Act Globally

Working in the field of global health has been a passion of mine since my wife, Melanie, and I served on a medical mission in the Dominican Republic many years ago. I saw first-hand the need to increase the quality of health care provided to women in other countries. All women require access to quality health care no matter where they live, and training and educating health workers is key to ensuring that care is available.

Mothers with babies in Vietnam by Sandy DoThe World Health Organization reports that almost all (99 percent) of the nearly 300,000 maternal deaths every year occur in developing countries. Two of the most common cancers affecting women – breast and cervical cancers – are of growing global concern. These alarming statistics are what make our partnership with Health Volunteer Overseas (HVO) so important. For nearly 30 years, HVO has empowered health care professionals in resource-scarce countries with knowledge and skills to address the health care needs of their communities.

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Guest Blog: Lady Ganga and the Fight to End Women’s Cancers

Larry Maxwell, MD, FACOG, COL(ret) U.S. Army, Director of the Globe-athon to End Women’s Cancers

Global statistics from the International Agency for Research on Cancer indicate that in 2012, gynecologic cancers accounted for 16% of the 6.6 million estimated new cases and 14% of the 3.5 million cancer related deaths among women. That means that 1 million women will be diagnosed this year with cancers below the belt and a woman will lose her battle with this disease almost every minute of every day. Cervical cancer accounted for 527,000 new cases and for 239,000 deaths. Although cervical cancer is the fourth-leading cause of cancer related death across the globe, it is the number one cause of cancer related deaths in some parts of Africa. Prevention of cervical cancer with the HPV vaccine is one of the best strategies to address the increasing problem of cervical cancer, particularly for low income countries. Unfortunately, only one third of eligible girls have received all 3 doses of the HPV vaccine in the U.S. This lack of compliance is increased among underserved groups such as African Americans. Public mistrust of the HPV vaccine has been fueled by information that is often misleading. The Vaccine Adverse Events Reporting System, a national database maintained by the CDC, has analyzed severe events and not found any causative relationships. In order to optimize public opinion and enhance compliance, it’s important to clarify additional misperceptions about the safety of the vaccine.

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Men’s Health Matters to Ob-Gyns

“Movember.” That’s the subject line of a recent email that landed in my inbox.

Movember?

My first reaction was that this was a misspelling. Then I thought, what the heck is that? It turns out that my male ob-gyn colleagues have decided to draw attention to men’s health by shaving their mustaches and beards at the start of the month. They’re having a contest to judge who grows the best mustache and beard by month’s end, all in the spirit of men’s health. Why? They want to ‘change the face’ of men’s health through awareness and education.

Launched in 2003 in Australia, Movember is now a global effort in which men grow a “Mo” (moustache) for 30 days during the month of November in an effort to raise awareness about men’s health.

What better way to raise awareness of men’s health than through ob-gyns? After all, we know that women tend to make health care decisions for the family, and often a woman is the one to bring (or drag!) her partner or parent in to the doctor for care. Perhaps if we share some men’s health statistics with our patients, the messages will reach more men. Movember has certainly created a buzz around my entire department, and often that “buzzzzzz” is the key to messaging.

Here are some key messages about men’s health to consider (from the us.movember.com website):

  • 24% of men are less likely to go to the doctor compared with women.
  • 1 in 6 men will be diagnosed with prostate cancer in his lifetime. In 2013, more than 238,000 new cases of the disease will be diagnosed and almost 30,000 men will die from it.
  • Testicular cancer is the most common cancer in males between the ages of 15 and 35. In 2013, 7,920 men will be diagnosed with testicular cancer and 370 will die from it.
  • 1 in 13 men will be diagnosed with lung cancer in his lifetime.
  • While not common, men can get breast cancer. About 2,240 new cases of breast cancer will be diagnosed among men and about 410 will die from it in 2013.
  • An estimated 13 million men, or 11.8% of all men over the age of 20, have diabetes.
  • More than 6 million men are diagnosed with depression each year. Almost four times as many males as females die by suicide each year.

As arguments continue around the Affordable Care Act, my message remains consistent: Prevention matters. We need to do everything we can to make healthy lifestyle choices for ourselves and our families. Regardless of whether it’s a male or a female, whether it’s prenatal care for a woman or aneurysm screening for a man—preventive health care is an investment in this AND future generations. Preventive health care is something we should all support.

A Lesson In Breasts, Starring Angelina Jolie

Sometimes, public interest in the lives of celebrities helps us in medicine. For years, I have wished that a celebrity would champion the importance of contraception, planned pregnancies, and reproductive choices. Someone to share that planning for a pregnancy, optimizing health, taking preconception folic acid, and making healthy choices was fashionable. Alas, I’m still waiting for this to happen.

But this week, Angelina Jolie did a great service by bringing attention to the very difficult choices women face in the complex world of breast cancer, screening, prevention, and genetics. It was almost 40 years ago when First Lady Betty Ford openly discussed her breast cancer, mastectomy (surgical removal of the breast), and the importance of a screening mammogram. There was a surge in screening mammography after her revelations, and she personally helped Nancy Brinker get the Susan G. Komen Foundation started. It’s a great example of a well-known individual making a big impact on women’s health.

Hopefully, Ms. Jolie’s announcement will have a similar effect. She has taken the key message of preventive health, and used a very important term, “empowerment.” Clearly, her decision to have a double mastectomy in order to lower her cancer risk was not made lightly—it was made with a collaborative team that factored in her family history, risk factors, and the individual options available to her. In describing her experience, Ms. Jolie addressed the concerns many women have about their family support, family impact, and perception of self. She discussed how rare BRCA gene mutations increase a woman’s risk of developing cancer and the health disparities that stand in the way of more screening and treatment for women with these inherited risk factors. These are the issues our ACOG Fellows face daily—determining which patients need a comprehensive screening approach, providing the appropriate care, and having a team well-versed in genetics and risks to tailor the care to the individual.

