In A Woman’s World
Nobody understands women’s health more instinctively than women practitioners. They’ve treated all manner of conditions in the female patient, and likely have experienced some of them firsthand as well. And because they’re naturally equipped to relate to women’s health issues, they can bring a lot of understanding into the exam room with them.
breast cancer in young women
It may be surprising to learn that breast cancer is the most common cause of cancer death in women under 40. But doctors say there are a number of ways they can treat it and save lives.
the dreaded disease
“There are about 240,000 new cases of breast cancer each year in the U.S.,” says Mercy breast surgeon Dr. Cara Hahs. “That overall number has stayed pretty stable, but some newer studies suggest there may have been a slight increase among younger women since the 1970s.” She says breast cancers in younger patients tend to grow more quickly, so they need more aggressive treatment. Still, doctors usually are able to treat women under 40 as successfully as they can older patients, she notes.
Most cancers begin in the milk ducts, often in just one breast, Hahs says. Treatment options such as chemotherapy, radiation, lumpectomy and mastectomy depend on factors like age, overall health, and whether a woman is done with childbearing. And DNA testing is available to see if there’s a genetic tendency for the disease.
note the distinctions
Hahs says women under 40 should keep breast health on their radar, especially when there is breast or ovarian cancer in the family. Mammography looks for inconsistencies in the density of breast tissue, which becomes more lax and easier to screen as women age—so the technology may be less effective in younger women with denser tissue, she notes. Still, new 3-D mammography is making strides in image quality and earlier detection of tumors, says Dr. Stephanie Schnepp, surgeon and medical director of the Breast Center at SSM Health St. Mary’s Hospital. “It’s possible for women in their 20s or 30s to get breast cancer. But we’ve gotten very good at finding and treating it,” she says.
It’s important to note that women can get breast cancer even when it doesn’t run in the family, Schnepp says. “Family history is key, but screening and risk reduction are just as important,” she explains. Some doctors say women should have a mammogram every two years starting at age 50, according to Schnepp. But because cancer can appear earlier, she advises a more cautious approach—yearly mammograms starting at age 40. “These days, when we catch it at stage 3, the patient still can be treated as effectively as someone at stage 1,” she says. “Anytime you notice something different during a self-exam, you should see your doctor and have testing done.”
There was a time when hysterectomy (surgical removal of the uterus) was a go-to solution for issues like benign fibroid growths on the uterus, endometriosis and heavy bleeding. But today, new treatments can solve many patient problems without removing the uterus. And those who do need the surgery can take advantage of less invasive procedures and shorter recovery times.
Dr. Brigid Holloran-Schwartz, SLUCare gynecologist and professor at Saint Louis University School of Medicine, says modern nonsurgical treatments include endometrial ablation and intrauterine devices (IUDs) like Mirena that release hormones to combat heavy menstrual bleeding. Thermal ablation treatments such as Acessa use heat to reduce fibroids. And other contraceptives such as pills, skin patches and vaginal rings can help control bleeding as well. “It’s an interesting time in this field,” says Dr. Brooke Winner, a gynecologist and assistant professor at Washington University School of Medicine. “Some women come in assuming they’ll need a hysterectomy because their mothers or grandmothers had one. But we’re able to lay out other options for many of them.”
not your mother’s hysterectomy
Winner says hysterectomy used to involve larger abdominal incisions, longer recovery periods and significant activity restrictions. Today, however, it can be done laparoscopically and even robotically, and patients can return to normal activities much more quickly. And Washington University physicians are using new procedures to make it even safer, she says. Sometimes the uterus is so enlarged that it has to be morcellated, or cut into small pieces, before removal. If cancer is present, morcellation may cause it to spread, so the new technique contains the uterine tissue in a bag to reduce that risk.
The main difference between hysterectomy and other treatments is that hysterectomy is the only permanent ‘fix’ for uterine conditions, Winner says. For example, a process called embolization cuts off blood supply to fibroids, but it shrinks them instead of removing them. Another surgery called myomectomy removes the fibroids, but they may come back. “If the patient has five or more growths, there’s a greater chance they’ll return,” she says.
Whatever her situation, today’s patient has several choices in treatment, Holloran-Schwartz notes. “I often hear women say they’ve had to organize their work and social schedules around their bleeding,” she says. “But there are a lot of medical and surgical options that can help. Most patients are much happier afterward and wonder why they didn’t see a doctor sooner.”
Your skin does a great job of protecting your body from infection and injury, but it’s not completely invulnerable. Rashes, bumps and moles are common occurrences that sometimes have serious consequences, doctors say. So how do you know when that itch, blemish or spot warrants a trip to the doctor’s office?
rules of thumb
“I tell patients if there’s a pink area, bump, itchy rash or spot that hasn’t healed in a month, or that bleeds or turns into a sore, it should be looked at,” says Dr. Andrea Garrett of Forefront Dermatology. “Sometimes we can recommend over-the-counter medications like hydrocortisone for a few weeks, but if the area isn’t healing, the patient should be seen by a doctor.”
Conditions like ringworm crop up at this time of year and may be easy to mistake for other rashes. “Ringworm is actually a fungal infection that gets pink, itchy and scaly, and can appear on any part of the body,” Garrett says. “It can be spread by contact with other people and pets, or objects that have the fungus on them.” Rosacea is a condition causing redness, irritation and blemishes, mostly on the face and neck, she says. It’s more common in women than men, and can be treated with topical or oral prescription drugs.
the not-so-great outdoors
Walking in grassy or wooded areas can increase risk of insect and tick bites, which potentially can be serious enough for a doctor visit. Garrett says there are several tick-borne illnesses to watch for, including ehrlichiosis (a bacterial infection), Lyme disease, Southern tick-associated rash, and serious allergies caused by the Lone Star tick’s bite. Again, she advises, if these conditions appear, seek a doctor’s advice.
Acne that hasn’t responded to over-the-counter remedies also should be treated by a doctor, Garrett says. So should moles, skin tags or spots that look asymmetrical or change color, size or shape—and any other skin condition that seems unusual or causes problems.