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Do you know the risk factors for breast cancer?

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By Diana Bitner, MD, Spectrum Health Beat


Many women come into the ER with chest pain, and they never thought they would be in that situation. But most heart attacks are preventable, and we need to be more active in telling women what they can do to avoid a heart attack.


The same is true with breast cancer—the more we know about preventing breast cancer, the more women we can help avoid being diagnosed with the disease.


Although breast cancer is far too common, breast cancer survival is improving due to more advanced treatments and early screening for women at high risk.


Do you know your risk, and do you have a plan for when you should be screened? If I asked you if you want to get breast cancer, of course you would answer with an emphatic, “No!” If you don’t want cancer, then you must know your risks, live a lifestyle that decreases your risk, and take your checkups seriously.


Several years ago, I read a story about a young woman who had metastatic breast cancer, and the article described her situation in detail.


There was a picture that showed her being comforted by her sister, who also had breast cancer five years earlier. Both women talked about their mother who had died of the same disease in her mid-40s.


As I read the story, I felt both sad and mad at the same time. Of course, I felt sad for them for all they had gone through, but I was also mad to think their cancer could have been prevented, or at least detected before it spread.


Here’s what I wish they would have known about the genetics of breast cancer:

  • Ten percent of breast cancer is associated with family history.
  • The risk of getting breast cancer increases two times if one first-degree relative has/had breast cancer.
  • The risk of getting breast cancer increases three times if two first-degree relatives have/had breast cancer.

In addition, 50 percent of breast cancer diagnoses are associated with known risk factors.


A patient I’ll call Kelly came to see me for a routine visit recently. In taking her history, several factors caught my attention: she was 48 years old and had never been pregnant; her mom had been diagnosed with breast cancer at 49; and she had regular mammograms that were always negative, but her breasts were very dense, decreasing the likelihood of diagnosis of a small cancer.


I recommended advanced screening with a special mammogram and ultrasound by a breast surgeon.


When she had the testing done, they detected several suspicious areas, and a biopsy showed pre-cancer. Kelly decided to have definitive surgery, and when she had a bilateral mastectomy, they detected early, almost-invasive cancer.


We were able to avoid invasive cancer by doing three things: 1) being proactive; 2) knowing her individual risk factors; and 3) acting early to save her from worrying about recurrence, and having to go through chemotherapy or radiation.


The lifetime risk of breast cancer for most women is 1 in 8. The risk at age 30 is 1 in 250 and increases as you get older. Other risk factors include being female, white and obese (having a BMI over 30). The risk is even greater if the weight is gained after the age of 40 and is in the form of belly fat (especially after menopause). In addition, your risk is greatest if you are diabetic and overweight.


So, what can you do to lower your risk of breast cancer? For starters, lifestyle matters:

  • Women who consume 10 or more alcoholic drinks per week have a higher risk for cancer of the colon and breast.
  • Women who started smoking early and have smoked for a long time are at higher risk.
  • Women who breastfed their children and are physically active have a lower risk.

Two other risk factors that may not be in your control include the following:

  • Women who work the night shift seem to experience more cancer, according to several large studies.
  • Women who received radiation for Hodgkins Lymphoma as a child have an increased risk of breast cancer.

If you have any of these high risk factors, get screening early and talk to your doctor about special screening with a Tomo mammogram or adding an ultrasound to your routine mammogram.


I had a patient who put off her mammogram because she had small breasts and thought she would easily be able to see any lumps, plus she had no family history of breast cancer. When her friend finally convinced her to get a mammogram, it showed she had breast cancer.


I’ve given you plenty of statistics and information about breast cancer in this blog, but there are a few takeaway points I want to make sure you remember:

  • Know your individual risk factors.
  • If you are at higher risk, talk to your doctor about special testing.
  • Be active! Exercise a minimum of 150 minutes per week.
  • Do not gain weight over 40—stay off the sugar.
  • Don’t drink more than ten drinks a week.
  • Don’t be afraid of mammograms—get tested!

Reprinted with permission from Spectrum Health Beat.



Perimenopause have you down?

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Be free of the symptoms of perimenopause. (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Any of this sound familiar?


