Every Woman, Every Time…Cada Mujer, Cada Vez

What a difference a year makes. It was only a year ago that I said 2013 was “The Year of the Woman” and asked ob-gyns around the nation to lead efforts on behalf of women’s health. We saw a rocky start to the Affordable Care Act, yet as ob-gyns we have appreciated that so much of what we value for our patients is now considered a health benefit:  cervical and breast cancer screening, preconception health, maternity care.

The challenge in front of us is to provide care, lead change efforts in our hospitals and communities, and sustain our practices. At times it is daunting. This last year, we heard your concerns and worked on your behalf to improve our care delivery, to empower safety efforts, and to challenge those who fight reproductive health access, payment reforms and medical liability reform. We have worked hard to keep legislators out of our exam rooms!

A year ago I introduced a mantra that reinforces all that we hold dear: Every Woman, Every Time. For every woman, at every encounter in our health care delivery system, we need to help her achieve optimal health and wellness in the context of reproductive choices. This year has seen uncertainty and changes in health care delivery. I challenged all of us as ACOG Fellows to take the lead, because the changes in medicine will come at a cost that requires each and every one of us to foster change and collaboration.

No longer can we sit back and let change happen. Rather, we need to direct the changes, to lead the transformation that places women first. Only if we place the focus on quality, on service and on attaining health care access for all women will our practices—and our skills—flourish. By making women our focus, we will succeed. This past year, ACOG led a well-woman task force, to achieve consistency in well-woman care across all medical providers. We have opportunities to share with colleagues in internal medicine, pediatrics and family practice, and with our partners who are nurse midwives and nurse practitioners, in all aspects of well-woman care.

It has been an honor to represent the most wonderful specialty, both here and abroad. ACOG has a strong voice—in the halls of Congress, amongst our colleagues across the US, and amongst our sister organizations around the world. We are leaders.

ACOG relies on the work of all our Fellows. I thank each and every one of you for the gift of this year, to represent women, to represent Fellows, to represent ACOG

For Every Woman, Every Time.

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.

Oral Health and Pregnancy: Tell Your Patients to Say “Cheese”

A healthy smile is more than a way to make a good first impression. It can be a strong health indicator, too. Poor dental health has been linked to heart disease, diabetes, and respiratory infections. Maintaining good oral health through the years is extremely important and pregnancy is no exception.

Pregnancy can cause changes in the gums and teeth and roughly 40% of pregnant women have some form of periodontal disease such as gingivitis (inflammation of the gums), cavities (tooth decay), and periodontitis (inflammation of ligaments and bones that support the teeth). Despite this, 56% of pregnant women report that they have not been to the dentist during pregnancy.

Dental care during pregnancy has been a source of confusion for women, their doctors, and dentists. Some people mistakenly think that pregnant women cannot be treated for oral health problems. However, the opposite is true. Pregnancy is an excellent time to discuss dental health with women, and ob-gyns can play a major role.

In a new Committee Opinion, ACOG urges ob-gyns to support good dental hygiene among pregnant patients by performing routine oral health assessments at the first prenatal visit and encouraging women to see a dentist. This can also help us reassure our patients that common treatments and procedures, such as teeth cleaning, dental X-rays, and root canals, are safe during pregnancy.

We can also reiterate important healthy mouth basics:
• Limit sugary foods and drinks
• Brush teeth twice daily with a fluoridated toothpaste
• Floss once daily
• Visit the dentist twice a year

With just a few questions and suggestions, we can help patients—some of whom may not have seen a dentist in years—take a step toward a healthier mouth. And, the benefits may reach beyond mom. Studies show that women with good dental hygiene are also less likely to pass cavity-causing bacteria on to their babies—two for one protection. By performing oral health screenings, ob-gyns can help ensure a healthier smile for women and their babies. So check in with your patients about their dental health and make sure they’re smiling for all the right reasons.

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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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Finally, Women’s Health Gets Its Due

It is an amazing time for women in the US. The recent passage of the Affordable Care Act (ACA) shows that women’s health has been embraced as a national priority. Implementation of this landmark legislation will improve and expand health care for millions of women. From yearly well-woman visits to cancer screenings and domestic violence screening and counseling, to breastfeeding support and contraceptive coverage, more women’s health services will be accessible and affordable than ever before.

