Health Connection - October 2019

Breast Cancer Screenings: Breaking Down the Facts

By Natalya M. Lvoff, MD

Breast Cancer Awareness Month is the perfect time to share some good news with the women of Marin County! Our breast cancer rate, once among the highest in the world, is now on par with the rest of California. According to the Marin County Health Department, there has been a 30% decrease in new breast cancer cases in Marin, and breast cancer deaths are down by 30%. A combination of factors is likely responsible for this encouraging news, including better patient education, increases in screening mammography, changes in hormone therapy, and healthier habits. Women are exercising more, maintaining a healthy weight, and reducing alcohol consumption.

Screening Recommendations from our Breast Health Center

Together with the American College of Radiologists, the American Congress of Obstetrics and Gynecology, the American College of Surgeons, the National Comprehensive California Network, and the Society of Breast Imaging, MarinHealth recommends annual mammography starting at age 40. This is the screening regimen that saves the most lives. One in six breast cancers occur in women aged 40 – 49, so screening starting at age 40 (or earlier in patients at increased risk) is absolutely critical. Studies have shown that regular mammography screening cuts breast cancer deaths by roughly a third in women ages 40 and over. Starting screening mammography at age 50 and screening every other year rather than every year would save money for insurance companies, but it approximately 6,500 additional women would die from breast cancer each year in the U.S. Likely thousands more would endure more invasive and expensive treatments than if their cancers were found early by an annual mammogram.

Tomosynthesis and Ultrasound: Technologies that Improve Imaging

At the MarinHealth Breast Health Center, all of our mammography units perform digital breast tomosynthesis (DBT), or 3D digital mammography. This technology takes digital pictures of the breast from multiple angles. Tomosynthesis enables us to detect smaller breast cancers, with fewer callbacks for additional imaging. It is most helpful for women with dense breasts.

If an abnormality is identified on a woman’s screening mammogram, we call the patient back for additional imaging. Most findings can be resolved with a few additional pictures and possibly, an ultrasound. If a suspicious mass is identified on ultrasound, the next step is to perform an ultrasound guided biopsy. If a suspicious finding is only seen by mammography, then a stereotactic biopsy is performed.

Risk Factors

The main risk factors for breast cancer are being a woman and being over the age of 40 – which covers a large number of people. In fact, 75% of women diagnosed with breast cancer have no other identifiable risk factors. There are, however, additional risk factors, some of which can be reduced by healthy lifestyle changes.

Non-modifiable risk factors:

• Family history
• Early menarche (before 11) and late menopause (after 55)
• First childbirth after the age of 30 or never having given birth
• Hormone replacement therapy
• Chest wall radiation (The amount of radiation from a mammogram is minimal. There are no reported cancers caused by mammography.)

The significance of breast density as a risk factor has not been definitively established.

Modifiable risk factors:

• Obesity
• Lack of regular exercise
• Alcohol consumption
• Smoking

Every patient at MarinHealth’s Breast Health Center receives a risk assessment. Between 3 – 6% of women with no family history of breast cancer turn out to be in the increased risk category. As part of our High-Risk program, we counsel each patient about her risk and develop a personalized surveillance plan based on her risk factors, age, health, and heredity.

Statistics about breast cancer can be scary, but as you plan for your annual mammogram keep this in mind: of 100 women screened, 10 may be called back for additional images, and less than 2% will require a biopsy. Early detection through annual mammograms is a woman’s best defense against breast cancer, so make sure it is a part of your ongoing wellness plan.

Dr. Lvoff is a fellowship trained Breast Imager and Board Certified Radiologist at MarinHealth.

Oh Sugar! It’s Time to Kick the Habit

By Pamela Riggs, MS, RDN, CSOWM

Halloween is upon us and those bite size chocolate bars are everywhere. But before you pop a piece of candy (or three) into your mouth, you may want to know what all that sugar can do to a healthy body.