Your periods are so heavy and irregular, you are left exhausted and weak. You never know when your period is going to appear, and during it, you can barely stay ahead of the mess. The cramps are not too bad, but once the bleeding starts, you know you are in for several bad days followed by a week of spotting. When the bleeding stops, the aftermath means being tired with less motivation to run or lift weights, let alone go for a brisk walk.


What is your diagnosis? Probably perimenopause.


Probably is an important word as just because someone might fit the story for perimenopause, it is necessary to make sure the irregular periods are not caused by anything else.


Perimenopause is the normal life phase when periods start to change as your ovaries run out of follicles, or immature eggs. Hormone levels change and fluctuate.


The result? Irregular periods, often close together or spaced out and sometimes heavy and sometimes light. These changes can also be caused by an over- or under-active thyroid, changes in weight such as rapid loss or gain, high prolactin levels, polycystic ovary, and conditions which affect the uterus such as polyps or fibroids.


Especially in women who are overweight, with diabetes or high blood pressure, it is crucial to make sure the uterine lining is not too thick, which could be caused by pre-cancer or uterine cancer.


A patient I’ll call Molly came to see me to figure out why she felt so tired all the time.


At 48, she could hardly keep up with life, including her high school kids’ schedules, spending time with her husband beyond comparing schedules, and her full-time job.

Her work was hosting a biggest loser contest, and she felt too tired and lacked motivation to start an exercise plan or make any real attempt at eating healthy in order to lose 15 pounds. Her periods interfered with work in that she had to leave a planning meeting because she felt her period start and feared she would make a mess.


What made matters worse, she was planning for a dream trip with several families and worried about bleeding while on the trip.


Her recent blood work revealed that her hemoglobin blood count was 10 and her iron (ferritin) was 15, which prompted her primary care doctor to find her a gynecologist. She had lost enough blood on a regular basis and couldn’t take enough iron to make up what her body needed.


Her doctor ruled out thyroid or prolactin problems. She had an ultrasound and came to see me, hoping for some options to get her irregular and heavy periods to stop.


She appeared otherwise healthy except for being slightly overweight. Her cholesterol and blood sugar levels were borderline high and thyroid and prolactin normal. Her ultrasound—done after a period—showed a normal lining thickness and no fibroids or any other abnormality.


We talked about the phase of life she’s in and her options.


Because her periods were so heavy, it would be a good idea to first sample her uterine lining with an endometrial biopsy. Because she did not smoke and had no family or personal history of blood clots, she was still a candidate for the low-dose birth control pills, which could be used to help her not have her period while on a trip.


Another option: bioidentical FDA-approved progesterone to take from day 10 of her cycle for 15 days, which could make the periods more regular and light, but would not provide birth control. An IUD with progesterone could also work for her as it would give her birth control as well as control heavy bleeding.


After a good discussion about the pros and cons of each option, she chose an IUD as she also needed birth control, and we placed the IUD in time to ensure her periods would at least be better, if not gone.


In terms of the other symptoms of perimenopause, she chose to focus on a healthy lifestyle now that the periods would no longer be the issue.


She chose a schedule of short daily workouts to fit in between other obligations, having been reminded she needed to care for herself in order to care for others.


This included all of the SEEDS and supporting her system with consistent sleep, water, multivitamin, Vitamin D, iron-rich foods, calcium in her diet, exercise—a bit every day—and a short time of quiet and gratitude every day.


Reprinted with permission from Spectrum Health Beat.


Run your way to your best self

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Want to run a 5K, 10K or 25K? Set a goal and make a plan for how to achieve it. (Chris Clark | Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat


Why do you run? Why should anyone run?


I once had a patient I’ll call Laura who taught me the power of goal-setting and running.


I always knew goal-setting could be an effective motivator and used this in my personal life to get through school, medical training, fitness goals, to help my kids, and so forth, but had not explored how to utilize the power of a goal for healthy aging for others.


I remember seeing Laura for her annual physical, and she told me she had been through a rough time in her marriage, did not like her job, had stopped working out, gained weight, ate without planning or thinking, and did not feel attractive or energetic.


