Dec. 6, 2018 / 3:57 PM ASTBy Shamard Charles, M.D.
Uterine cancer on the rise, especially for black women
Most types of cancer are decreasing nationwide, but uterine cancer is proving to be a stubborn exception, and it’s taking its greatest toll on African-American women, federal researchers said Thursday.
This rise is due in part to the epidemic of overweight and obesity in the U.S., the Centers for Disease Control and Prevention said in a weekly report.
“There are many risk factors for developing uterine cancer," said Dr. Joseph Davis, an OB-GYN and medical director of the Cayman Fertility Center in the Caribbean who was not involved in the report. The lining of the uterus is hormonally sensitive, so people with higher-than-normal estrogen are especially at risk, "but there are also social factors that contribute to this increase," he told NBC News, "like diabetes and obesity that have become more and more common with the introduction of processed foods in our diet.”
Uterine cancer is the fourth most common cancer and the seventh most common cause of cancer death among U.S. women. Over 53,000 new cases were diagnosed in 2015, the CDC says.
The researchers found that the rate of new cases of uterine cancer increased 0.7 percent per year from 1999 to 2015, and that death rates increased 1.1 percent per year from 1999 to 2016, with smaller increases observed among non-Hispanic white women than among women in other racial or ethnic groups. While new cases of uterine cancer were higher among both black and white women than among other racial/ethnic groups, deaths from the disease were twice as high for black women.
Dr. Michael Birrer, an oncologist and director of the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, said he was not surprised by the report.
“There’s no doubt that the incidence and mortality of uterine cancer, specifically endometrial cancer, is higher in African-American women," he said. "The reason why is not entirely understood. One reason could be genetics. Another is access to health care. Black patient populations that are poor or from rural communities may not have equal access to care. When the tumors are finally identified, the disease may have already spread."
The most common type of uterine cancer is endometrial cancer, which occurs most often in women over 55. The cancer strikes the endometrium, the lining of the uterus, when too much estrogen is produced. Women who do not ovulate regularly, such as those with polycystic ovary syndrome or those on hormone replacement therapy, are at greater risk. Using birth control pills is generally seen as protective because the pills contain progesterone, which counters the effects of estrogen and inhibits the growth of abnormal endometrial cells.
"Obese women have higher circulating levels of estrogen, so that tends to put them at higher risk,” said Birrer.
Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, a hysterectomy is often a cure.
Other common symptoms include pelvic pain, bleeding between periods, and bleeding after menopause.
The CDC called for public health efforts to help women achieve and maintain a healthy weight and adopt sufficient physical activity to reduce the risk of uterine cancer.
“Public health awareness is important, but more research needs to be done to address all the genetic and environmental factors that contribute to the difference in prevalence between African-American women and other groups,” said Birrer.
Shamard Charles, M.D.
Dr. Shamard Charles is a physician-journalist for NBC News and Today, reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments.
By Lauren Sieben | August 23, 2018EXPLAINERS
For women who have spent most of their reproductive years planning their lives around birth control — whether that means dealing with side effects from the Pill or scheduling doctor’s visits for IUDs, implants or shots — the idea of a hormone-free, noninvasive contraceptive might be alluring.
Today, some mobile apps promise exactly that. Earlier this month, Natural Cyclesbecame the first FDA-approved mobile app for contraception. Although women have been using fertility-tracking apps to aid pregnancy efforts for years, a growing number of women are now using them to avoid unwanted pregnancy.
“Some patients are interested in contraceptive options that they feel are more natural and less likely to have side effects,” said Allie Linton, an ob-gyn at Children’s Hospital of Wisconsin and Froedtert Hospital and a professor at Medical College of Wisconsin. “Some women wish to avoid hormones altogether, and others dislike the idea of using a contraceptive device such as an IUD or implant.”
Using a mobile app in lieu of popping a pill or inserting an IUD might sound good on paper, but apps aren’t a fit for everyone. Here’s what to know if you’re thinking of making the switch to a contraceptive app.
Natural Cycles uses an algorithm to monitor your cycle by analyzing daily basal body temperature readings, meaning your lowest at-rest temperature. Users take their temperatures first thing in the morning before getting out of bed and record their data in the app. According to its creators, the algorithm also factors in sperm survival, temperature fluctuations and cycle irregularities. Based on that information, the app tells you whether it’s a green day — when you’re not fertile and it’s safe to have sex — or a red day, when you’re at risk for pregnancy and should either use protection or abstain from sex.