According to the American Diabetes Council, Americans are the world’s top consumers of sugar. The average American consumes the equivalent of 25.28 teaspoons of sugar a day – 11.98 teaspoons more than recommended in the Dietary Guidelines for Americans and by the American Heart Association. Excess sugar consumption may be negatively impacting our health in a number of important ways:

• Excess sugar consumption places a demand on your pancreas to make more insulin. This can lead to insulin resistance and over time this can increase your risk of developing type 2 diabetes.
• A diet high in added sugars is associated with higher triglycerides, lower HDL and higher LDL in the blood, increasing your risk for heart disease and fatty liver.
• Sugar itself is just empty calories. In other words, it provides calories but no other nutritional value. If you’re choosing to eat more sweets than complex carbohydrates (fruits, vegetables, whole grains etc.), you’re missing out on health promoting vitamins, minerals, phytochemicals and fiber.
• Excess sugar consumption can lead to weight gain. Being overweight is a strain on the joints and increases the risk of diabetes, heart disease and certain cancers.
• Your dentist was right! Sugar causes tooth decay.
• Sugar may be addictive for some. Research suggests that sugar causes a dopamine spike in your brain in much the same way as nicotine, heroin, and other addictive drugs. More research is needed to better understand why some people may be susceptible than others.

Here are a few pointers to help you tame your sweet tooth, or at least reduce your consumption to the occasional treat.

1. Read labels. Look for added sugars. Every 4 grams of added sugar is equivalent to 1 tsp. Canned soups, bread, nut butters and other processed foods are often hidden sources of added sugars.
2. Indulge intelligently and infrequently. A fancy dessert on a special occasion can be memorable. Sugary cereal every morning is a habit worth breaking.
3. Avoid sugary sweetened beverages, including fruit juices. Try a glass of sparkling water with a slice of lemon instead.
4. Manage your cravings. Sugar cravings may be related to stress, low energy or fatigue. In women, they may also be related to premenstrual hormone changes. If you start to crave sugar, drink a glass of water and wait 15 minutes. If you’re craving sugar close to mealtime, just eat a healthy meal. By the time you feel full, the sugar craving will have dissipated. Remember cravings are temporary and will pass if you let them.
5. Address your stress. Exercise, meditation, deep breathing, or a nice hot bath are all sugar-free forms of relaxation.
6. Don’t skip meals. Going without food for hours may cause a drop in blood sugar, promoting hunger and a yearning for carbohydrates and sweets.
7. Shop smart. Having kids is no excuse for stocking up on sweets. Take soda, sugary cereals, cookies, and candy off your grocery list. Your kids will be healthier snacking on string cheese, peanut butter, fresh fruit, or popcorn and you won’t be tempted to reach for something sweet.
8. Nix artificial sweeteners. Researchers aren’t sure why, but a recent study associated the daily consumption of diet drinks with a 36% greater risk for metabolic syndrome and a 67% increased risk for type 2 diabetes. If you need to sweeten your coffee, try a little stevia or monk fruit extract. They are safe and natural sweeteners and using a little goes a long way.

Pamela Riggs is a Registered Dietitian Nutritionist and Certified Specialist in Obesity and Weight Management at the MarinHealth Integrative Wellness Center.

Tips for a Spooky but Safe Halloween

The days of trick or treating around the block with your little ones are sweet but fleeting. Before you know it, they’re clamoring to go out all by themselves – a scary milestone for many parents. Follow these tips to help ensure that family members of all ages stay safe this Halloween.

Costumes. Choose bright, reflective costumes so kids are easy to see at night. Make sure the costume isn’t too long so your child won’t trip and check if costumes and wigs are flame-retardant. Suggest makeup instead of masks that can obstruct vision. Attach ID information to your child’s costume.

Pumpkin Carving. Don’t let the little ones carve pumpkins. They can draw on the pumpkins with markers. Kids 5 – 10 years old should be supervised during carving and use pumpkin cutters equipped with safety bars. Use small votive candles for candle-lit pumpkins and place pumpkins far from anything flammable.