When asked what goal she had for herself at a date in the future, she said she wanted to be hot. She defined ‘hot’ as fit, back in her old clothes, and able to run and exercise like when she was 40.


My next question was, “How badly do you want this?” She told me she knew she wanted this.


In the past she had been a runner, and knew the River Bank Run was coming up. She told me to expect great things and left with her shoulders back and a smile.


More than a year later, while rushing through a busy day, I went around the corner fast in the hallway. I almost ran into a woman I did not recognize, and excused myself. It was Laura, and she laughed when she realized I did not recognize her. I looked closer and my chin dropped.


Laura had achieved her goal. She looked fit, had lost a significant amount of weight, and had a big smile on her face. She said, “I did it, I am hot!”


In the intervening year, she had gone online to the River Bank Run website, and used its planning tool to train for the race.


She had not run in years, and took the first several months slow, working on her endurance, and being careful to not get too impatient. She took note of warming up, stretching and improving her core strength to avoid injury, and even visited a local trainer to make sure she was being smart.


Once she built her base, she started working harder, and at the same time did research on a healthy diet for her workouts and made sure she had plenty of complex carbs like brown rice, Ezekiel bread, sweet potatoes and oatmeal.


Running most days helped her sleep improve, and on busy days she would even run indoors at 8 or 9 at night. Her mood improved, she made better choices in her personal and professional life, and began to fit into her old clothes again. The image of being hot at 50 kept her going, even on days she did not feel like running. She always felt better after a run.


Race day came and she finished in a respectable time. She lost 55 pounds, regained her self-respect and liked herself again. She was ready to enjoy her 50th.


I loved her story as it shows what a goal can do to motivate someone. Not only did she achieve her goal, but felt better and better each day. And not only did she change her outside, but her inside as well.


With exercise and weight loss come a healthier blood vessel system with smooth walls and a lower chance of building up plaque. This lowers the chance of dementia, stroke and heart attack.


Her bones increased in density, lowering the risk of osteoporosis and fracture. The weight loss also lowered her risk of many cancers, namely breast and uterine cancer.


Most of all, Laura took care of herself.


Even if running is not your thing, we encourage all people to set a life goal. Think of a key event in your life — a birthday, a child’s wedding (or your own), retirement, or a dream vacation. Write it down, talk about it, make a plan on how to achieve that goal, and get busy.


Reprinted with permission from Spectrum Health Beat.


Don’t let anxiety or depression take control

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Break through the fog of depression. You can do it! (Courtesy Spectrum Health Beat)

By Diana Bitner, MD, Spectrum Health Beat

 

Depression and anxiety are both common and potentially serious health issues.

 

In fact, approximately 10 percent of us suffer from one of these disorders, with anxiety being more common in women than in men.

 

The symptoms of anxiety and depression can go away and come back throughout life if left untreated, and many people find it difficult to admit they have anxiety or depression, thinking there isn’t a cure for what they are experiencing. Fortunately, this couldn’t be further from the truth.

 

A few months ago, a patient I’ll call Cindy came to see me for her annual visit. She started to talk about her life and how she was feeling down most of the time. She didn’t understand why she was feeling this way—everything seemed like it should be nearly perfect.

 

Cindy is married, has three great kids and a part-time job she enjoys. She also has a strong group of friends at church and her parents live nearby, so she really feels like she has a good life.

 

As I probed a bit further with questions, she admitted she had been feeling down for about three months and wondered if she would ever feel like her old self again.

 

Her kids are doing well, but they are becoming busier with sports, church and school. Of course, this meant that Cindy is becoming busier as well. Although she generally isn’t feeling stressed or anxious, she started noticing some changes in herself: doubting how well she could handle her busy life, losing interest in playing games with her kids, making excuses to avoid going out with friends, cooking less (something she once loved to do), losing interest in sex, and exercising less.

 

When I asked Cindy about her extended family, she said that her mom had suffered from depression during Cindy’s childhood, and she remembers her mom withdrawing and spending quite a bit of time in her bedroom.

 

Cindy felt that her mom didn’t really know her and was never supportive of anything she wanted to do. In fact, when Cindy wanted to join the cheer team in high school, her mom would not take her to practice, and never encouraged Cindy to practice on her own or exercise to stay in shape. In addition, her mom always seemed sad and unusually quiet, her dad worked long hours and was never home, and her brother kept to himself most of the time.

