October 31, 2016
Breast cancer is the second leading cause of death among women, so prevention and screening are important, not only for breast cancer but also for other gynecologic cancers, according to Dr. Kristie Graettinger, associate professor and chair of the College’s Department of Obstetrics and Gynecology. Graettinger provided a presentation, “Women’s Health Update: Cancer Prevention,” at the Oct. 20 Mini Medical School program conducted in collaboration with UA’s OLLI program. In addition to her presentation, three other faculty members presented during the month of October. Dr. Ray Stewart, assistant professor of Sports Medicine, talked about “Preventing Injury” on Oct. 6, and Dr. Karen Burgess, chair of Pediatrics, gave a presentation on “Telemedicine” on Oct. 13. Mini Medical School lets adults and community learners explore trends in medicine and health, and the lectures by CCHS faculty and residents provide information about issues and advances in medicine and research. OLLI, short for Osher Lifelong Learning Institute, is a member-led program catering to those aged 50 years and older and offers education courses as well as field trips, socials, special events and travel. In her presentation, Graettinger said to think of cancer prevention as three tiers: “prevention, screening and treatment.” Prevention is interventions to reduce the risk of cancer, including maintaining a healthy weight, being physically active, having a diet high in fruits, vegetables and whole grains and low in processed foods and red meats, and receiving vaccinations that can protect against cancer, such as the HPV vaccine for cervical cancer. Examples of screening include mammograms for breast cancer and pap smears for cervical cancer. “The goal is first to try and prevent cancer, and also to identify people at risk for the disease,” Graettinger said. Breast cancer is the second leading cause of death among women, right behind lung cancer, and will affect 1 in 8 women in their lifetimes. Approximately 250,000 cases of breast cancer are diagnosed every year. Having a first-degree relative, such as a mother or sister, with breast cancer doubles the risk, but that amounts to only 15 percent of women diagnosed. Breast cancer screening includes mammograms, clinical exams performed by a physician or health professional, breast self-exams and genetic testing. A mammogram is an x-ray of the breast. Currently there is not a consensus among organizations about the age a woman without a family history of breast cancer should be – ranging from 40 to 50 – to begin receiving annual mammograms. There is recent evidence that clinical breast exams might not be helpful for women without symptoms of breast cancer, “but have that discussion with your doctor,” Graettinger said. She added that the concept of breast self-exams has shifted to “being aware of your breasts.” For women with the inherited BRCA gene mutation, “this is serious business and increases the risk of breast cancer from 1 in 8 to 1 in 2, or by 50 percent, and the risk of ovarian cancer is 10 times greater,” Graettinger said. Having the BRCA gene is “not extremely common, but it’s not rare,” she said, adding that women with a personal history of breast cancer should consult with their physicians about this genetic testing. Other gynecologic cancers include cervical, ovarian and uterine cancer. Of those, only cervical cancer has a screening test – pap smears, which detect precancerous changes on the cervix. Pap smears are now recommended every three years for women ages 21 to 65. Ovarian and uterine cancers are detected by signs and symptoms, “which is scary because sometimes these are found in the later stages,” Graettinger said. Symptoms of ovarian cancer are vague and include pelvic and abdominal pain and pressure, bloating and feeling full quickly, and irregular bleeding. Approximately 20,000 cases of ovarian cancer are diagnosed annually. Pressure, pain and bleeding after menopause are common symptoms of uterine cancer, which primarily strikes women over the age of 50. In Stewart’s presentation, he said that “sprains and strains are where the vast majority of injuries are occurring.” The most common sports injury is an ankle sprain, followed by a groin sprain and a hamstring sprain. Stewart said the goal is to introduce preventive measures to avoid the injury. A warm up is a good way to do that. A warm up should get the body moving, introduce a light sweat and “literally warm up the muscles,” he said. Stretching is a good way to prevent injuries, too. There is dynamic stretching, which are bouncing, jerking movements, static stretching, which are slow, deliberate movements that are held for about 20 seconds, and then proprioceptive neuromuscular facilitation, or PNF stretching, which combines static stretching with isometric movements to increase flexibility. To prevent an ankle sprain, Stewart suggested wearing an ankle support to reduce the risk and to conduct balance training: stand on one leg in order to train muscles to support the ankle. To prevent a hamstring sprain, Nordic hamstring exercises are best, Stewart said. There is a higher injury rate of the ACL in women, and prevention requires regular exercises. Plyometrics, known as “jump training” help may reduce an ACL injury, but must be performed throughout the athlete’s season. After the participant stops performing the training exercises, he or she becomes at risk for injury again. Burgess introduced many of participants in the Mini Medical School series to the concept of telemedicine for the first time. Telemedicine is any medical information exchanged from one site to another through the use of technology. It could be a phone or computer. “We use it to improve access to care,” said Burgess. Many parts of Alabama are rural and are underserved in primary care and specialty care providers. Unfortunately, many of the underserved areas in Alabama are also areas with limited connectivity, which makes it difficult to access telemedicine, Burgess said. Burgess spoke about CCHS Telemedicine and Telehealth efforts, including the asthma education program that she and Beth Smith, a nurse practitioner in pediatrics at University Medical Center, have led. Students at Greensboro Elementary School in Hale County and their parents are taught through telemedicine about asthma symptoms, medication and treatment. The program teaches students how to use a spacer with their asthma inhaler for more effective usage of their medicine. The program so far has revealed that students and parents are learning more about asthma and how to treat it. One participant said: “Until today I had no idea what telemedicine was. Thank you for coming here and telling us about that today.”