Quite frankly, we as ob-gyns can’t know it all, but we sure can get a team that collectively does! We need to be knowledgeable in the appropriate screening protocol (ACOG recommends routine screening for hereditary breast and ovarian cancer). We also need to be prepared to counsel patients with elevated risk, and to call on the expertise of geneticists, surgeons, oncologists, and radiologists to collaboratively manage a patient’s care. It is up to us to be aware of risks for our patients and develop the best available system to help them make personal decisions.

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The Truth about Breast Cancer

During National Breast Cancer Awareness Month (NBCAM) in October, health organizations, advocacy groups, and women and men across the country shine a spotlight on the second leading cancer killer of women. Raising the visibility of breast cancer and how to both prevent and detect it has helped fuel a steady decrease in death rates since the 1990s. More women are getting mammograms—one of the best weapons for detecting breast cancer—and earlier treatment. But despite increased attention, fears and misconceptions about the disease remain.

A recent Health magazine study of women and ACOG Fellows shows that women are receiving mixed messages about how to best reduce their chances of developing breast cancer. For example, 63% of women think family history is the biggest breast cancer risk factor. In actuality, most people with breast cancer do not have a family history of the disease, but do have the two biggest risk-increasing factors: being female and getting older.

With so much misinformation, it’s important to continue educating women about prevention and detection strategies that work. ACOG recommends that women begin annual mammography screening at age 40. Lifestyle changes such as achieving and maintaining a healthy body weight, avoiding alcohol, and exercising have also been shown to reduce risk.

The truth is, you can wage your own war against breast cancer during NBCAM and throughout the year. Learn more about lowering your risk here.

Staying Healthy After Cancer Treatment

If you’re one of the 2 million breast cancer survivors in the US today, you know that battling cancer is no small feat. But after cancer goes into remission, you might think the hard part’s over, right? Not always.

Although the tools we use to fight cancer—from chemotherapy to surgery—can be life-saving, they also can affect fertility, sexual function, body image, and contraceptive needs. Some anti-cancer medications can also increase the risk of osteoporosis.

Symptoms such as vaginal dryness, decreased sex drive, and hot flashes are common, but compared with cancer, they may not seem worthy of a complaint. And even if you felt strong and didn’t lean heavily on others for emotional support during the initial cancer treatments, the long-term effects of “being an island” can erode relationships and lead to depressive symptoms. All of these treatable symptoms can have a very real effect on your quality of life. You’ve been through enough, and there’s no need to suffer in silence.

Talk to your doctor about your symptoms. He or she can recommend lubricating creams or gels to combat vaginal dryness, or suggest relaxation and dietary changes to help reduce hot flashes. You and your doctor should discuss your contraceptive options to prevent pregnancy or talk about fertility concerns if you’re considering getting pregnant in the future. Reduce your risk of bone loss or fractures through lifestyle changes such as weight-bearing and muscle-strengthening exercise, quitting smoking, and consuming less alcohol. If you are depressed, your doctor can refer you to counselors or support groups.

No matter the problem, your doctor should know about it and may be able to help. Keep an open line of communication after your treatment ends, and speak up. You’ll be glad you did.

Increased Health Risks for DES-exposed Women

Back in the 1940s and until 1971, women took a synthetic estrogen called diethylstilbestrol (DES) to prevent miscarriages and other pregnancy complications. As a result, millions of babies were exposed to DES in utero with profound health consequences.

Now, a new study in the New England Journal of Medicine quantifies the magnitude of that impact. Government researchers analyzed data from three studies that began in the 1970s, looking at 12 health risks in 4,600 women who were exposed to DES in utero and compared them to 1,900 women who were not.

Investigators found that exposed women had higher rates of infertility (33% vs. 16%), miscarriage (50% vs. 39%) and premature delivery (53% vs. 18%) than unexposed women. In addition, they were more likely to develop preeclampsia (26% vs. 14%), miscarry in the second trimester (16% vs. 2%), and experience early menopause (5% vs. 2%). DES daughters also had a slightly higher risk for breast cancer after age 40 (4% vs. 2%).

Little can be done now to undo this public health disaster. Researchers plan to follow these women through menopause and study their daughters to see whether the impact will affect future generations.

Spotlight on Breast Cancer

Breast cancer consistently tops the list of health concerns for many women and fear of developing the disease can be a tremendous source of anxiety. During National Breast Cancer Awareness Month in October, I urge women to move beyond fear and into action by reducing personal breast cancer risk factors, having regular mammograms, and tuning in to breast changes that warrant further assessment.  

There’s still a lot more to be done in the fight against breast cancer, but we have come a long way. The 2.5 million breast cancer survivors in the US serve as proof that more women are beating breast cancer than ever before. Women diagnosed with breast cancer also have a wider variety of breast-conserving treatments and reconstruction options to consider.

There’s a reason why so many doctors preach the gospel of living a healthy lifestyle. Almost 40% of the breast cancer cases in the US—about 70,000 cases a year—could be prevented if women maintained a healthy weight, exercised, and limited the amount of alcohol they drink.

In some instances, women who’ve done everything that they can to avoid breast cancer still develop the disease. This is why regular mammography screening is so critical. Mammograms are central to early detection before the cancer has spread to other parts of the body. The five-year survival rate for cancer caught at this stage is 98%, a compelling reason to get screened.

To learn more about taking control of your breast health, read ACOG’s “Spotlight on Breast Cancer.”