Decorating. Remove fall hazards including slippery wet leaves, garden hoses, toys, lawn decorations etc. Replace burned-out bulbs on outdoor lights.

Treats. Feed children before they go trick or treating or attend a Halloween party so they don’t fill up on sweets. Check the treat haul when they get back and toss out anything spoiled, unwrapped or homemade. Watch out for hard candy that can be a choking hazard for small children.

Safety Parameters. Insist that youngsters plan their route and tell you where they are going. Make sure they trick or treat in groups of three or more and stick together. Equip your child with a flashlight (check the battery!). Have older kids wear a wristwatch and carry a cellphone.

Rules of the Road. Make sure your kids understand the following safety rules for trick or treating:

• Only go to homes with a porch light on.
• Stay on well-lit streets and use the sidewalk, not the street. If there’s no sidewalk, walk at the farthest edge of the roadway, facing traffic.
• Never cut across yards or use alleys.
• Never enter a stranger’s home or car for ANY reason.
• Walk – don’t run – across the street. Use the crosswalk and cross as a group.

Safety Tips for Teens. If a teenager is going out, set a curfew. Set a family rule that your teen’s phone be charged and on at all times. Help prevent tricks and the trouble they can cause: hide eggs and extra toilet paper, and make sure they don’t have access to alcohol.Take this opportunity to talk about laws regarding private property, vandalism, town curfews, and alcohol.

It’s preferable for your teen not to drive on Halloween but if it can’t be avoided, remind them to drive slowly and be on the lookout for little kids darting out into the street.

For more ways to keep your family safe at Halloween, click here for our downloadable tip sheet.

How a Local Firefighter Extinguished AFib

Fire Captain Jake Peterson, of San Rafael, was just twenty-nine years old the first time his heart went into atrial fibrillation. He was at a Giant’s game with a paramedic friend when he felt a fluttering in his chest. As Jake describes it, “It felt weird. I felt off. I felt like something wasn’t right.” His friend thought it was most likely nothing, but they headed for the medical tent – just in case. The physician working the tent put Jake on a heart monitor. Looking up at the doctor, the medical technician, and his friend, Jake immediately knew something was wrong. “Their eyes got wide,” he remembers, “and their mouths dropped.” Jake was transported to St. Francis Hospital. When medication failed to put his heart back into normal rhythm, Jake was electrically cardioverted.

Read how Jake worked with Dr. Robert Sperling, an Interventional Cardiologist at MarinHealth Cardiovascular Medicine | A UCSF Health Clinic to find the right treatment and modify his lifestyle so he could get back to fighting fires and keeping the community safe.

Open Enrollment Begins Soon

Open enrollment is the perfect opportunity for you to review your healthcare needs and make sure you have the appropriate insurance plan in place for 2020. This year open enrollment for those on Medicare runs from Oct. 15 – Dec 7, and Nov. 1 – Dec 15 for those with commercial plans obtained through their workplace or on their own. Be sure and make any necessary changes before the deadline; after that you’ll only be eligible to change your health plan if you have a qualifying life event, such as a marriage or new baby. To see a list of insurance plans currently accepted by MarinHealth, click here.

This is also the perfect time to assess your physicians – both specialists and primary care doctors. It’s important to have a primary care physician (PCP) who can manage your general health and wellness needs and coordinate with specialists when necessary. Selecting the right primary care doctor is one of the most important decisions you can make, so be sure you take time to review profiles and find a doctor who’s right for your needs.

Are You In the Dark About How to Prepare for an Extended Power Outage?

PG&E has announced that Public Safety Power Shutoffs (PSPS) are likely to continue in Marin if hazardous weather conditions cause a heightened risk of fire from power equipment. We want to help spread the word and make it easy for you to find resources to manage a prolonged outage. All residents should prepare, but it’s particularly important for those who rely on electricity- and battery-dependent assistive technology and medical devices. Learn how to prepare.