a year, while 1 in 3 dies of heart disease. In fact, heart disease is the number one cause of death in women claiming more deaths than all cancers combined.
Are You At Risk?
· Are you over the age of 55?
· Do you have a family history of heart disease?
· Do you have an elevated cholesterol level?
· Do you have high blood pressure and/or a history of pre-eclampsia?
· Are you a smoker?
· Do you have a sedentary lifestyle?
· Are you obese?
· Do you have diabetes and/or and history of gestational diabetes?
If you answered yes to any of these questions, take comfort in the fact that you are not alone. In fact, 90% of American women have one or more risk factors for heart disease.
Warning Signs of Heart Disease and Heart Attacks in Women
Although heart disease affects both men and women, some risk factors such as diabetes, obesity, and some auto-immune diseases make this condition more deadly in women. Symptoms of heart disease can be a little different for women as well. We all have heard of the usual red flags: chest pain and shortness of breath. However, some women may experience symptoms that are a little more vague like jaw pain, nausea, upper back pain and fatigue. These are all symptoms that we might not immediately associate with heart disease and would therefore not seek medical attention.
THE GOOD NEWS
80% of the risks factors are preventable by following a few simple steps:
The Mediterranean Diet can decrease the incidence of heart disease by 30%. Here is what the American Heart Association has to say about it:
“If you adopt the Mediterranean diet, you’ll eat a lot of plant-based, minimally processed foods. You’ll use olive oil instead of butter or margarine, thereby substituting monounsaturated “good” fat for unhealthful saturated and trans fats. Fish is the central meat, and red meat is eaten pretty rarely. Dessert is fresh fruit, and, yes, you’re allowed a glass of wine a day.”
Adding at least 150 minutes of cardiovascular exercise per week can decrease heart disease, stroke, obesity, diabetes and can elevate mood. Just three, brisk ten-minute walks a day is enough to make a difference.
Smoking cessation not only can reduce cardiac risk, but also the risk of cancer, chronic lung disease and early death.
Talk to Your Doctors
Your physician and the Women’s Health Program at Jupiter Medical Center can help. Nutrition counseling, weight management and wellness programs, and cardiac screening packages are available to all women in the community. Discuss your family, personal and pregnancy history with your provider to determine what early interventions can decrease your cardiac risk.
Now that you know how easy it is to lower your risk of heart disease, go tell your mom, sister, daughter or any other woman you love. Maybe this year instead of giving out candy hearts with messages like “Be Mine” or “U R Special,” give ones out that say “Eat More Fish” or “What’s Your LDL?” and show someone you really care.
Before you read this post, check out Jupiter Medical Center’s wordeo on 5 things you can do for your health in 2014!
How are your New Year’s resolutions going? Are they just a distant memory, a plan for next year or have they become a part of your life? How do you become the twenty percent that see their resolutions realized?
SIMPLIFY. Make your goals attainable by decreasing the steps to reach them.
– Place healthy foods at eye level in the refrigerator.
– Plan out snacks for the week.
– Have a trainer plan your exercise.
– Place your workout clothes at your bedside.
It is just as important to have a fit mind as a fit body. Simplify the path to better behavior. Instead of reaching for a cigarette or another glass of wine, have your favorite book, needlepoint, newest exercise gear, guitar, or latest tech device in arm’s reach. Create a new habit with the direction of least resistance, and remember, a goal without a plan is a wish.
TOGETHER. Invest in your friends, family and social networking. Let them know your progress to help steer and encourage you. Surround yourself with those who may have achieved similar goals or engage in the habits you wish to create. Meet for exercise, attend education lectures (Jupiter Medical Center has fabulous ones, go grocery shopping or share music lessons.
APP. There’s an app for that! Use technology to track your progress and simplify your goals. Weight loss, recipe, memory, and music apps abound. List your goals and make them your smart phone’s wallpaper.
REWARD. Reward yourself for goals achieved. Entertain your support network.
– a play at the Maltz
– a trip to Trapper Nelson’s
– the JMC Foundation Annual Ball
– a visit to Loggerhead Marinelife Center
TIME. Recognize that it took time to get here, and it will take patience to fulfill your resolution. Use the steps above to accelerate towards your goal!
Hopefully this new year will find you automatically waking, putting on your running gear, meeting friends for a jog, eating your already prepared breakfast, joining coworkers at lunch for a walk instead of a cigarette, playing a new musical instrument and rewarding yourself with a trip to the beach (don’t forget the sunblock)!
It’s time to (re)START your resolutions. The lunar new year begins January 31st!