If this idea sounds familiar, that’s because Natural Cycles is a digital version of fertility awareness–based birth control, sometimes referred to as natural family planning or the rhythm method. The rhythm method has long been championed by the Catholic Church, but it’s often dismissed by critics as a game of “Vatican roulette,” a nod to the relatively high failure rate of fertility awareness–based birth control.
The American College of Obstetricians and Gynecologists reports that fertility-awareness methods are some of the least effective at preventing unwanted pregnancies. They have a 24-percent typical use failure rate, meaning an average of 24 women out of 100 accidentally become pregnant during their first year using that contraception method. By comparison, the typical use rate for the Pill is 9 percent and between 0.2 and 0.8 percent for IUDs. The Natural Cycles app also faced a backlash recently after 37 women in Sweden became pregnant while using it.
However, a study of more than 22,000 women using Natural Cycles (funded by the company) found a typical use rate of 7 percent, putting it on par with hormonal birth control pills. To some experts, those numbers are promising.
“The big thing with being able to establish safety and efficacy is to have enough data that’s reliable,” said Joseph B. Davis, a fertility specialist and assistant professor of obstetrics and gynecology at the Icahn School of Medicine at Mount Sinai in New York City. “The company went through a lot of effort to show the actual benefit of it.”
After taking birth control pills for nearly 15 years, Holly, a 29-year-old marketer in Los Angeles, wanted a break. When she went off the Pill, she started using two apps in conjunction: Natural Cycles and the period-tracking app Clue.
“I didn’t want to take hormonal birth control anymore. There were just too many bad side effects,” she said, adding that the anxiety she experienced during the Pill’s placebo weeks was worse than typical PMS symptoms. “I felt like it was affecting my mental health.”
For women who experience unpleasant or upsetting side effects on hormonal birth control, an app like Natural Cycles might be a worthwhile alternative. The app might also appeal to women who are allergic to the copper used in the nonhormonal ParaGard IUD.
Aside from avoiding the pill’s side effects, Holly liked the idea of switching to an app to “make sure things were working” in case she wanted to have kids one day. Women who are planning to start a family soon may be especially good candidates for Natural Cycles, Davis said.
“That might be a really nice transition,” he said, “because they can come off the hormones, get cycles back to regularity and still postpone pregnancy as long as they want to use the app.”
Compared to other forms of birth control, the app requires a lot of legwork. The ideal user is someone who’s motivated to follow the app’s instructions to a T and can consistently record temperature readings at the same time each morning.
Before deciding if it’s a good fit, you should fully understand the limitations of the app and the steps required to avoid pregnancy, which include practicing abstinence or using barrier-method contraception like condoms during ovulation. The ideal candidate also has regular menstrual cycles. Women transitioning off hormonal birth control might have irregular periods for a while, which could compromise the app’s accuracy or result in more red (no-sex) days. Adolescents and women nearing menopause tend to have irregular cycles and might not be good candidates for the app.
If you have irregular cycles or experience amenorrhea (absence of periods) while on hormonal birth control, an immediate switch to the app may not be entirely effective. Natural Cycles says it takes around one to three cycles for the app to “get to know you,”so you may have more red days in the beginning. If your periods were irregular before starting hormonal birth control, you may find that they’re still erratic after you come off the hormones, making it harder for the app to predict your cycle.
Women should also consider whether an app fits their lifestyle. If you wake at a different hour every morning to accommodate an erratic work schedule, or if you tend to sleep in on the weekends, you may find it more challenging to enter consistent temperature readings than a woman with a rigid daily schedule. Natural Cycles also warns that sickness and hangovers can affect your temperature, which can lead to more red days during a given cycle.
Ultimately, fertility awareness apps like Natural Cycles could be a good option for women who are able and willing to take consistent, daily temperature readings, women with predictable menstrual cycles, women planning to start a family soon or women who are avoiding hormonal birth control for personal or medical reasons.
But if an unplanned pregnancy would be catastrophic, you’re better off using contraceptives with a higher success rate, like an IUD.