 

Cindy obviously didn’t have a perfect childhood. She once had big dreams of attending college, but those dreams never materialized. She hadn’t thought about her college dreams in a long time, but talking to me about her childhood stirred up some old memories.

 

On a positive note, Cindy doesn’t drink much alcohol, never smoked, and eats a fairly healthy diet. She also walks the dog around her neighborhood daily, but she didn’t follow an intense workout program. Although she feels OK with her weight, she admits that she would feel better if she lost a few pounds.

 

Cindy just wanted to know how she could feel better. I certainly understand Cindy’s frustrations, and I was anxious to figure out why she was feeling this way and help her develop a plan to move forward.

 

I talked with her about anxiety and depression. We first looked at common risk factors of both: genetics (family history), low self esteem, prior traumatic events, abuse or neglect, substance abuse and early onset of anxiety and depression.

 

Cindy obviously had at least one of these factors in her life. We also talked about other reasons people struggle with these issues.

 

Anxiety and depression can be related to life events (past and present), but they can also be caused by chemical imbalances in the brain. The analogy I use to explain our brain chemistry goes something like this: brain chemicals are like money in the bank—we only have so much to spend before we run out. We make brain chemicals when we sleep, and genetically (linked to many genes), some of us make more than others. We spend brain chemical on life events, which can cause our supply to get low.

 

For Cindy, life events (busy kids, busy husband, busy household) were causing her to use her supply of brain chemicals. She also had unresolved issues come to the surface: her kids getting to do things she never did in her childhood, her husband working long hours (just like her dad did), and thinking more about her earlier dreams of college. Add to all of this a little weight gain, and you can imagine the stress Cindy felt.

 

When we have unresolved issues on our minds (like Cindy did), they cost brain chemicals. Sometimes we may not even be aware of some of the things that are floating around in our head. So, when our friends ask us out for coffee or it is time to make dinner, we don’t have enough brain chemicals to propel us forward. We slowly start to shut down, and life starts to pass us by. Depression can set in and affect not only ourselves, but our family, friends and co-workers as well.

 

There are several common symptoms of depression that you can look out for, including feeling down most days, losing interest in usual things, sleeping too much or not enough, losing or gaining weight, feeling unable to concentrate or think clearly, and thinking you are not good enough.

 

If depression is left untreated, other issues can arise, such as anxiety, diabetes, heart disease and thyroid disease.

 

In order to help Cindy, I first ordered some lab work, which included her blood count, thyroid levels, body chemistry function, vitamin levels, and sugar levels. All came back normal. My hope was that we could work together to treat her symptoms.

 

Cindy felt a sense of relief just getting her worries off her chest, and she became hopeful when I told her she wasn’t crazy. Her experiences are normal, common and treatable.

 

I first recommended that she see a therapist who practiced Cognitive Behavioral Therapy to help her sort out issues from her past. I also suggested more exercise in her daily routine, even if it is in small amounts (like 10,000 steps per day).

 

And, finally, I recommended a short-term course of medicine from a group called SSRIs (Selective Serotonin Reuptake Inhibitors). These drugs increase the brain chemical levels so there is “more money in the bank” to help people like Cindy get back on track and stop the downward spiral.

 

Cindy came to see me two months later, and she felt much more like herself again—hooray!

 

She had seen her therapist several times and had started a very low dose of the medication. She also developed a meal and exercise plan that worked well. Her kids and husband had noticed, and commented that they had missed having fun with her and were happy to have her back.

 

Cindy started to think about her part-time job and maybe quitting so she could go back to school. She had coffee with a friend and realized how good it felt to stay connected and laugh again.

 

I have no doubt that Cindy will be fine, but she will always have to be aware of her feelings, or even ask a friend to check in with her if she notices any new symptoms Cindy might be displaying. Cindy will inevitably experience stressful events in her future (we all will), so she will always be at risk for starting a downward spiral at some point.

 

However, with treatment and awareness, she should live a happy, connected and fulfilled life.

 

Reprinted with permission from Spectrum Health Beat.