It’s with this backdrop that I take the reins as president of The American Congress of Obstetricians and Gynecologists, and I couldn’t be more excited. As a nation, we’re finally recognizing that health care is about more than solving accute health crises. It’s about promoting wellness to prevent disease. For ob-gyns, providing top-notch health care includes having meaningful interactions with women and providing them tools not only to maintain their physical health, but to improve their physical, mental, and emotional health, too.

Ob-gyns will be greatly affected by the new law, but we’ll also have a chance to make a great impact. We will be gaining new patients and collaborating with colleagues to optimize their health. We should strive to make the most of these patient-doctor visits and encourage women to put their health first—take advantage of the services ACA offers; get preexisting health conditions under control; make time for eating right, exercise, and the stress-relieving activities that they enjoy. These are fundamental health reminders that we must convey to every woman, every time.

As an ob-gyn, I believe that no medical specialty knows women’s health better than we do. We have a duty to speak up in the best interest of women’s health. During my year as ACOG president, I plan to take every opportunity to advocate for women. I challenge ACOG Fellows to let your voices be heard as well. Talk to your legislators and your community about women’s health, but most of all, talk to your patients. Working with them one-on-one to build the foundation for a healthier future is where we can make the biggest difference.

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With Routine Medical Tests and Procedures, Choose Wisely

Hal C. Lawrence III, MD, ACOG Vice President, speaking during the press briefing.

Hal C. Lawrence III, MD, ACOG Executive Vice President, speaking during the press briefing.

Open lines of communication are the basis of successful doctor-patient interactions. However, when it comes to medical tests and procedures, doctors and patients alike can easily slide into cruise control without taking the time to discuss what’s truly needed, appropriate, supported by evidence-based research, and in the best interest of the patient’s care.

With this in mind, ACOG has teamed up with the Choosing Wisely campaign—an initiative that aims to spark a conversation about commonly performed tests and exams in different areas of medicine. By taking a critical eye to routine health care practices, we can make better decisions on how to provide thorough and comprehensive care while avoiding unnecessary, redundant, or even risk-increasing procedures.

Today, at a joint press conference with 16 other partnering organizations, ACOG made the following recommendations:

1. Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.
Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.

2. Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.
Ideally, labor should start on its own initiative whenever possible. Higher cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care practitioners should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.

3. Don’t perform routine annual cervical cytology screening (Pap tests) in women 30–65 years of age.
In average–risk women, annual cervical cytology screening has been shown to offer no advantage over screening performed at 3-year intervals. However, a well-woman visit should occur annually for patients with their health care practitioner to discuss concerns and problems and to have appropriate screening with consideration of a pelvic examination.

4. Don’t treat patients who have mild dysplasia of less than two years in duration.
Mild dysplasia (Cervical Intraepithelial Neoplasia [CIN 1]) is associated with the presence of the human papillomavirus (HPV), which does not require treatment in average–risk women. Most women with CIN 1 on biopsy have a transient HPV infection that will usually clear in less than 12 months and, therefore, does not require treatment.

5. Don’t screen for ovarian cancer in asymptomatic women at average risk.
In population studies, there is only fair evidence that screening of asymptomatic women with serum CA-125 level and/or transvaginal ultrasound can detect ovarian cancer at an earlier stage than can be detected in the absence of screening. Because of the low prevalence of ovarian cancer and the invasive nature of the interventions required after a positive screening test, the potential harms of screening outweigh the potential benefits.

Learn more.

Guest Blog: With the ACA, Many Ounces of Prevention

Barbara S. Levy, MD

Barbara S. Levy, MD

Have you ever heard the phrase “an ounce of prevention = a pound of cure”? It’s an often-used mantra in the medical community and a message we continuously repeat to our patients. That’s because intervention through prevention makes good sense. In many cases, catastrophic illness can be avoided by nipping small problems in the bud or diagnosing and treating disease early. In addition to living a healthy lifestyle, regularly visiting your doctor for routine screenings and counseling is paramount to achieving this goal.