“I support giving women as many options as possible,” Linton said. “That said, it is important for women to know that if pregnancy prevention is their primary goal, we have methods of contraception that are more effective than Natural Cycles.”
Lauren Sieben is a freelance writer and journalist in Milwaukee. Her work has appeared in publications including The Guardian, The Washington Post and Milwaukee Magazine.
Natasha Lavender Aug 12, 2018
Trying to clearly communicate a medical problem can often be challenging, but it’s especially difficult when you feel like the doctor you’re talking to isn’t listening or taking you seriously. Research has found that this is more likely to be the case with female patients and for people of color — a fact recently highlighted by tennis superstar Serena Williams. In a recent study in the Journal of General Internal Medicine (JGIM), researchers looked at interactions between clinicians and patients and found that the medical professionals directly asked their patient the purpose of their visit in only 36 percent of cases. In over two-thirds of those cases, doctors interrupted the patient, allowing them an average of just 11 seconds to talk before interjecting.
Not allowing a patient to explain their condition can lead to less effective treatment. Dr. David D. Clarke, MD, who is based in Portland, OR and is president of the Psychophysiologic Disorders Association, explains, “Doctors begin formulating a hypothesis when patients start describing symptoms, and they want to narrow the range of possibilities quickly by asking questions. However, interrupting the patient tends to prevent disclosure of all relevant information, resulting in a less accurate diagnosis.”
So how do you make sure your appointment is on point? Here’s what doctors want you to know.
1. Make sure your doc has done their homework. A valid reason that doctors jump right in is that they already know why you made the appointment. “By the time a patient sees the doctor, they’ve usually stated the purpose of the visit to an assistant or nurse,” explains Dr. Kaushal Kulkarni, MD, a board-certified ophthalmologist in San Diego, CA. “A good physician will review this beforehand, as well as the patient’s chart and history, and will know the nature of the visit before they walk in.”
This is particularly true when it comes to specialists. The JGIM study found that specialists were less likely than primary care doctors to ask the patient why they sought medical help, asking in only 20 percent of cases as opposed to 49 percent respectively. But Kulkarni points out that this is the marker of someone who has done their homework, not necessarily someone who doesn’t care. “Most patients prefer a specialist who demonstrates that they have reviewed your case beforehand and are aware of the problem. It’s much more comforting to hear that than to be asked to tell your story all over again.”
2. Be assertive. Another reason doctors may accidentally take over an appointment is that they sense you’re feeling shy or embarrassed. Dr. Joseph Davis, DO, New York City-based board-certified OB/GYN, says, “If patients start with a question or say little, doctors may feel the need to fill in the silence, which could result in them taking over the conversation. Begin the appointment with a strong statement like, ‘I would like to give you some background,’ which tells me as a doctor that I should wait for you to say everything you plan to say.” Also, never be afraid to ask if you don’t understand something. “Doctors become so accustomed to medical terms that they forget that the rest of the world doesn’t speak that language,” Davis notes. “If the doctor uses technical terms that you don’t understand, insist on an explanation until it’s clear.” This meeting is about you, after all.
3. Not all interruptions are bad. Most doctors agree that letting a patient describe their experience uninterrupted is the best way to get all the important information. The results of the JGIM study are somewhat misleading, since they don’t clarify the nature of the interruptions. Kulkarni points out, “It is often in the best interests of the patient for the physician to ask for clarification during parts of the story. For example, they might ask about a timeframe, or for more details of a particular symptom, or even say something like, ‘I’m sorry to hear that.’ In this study, all of these useful points were counted as interruptions.” Compare it to talking to a friend: You can tell the difference between someone who’s about to hijack the conversation and relevant interjections that actually prove they’re paying attention.
4. Come prepared. It’s totally normal to draw a blank on your symptoms the moment you’re sitting opposite your doctor. To help, Clarke recommends bringing a physical list of what you want to say. “Write down in advance everything you want to communicate,” he advises. “If the doctor interrupts, politely ask them to wait until you are done, or answer their question and then immediately resume reading your list.” He also suggests you list all your medications, “and how you are actually taking them. Be honest about tobacco, alcohol, drugs, and major stresses in your life, such as violence from an intimate partner,” Clarke says.
When explaining the problem, start at the beginning. “Physicians think about problems chronologically, so relating your story in that way makes it much easier for your doctor to help you,” Kulkarni explains. “Use exact dates, rather than days of the week, which can be vague.” This isn’t a public speaking exam; notes are definitely encouraged!
5. Prioritize your questions. It’s an unfortunate fact of medicine today that doctors are under a lot of time pressure. Make sure you’re getting the most from the minutes you have with them. “I appreciate when patients ask, ‘How much time do we have? I want to make sure we cover XYZ,'” Davis says. “This ensures we’re working on the same schedule, and gives us a list of things to tackle in the time available.” And raise your most pressing concern first. “It’s okay to have multiple concerns or questions,” says Kulkarni, “but decide beforehand which is the most important, or if there is one overarching fear that you want alleviated. Most doctors will be eager to address it.”
All of the doctors interviewed stressed that while this study raised an important point about listening to patients, most healthcare providers really do want to hear what you have to say because it helps them do their jobs. Be organized and confident in your ability to assess your symptoms, and speak up for yourself. With the help of a good doctor, you have a prescription for success.
Is your doctor a good listener? Share your experiences @BritandCo.
(Photo via Getty)
Natasha LavenderNatasha Lavender is a Londoner living in Chicago, and is fluent in British and American. She writes about pop culture, health, lifestyle, feminism, fashion, and interviews with interesting people, and has previously worked for Good Housekeeping magazine, Buzzfeed, and Hello Giggles. She loves podcasts, running, reading, dogs and cats equally, and peanut butter and jelly sandwich.
By Stephanie K. Baer, Journal Sentinel Staff
Mike Kisner thought the doctor had to be kidding. Triplets, the doctor said. Kisner and his fiancée were having triplets.
The couple had little time to absorb the idea when, two days later, the doctor found a fourth baby.
Kisner, 26, and his fiancée, Charity McCulloch, 39, of Wilmot in Kenosha County, had conceived quadruplets without the assistance of fertility drugs.
"I thought it was a joke at first," McCulloch said.
The couple found themselves in a rather exclusive club. The chance of conceiving quadruplets naturally is 1 in 700,000, said Joseph Davis, a gynecologist and fertility specialist at Froedtert & The Medical College of Wisconsin. Experts say 90% of quadruplets are born with the aid of medical technology.
"It is a surprise to have natural quadruplets, but it's not unheard of," Davis said. "It's just exceedingly rare."
The couple had planned to have one child once they were married — they plan to marry Aug. 31.
But when the four boys were born at Wheaton Franciscan All Saints Hospital in Racine on June 5, they became an instant family.
"The Lord has a plan for us. I don't know what it is, but He has a plan for us," Kisner said.
Kisner remembers being in the operating room that day with more than 20 doctors and nurses.
"It was very chaotic," he said. "Each person had their own little job to do and in a matter of three minutes all of them were out."
The quadruplets were born at 28 weeks and four days — birth normally occurs around 40 weeks. Typically, multiple pregnancies reduce the gestation period about three weeks per baby, or "multiple," said Davis.
Because of the early delivery, the quadruplets stayed in the neonatal intensive care unit several weeks after they were born. The smallest baby weighed 1 pound, 12 ounces.
Two boys, Kerrigan and Christian, went home July 29, while Brice and Oliver, the smaller of the four, stayed at the hospital a bit longer. They came home on Aug. 8. None of them faced severe complications.
While family history of twins can increase the
chances of multiple births, the science behind conceiving quadruplets, or even triplets, is a bit of a mystery. Davis said one theory is that the closer women are to menopause, the higher their chances are of multiple births. These women typically have elevated follicle-stimulating hormones levels, which can increase their chance of having more than one egg released.
"From a reproductive standpoint she's closer to advanced reproductive age," Davis said of McCulloch. "It may be a factor."
Davis said the age of the male is usually less of a factor because males have the same fertility chances up until age 50 or 60.
Kisner and McCulloch met at work about five years ago and got engaged last summer. The two are paramedics for Bell Ambulance in Milwaukee.
Though the stress of caring for four babies at once has challenged the new parents, Kisner and McCulloch have prepared themselves.
"We're just trying to keep the boys healthy and keep our sanity," Kisner said.
"Four's enough," McCulloch said.