As women, we are often the primary (or sole) caregiver for our families—not to mention the cook, head nurse, and chief financial officer among many other roles. Without a second thought, we may put the needs of others before our own. This is especially true if money is tight and it’s a decision between getting an annual well-woman exam, paying $50 for a birth control prescription, or meeting the needs of a child, spouse, parent, or friend. But this philosophy doesn’t serve women well—if you’re sick, who will look after the people you care about?

The Affordable Care Act (ACA)—the new US law that expands health care coverage by making health care more affordable and accessible—focuses on expanded access to preventive services. Making preventive services available for little or no out-of-pocket cost makes it easier for women to do the right thing for their health and put themselves first. As I discussed in my last post, a growing number of women are now eligible to receive contraception and other preventive health services without a co-pay.

Preventive services that are now covered include:

  • Annual well-woman visit
  • Human papillomavirus (HPV) testing
  • Preventive vaccinations including HPV, flu, hepatitis A & B, shingles, and chicken pox
  • Sexually transmitted disease prevention counseling
  • Obesity screening and counseling
  • Smoking cessation
  • Depression screening

The ACA chips away at many of the barriers to access and care that women have faced for years. Here at ACOG, we’re closely monitoring the implementation of the law and will continue to advocate for comprehensive care for the women we serve. I believe this legislation is a major step in the right direction to improving women’s health and improving health outcomes for all Americans.

Check out these links to learn more about ACA and how it will affect you:

Prevention, Wellness, and Comparing Providers (HealthCare.gov)

Benefits for Women and Children of New Affordable Care Act Rules on Expanding Prevention Coverage (HealthCare.gov)

Effective Date: Women’s Preventive Health Coverage Requirements (ACOG)

Barbara S. Levy, MD, is vice president of health policy at ACOG.

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.

What’s Up, Doc?

Sometimes it seems you can’t go more than a few weeks without hearing about a medical organization changing recommendations about a particular health screening regimen or a tried-and-true treatment. From mammograms to prostate exams—not to mention the endless advice on which new or old medicines to take or avoid—it happens in every area of health and medicine. Just this week, two organizations released new advice on how often women should be screened for cervical cancer.

Each time a standard recommendation changes, I can expect a flurry of questions from my patients. The most common question is “Why should I switch from doing something that I know (eg, get a Pap test every year) to something that’s so different (eg, wait three to five years between cervical screenings)?” The answer will vary depending on the specific test or the recommendations involved, but it often comes down to the same concept: evidence-based medicine.

Evidence-based medicine combines research findings on how a disease works with real-life data and feedback on how that disease—and patients—respond to certain prevention and treatment strategies. This evidence provides a more complete picture of how a disease is best handled. Medical organizations like ACOG use it to develop practice recommendations and physicians rely on it as the foundation for how we treat patients.

Because new information is always being discovered, health recommendations need to be routinely updated. This is all part of the process of providing the patient with the best, most effective, and up-to-date care available.

If news of new recommendations leaves you feeling confused or frustrated, talk to your doctor.  He or she can explain the changes. And because every guideline does not apply to every patient, only you and your doctor can determine what impact, if any, it will have on you. It’s always ok to ask: “What’s up doc?”

The Real Recipe for Good Health

Last week’s announcement that Paula Deen, the reigning queen of rich and decadent Southern cooking, has type-2 diabetes caused some controversy in the public and in the health community. The fact that Ms. Deen signed on as a spokesperson for a diabetes drug further fueled the debate. But in arguing about the rightness of Ms. Deen’s cooking style in light of her health issues, we may be missing the most important point: it is far easier to prevent diabetes than to make it go away once you’ve got it.

To avoid diabetes—a chronic and potentially life-threatening disease—diligence is key. You should know if your blood sugar level is within a normal range, so be sure to ask your doctor for a fasting blood glucose test at your next check-up. If your results come back high, or if you have a strong family history of diabetes, take steps to lower blood glucose levels through healthy diet and regular exercise. This is a far smarter plan than letting diabetes happen and trying to medicate it away. Additionally, making a preemptive investment in healthy habits now (eg, fresh fruits and vegetables, lean meats, and the occasional new pair of sneakers) is much cheaper in the long run than a lifetime of diabetes medication.

Though heredity and age play a role, for most people, diabetes is not a given. Don’t let it happen to you. Do something now to prevent the disease later.